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INTRODUZIONE: Abbiamo pensato di effettuare uno studio che indagasse circa la presenza delle citochine nell’albuginea di soggetti affetti da malattia di La Peyronie. Le citochine, in quanto responsabili della comunicazione intercellulare, potrebbero essere coinvolte nella patogenesi della malattia. L’individuazione di una o più citochine responsabili potrebbe, infatti, risultare utile nel trattamento farmacologico grazie ai c.d. farmaci biologici, in grado di interferire con le citochine. MATERIALI E METODI: Per lo studio sono stati reclutati tra gennaio 2009 e dicembre 2010 presso l’Ambulatorio di Chirurgia Andrologica del Policlinico di Palermo 20 soggetti affetti da malattia di La Peyronie (fig. 1) e 8 soggetti affetti da recurvatum penis congenito, questi ultimi adoperati come controllo. Come criteri di inclusione allo studio abbiamo considerato i criteri di operabilità con corporoplastica secondo Nesbit. I prelievi bioptici ottenuti dalle losanghe escisse in corso di intervento chirurgico sono stati utilizzati per saggiare l’espressione genica, attraverso Real-Time PCR, di citochine pro-fibrotiche e pro-infiammatorie. Inoltre sono stati sottoposti dopo fissazione ad esame istologico con la colorazione ematossilina-eosina. RISULTATI E DISCUSSIONE: L’esame istologico ha rilevato l’assenza di cellule infiammatorie in tutti i pazienti recensiti per lo studio. L’analisi dell’espressione dei geni codificanti per IL-4 (Interleuchina-4), IL-6 (Interleuchina-6), IL-13 (Interleuchina-13), TGF-β1 (Trasforming Growth Factor - β1), IL-2 (Interleuchina-2), IL-10 (Interleuchina-10), TNF-α (Tumor Necrosis Factor- α) e IFN-γ (Interferone- γ) ha evidenziato in tutti i campioni un livello molto basso di trascritti e in alcuni casi indosabili (fig. 2). Inoltre i livelli dei trascritti delle citochine prese in esame sono risultati minori nei campioni provenienti dagli individui affetti da malattia di La Peyronie rispetto ai controlli. CONCLUSIONI: Alla luce dei risultati ottenuti, l’utilizzo di farmaci biologici (anticorpi) contro le citochine non sembra essere applicabile nella fase stabile della malattia di La Peyronie

Introduction & Objectives: The aim of our study was to compare and analyse the effectiveness of pharmacological treatment and the psychotherapy alone or in association in terms of increase of Quality of Life (QoL) measured through Premature Ejaculation Diagnostic Tool (PEDT) and increase of intravaginal eiaculation latency time (IELT) in patients affected by primitive premature ejaculation(PE). Material & Methods: Between January and December 2012, in our department underwent to medical examination 540 patients complaining PE. Criteria for enrollment were primitive PE with IELT ≤ 2 minutes, PEDT > 9 and absence of psychiatric disease, severe chronic disease, drugs and alcool abuse. Out of 540 patients, 270 were elegible and were enrolled for the study. This patients were randomly divided in 3 group, A,B and C. Patients in Group A were treated with Dapoxetine, mean age 49,8 years(range 20-68). Patients in Group B were treated with Dapoxetine in association with Psycological counselling and group therapy, mean age 49,2 years. Patients in Group C were treated with psycologycal counselling and group therapy alone, mean age 36,9(range 20-56). In the Group A and B was precribed Dapoxetine 30 mg 1 cps 1h before the intercourse with increase in dose to 60mg in case of ineffectiveness. In group B and C after a first psycological counselling one by one patients entered in group therapy with 20 weekly scheduled meetings. All patients were followed for 20 weeks, with 4 schedueld visit during this period. The PEDT was administred before treatment and one month after the end of the therapy. Data were recorded and analysed trought a multivariated analysis. Results: Out of 270 patients enrolled, 120 (44,4%) were compliant to therapy and weren’t evaluable. GROUP A. Out of 90 patients enrolled 60 were compliant to the study. Mean IELT pre-treatment 79,75 sec (range 15 sec–120 sec) and mean PEDT score 15,95 (severe PE). Mean IELT post-treatment 203 sec and mean PEDT 8,26 (moderate PE). Thirteen patients(21,6%) showed an improvement of clinical with mean PEDT score ≤ 8 and IELT ≥ 2 ( p ≤ 0,001). GROUP B. Out of 90 patients enrolled 60 completed the scheduled therapy. Mean IELT pre-treatment 74,83 sec (range 15 sec–120 sec) and mean PEDT score 16 (sever PE). Mean IELT post-treatment 600 sec and mean PEDT 3,3 (absence PE/ light PE) (p ≤ 0,001). In all patients of Group B was detected a reduction of PE. GROUP C. Out of 90 patients enrolled only 30 patients completed the scheduled therapy. Mean IELT pre-treatment 75 sec (range 15 sec–120 sec) and mean PEDT score 15,7. Mean IELT post-treatment 323 sec and mean PEDT 4,03(absence PE/ light PE). Fifteen patients (50%)showed a reduction of PE.All the results analyzed by multivariate analysis were statically significative. Conclusions: Comparing the result obtained in our three groups: in the Group B (Pharmacotherapy plus Psycotherapy) all patients showed an improvement of IELT and PEDT, while in the group A (only Pharmacotherapy)and C (only Psycotherapy) the percentage of patients that reported an improvement of IELT and PEDT were respectively 21,6% and 50%. Our study demonstrate that the psyclogical counselling have a significative role in the treatment of PE. In particulary in association with the pharmacological therapy the psycological group therapy could increase the IELT and ameliorate QoL of patients affected by primitive PE as showed by the decrease of PEDT score.

Scopo del lavoro Scopo dello studio è valutare in pz affetti da Eiaculazione Precoce (EP) il trattamento associato Farmaco+Psicoterapia di gruppo, vs Farmaco, vs Psicoterapia di gruppo in termini di aumento del Tempo di latenza eiaculatoria intravaginale (IELT) e migliore Qualità di vita (QoL). Materiali e metodi Tra gennaio e dicembre 2012 sono stati osservati tra la popolazione maschile afferita all’U.O.C. di Urologia del Policlinico P. Giaccone di Palermo 540 pz affetti da EP. Da questa popolazione selezionata è stato arruolato un campione di 270 pz secondo i criteri di inclusione: IELT ≤ a 2 minuti, Premature Ejaculation Diagnostic Tool (PEDT) ≥9, età 18-70 anni. Criteri di esclusione: disturbi psichici, malattie croniche gravi, uso di sostanze stupefacenti e abuso di alcool. I 270 pz sono stati randomizzati secondo ordine di arruolamento consecutivo in tre gruppi di 90 pz come segue: Gruppo A-Farmaco, età media 49,8 anni (range 20-68) Gruppo B-Farmaco+Psicoterapia di Gruppo, età media 49,2 anni (range 20-68) Gruppo C-Psicoterapia di Gruppo, età media 36,9 anni (range 20-56) Nel Gruppo A e nel Gruppo B è stata impiegata la Dapoxetina. I pz sono stati seguiti per 20 settimane con 4 visite ambulatoriali. Per il Gruppo B e il Gruppo C lo strumento psicoterapeutico utilizzato è stato il Gruppo Omogeneo Aperto a cadenza per 20 sedute totali. Pre e post trattamento è stato somministrato il PEDT, questionario sull’eiaculazione e sulla QoL del pz. Risultati Centoventi (44,4%) dei 270 pz arruolati non sono stati complianti alla terapia e non vi sono dati al riguardo. GRUPPO A Sessanta dei 90 pz arruolati hanno terminato il protocollo, IELT medio pre-trattamento di 79,75 sec (range 15 sec–120 sec) e punteggio medio al PEDT 15,95 (EP grave). Nel post trattamento lo IELT medio è stato di 203 sec e punteggio medio al PEDT è 8,26 (moderata EP).In 13 (21,6%) pz si è evidenziato un miglioramento del quadro clinico con punteggi medi PEDT a termine di terapia ≤ 8, e IELT riferito ≥ 2 . GRUPPO B Sessanta dei 90 pz arruolati hanno concluso il protocollo, IELT medio pre-trattamento di 74,25 sec (range 15 sec–120sec) e punteggio medio PEDT di 16 (EP grave). Nel post trattamento lo IELT medio è stato di 200 sec e punteggio medio al PEDT di 3,3 (assenza/basso livello di EP). In tutti i pazienti del Gruppo (100%) si è riscontrato miglioramento dell’EP GRUPPO C Trenta dei 90 pz arruolati hanno concluso il protocollo, IELT medio pre-trattamento di 75 sec (range 15 sec–120 sec) e punteggio medio PEDT di 15,7. Nel post trattamento lo IELT medio è stato di 186 sec e punteggio medio al PEDT di 4,03(assenza/basso livello di EP).Quindici pz (50%) hanno riportato miglioramento della EP. Discussione Il Gruppo A ha riportato miglioramenti nello IELT e nel PEDT nel 21,6% dei casi; il Gruppo B in tutti i pz (100%), mentre il Gruppo C nel 50% dei casi. Conclusioni La terapia associata si è dimostrata efficace nel trattamento dell’EP con aumento significativo dello IELT e punteggi al PEDT rientranti nel range di “normalità” al post trattamento.

Premature Ejaculation (PE) is a sexual dysfunction that concern 20-30% of the male population. Dapoxetine is a new serotonine re-uptake inhibitor (SSRI)specific for PE treatment.Aim of the study is to assess compliance and effectiveness of the treatment with dapoxetine compared to the treatment with citalopram (a classic SSRI used to treat PE).

INTRODUCTION & OBJECTIVES: Cytokines may be involved in the pathogenesis of the Peyronie's disease (PD). Cytokines levels in tunica albuginea (TA) specimens were measured by Real Time PCR in PD patients and in control group. MATERIAL & METHODS: Between January 2009 and December 2010 20 PD patients affected by PD and 8 patients affected by congenital recurvatum penis (control group) undergoing surgery were entered in the study. Routine histological examination and measurement by Real Time PCR of the expression of the encoding genes for IL-2, IL-4, IL-6, IL-10, IL-13, TGF-β1, TNF-α, IFN-γ and Metalloproteinase (MMP-2) were performed. For the normalization of data, GAPDH (glucerldehyde-3 fosfatehydrogenase) gene normally expressed in all cells was adopted. The analysis of the data was performed using the comparative method of Δct. The target gene expression were reported with the fold of induction (FOI) method calculated according to GAPDH both in PD and in control Group samples. RESULTS: The absence of inflammatory cells was demonstrated by routine histological examination in all samples. A lower median level of gene expression cytokines was detected in the PD patients when compared with the control group: IL-10 0,3864 (range 0- 1,1483), IL-2 0,089 (range 0- 0,3586), IL-6 0,0406 (range 0-0,1478), IFN-γ 0,029 (range 0-0,1187), MMP-2 0,2491 (range 0- 0,6480). IL-4, IL-13 and TNF-α were not detectable. No significant difference emerged between PD and control patients, although a trend for higher levels of TGF-β in PD patients 1,0396 (range 0,1540- 3,6432) vs 1 (control group). CONCLUSIONS: The expression of cytokines in tunica albuginea of PD patients compared to the control patients do not show any significative difference. Cytokines promoting inflammation are undetectable in PD patients and not seem to be involved in the pathogenesis of the disease. A higher level, althoug the difference was not statistically significative of the TGF- β, a profibrotic cytokine, was detected in PD patients representing a possible explain action of fibtotic tissue when the inflammation is off.

INTRODUCTION: The Nesbit procedure is the most common surgical technique to correct congenital or acquired penile curvature. It is a common opinion that this surgical procedure has to be completed with a circumcision to prevent foreskin necrosis or phimosis. According to our experience we believe that some procedural "tricks" could strongly reduce that mechanical and ischemic trauma on the foreskin responsible for these complications. MATERIALS AND METHODS: From 1988 to 2010 we selected 158 patients treated with Nesbit's corporoplasty. The procedure was recommended to patients who presented a penile curvature wider than 30° and reporting however some difficulty or pain at coitus, or to patients who complained about aesthetical problems (123 patients presented a La Peyronie disease and 35 presented a congenital curvature). RESULTS: Eleven patients underwent circumcision during surgery because of a pre-operative phimosis, or according to their own desire. Among the patients who did not undergo circumcision (147), paraphimosis was present in 3 patients. We reported only one case of curvature recurrence in a patient who had a sexual intercourse the day after surgery. We also had one case of hourglass effect in a congenital curvature. DISCUSSION: We believe that some tricks during Nesbit surgical procedure could prevent tissue and vascular trauma that give rise to tissue retraction, and consequently to phimosis and foreskin necrosis: a coronal incision to 0.5-1cm from the gland line would allow to let intact an adequate amount of reflection of skin (prepuce) bound of preputial skin reflection , maintaining good vascularity. The careful degloving with preparatory isolation of the dissection plan between dartos and Buck's fascia, can reduce vascular trauma of the fascia, minimizing bleeding and ensuring tissue vitality. Moreover, execution of only two hydraulics erections, after degloving and after correction, causes a minimal tissue stress. CONCLUSIONS: Circumcision must not be considered a mandatory time in Nesbit procedure: on the contrary, mandatory is the respect of the anatomical structures surgically attacked to avoid preputial resection.

INTRODUCTION: We decided to conduct a study to investigate the presence of cytokines in the albuginea of subjects with Peyronie's disease (PD). Cytokines, as responsible for intercellular communication, maybe involved in the pathogenesis of the disease. The identification of one or more involved cytokines may, in fact, be useful in the pharmacological treatment with biologic drugs that are able to interfere with specific cytokines. MATERIALS AND METHODS: Between January 2009 and Decembre 2010 at the Clinic of Urological outpatients clinic of the Policlinico of Palermo were recruited 20 subjects with PD, mean age 62.3 years (range 51-70) and 8 subjects with congenital recurvatum penis (mean age 21.5; range 19-28), the latter used as a control group. Inclusion criteria were the criteria for operability with Nesbit corporoplasty. The albuginea specimens were used to test gene expression of pro-fibrotic and pro-inflammatory, using Real-Time PCR. They were also subjected to histological examination after fixation by staining with hematoxylin-eosin (H&E). RESULTS: Histological examination performed on samples from both groups demonstrated the absence of inflammatory cells in all patients reviewed for the study. The analysis of the expression of genes encoding IL-4 (Interleukin-4), IL-6 (Interleukin-6), IL-13 (Interleukin-13), TGF-β (Transforming Growth Factor-β1), IL-2 (Interleukin-2), IL-10 (Interleukin-10), TNF-α (Tumor Necrosis Factor-α) and IFN-γ (Interferon-γ) showed a very low level of transcripts in all samples (in some cases undetectable). The levels of cytokine transcripts examined were lower in samples from patients with PD compared with controls. CONCLUSIONS: From the results obtained, the use of biologic drugs (antibodies) againsta the cytokine does not seem to be useful in the stable phase of Peyronie's disease due to the very low concentrations of cytokines found in the tunica albuginea of the patients.

Objective. To assess the possibility of intralesional therapy for the treatment of Peyronie's disease, we have verified the safety and tolerability of intralesional injections of Iloprost ( an I 2 Prostacyclin analogue) for its property to suppress the production of CTFG in fibroblasts. CTFG is a connective tissue growth factor that acts in concert with TGF-β to stimulate the fibrotic process. Materials and methods. 38 patients with Peyronie’s disease were preliminarily evaluated by considering the symptoms, the degree of penile curvature, and the size of the plaque. Each patient received weekly intralesional injections of 200 ng of Iloprost in 1 ml normal saline for 5 weeks. If tolerated, the single dose was increased weekly to the maximum of 400 ng (2ml). All patients tolerated well a Iloprost dose of 200 ng; 19 of them reached a 300 ng dose and 14 tolerated a 400 ng dose without showing side effects. There was no placebo control group in this phase I study. Results. To evaluate the efficacy of the treatment, all the patients were preliminarily evaluated by an at-home photography. Two months after the end of the treatment they were re-evaluated. Almost all patients showed mild side effects (burning or pain) during the treatment at the site of injection. 29% of the patients showed an improvement in curvature. Conclusion. According to the results, therapy with intralesional Iloprost (prostacyclin drug with antifibrotic properties) in Peyronie’s disease seems to be an encouraging alternative to surgery.

Introduction and Objectives. We treated a 45 years old patient, suffering from diabetes mellitus since childhood, with retinal, neurovascular and kidney complications. In 1988, for erectile dysfunction (ED) resistant to medical injective treatment, the patient underwent ligation of the dorsal vein of the penis without any result. In 1989 a Flexiflate® hydraulic prosthesis was implanted with resolution of ED. In 2005 the patient underwent simultaneous kidney and pancreas transplant with a trans-laparotomic approach for end stage renal disease and diabetes mellitus. In 2009, because of the Flexiflate® Surgitek malfunction, the patient underwent explantation of the Flexiflate® prosthesis and simultaneous implantation of a Titan® Alpha 1 prosthesis with a double surgical approach.?Material and Methods. After a peno-scrotal incision and the explant of the Flexiflate® Surgitek, a Titan® Alpha 1 prosthesis was implanted with a double incision technique. The placement of two inflatable cylinders and the pump was performed by peno-scrotal approach. Instead, the prosthesis’ reservoir was placed with a separate infra-pubic incision to avoid possible injury from a single trans-inguinal approach, due to the previous laparotomy. Results. After follow-up at 9 months and 1 year the prosthesis was working well and the patient satisfied. Conclusions. We couldn’t find any related paper in the literature and as far as we know this is the only report on a simultaneous explant/implant of penile prosthesis with a double surgical approach in a patient with kidney and pancreas transplant.?

INTRODUCTION. Serenoa repens (saw palmetto) has been employed for the treatment of lower urinary tract symptoms (LUTS) for several years. Its mechanism of action is believed to be due to antiandrogenic, antiproliferative and antinflammatory properties. An association of Serenoa with the nettle “Utica dioica” showing antiproliferative activity and the pine “Pinus pinaster” derivative, showing antinflammatory action, has been proposed in recent years. Such an action is hoped to act not only by reducing LUTS but also by preventing the development of prostate cancer. MATHERIAL AND METHODS. During the years 2007 and 2008, 320 patients suffering from LUTS were treated with an association of Serenoa repens 320 mg, Utica dioica 120 mg and Pinus pinaster 5 mg, named IPBTRE. This treatment was administered to all patients for a minimal duration of 30 days to a maximum of a year, either alone or in association with antibiotics or alpha-blockers, if needed. Outcome analysis was based on evaluation of symptoms, prostate volume and maximum flow rate (Qmax). RESULTS. From a careful analysis of the data collected in our database, the following observations can be made: age varied between 19 and 78 years. The patients were affected by BPH in 46% of cases, chronic prostatitis syndrome in 43%, chronic genital-pelvic pain in 7% and other conditions in 4%, the absolute numbers being 147, 138, 22 and 7 patients respectively. No untoward side effect was reported in any case. Variations in symptom score could be fully evaluated only in 80 of 320 patients (25%), of whom 68 (85%) reported a significant benefit, with special reference to an improvement of pain, urgency, strangury and nocturia. Data on variations in prostate volume, as measured by digital rectal examination, were available in 84 (26.5%) patients. No significant change was observed. Qmax after treatment was measured in 83 (26%) patients. It did not show significant changes from the initial values. DISCUSSION. The association tested in our study appeared to be safe and well tolerated. No changes in flow rate and prostate volume were observed, but a marked reduction of LUTS was observed in 85% of evaluable cases, especially with regard to pain and irritative symptoms. Whether or not such an association may display a prevention of prostate cancer, may be investigated in additional studies.

Purpose. Intralesional therapy is a less invasive method for the treatment of Peyronie's disease. The objective of this study was to evaluate safety and tolerability of intralesional injections of Iloprost (I2 Prostacyclin analogue) for its property to suppress in fibroblasts CTFG (Connective tissue growth factor) production, which acts in concert with TGF-ß to stimulate the fibrotic process.?Methods. Nineteen patients with Peyronie's disease were preliminarily evaluated by considering the degree of penile curvature, plaque size and local and systemic symptoms. Each patient then received weekly intralesional injections of 200ng of Iloprost in 1 ml of normal saline for 4-5 weeks. If tolerated, the single dose increased weekly to the maximum of 400 ng (2 mL). Results. The treatment has shown that all patients seem to well tolerate a 200 ng Iloprost dose; 7 of them reached a 300 ng dose and 6 tolerate a 400 ng dose without showing side effects. There was no placebo control group in this study.?To evaluate the efficacy of the treatment, the absence of objective parameters (except for the auto-photograph of penis in erection) led us to develop a subjective questionnaire that was given to all patients to assess sexual function, pain reduction, ecc. Conclusions. Due to the relatively small size of the sample, the efficacy evaluation has been restricted to check the questionnaire reliability. Iloprost is well tolerated to a dose of 400ng in the local treatment of Peyronie's disease.

PURPOSE. Seminal-sparing cystectomy is reported in literature only with reference to oncological conditions. However, it can be applied also in non-neoplastic conditions in young patients with good renal function. In the present report we will describe our experience in this field, with special reference to erectile function, urinary continence, fertility and feasibility. MATERIALS AND METHODS. Between 2000 and 2009 we have treated five patients with seminalsparing cystectomy for benign conditions, namely sclerosing cystitis, tuberculosis and a benign paraganglioma. All patients underwent a complete diagnostic evaluation including CT of upper abdomen and pelvis, and bone scintigraphy. Digital rectal examination was normal, PSA less than 2.5, with a free to total ratio above 25%. Cystectomy was performed, leaving in situ vas deferent, seminal vesicles, neurovascular bundles and prostatic capsule. Finally, an orthotopic bladder was performed. The ileal segment was anastomized to the prostatic capsule. RESULTS. All patients had uneventful recoveries and were continent within 2 weeks from the operation. Erectile function was maintained in all cases; in one patients fertility was preserved. CONCLUSIONS. In our experience, seminal–sparing cystectomy showed satisfactory clinical and functional preliminary results in selected patients. Young males, for whom maintenance of bladder function and sexual activity have a great impact on their quality of life, can be offered this alternative surgical procedure.