Prove Cliniche Su Prostatite
Tumore prostata localizzato
Calcoli nella prostata e nella vescica in english version
Non assorbire compromessi, non aver terrore del ragione estraneo, sii sempre te stessa, segui il tuo istinto, non denaturalizzarti, sii la persona eclettica così come sei, non scandalizzarti delle gote rosse estraneo. It secretes fluids that help the transportation and activation of sperm.
The common prostate medical bacterial prostatitis young male are prostate infection, enlarged prostate and cancer of the prostate. Prostate infection, often known as prostatitis, is easily the bacterial prostatitis young male common prostate-related overuse injury in men younger than 55 yrs. Infections in the prostate related are classified into four types — acute bacterial prostatitis, chronic bacterial prostatitis, chronic abacterial prostatitis and prosttodynia.
Acute bacterial prostatitis could be the least common of all kinds of prostate infection. It is caused by bacteria found in the large intestines or urinary tract.Caffeina dopo chirurgia prostatica Adenocarcinoma prostatico di tipo acinar gleason score 4 4 8 10 grade group 4 Xxx massaggio prostatico italiano
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Vantaggi della chirurgia robotica per il cancro alla prostata
Auxologico San Luca. Aiuta a progredire l'aspetto riguardo smagliature ed cicatrici, contrasta Kofimucil Mucolitico 30 Buste. Viagra vantaggi un medicinale contenente il levitra orosolubile da cialis dosi consigliate 29 mg il pistola (fig. Tutti i massaggi sono effettuati su via riguardo olio su lettuccio proffessionalex massaggi.
Your Nonbacterial Prostatitis symptoms might be caused by your PELVIC FLOOR
There is no biomarker that can be used for diagnosis or follow up of patients, and there is lack of novel treatment strategies taking into account pathophysiological pathways. Casellario Italiano riguardo Urologia inoltre Andrologia ; 90, 4.
In terms of diagnosis there is an agreement that infection should be ruled out by localization tests, as described early by Stamey 1. To what extent ejaculate investigations could be beneficial is not entirely clear. Ejaculate testing is frequently performed on routine examinations heading for mere culture, which frequently provides contamination samples, or in other words reflects the microbiome of the external genitalia.
Epigenetic changes are frequently seen in chronic inflammatory diseases and should be investigated according to systemic and compartmentspecific signals for epigenetic dysregulation of inflammatory factors. By doing so a significant association with systemic and local epigenetic inactivation of a mast-cell recruiting molecule CXCR4, the receptor for CXCL12 was identified The search for biomarkers should include various pathways, including hormonal pathways In one study elevated local estrogen levels associated with an epigenetic down-regulation of the estrogen receptors was identified.
Investigating estrogen levels in semen could therefore serve as a promising biomarker to select patients for estrogen targeted therapy Anandamide is a cannabinoid CB produced on demand in response to elevated intracellular calcium levels in post-synapse.
It is an endogenous agonist of the CB1 receptor which exerts potent inhibitory effects on pre-synaptic glutamate release. The fatty acid amide hydrolase FAAH is involved in the enzymatic regulation of anandamide and the inhibition of FAAH elevates levels of anandamide in hyperexcited synapse and potentially could scampato pain perception. It can be considered one of the challenges that urologists have to face. What kind of therapy urologists could use against prostatitis?
First of all, in case of diagnosis of prostatitis, antibiotics are the firstline agents for the treatment of CP, for weeks. If patient has voiding low urinary tract symptoms LUTS Eccitabile, alphablockers for weeks are also used. The use of alphablockers demonstrates an average NIH-CPSI total score reduction, an average pain ed average voiding symptoms reduction with an increase of quality of life Different studies compare the use of rofecoxib and celecoxib against placebo.
They demonstrate a pain reduction and a better quality of life Improvement of results has instead been reached by the contemporary use of alpha-blockers, antibiotics and anti-inflammatory 90 Indietro, showing a better control of prostatitis symptoms than use of a single drug. In fact, unfortunately, no efficient monotherapeutic option is available.
It could be recommended as primary therapy or in association with other drugs to treat CP, because of their few side effects. The use of quercetin mg twice a day che formavano malevolenter e quindi segue una regola differente), in man with Chronic pelvic pain syndrome, show a better control urinary symptoms, a lower symptoms duration and a better quality of life against placebo Pollen extract was studied against placebo also in association with vitamins Deprox for pain relief: after only 1 month from start of therapy it was observed a decrease of NIH-CPSI score, although IPSS remain constant.
Most important was the comparison between Deprox mg and Ibuprofen mg for early pain relief. Another studied phytotherapy drug is Serenoa repens. Profluss, an associa-. In the last years other drug associations were studied for the treatment of patients with chronic prostatitis. An Italian study reported about the association between curcumin and Calendula Riflog versus placebo.
Moreover, as already mentioned before, multimodal therapy has greater effectiveness than a single therapy. Riflog, in association with alpha-blocker and antibiotics, improves quality of life, Qmax and reduced Santorini ectasia and number of Stamey positive patients. At last Calendula officinalis could be another phytotherapy drug used in prostatitis, exploiting the numerous effect already studied and know, like antiflammatory, antioxidant, antiedematous or analgesic effects.
In our experience out of patients suffering from prostatic inflammation, The interaction of bacterial intestinal flora interaction with food is the basis of many phenomena that influence the state of health or illness. In fact the microbiota, according to its composition and by means of the products of bacterial metabolism, influences the metabolic, vaccinato and inflammatory response of the organism An anti-inflammatory action occurs at the level of Toll-like receptors TLR ; probiotics are able to regulate the balance if intestinal flora, so the TLR can correctly distinguish dangerous antigens from those that must be tolerated.
Reduced intake of fiber in the diet alters the intestinal microbiota, with reduced bacterial production of compounds modulating the vaccinato response. To regulate the intestinal flora, proper nutrition is therefore crucial. Numerous studies attest the important role of diet in proper formation and maintenance of the intestinal microbiome. Epidemiological studies have correlated the increase of inflammatory pathologies with "modern" nutrition, the so called "Western diet" that is the intake of large quantities of red meat, simple carbohydrates, fat, refined cereals and poor portions of vegetables, fruit and fish.
The damages caused by this diet are due to the inability of the human genome to adapt to rapid changes in the environment, especially diet The complex cumulative nutritional effects of the foods rather than the intake of single macronutrients proteins, carbohydrates, fats and micronutrients minerals and vitamins play an important role in the protective effect of the Mediterranean diet The diet has its effects on inflammation both by direct. Foods directly influence the vaccinato response and therefore inflammation of intestinal and extra-intestinal tissue.
In fact an inflammation in the absence of pathogens can occur in all the tissues, in response to a wide range of stimuli, which cause stress and damage to cells sterile inflammation In the sterile inflammation some nutrients are able to cause conditions of cellular stress.
In particular DAMPs lead to the assembly of a cytosol protein complex, called inflammasome, which activates the caspase-1 protease with consequent activation and secretion of IL-1beta. The nutrients can therefore interact with the intestinal epithelium and the cells of the system vaccinato, as do viruses, bacteria and other environmental factors, activating the same pathways of cellular signals that activate or sopravvissuto inflammation.
The pool of bacteria and other microorganisms viruses and prokaryotes that lives in coexistence in the human intestine is called intestinal microbiota The Microbiota is made up of trillion bacteria in a balanced composition of several divisions Phyla Generare, genera and bacterial species, which can act as — "commensals" that do not provide any benefits or harm to the guest — "symbionts" mainly Bifidobacteria and Lattobacilli with probiotic activity — "pathobionts" resident bacteria with potential for pathological induction.
The composition and concentration of bacterial genera and species differs in the various segments of the gastrointestinal tract from in the stomach to in the colon. The intestinal microbiota implements 3 probiotic functions: — protective function against pathogenic bacteria from the outside and pathobiont bacteria: this action is carried out by anti-bacterial activity bacteriocins for space and nutrient competition and for slight acidification of the environment to inhibit the growth of pathogenic bacteria — metabolic function by synthesis of vitamins, decomposition of bile acids and above all production of short-chain, butyric, propionic and acetic fatty acids butyrate is the trophic factor for intestinal mucosal cells Schedario Italiano riguardo Urologia inoltre Andrologia ; 90, 4.
In addition, the intestinal epithelial cells produce a mucous layer that covers the intestinal surface, consisting of mucin polymers that act as nutrients and sites of adhesion of probiotic bacteria.
The causes of dysbiosis in adults are determined by drugs, stress, wrong diet, bad lifestyle, infections and food intolerances. Dysbiosis can be "deficienct" when caused by drugs or stress or wrong fiber-free diet, or "stagnant" or "putrefactive" when foods such as fats and red meat that stimulate the flora to putrefactive activity prevail in the diet or, on the other side, when fermentable foods legumes, citrus fruits, etc.
A diagnostic innovation regards the evaluation of the dysbiotic action of colina by excess of eggs and carnitine by excess of red meat.
This product stimulates the formation of foam cells, inflammatory cells with oxidized LDL, which stimulate the formation of atheromatous plaque.
TMAO represents an important new cardiovascular risk marker. The presence of dysbiosis mainly determines low-grade inflammation with hyperstimulation of the vaccinato system and endotoxaemia, because the dysbiotic bacteria produce substances that stimulate the receptors of dendritic cells inducing the production of inflammatory interleukins with increased reactivity of T17 and T1 lymphocytes to pro-inflammatory action.
Dysbiosis, as well as other stimuli, such as gluten, determine the secretion by intestinal cells of the zonulin protein, which acts on the "tight junctions" of the intestinal epithelial cells, causing increased intestinal permeability. Dysbiosis, zonulin and consequent low-grade inflammation are the pathophysiological causes of the numerous diseases related to the alteration of the microbiota.
Dysbiosis can cause, for the pathophysiological factors mentioned above, systemic diseases such as diabetes mellitus as the produced inflammatory factors as inter-. This ratio is normally about 0. Low-grade inflammation, increased intestinal permeability, presence of pathobionts bacteria and trans-parietal migration may also be involved in the pathogenesis of acute and chronic prostatitis.
Repeated antibiotic therapies that often accompany the clinical process of urogenital and prostatic infections represent a factor that repeatedly feeds the dysbiosis related to these diseases highlighting the importance of the therapy with probiotic bacteria to restore the eubiosis and stop the vicious circle of dysbiosis-urogenital infections.
The timing of administration of bacterial therapy should never be less than 21 days and the amount of live bacteria should never be less than one billion daily. Dysbiosis with persistence of pathogenic noxae can activate mast cells causing chronic inflammation.
Bacteria belonging to the phylum Proteobacteria have an outer membrane composed mainly of lipopolysaccharides LPS that stimulate monocyte activity through various steps. LPS are anchored to the external membrane of the bacteria and are released once bacteria die provoking a reaction from the organism with possible increase of the vascular permeability and consequent inflammatory state.
They increase intestinal permeability through an intracellular mechanism that involves the up-regulation of TLR-4, which depends on the membrane expression of CD TLRs are receptors expressed on the membrane of sentinel cells such as macrophages, dendritic cells and antigen-presenting cells APC.
In particular,. The activation of TLRs in the intestinal microbiota by the presence of pathogenic microorganisms induces the triggering of the mechanisms of innate immunity and the onset of inflammatory phenomena. The condition of dysbiosis leads to an indirect dysfunction, therefore not primary but secondary, of the intestinal epithelia barrier which creates a way of entry into the organism, through the blood, of bacteria, giving rise to phenomena of bacterial translocation bacteria in places other than those of origin.
The alteration of intestinal permeability, due to lactobacilli and bifidobacteria deficiency, leads to loss of integrity of the mucosal barrier, passage of antigens in the submucosa and vaccinato activation. The activation of the mast cells maintain an up-regulation with acute and chronic pro inflammatory consequences.
Recent studies have widely established that mast cells can also respond to non-IgE dependent stimulation. In these cases, mast cells appear to undergo ultrastructural alterations of the granular nucleus, that appears dense with electrons, without the classic evidence of degranulation that is related to an increase of IgE. A condition of chronic mild inflammation is developed that reverberates at the intestinal, prostatic and vaginal level.
The best known triggers of this alternative activation path include bacterial toxins, neurotransmitters and stress that may be involved in the pathophysiology of IBS. The involvement of mast cells in abdominal pain of patients with IBS has been widely demonstrated, in particular the presence of activated mast cells near the nerve endings, is related to the intensity and frequency of abdominal pain.
Mast cells represent the most active sentinels towards the external environment having a high quantity of receptors that can be activated by allergens such as food, drugs, cytokines. The mast cell can acts both by paracrine signaling, especially for the presence of pseudopods which can extend the inflammatory response to blood vessels and nerve endings, and autocrine signaling to itself because it has receptors to the substances that it releases.
Consequently, if the causes of its activation are not removed, the inflammatory process can become chronic. Some studies have shown that dysbiosis can cause the release of zonulin which leads to the passage of endoluminal contents through the epithelial barrier with consequent release of pro-inflammatory cytokines. Zonulin is a protein that regulates the junctions of the intestinal walls and ,if in excess, loosens them, favoring a state of intestinal permeability.
It was first described in by Fasano et al. The values of zonulin may represent the reference parameter for the evaluation of the extent of the intestinal mucosa alteration and the consequent state of its permeability. The values found are significant of the progression of the inflammatory condition and correlated with clinical symptoms and can be a guide of the treatment.
Accordingly, the therapeutic approach could aim at restoring the intestinal microbiota through the examination of the stool, the rebalancement of the microbiota, an adequate diet and the application of hydrocolon therapy to eliminate bacterial over-growth and pro-inflammatory toxins generated by lipopolysaccharides LPS.
The application of hydrocolon therapy in chronic prostatitis is based on the ability of a gentle and targeted flow of water entering the intestine during the treatment sessions to regenerate the intestinal environment, through the elimination of inflammatory components that reside in the microbiota. The regularity of the incoming flow through the targeted maneuvers of the operator, which operates on the water flow and pressure parameters in an appropriate manner, allows to create an environment favorable to the regrowth of a microbiota rich in lactobacilli and bifidobacteria that is essential to maintain the intestinal mucosal integrity and to guarantee an effective motor peristalsis.
The application of hydrocolon therapy in vulvodinia has achieved a significant improvement of pain with concomitant decrease of inflammatory parameters. This ecosystem is open to contaminations both from the external and from the intestinal environment, so it is susceptible to colonization from microorganism that can be symbiotic or pathogenic according to their bacterial counts and to their ability to modify the vaginal homeostatic mechanisms.
All the participants to vaginal ecosystem vaginal epithelium, pH, glycogen and lactobacillary flora are modified along the different ages of a woman due to different hormonal production. A high oestrogen production, such as during puberty or pregnancy, stimulates the vaginal cells to proliferation and the glycogen storage. Moreover, glycogen facilitates the lactic Raccolta Italiano su Urologia inoltre Andrologia ; 90, 4. Moreover, the lactobacillary flora, divided in five groups following the predominant species L.
Furthermore, menstrual cycles Guastarsi, sexual activity, antibiotics or oral contraceptives assumption can modify the vaginal macrobiotic.
The vaginal microbiota has an active role in the mechanisms of conception, pregnancy and delivery time and modality In presence of disruption of vaginal homeostasis due to alteration of control mechanisms or to different susceptibility of the host Peloso, there are vaginal infections vaginitis due to attack from external pathogens or dysbiosis vaginosis due to a quantitative redistribution of local flora.
Partners of patients suffering from Chronic Prostatitis or Chronic Pelvis Pain Syndrome: who underwent to a vaginal, cervical or urethral swab showed the same pathogen isolated in male patients, namely Enterobacteria, Uraplasma uralyticum, Gardnerella vaginalis and Chlamydia. Moreover, clinical characteristics of vaginal infections, their association with sexual transmitted diseases STD . O linfocito, the gynaecological and reproductive consequences and the obstetric complications have to be analysed Stamey TA.
J Royal Soc Med. Johns Hopkins Hospital Reports. Research guidelines for chronic prostatitis: consensus report from the first National Institutes of Health International Prostatitis Collaborative Network. Antibiotics: basic concepts. In: Nickel JC ed. Textbook of Prostatitis. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network.
J Urol. Prostate Cancer Prostatic Dis. Effects of comicronized composite containing palmitoylethanolamide and polydatin in an experimental model of benign prostatic hyperplasia. Toxicol Appl Pharmacol. The role of prostatitis in prostate cancer: meta-analysis. PLoS One ; 8:e Int J Cancer. Racial differences in the relationship between clinical prostatitis, presence of inflammation in benign prostate and subsequent risk of prostate cancer.
Prostatitis, other genitourinary infections and prostate cancer: results from a populationbased case-control study. World J Urol. The association between prostatitis and prostate cancer. Systematic review and meta-analysis.
Arch Ital Urol Androl. Does prostatitis increase the risk of prostate cancer? A meta-analysis. Int J Clin Exp Med. NIH consensus definition and classification of prostatitis. Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol. BJU Int. Chronic prostatitis and erectile dysfunction: results from a cross-sectional study.
Chlamydia trachomatis infection is related to premature ejaculation in chronic prostatitis patients: results from a cross-sectional study. J Sex Med. X Chromosomal short tandem repeat polymorphisms near the phosphoglycerate kinase gene in men with chronic prostatitis.
Biochim Biophys Acta. The beneficial effect of alfuzosin 10 mg once daily in 'real-life'. Effectiveness of doxazosin on erectile dysfunction in patients with lower urinary tract symptoms. Int Urol Nephrol. Antioxidant treatment with quercetin ameliorates erectile dysfunction in streptozotocin-induced diabetic rats.
J Biosci Bioeng. Comparison of ultrasound imaging in patients undergoing transperineal and transrectal prostate ultrasound. Roy C. Imagerie de la prostate. Correlation between ultrasound alterations of the preprostatic sphincter and symptoms in patients with chronic prostatitis-chronic pelvic pain syndrome.
Urology ; Prostatic calculi in- fluence the antimicrobial efficacy in men with chronic bacterial prostatitis. Asian J Androl. Urol Int. Results of a prospective parallel-cohort study. Investig Clin Urol. Mycoplasma genitalium infection in men. J Infect Dis ;S Horner P, et al. Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? J Eur Acad Dermatol Venereol.
Jungwirth A, et al. Guidelines on Male infertility, European Association of Urology, Miller JM, et al. A guide to utilization of the Microbiology Laboratory for diagnosis of infectious diseases: update by the Infectious Diseases Society of America and the American Association for Microbiology. Clin Infect Dis. Mobley DF. Semen cultures in the diagnosis of bacterial prostatitis J Urol.
Leigh DA. Prostatitis--an increasing clinical problem for diagnosis and management. Antimicrob Chemother. Semen analysis in chronic bacterial prostatitis: diagnostic and therapeutic implications. Nickel JC.
Recommendations for the evaluation of patients with prostatitis. Semen and urine culture in the diagnosis of chronic bacterial prostatitis. Int Braz J Urol. Value of semen culture in the diagnosis of chronic bacterial prostatitis: a simplified method. Scand J Urol Nephrol. Multiparametric magnetic resonance imaging characteristics of normal, benign and malignant conditions in the prostate.
Eur Radiol. Kasivisvanathan V, et al. N Engl J Med. Mazzoli S. Prostate Cancer. EAU Guidelines. Hom JJ, et al. High-grade prostatic intraepithelial neoplasia in patients with prostate cancer: MR and MR spectroscopic imaging features--initial experience. Radiology, ; Sciarra A, et al. Cancer Invest, ; Nagel KN, et al. Differentiation of prostatitis and prostate cancer by using diffusion-weighted MR imaging and MR-guided biopsy at 3 T.
Cai T, et al. Chlamydia trachomatis versus common uropathogens as a cause of chronic bacterial prostatitis: is there any difference? The impact of biofilm-producing bacteria on chronic bacterial prostatitis treatment: results from a longitudinal cohort study.
Prostate calcifications: A case series supporting the microbial biofilm theory. Lobel B, Rodriguez A. Chronic prostatitis: what we know, what we do not know, and what we should do! Sexually transmitted infections, prostatitis, ejaculation frequency, and the odds of lower urinary tract symptoms. Am J Epidemiol. Fluoroquinolone treatment of chronic bacterial prostatitis: a prospective cohort study.
J Chemother. Seo Y, Lee G. Korean J Urol. Compensation of Catalogo Italiano riguardo Urologia ed Andrologia ; 90, 4. Agents Chemother. Epidemiological features and resistance pattern in uropathogens isolated from chronic bacterial prostatitis. J Microbiol. The role of antibiotics in chronic bacterial prostatitis. Int J Antimicrob Agents. Penetration of antimicrobial agents into the prostate. Antimicrobial therapy for chronic bacterial prostatitis.
Cochrane Database Syst Rev. Oral fosfomycin for the treatment of acute and chronic bacterial prostatitis caused by multidrug-resistant Escherichia coli Can J Infect Dis Med Microbiol. Safety and efficacy of levofloxacin mg for 2 weeks or 3 weeks compared with levofloxacin mg for 4 weeks in treating chronic bacterial prostatitis. Curr Med Res Opin. Treatment of bacterial prostatitis. Patient specific risk stratification for antimicrobial resistance and possible treatment strategies in gram-negative bacterial infections.
Expert Rev Anti Infect Ther. Penetration of piperacillin—tazobactam into human prostate tissue and dosing considerations for prostatitis based on site-specific pharmacokinetics and pharmacodynamics. J Infect Chemother. Tigecycline treatment of urinary tract infection and prostatitis: case report and literature review. Can J Hosp Pharm. Eur Urol. Exp Ther Med. PLoS One che è proprio o si riferisce al nucleo dell'atomo: fisica nucleare, 7:e Rofecoxib Prostatitis Investigator Team A randomized,placebo controlled,multicenter study to evaluate the safety and efficacy of rofecoxib in the treatment of chronic nonbacterial prostatitis J Urol.
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Understanding the effects of diet on bacterial metabolism in the large intestine. J Appl Microb ; Sexually transmitted infection: challenges ahead.
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Objective: Retropubic radical prostatectomy RRP is still widely used in clinical practice in localized prostate cancer because of its high oncological success. The aim of this study was to define the continence status in patients where rhabdosphincter was included in the vesicourethral anastomosis.
Materials and methods: Between November and September Non addomesticato, 90 cases who underwent RRP by the same surgeon in our clinic were taken into the study. In all cases vesicourethral anastomosis was performed include the rhabdosphincter. The anastomosis was performed with mean 2. Pad test was performed to all patients at 1, 3, 6 and 12 months postoperatively. Results: Preoperative total PSA value was Preoperative prostate biopsy results were found that Gleason scores were 5, 6, 7 and 8 in 7, 53, 21, 9 patients, respectively.
Mean operation and urethral catheter removal time was minutes and 14,6 days - restare inutilizzato, respectively. Mean hospital stay was 4. According to results of postoperative pad tests, 38 Conclusions: We think that, our novel technique of vesicourethral anastomosis in standard RRP provides more optimal urethral position during fixation of pelvic floor and urethra, protect caudal retraction, preserve functional urethral length.
Also strong full thickness stitch on urethra provides better urinary continence by hanging urethra in our patients. Although our early continence rate is better, our long term continence rate is similar to literature. Submitted 3 June ; Accepted 19 July Prostate cancer is common in man and is the second most common cause of death after lung cancer. Incidence of prostate cancer incline after 50 years old and change in different countries according to diet, ethnicity, life style and screening protocols 1.
Although this surgical procedure has important efficiencies it has also morbidities that should be considered. To get rid of morbidities and increase efficiency some modified techniques have been tried over years. Although in recent decades, laparoscopic and robot-assisted laparoscopic RP have been utilized as alternatives to traditional open surgery, RRP is still widely used in clinical practice 4.
In all surgical techniques main aim is to get oncologic control and at the same time to maintain erectile function and continence which otherwise affected can decrease patient quality of life.
Perioperative and post-operative early complications of radical prostatectomy are bleeding, rectal injury, deep venous thrombosis, pulmonary emboli and lymphocele. Late complications are urinary incontinence, erectile dysfunction and anastomotic stricture. Most important complication that affect quality of life is urinary incontinence.
Although older studies indicate higher incidence of urinary incontinence in recent years with better knowledge about pelvic anatomy this incidence has decreased. Vesicoureteral anastomosis is one of the most important step in radical prostatectomy and if it is not done properly it leads urinary leak, urine accumulation in surgical field and prolonged drainage 7. On the other hand, it leads periurethral fibrosis, bladder neck stricture and urinary incontinence 8.
Recently improvements in techniques of vesicoureteral anastomosis provides decrease in incidence of stricture and incontinence. Aim of our study is to evaluate post-operative urinary incontinence in patients who underwent RRP and had vesicoureteral anastomosis that includes rhabdosphincter.
Local ethics committee approval was taken for study and written consent for each patient was also taken. Preoperative and postoperative information of all patient was recorded prospectively. Exclusion criteria were: previous urethral or prostatic endoscopic procedures, preoperative urinary incontinence and concomitant neurological diseases ed. Parkinson disease. Bone scan was performed for intermediate and high-risk prostate cancer group and also patients who were symptomatic.
In some patients MRI was used for confirmation of bone scan lesion. One experienced surgeon performed all surgeries and bladder neck preserved as much as possible. When indicated lymph node dissection was performed and in proper patients nerve sparing technique was used vicryl suture was used in vesicourethral anastomosis.
Sutures placed on urethra including rhabdospinchter from out to in and in to out for bladder Figure 1. A watertight test was performed at the end of the procedure.
Age, psa levels, prostate volumes and prostate biopsy results of all patients were recorded preoperatively. Operation time, urethral catheterization time, retrivel of drenage time, hospital stay, suture number for vesicoureteral anastomosis and perioperative bleeding was recorded for all patient. Also, post-operative follow up period, pathological parameters and complications were recorded.
For all patients postoperative third-generation cephalosporin, low-molecular-weight heparin, and elasto-compressive stockings were used for prophylaxis of infections and thromboembolic events, respectively. In postoperative period patients were followed up regularly for urinary incontinence. After retrieval of urethral catheter pad test were used for evaluation of urinary incontinence in 1, 3 and 12 months. Patient number, age, prostate volume, preop PSA values, prostate biopsy results, surgical parameters, hospitality and follow up period were summarized in Table 1.
In one patient myocardial infarction occurred in postoperative second day and transferred to coronary intensive care unit.
In this patient urethral catheter was taken off at postoperative 28th day. Average suture number for vesicourethral anastomosis was 2. In three patients 3. In four patients 4. In one patient omental flap with pedicul was used for strengthening rectal repair. In one patient during bladder neck dissection ureteral damage occurred and repaired intraoperatively with ureteroneocystostomy.
Figure 2. Suture numbers for vesicourethral anastomosis. According to pathologic reports 13 On the other hand, 6 6. In 6 patients with surgical margin positivity, 4 positivity was in prostatic apex while 2 positivity was in other regions of the prostate At first year of follow up 75 The continence status of the patients according to the postoperative month was summarized in Figure 3.
Seven patients with moderate incontinence and three patients with severe incontinence were found to have endoscopic procedures due to bladder neck stenosis after RRP at the first year of follow-up. Although there was high rate of urinary incontinence in first years of radical prostatectomy prevalence has decreased over years with better understanding of pelvic anatomy, increase in experience, technology and surgical techniques.
One of the most important step in radical prostatectomy is vesicourethral anastomosis. General principles for good anastomosis are watertight, non-stretch, anastomoses that provide the best urethral length and mucosa to mucosa anastomosis. Some authors indicated that nerve sparing surgery had positive affect on recovery of urinary continence On the other hand, few studies indicated that nerve sparing surgery had no effect on urinary continence In summary nerve sparing surgery has positive contribution on urinary continence.
In our study we did not evaluate the nerve-sparing technique variable in our study this deficiency can cause misconceptions. Rhabdospinchter is major structure that influence continence anatomically. In normal conditions, the urethral sphincter is supported anteriorly by puboprostatic and pubourethral suspensory components, laterally by the medial portion of the levatori ani muscle forming a hammock around the urethra, and by the ischioprostatic ligaments.
In our study we placed anastomotic sutures deeply unlike the traditional RRP described by Walsh especially in anterior urethra where intense rabdosphincter that surrounds urethra exist 3. We suppose that anastomotic suture that includes rhabdosphincter provides almost original urethral length, prevent caudal retraction of urethra and provide better anatomic positioning of urethra and bladder on pelvic floor.
In patients with our technique early functional results are better than literature but long-term outcomes are same. Proper and well done apical dissection leads to a better appearance of rhabdosphincter by protecting it. In Montorsi et al. In our study apical surgical margin positivity was seen only in four 4.
Prevalance of apical surgical margin positivity in literature is between 6. We think that well done apical dissection for protecting rhabdospincter provides better continence status. Rocco et al. At the third month of follow up incontinence rate was There are conflicts in studies which evaluate the relationship between incontinence and intraoperative hemorrhage. In some studies, there was no relationship between intraoperative hemorrhage and post prostatectomy incontinence.
On the other hand, some studies reported that there was significant relationship between intraoperative hemorrhage and post prostatectomy incontinence 13, Intraoperative hemorrhage chioma is not a predictive factor for post prostatectomy incontinence without evaluation of other surgical factors. In our Raccolta Italiano su Urologia inoltre Andrologia ; 90, 4.
Some studies stated that urethral length should be kept as long as possible for the recovery of continence after RRP and too many sutures for anastomosis shortens urethral length Additionally, some studies indicated that less suture number for vesicourethral anastomosis had positive effects on urinary continence and bladder neck stenosis In our study mean suture number was 2. We think that too many sutures for anastomosis has negative effects on urethral length.
Another topic related to continence is preservation of bladder neck in radical prostatectomy. Many authors investigated relationship between urinary continence and preservation of bladder neck. Licht et al. Another study indicated that 24 patient who had bladder preserving radical prostatectomy had early recovery of urinary incontinence When we look at these studies, the continence effect of preservation of internal sphincter is to passively keep urine above in the storage phase.
Preservation of puboprostatic ligaments is another topic which can be related to urinary incontinence. Some authors indicated positive effects of preservation of puboprostatic ligaments on post prostatectomy incontinence. Poore et al. As a conclusion he founded early continence recovery in patients who underwent puboprostatic ligament preservation.
In another study patients were divided into three groups. In first group bladder neck preserving surgery was done in second group puboprostatic ligament preserving surgery was done and to last group both bladder neck and puboprostatic preserving surgery was performed There was no significant difference between three groups in long term urinary incontinence.
But bladder neck preserving group had earlier urinary continence than ligament preserving group. In another study sling technique was performed by suturing bladder neck to pubic bone and significant earlier continence rates were indicated according to control group But we think that wide suturing in anterior urethra provides normal anatomic position of urethra and by this way it can help external sphincter functions by preventing urethral hypermobility. Lack of control group, randomization and the small number of patients included in this preliminary analysis could be considered as the main limitations of the present study.
Recovery of urinary continence depends on patient selection, surgical techniques and definition of conti-. We think that by modifications in our vesicourethral anastomosis technique; urethra is placed more anatomically on pelvic floor; caudal retraction of urethra is prevented and by this way functional urethral length stays long and especially wide suturing on anterior urethra sling the urethra anteriorly.
According to our experience placing vesicourethral anastomotic suture along with rhabdospinchter is easy to perform. We also think that It is safe and shortens operation time and on the same time offers promising functional results. Multicentered, randomized controlled wide series is needed for these topics. Canser statistics.
Canser J Clin. Cancer statistics, CA Cancer J Clin. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Comparative effectiveness of robot-assisted and open radical prostatectomy in the postdissemination tempo. J Clin Oncol. Potency, continence and complications in 3, consecutive radical retropubic prostatectomies. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy.
Management of prolonged urinary leakage at the urethra-vesical anastomosis. Male sling postprostatectomy incontinence: Mean follow up 18 months. J Urology. Urinary incontinence after radical prostatectomy: incidence by definition, risk factors and temporal trend in a large series with a long-term follow-up.
Impact of variations in prostatic apex shape on early recovery of urinary continence after radical retropubic prostatectomy. Nerve sparing open radical retropubic prostatectomy--does it have an impact on urinary continence?
Lepor H, Kaci L. The impact of open radical prostatectomy on continence and lower urinary tract symptoms: a prospective assessment using validated self-administered outcome instruments.
Improving the preservation of the urethral sphincter and neurovascular bundles during open radical retropubic prostatectomy. Level of invasion into fibromuscular complesso is an independent factor for positive surgical marginand biochemical recurrence in men with organ confined prostate cancer. BMC Urol. Early continence recovery after open radical prostatectomy with restoration of the posterior aspect of the rhabdosphincter.
Risk factors for urinary incontinence after radical prostatectomy. Myers RP. Male urethral sphincteric anatomy and radical prostatectomy. Urol Clin North Am. Reducing the number of sutures for vesicourethral anastomosis in radical retropubic prostatectomy.
Impact of bladder neck preservation during radical prostatectomy on continence and cancer control. Radical prostatectomy with preservation of urinary continence. Puboprostatic ligament sparing improves urinary continence after radical retropubic prostatectomy. Radical prostatectomy: bladder neck preservation and puboprostatic ligament sparing-effects on continence and positive margins. Bladder neck sling suspension during robot-assisted radical prostatectomy to improve early return of urinary continence: a comparative analysis.
Objective: the aim of our study was to put forward insights to treat any possible correlation among sperm quality, sperm DNA damage and male age as they may have fertility implications for men who choose to delay fatherhood.
Materials and methods: Our study is a non-interventional retrospective analysis of semen samples from patients that were investigated for the conventional semen parameters.
We applied the Kappa index to compare both the and the World Health Organization WHO reference criteria to evaluate the competence of such semen parameters categorization during the standard routine of our laboratory.
When comparing both the and the WHO scales we found no accordance in the appraisal of sperm morphology but a very good one in the evaluation of the other parameters. Conclusions: Conventional semen analysis represents the opportunity to draw up a proxy insight on the male fertility status even if semen quality can only indirectly assess the probability of pregnancy. Several studies have verified a decay in the male reproductive system, sperm quality and fertility with advancing age although the reported results are not yet conclusive.
Our results substantially agree with those findings outlined in the literature. Moreover we find that the discrepancy between the two WHO reference scales would eventually lead to an improper diagnosis of infertility.
Submitted 25 june ; Accepted 31 July Infertility has a wide impact on public health. In developed countries, where expectancy of a prolonged life is well established, modern trends have enforced the delay of first parenthood 1. It partly reflects the complica-. Aging is explained by biological and demographic topics characterized by the impairment of several physiological functions and to what concern human reproduction, age related decrease of couples fertility potential is usually associated to female aging 1, 3.
Female germ cells are lessened during life span and do not replace 4. Therefore, as ovary grow older, the total number of oocytes and their quality decrease, lowering female fecundity 5. Female age has been explained as a predictor of poor reproductive success resulting in decreased fertilization and implantation rates as well as in increased abortion rates 5.
Efficient reproduction and early embryonic development mostly rely on oocyte quality with those from older women being more prone to nondisjunction caused by meiotic errors and therefore impaired by an increased occurrence of aneuploid abnormalities 4, 5. Male reproductive functions do not suddenly tanto to an end as spermatogenesis continues into advanced ages. Consequently men can conceive children at later ages 6. Anyway a large number of studies have marked a linkage between advanced male age and the decrease in fertility potential status 1, 3, 7.
The effect of advanced paternal age on embryo quality, miscarriage rate or pregnancy rate has been assessed for the general population and for infertile patients outlining an increased time-to-pregnancy disorder 2, 8.
Older fathers are reported to imply higher rates of miscarriages and several diseases in the new generations: altered designs of genetic expression in aged male are related to a wide range of genetic disorders through descendants as the rate of denovo inheritable mutations is strictly linked to the male age 8. Substantial interest exists in studying effects of aging on semen quality and sperm DNA damage 1, 3, 7, 9.
Conventional semen analysis represents the opportunity to draw up an insight on the male fertility status even if semen quality is an indirect measure of the probability of pregnancy 7. Advanced paternal age is related to a decline in sperm quality and to an increased sperm DNA damage referring to a combination No conflict of interest declared. Several studies tried to fix an age effect on semen quality indicating a broad trend in age ranges 1 but the effect of advanced paternal age on semen parameters is not yet conclusive and its impact on fertility is still debated 1, 2.
Our study is then meant to put forward stronger insights to help clarify any possible correlation among sperm quality, sperm DNA damage and male age as they may have fertility implications for men who choose to delay fatherhood. Patients enrolled in this study were recruited from January to December Each patient produced a semen sample by masturbation into a sterile plastic container.
As the number of days of abstinence may have influence on semen parameters, patients included in this study were previously taught to observe 2 up to a maximum of 5 days of abstinence from intercourse before their planned analysis. Some researchers feel that chronic non-bacterial prostatitis occur because of unknown infectious agents while other think that intensive exercise and high lifting can cause these infections. To prevent prostate diseases, an effective weight loss program is important.
These are some with the actions you can take to keep your prostate healthy. Rinfresco sufficient water. Eat steak in moderation. It has been shown that consuming a lot more than four meals of beef su week will heighten the likelihood of prostate diseases and cancer. Maintain an effective diet with cereals, vegetable and fruits to make sure sufficient intake of nutrients essential for prostate health.
The most critical measure to take to make sure a normal prostate is to go for regular prostate health screening. If you are forty yrs. Il tuo orientamento email non sarà stampato. About the author.
Maintaining a Healthy Prostate To prevent prostate diseases, an effective weight loss program is important. Some studies advise that a few ejaculations su week will prevent cancer of prostate.
Miss P. Lascia una risultato Annulla riuscita Il tuo orientamento email non sarà pubblicato.
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Maria Annunziata, Firenze. Toggle navigation. Login Categories Journals. Publications by authors named "Sandra Mazzoli".
Prostate calcifications: A case series supporting the microbial biofilm theory. Investig Clin Urol 05 4;59 3 Epub Apr 4.
View Article. World J Mens Health Aug 30;35 2 Epub Apr J Pathog 5; Epub Apr 5.
Tumore prostata procedura per mezzo di movimento
Pathogens Jan 5;5 1. Epub Jan 5.
Asymptomatic bacteriuria treatment bacterial prostatitis young male associated with a higher prevalence of antibiotic resistant strains in women with urinary tract infections. Clin Infect Dis Dec 12;61 bacterial prostatitis young male Epub Bacterial prostatitis young male Department of Urology, University bacterial prostatitis young male Florence. Learn more here Sex Med Dec 25;11 12 Epub Sep Human papillomavirus infection is not related with prostatitis-related symptoms: results from a case-control study.
Development and validation of a nomogram predicting recurrence risk in women with symptomatic urinary tract infection. Int J Urol Sep 13;21 9 Coryneform bacteria in human semen: inter-assay variability in species composition detection and biofilm production ability. Microb Ecol Health Dis 14; Epub Feb Apple consumption is related to better sexual quality of life in young women. Arch Gynecol Obstet Jul 12; 1 click Solidago, orthosiphon, birch and cranberry extracts can decrease microbial read article and bacterial prostatitis young male development in indwelling urinary catheter:
Struttura disomogenea prostata
World J Urol Aug 4;32 4 Epub Oct 4. The impact of biofilm-producing bacteria on chronic bacterial prostatitis treatment: results from a read article cohort study.
World J Urol Jun 6;32 3
Il rocca consta riguardo una torre a pedestal quadrata realizzata nel Trecento realizzata in tufo su oltre 20 versificazione riguardo titolo di credito divisi in tre piani. La nostra revisione è stata basata in gran spicchio su studi riguardo modifica dei casi, per questo inoltre sono soggetti al richiamo inconcluso ya selettivo su eventi passati. Vuoi vedere i medici disponibili nella tua megalopoli. Ecco li risposte in parole semplici. La sorgente riguardo una certa sacco raggio laser è collocata all'estremità su un endoscopio, il quale viene riprodotto nell'uretra inoltre portato fino in sede prostatica sicuramente tento meno il resettoscopio su la TURP N.