PubMed Health⌕ Search

Biomedical subjects

E Micheli

Publications and source records attributed to E Micheli.

At least 19 recordsLinked to original sources
PubMed2002

End-to-end urethroplasty: long-term results.

OBJECTIVE: To retrospectively review patients with strictures (<3 cm) of the bulbous urethra who had undergone urethroplasty with excision of the stenotic segment and end-to-end anastomosis. PATIENTS AND METHODS: The review included 74 patients (all men, mean age 39 years, range 18-70) treated between 1989 and 1999 for strictures 5-30 mm long. Forty-one of the patients (55%) had been treated previously, 39 endoscopically (urethrotomy and/or dilatation) and two surgically. Surgical access was perineal, with the patient in an exaggerated lithotomy position; the stenotic segment was excised and the stumps spatulated for end-to-end anastomosis. The mean (range) duration of surgery was 140 (75-280) min. There were no complications during or after surgery, and none related to the duration in the lithotomy position. RESULTS: At a mean follow-up of 60 months, 93% of the patients had no recurrence of the stricture and were therefore considered cured. There were no treatment-related complications. CONCLUSION: End-to-end anastomosis is confirmed as the treatment of choice for short bulbous urethral strictures, giving cure rates close to 100%.

Adult↗
PubMed2000

[Report of a case of compartmental syndrome secondary to prolonged lithotomy position].

The lithotomy position is widely used in urological surgery to obtain adequate exposure of the perineal plane. It is used, for instance, for stenosis of the posterior urethra. Fortunately, it rarely gives rise to complications although if the operation takes a long time the patient may suffer various adverse reactions; these range from simple peroneal nerve distress to thromboembolism [1, 2] and the much more serious "compartmental syndrome" [2, 3, 4]. There is still debate about the best therapeutic approach to a lesion caused by prolonged muscle compression. Some suggest immediate fasciotomy, whether others hold out for conservative treatment. We report here a case of compartmental syndrome arising in a patient who had to remain the the lithotomy position for a long time, which responded well to conservative treatment.

Adult↗
PubMed1999

[Retroperitoneal lymphadenectomy and disorders of ejaculation].

Retrograde ejaculation is a frequent and permanent complication after bilateral retroperitoneal lymphadenectomy (RPLND). Seminal emission and ejaculation are primarily under sympathetic control. Several studies after RPLND in patients with nonseminomatous testis cancer proved the role of preservation of the efferent fibers originating from the lumbar sympathetic ganglia. Based on the results of anatomical studies, a modified unilateral operative technique and nerve-sparing approach permit to preserve normal anterograde ejaculation without reduction of long-term survival.

Ejaculation↗
PubMed1998

Intravesical instillation of mitomycin-C in 242 patients with superficial bladder cancer at high risk of recurrence: long-term results.

OBJECTIVE: The present study evaluated the long-term results of intravesical mitomycin C (MMC) instillation after transurethral resection (TUR) in 242 consecutive patients with superficial bladder cancer at high risk of recurrence (stage Ta, grade 1-3, or stage T1, grade 1 and 2, primary multiple or recurrent tumor). MATERIALS AND METHODS: 242 patients were treated with weekly instillations of 40 mg MMC for 8 weeks after TUR. Tumor-free patients then followed a maintenance course with monthly instillations for 3 months. RESULTS: Median follow-up of disease-free patients is 43.5 (range 23-112) months. The incidence of first recurrence is 59.5% (144/242 patients) with a median time to first recurrence of 29 months. 95 patients (39.3%) remained disease-free. Three had disease progression as the first event. The risk of recurrence was significantly higher for multifocal tumors (p = 0.0023, hazard ratio 1.79, 95% CI 1.23-2.59). Overall, patients have been followed for a median time of 57 (range 10-114) months. During this period the recurrence rate was 4.9. Eleven more patients had disease progression. The progression rate is 5.8% (14/242), with a mean time to progression of 34 months. At present 209 patients are alive, 6 have died of bladder cancer, 16 of causes unrelated to the disease and 11 (4.5%) have been lost to follow-up. Thus the crude survival rate is 86.4%, disease-specific mortality 2.5%, and non-disease-specific mortality 6.6%. CONCLUSIONS: Patients with multiple tumors seem to benefit the least from MMC instillation. Probably recurrent disease could be better prevented with intravesical bacillus Calmette-Guérin.

Administration, Intravesical↗
PubMed1997

[Conservative surgery of parenchymal renal carcinoma: urologic data from Lombardy].

We report the results of a questionnaire sent to various Urology departments in Lombardy about "Conservative Surgery in Renal Cell Carcinoma" which was the subject of discussion at the 50th meeting of the Lombardian Society of Urologist. 23 centres out of 34 i.e. 68% answered. 100% of the departments performed nephron sparing surgery, 91% in cases of imperative and elective indication and 9% only in imperative indication. 100% of the patients underwent preoperative staging with ultrasound and computer tomography. 48% treated in elective surgery only incidentally asintomatic discovered tumours, but 52% treated both incidentally and sintomatic ones. Elective surgery is suggested when the tumor has a diameter less than or up to 3 cm., from 3 to 5 cm., and more than 5 cm. in 48%, 48% and 4% of the urological departments respectively. 70% consider the importance of tumor location and do not perform partial nephrectomy when the tumor is intraparenchymal or in contact with the secretory tract. From a technical point of view 82% carried out partial nephrectomies while 18% carried out enucleation; 57% performed routinally frozen section on tumor bed and 61% do not performed lymphadenectomy. 83% believe in the multifocality problem. A macroscopic and microscopic haematuria does not condition the elective indication in 62% of the urology departments. The follow-up is carried out with ultrasonography alternated with CT in 78% of the departments and is continued for over 5 years in a likewise 52%. From 1990 to 1995, 3332 patients were surgically treated for renal cell carcinoma in 23 urology departments; 487 (14.6%) underwent nephron sparing surgery; 320 elective and 167 imperative indication. The local global relapse was 2.9% (14/487); 5.3% (9/167) in imperative group and 1.4% (5/320) in elective group. Conservative surgery in Lombardy will always try to have the golden standard treatment in the incidental, single renal cell carcinoma.

Carcinoma, Renal Cell↗
PubMed1996

[T1G3 transitional cell carcinoma of the bladder: our experience with 44 patients treated with intravesical BCG after TUR].

Forty-four patients affected by poorly differentiated (G3) superficial TCC invading lamina propria (stage T1) were treated with intravesical BCG. They underwent weekly instillations of 75 mg BCG for six week after trans-urethral resection (TUR) of bladder cancer. An additional induction course was given to patients who relapsed. A maintenance course with monthly instillations for twelve months followed in complete responder patients. After the first induction course, 34/44 patients (77.2%) showed complete response. In 10 patients a second induction course was necessary, with complete response in four. After one or two induction course, 38/44 patients (86.5%) showed complete response. The maintenance course was administered to 38 patients with 35/38 complete responses. After a median follow-up of 30 months, there were 29/44 (65.9%) disease free patients, 11/44 (25%) tumor recurrences and 4/44 (9%) tumor progressions. The drug has been well tolerated with few side effects. Our data suggest that intravescical BCG after TUR is effective in the treatment of high-risk superficial bladder cancer and we believe that it can be used a first approach in treating patients affected by T1G3 bladder cancer.

Administration, Intravesical↗
PubMed1996

[Conventional surgical treatment of penile tumors].

The surgical treatment of primary lesion in Carcinoma of the penis is the total excision of the carcinoma with tumor free margins. Distal preputial carcinomas without deep infiltration are often treated by extensive circumcision. Partial or total amputation of the penis is required by the location and the extent of the tumor. The evaluation and the treatment of the lymph nodes in penile cancer are still unclear.

Humans↗
PubMed1995

[Surgical treatment of benign prostatic hypertrophy: what and when TURP vs adenomectomy].

Surgical treatment is the gold standard for Benign Prostatic Hyperplasia (BPH) therapy. At the present diagnostic approach allows better patient selection and treatment assignment. In this work we have studied retrospectively the outcome of 120 BHP patients who underwent trans urethral resection (TURP) and of 145 BPH patients underwent "open" prostatectomy. In all the patients surgical time, prostate weight, indwelling catheter standing, rest in bed, early and late complications were evaluated. Irritative symptoms occurred after TURP in 10% of the cases. The two therapeutical options are not comparable for they technically different. The choice between the two depends on the accurate patient characterization and selection.

Bed Rest↗
PubMed1994

[Nerve-sparing retroperitoneal lymph node dissection in patients with non-seminomatous testicular tumors at clinical stage 1].

Retroperitoneal lymph node dissection (RPLND) for low stage testicular cancer involves a low rate of dry ejaculation. The nerve-sparing technique avoids the damage of sympathetic fibers. 7 cases of non seminomatous testicular cancer have been treated by the Author. Through midline incision and intestinal derotation the vascular plane and the sympathetic fiber are identified before starting lymph node dissection. All the patients report physiological ejaculation; the post-operative follow-up is still short but at the present all patients are tumor free. In low stage testicular cancer nerve-sparing lymphadenectomy preserve physiological ejaculation and reducing surgical morbidity as well.

Erectile Dysfunction↗