Biomedical subjects

Massimo Porena

Publications and source records attributed to Massimo Porena.

23 records · Page 2Linked to original sources

PubMed2003

Clinical and urodynamic features of intrinsic sphincter deficiency.

AIMS: A prospective analysis of 92 patients with genuine stress incontinence was performed to identify the clinical and urodynamic features of intrinsic sphincter deficiency (ISD). METHODS: We divided the patients into two categories: 50 patients affected by pure ISD as they had severe stress incontinence and no urethral mobility; 42 patients suffering from stress urinary incontinence without ISD as they had mild stress incontinence and marked urethral hypermobility. Cystometry was normal in all patients. The presence/absence of ISD was considered the dependent variable and was correlated against the following independent variables: age, vaginal deliveries, menopause, previous urogynecological surgery and/or hysterectomy, supine stress test, irritative and/or obstructive symptoms, Valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), urethral functional length (UFL), and leakage during cystometry. RESULTS: The statistical analysis showed close correlations between ISD and age (P < 0.001), menopausal status (P < 0.001), previous surgery (P < 0.0001), supine stress test (P < 0.0001), leakage during cystometry (P < 0.001), and UFL (P < 0.01). The VLPP was below the cut-off value (</=60 cm H(2)O) in 70% of ISD patients (P < 0.0001), whereas the MUCP in 50% of ISD patients (P < 0.0001). Multiple logistic analysis showed that lower VLPP, lower MUCP, and previous surgery correlate more significantly with ISD. After backward conditional stepwise logistic regression, the odds ratio of having ISD were VLPP = 2.3, MUCP = 7.7, VLPP + MUCP = 62.8. CONCLUSIONS: ISD is related to the presence of a more severe clinical picture and case history, but the most significant independent variables are the VLPP and MUCP.

Adult↗

PubMed2003

Pelvic floor muscle behavior during Valsalva leak point pressure measurement in males and females affected by stress urinary incontinence.

PURPOSE: We evaluated pelvic floor muscle (PFM) behavior during Valsalva leak point pressure (VLPP) measurement in males and females affected by stress urinary incontinence and investigated whether VLPP results are influenced by PFM contraction. MATERIALS AND METHODS: A total of 25 females and 14 males underwent surface electromyographic (EMG) recording of PFM activity while performing VLPP. We investigated 2 conditions, VLPP during spontaneous strain (test A), and with simultaneous relaxation of the pelvic floor (test B). We analyzed average EMG activity (microV) at rest and during VLPP in tests A and B, the increasing EMG activity during tests A and B (the difference between average EMG activity during tests A and B and at rest), and the mean duration (seconds) of EMG activity during tests A and B. RESULTS: We detected a significant increase in EMG activity during tests A and B as compared to activity at rest (p <0.0001). Increasing EMG activity during test B was significantly reduced in females (p <0.05) but not in males. During test A patients reporting urinary incontinence showed a significantly lower EMG activity than that of continent patients (p <0.05). A significant reduction in maximum abdominal pressure was detected in test B compared to test A, but there was no difference in VLPP values between tests A and B. CONCLUSIONS: PFM activity significantly increases during VLPP measurement. Eliminating muscular contraction of the pelvic floor does not significantly alter VLPP results.

Electromyography↗

PubMed2002

Intravesical capsaicin versus resiniferatoxin in patients with detrusor hyperreflexia: a prospective randomized study.

PURPOSE: Capsaicin and resiniferatoxin (Sigma Chemical Co., St. Louis, Missouri) administered intravesically are attractive options for treating detrusor hyperreflexia. Because the 2 agents differ in chemical structure and relative potency, possible differences in their clinical and urodynamic effects were investigated in this prospective comparative study. MATERIALS AND METHODS: A group of 24 spinal cord injured patients with refractory detrusor hyperreflexia were randomly assigned to receive a single dose of 2 mM. capsaicin in 30 ml. ethanol plus 70 ml. 0.9% sodium chloride or 100 nM. resiniferatoxin in 100 ml. 0.9% sodium chloride. Dwell time was 40 minutes with urodynamic monitoring. Urodynamics were performed at baseline before treatment, and after followups of 30 and 60 days. The frequency of daily catheterizations, incontinence episodes and side effects was recorded. RESULTS: There was no significant urodynamic or clinical improvement in the capsaicin arm at 30 and 60 days of followup. In the resiniferatoxin arm the mean uninhibited detrusor contraction threshold plus or minus standard deviation increased from 176 +/- 54 to 250 +/- 107 ml. at 30 days (p <0.05) and to 275 +/- 98 ml. at 60 days (p <0.01). Mean maximum bladder capacity increased from 196 +/- 75 to 365 +/- 113 ml. at 30 days (p <0.001) and to 357 +/- 101 ml. at 60 days (p <0.001). Daily catheterizations and incontinent episodes were significantly decreased at 30 and 60 days of followup. Autonomic dysreflexia, limb spasms, suprapubic discomfort and hematuria developed in most patients who received capsaicin but in none who received resiniferatoxin. CONCLUSIONS: Intravesical administration of resiniferatoxin is superior to that of capsaicin in terms of urodynamic results and clinical benefits in spinal cord injured patients and it does not cause the inflammatory side effects associated with capsaicin.

Administration, Intravesical↗

PubMed2002

[Staging of prostatic carcinoma: TRUS prospective study versus endocoil MRI].

OBJECTIVE: Accurate staging of prostatic cancer is important for planning an optimal treatment, such as radical prostatectomy in clinical stage T2. About 40-50% of patients operated for cT2 disease show a pathological stage T3 disease. In a prospective study we analysed accuracy of TRUS and endocoil MRI in a group of patients before radical prostatectomy. MATERIALS AND METHODS: 33 consecutive patients suspicious of prostate neoplasms were studied and staged with TRUS and endocoil MRI before prostatic biopsy and before radical prostatectomy. One urologist trained in TRUS conducted the exam, while one radiologist interpreted the MRI studies in a blind mode. The criteria evaluated were accuracy of global staging, extracapsular extension (ECE) and seminal vesicle invasion (SVI). These results were correlated with the histopathological findings after radical prostatectomy. RESULTS: The histopathological results showed 14 patients (42%) with pT2 disease, 18 patients (54%) with pT3 disease and 1 case (4%) of pT4 disease. TRUS showed a low sensitivity (38%) and a good specificity (78%), with an overall accuracy of 50%; the best result was 96% specificity for SVI. Endocoil MRI showed a good sensitivity (70%) and specificity (76%), with an overall accuracy of 73%. Endocoilc was also useful to stage T1c disease when TRUS is negative. TRUS tends to understage, whereas endocoil MRI over-stages prostate cancer. CONCLUSIONS: TRUS and endocoil MRI may help in decision making about the appropriate treatment of prostatic cancer, even if they have limited current value, due to understaging or overstaging.

Aged↗

PubMedDate not supplied

Treatment of varicocele: randomized prospective study on open surgery versus Tauber antegrade sclerotherapy.

The goal of this randomized prospective study in patients with varicocele was to evaluate the outcome following open surgery with inguinal approach versus antegrade sclerotherapy according to the Tauber procedure. From January 2002 to November 2003, we recruited 64 patients with left varicocele for this study. All patients were clinically examined, before surgery and again 8 months postsurgery, by objective examination, scrotal color Doppler ultrasound, and semen analysis. These patients were randomized in a balanced 4-block pattern: depending on randomization, the patients underwent open surgery (group A: 32 patients) or antegrade sclerotherapy according to the Tauber procedure (group B: 32 patients). At the current follow-up, it is possible to evaluate all the patients for whom we have preoperative and postoperative Doppler imaging and semen analysis. An analysis of seminal parameters shows a statistically significant improvement of the rate of fast progressive spermatozoa (P < .05) and reduction in immotile spermatozoa (P < .01) in those patients who underwent sclerotherapy compared to the patients who underwent open surgery. The outcomes of all other parameters (number and morphology) are fully comparable. Operating time is decidedly shorter for antegrade sclerotherapy (P < .01), but there are no significant differences in terms of early or late postoperative complications. It is widely known that varicocele is a condition found in 9% to 23% of the male population around the world; this percentage rises to 40% among infertile males. The treatment of this condition not only resolves clinical symptoms but also stops continuous damage to spermatogenesis, thereby potentially improving fertility. Our experience demonstrates that sclerotherapy (Tauber procedure) combines shorter surgical time and faster recovery of normal daily activities with significant improvement in sperm motility.

Adolescent↗