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A comprehensive evaluation of sexual and reproductive outcomes following robot-assisted retroperitoneal lymph node dissection for nonseminomatous germ cell tumor

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Asian Journal of Andrology 2022年第6期24卷 579-583页

作者： Francesco A Mistretta Ottavio de Cobelli Paolo Verze Francesco Botticelli Letizia Jannello Stefano Luzzago Gabriele Cozzi Roberto Bianchi Ettore Di Trapani Matteo Ferro Giovanni Cordima Danilo Bottero Deliu Victor Matei vincenzo mirone Gennaro Musi Department of Urology European Institute of OncologyIRccSMilan 20141Italy Department of Oncology and Hemato-Oncology University of MilanMilan 20122Italy Department of Urology University of NaplesFederico IlNaples 80138Italy

Sexual disorders following retroperitoneal pelvic lymph node dissection(RPLND)for testis tumor can affect the quality of life of patients.The aim of the current study was to investigate several different andrological outcomes,which may be influenced by robot-assisted(RA)RPLND.From January 2012 to March 2020,32 patients underwent RA-RPLND for stage I nonseminomatous testis cancer or postchemotherapy(PC)residual mass.Modified unilateral RPLND nerve-sparing template was always used.Major variables of interest were erectile dysfunction(ED),premature ejaculation(PE),dry ejaculation(DE),or orgasm alteration.Finally,fertility as well as the fecundation process(sexual intercourse or medically assisted procreation[MAP])was investigated.Ten patients(31.3%)presented an andrological disorder of any type after RA-RPLND.Hypospermia was present in 4(12.5%)patients,DE(International Index of Erectile Function-5[IIEF-5]<25)in 3(9.4%)patients,and ED in 3(9.4%)patients.No PE or orgasmic alterations were described.Similar median age at surgery,body mass index(BMI),number of nodes removed,scholar status,and preoperative risk factor rates were identified between groups.Of all these 10 patients,6(60.0%)were treated at the beginning of our robotic experience(2012-2016).Of all 32 patients,5(15.6%)attempted to have a child after RA-RPLND.All of these 5 patients have successfully fathered children,but 2(40.0%)required a MAP.In conclusion,a nonnegligible number of andrological complications occurred after RA-RPLND,mainly represented by ejaculation disorders,but ED occurrence and overall sexual satisfaction deficit should be definitely considered.No negative impact on fertility was described after RA-RPLND.

关键词： andrology lymph node excision nonseminomatous germ cell tumor robotics testicular cancer

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Efficacy and safety of low-intensity shockwave therapy plus tadalafil 5 mg once daily in men with type 2 diabetes mellitus and erectile dysfunction:a matched-pair comparison study

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Asian Journal of Andrology 2020年第4期22卷 379-382页

作者： Paolo Verze Marco Capece Massimiliano Creta Roberto La Rocca Francesco Persico Lorenzo Spirito Antonio Cardi vincenzo mirone Department of Neurosciences Reproductive Sciences and OdontostomatologyUniversity of Naples“Federico II”Naples 80131Italy Department of Urology San Giovanni Addolorata HospitalRome 00184Italy

Low-intensity extracorporeal shockwave therapy(LiESWT)represents a promising treatment for patients with erectile dysfunction(ED).We investigated the efficacy of LiESWT combined with tadalafil 5 mg once daily in men with type 2 diabetes mellitus(T2DM)and ED and compared LiESWT protocols administering different number of shockwaves.We performed a retrospective matched-pair comparison using data from a prospectively maintained database.Seventy-eight patients who received tadalafil 5 mg once dai7ly for 12 weeks+LiESWT performed with an electrohydraulic source for 3 weeks(Group A)were matched 1:1 to patients who received tadalafil 5 mg once daily alone for 12 weeks(Group B).A subgroup analysis was performed according to the number of shockwaves delivered during each session(1500,1800,and 2400 in subgroup A1,A2,and A3,respectively).The mean International Index of Erectile Function-5(IIEF-5)score variations with respect to baseline recorded at 4,12,and 24 weeks after the end of the treatment were investigated as treatment outcomes.The mean IIEF-5 scores significantly improved in all groups and subgroups at 4-week follow-up without intergroup differences.At 12-and 24-week follow-up,the mean IIEF-5 improvement was significantly higher among patients in the A3 subgroup(+5.0±2.1[P<0.001]and+4.7±2.3[P<0.001],respectively).The combined approach with tadalafil 5 mg once daily and LiESWT with a protocol involving 2400 shockwaves provides significant advantages in terms of IIEF-5 improvement and durability compared to tadalafil 5 mg once daily alone in patients with T2DM and ED.

关键词： diabetes mellitus erectile dysfunction low-intensity shockwave therapy tadalafil

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Evaluation of an alternative dosing regimen with tadalafil, three times per week, for men with erectile dysfunction： SURE study in Italy

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Asian Journal of Andrology 2007年第3期9卷 395-402页

作者： vincenzo mirone Ciro Imbimbo Andrea Rossi Riccardo Sicuteri Domenico Valle Nicola Longo Ferdinando Fusco Italian SURE Study Group Department of Urology University Federico H of Naples Naples 80132 Italy Ely Lilly Italy Florence 50019 Italy 不详

Aim： To examine the preference for two dosing regimens of 20 mg of tadalafil, on demand or three times per week, in men affected with erectile dysfunction （ED） in Italy. Methods： Scheduled Use versus on demand Regimen Evaluation （SURE） is a multicenter, crossover and open-label study, involving 94 urology centers in Italy. Patients aged 18 years or older affected with ED for at least 3 months were enrolled and randomized to 20 mg of tadalafil treatment on demand or three times per week for 5-6 weeks. After a 1-week washout, patients were crossed over to the alternate regimen for 5-6 weeks. A treatment preference question was used to determine the preferred treatment regimen. International Index of Erectile Function （IIEF） and Sexual Encounter Profile （SEP） questionnaire were used as efficacy measures. Results： A total of 1 058 men （mean age 54.8 years）, were randomized to treatment. Overall, 59.1% of patients preferred the on-demand regimen and 41.9% preferred the three times per week dosing. Both regimens were efficacious and well tolerated. Although a statistically higher improvement of the IIEF erectile function （IIEF-EF） domain score and the SEP questionnaire was reported for the three times per week compared to the ondemand treatment regimen, this difference was numerically minimal and lacking in clinical significance. Conclusion： Tadalafil is effective and well tolerated whether used on demand or three times per week. Patients should be given the option to choose the best treatment regimen according to personal needs and preferences.

关键词： erectile dysfunction SURE study on demand three times per week alternate tadalafil

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Infectious complications after prostate biopsy:Time to rethink our clinical practice

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World Journal of Clinical Urology 2015年第2期4卷 78-82页

作者： Tommaso Cai Paolo Verze Riccardo Bartoletti vincenzo mirone Truls E Bjerklund Johansen Department of Urology Santa Chiara Regional Hospital Department of Urology University of Naples Department of Urology University of Florence Department of Urology Oslo University Hospital

Prostate biopsy is a very common procedure performed worldwide which still represents the only way for prostate cancer diagnosis and reference point for subsequent treatments. Even if transrectal prostate biopsy is considered a safe procedure, it may be accompanied by infective complications, ranging from asymptomatic bacteriuria to symptomatic urinary tract infections and sepsis. During the recent decade we observed an increasing number of infectious complications and subsequent hospitalizations after and transrectal prostate biopsy. The most probable reason for the increasing rate of infectious complications after prostate biopsy is the increasing antimicrobial resistance, especially to the current first-line recommended fluoroquinolone antibiotics. We believe the time has come to re-think our current practice of diagnosing prostate cancer. We need to focus on the selection of patients at higher risk of infective complications, on microbiological sampling of the faecal flora prior to biopsy to identify resistance to specific agents, on the number of biopsy cores, on the biopsy route(perineal or transrectal approach) and, finally, consider alternative antibiotics with improved susceptibility to be used for prophylaxis.

关键词： Prostate cancer Prostate biopsy Transrectal biopsy Rectal swab Antibiotic prophylaxis

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Chlamydial infections in urological disease: A challenging management

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World Journal of Clinical Urology 2014年第1期3卷 38-43页

作者： Tommaso Cai Paolo Verze Sandra Mazzoli Francesca Pisano Daniele Tiscione Paolo Gontero vincenzo mirone Riccardo Bartoletti Department of Urology Santa Chiara Regional Hospital Department of Urology University of Federico II Sexually Transmitted Diseases (STD) Centre Santa Maria Annunziata Hospital Department of Urology University of Turin Department of Urology University of Florence

Chlamydia trachomatis(Ct) infections are the most prevalent sexually transmitted bacterial infections worldwide, causing considerable morbidity and socioeconomic problems. Moreover, Ct infections are asymptomatic in approximately 50% of infected men and 70% of infected women, with the risk for reproductive tract sequelae both in women and men. Recent studies have improved the comprehension of this infection and its natural history, also highlighting its role in decreasing male fertility. Severe complications can be avoided only by a proper early diagnosis and appropriate treatment. We reviewed the literature relating to the new findings in the treatment of Ct infection in sexually active young men. Articles from 1960-2012 were identified through a Medline search using the keywords"Chlamydia trachomatis " combined with "urethritis", "epididymitis", "prostatitis", "treatment" or "management". Currently, several studies have been published about the role of new antibiotic schedules and new associated compounds in order to improve the efficacy in terms of microbiological results and patient quality of life. In particular, several studies stress the fact that Chlamydia is only metabolically active in the host cell and therefore only targeted intracellularly by antibiotics. Even although the standard therapy includes intracellularly-accumulated antibiotics such as tetracyclines or macrolides, recent evidence highlights the role of quinolones. In particular, recent studies highlight the role of prulifloxacin in the treatment of chronic prostatitis for improving the patient's quality of life and decreasing the IL-8 level. However, future studies should focus on delineating the natural history of recurrent infections, paying particular attention to treatment failures.

关键词： Chlamydia trachomatis Prostate Male Fertility Treatment Review

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一种治疗勃起功能障碍的新方法：尾加压素-II受体的高亲和力受体激动剂的配体

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Asian Journal of Andrology 2015年第1期17卷 81-85,I0008,I0009页

作者： Roberta d'Emmanuele di Villa Bianca Emma Mitidieri Erminia Donnarumma Ferdinando Fusco Nicola Longo Giuseppe De Rosa Ettore Novellino Paolo Grieco vincenzo mirone Giuseppe Cirino Raffaella Sorrentino Department of Pharmacy University of Naples Federico II Via D. Montesano 49 Naples Italy Interdepartmental Centre for Sexual Medicine University of Naples Federico II Via S. Pansini 5 Naples Italy Department of Neurosciences Human Reproduction and Odontostomatology University of Naples Federico II Via S. Pansini 5 Naples Italy.

尾加压素IIfu—111是一种通过G蛋白偶联受体发挥作用的环形多肽，主要与心血管功能相关。同时，尾加压素能量系统也与泌尿生殖道有关联。U—II能够松弛阴茎海绵体，增加阴茎海绵体内压（ICP）。因此，尾加压素II／尾加压素II受体（U．II... 详细信息

尾加压素IIfu—111是一种通过G蛋白偶联受体发挥作用的环形多肽，主要与心血管功能相关。同时，尾加压素能量系统也与泌尿生殖道有关联。U—II能够松弛阴茎海绵体，增加阴茎海绵体内压（ICP）。因此，尾加压素II／尾加压素II受体（U．II／UTR）通路有可能成为治疗勃起功能障碍的新靶点。本研究中，我们检测了两种新型UTR的高亲和力受体激动剂P5u（H．Asp—c[Pen．Phe—Trp—Lys-ryr-Cys]一Val-OH）和UPG84（H—Asp—c[Pen—Phe—DTrp—Orn．（pNH2）Phe．Cys]．Val．OH）。通过测量大鼠的ICP，分别比较了P5U、UPG84与u．II的作用。海绵窦内注射u．II（O．03—1nm01）、P5UfO．03—1nm01）、UPG84（O．03-lnmol）能够增加ICP。与U．II相比，P5U可引起ICP的显著增加。每只大鼠注射0．1nmolP5U与0．3nmolU—II的效果相当。此外，最低剂量（0．03nm01）的UPG84与最高剂量（1nm01）的u．II具有相似的效果。而且我们发现UPG84LkP5U更加有效。最低剂量（0．03nm01）的P5U对ICP无影响，而同样剂量的UPG84则可引起大鼠阴茎明显勃起。此两种化合物对血压无影响，表明其具有更高的安全性。综上，UPG84和P5U可能为治疗勃起功能障碍开启一个新的视角。

关键词：勃起功能障碍阴茎海绵体内压大鼠尾加压素-II 尾加压素-II配体

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Systematic review of the non surgical management of Peyronie's disease

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World Journal of Clinical Urology 2014年第1期3卷 31-37页

作者： Paolo Verze Davide Arcaniolo Tommaso Cai Marco Franco Roberto La Rocca Mario Acquaviva Lorenzo Spirito Aleksandre Bochorishvili vincenzo mirone Department of Neuroscience Reproductive Sciences and Odontostomatology Urology Unit University of Naples Federico Ⅱ National Centre of Urology

This systematic review shows the "Status quo" on medical treatment for Peyronie's disease(PD). PD is a connective tissue disorder, characterised by the formation of a fibrotic lesion or plaque in the tunica albuginea, which leads to penile deformity. The aetiology of PD is unknown. Nowadays the most widely accepted hypothesis proposed by Gonzalez-Cadavid et al, is repetitive microvascular injury or trauma to the tunica albuginea. Physicians have proposed several medical alternatives for treatment of this disease with few effective results. Nevertheless, as of today nonsurgical options are currently available, and some of them are able to stabilize or even reduce deformity while improving pain relief and sexual function. A systematic literature search throughout the Medline database was carried out. Thecontrolled vocabulary of the medical subject headings database employs the specific term "penile induratio" for PD. A total of 50 articles on PD were found. Studies were selected based on clinical relevance. The recommended standard of care for PD involves an initial treatment in the acute phase. Several non-operative treatment options have been used. Unfortunately no further substantial, quality evidence on the use of medical therapy currently exits. There is, however, an increasingly enhanced interest in this disorder and basic scientifi c and clinical research will eventually lead to a more effective methodology to study the disease.

关键词： Peyronie’s disease Non surgical Dupuytren Extracorporeal shockwave therapy

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