Background: Fournier’s gangrene (FG) is a very aggressive necrotizing fasciitis involving subcutaneous fat and skin of scrotal and perineal regions. Vacuum-assisted closure (VAC) is a well-known method used to treat complex wounds. The authors for the first time enhance a multimodal strategy to treat the FG using VAC, reducing the number of surgical debridements, allowing a one-step surgical reconstruction with locoregional fasciocutaneous flap. Methods: Six patients with the diagnosis of FG were reviewed retrospectively at our institution. All patients were affected by very extensive FG. The FG Severity Index (FGSI) was used to evaluate the prognosis of the case at admission. Following the acute phase (24–48 h), VAC was used to achieve wound cleaning and prepare the area to a single-stage reconstruction with superomedial thigh flap. Hyperbaric oxygen therapy was also used before final reconstruction. Results: The average FGSI was 10.5, ranging from 8 to 12. All patients survived and were completely healed at the mean follow-up time of 9 months (range 3–30 months). Conclusions: VAC therapy is effective to clean and prepare the wounds, cutting off the fasciitis process and reducing the hospital stay and patient discomfort. Multidisciplinary treatment is mandatory during this devastating infection.

We identify DU as a possible novel risk factor for BNC formation after radical prostatectomy that may contribute to its development.

BackgroundPacemakers in upper urinary tract (UUT) are still under study.AimWe reviewed the role of some cells that seem to be involved in the propulsion of urinary bolus from UUT to the bladder. Materials & MethodsWe focuses on evaluating studies on the mechanisms by which the UUT propels urine to the bladder via pacemaker cells.ResultsElectric active pacemaker cells generate pyeloureteric autorhythmicity driving adjacent smooth muscle cells (SMCs); it emphasizes the role of the interstitial cells of Cajal‐like cells (ICC‐LCs) localized in the UUT. Interstitial cells of Cajal (ICCs) are now thought to cooperate in conducting and amplifying pacemaker activity in the UUT. These cells produce electrical slow‐wave potentials and determine the propagation of peristaltic activity. Identification of ICC‐LCs is facilitated by use of c‐kit antibodies. Contraction waves arising from the UUT and the propagation of these waves may require the direct involvement of ICC‐LCs, as c‐kit immunoreactivity appears developmentally at the same time as coordinated unidirectional peristaltic contraction. ICC‐LCs observed in the UUT have morphological features similar to those of c‐kitpositive ICCs in the gastrointestinal tract. In addition to gastrointestinal motility, ICCs may also play a significant role in the propagation, coordination, and modulation of ureteropelvic peristalsis.DiscussionAlterations in ICC‐LCs are closely associated with a variety of motility disorders and many congenital urological diseases of the UUT such as primary obstructive megaureter, congenital ureteropelvic junction obstruction, and vesicoureteral reflux.ConclusionThese observations open the way for further investigations of this cell type. Neurourol. Urodynam. 32: 349–353, 2013. © 2012 Wiley Periodicals, Inc.

Objectives: To evaluate the efficacy and safety of Serenoa repens + selenium and lycopene (Profluss®) versus S. repens alone for the treatment of category IIIa chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Patients and Methods: 102 patients with IIIa CP/CPPS were enrolled and randomized into two groups each to receive Profluss or S. repens alone for 8 weeks. Evaluation was based on results of the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), IPSS, maximum peak flow rate (MPFR), and PSA measurements at baseline and at weeks 4, 8 and 8 after the end of treatment. The primary endpoint was a >50% reduction in NIH-CPSI score. Secondary endpoints evaluated were MPFR, IPSS, PSA and white blood cell count. Results: No patients withdrew from the study. The mean NIH-CPSI score decreased significantly (p < 0.001) in both groups; we observed a decrease in the total score from 27.45 to 13.27 in group 1 (–51.64%) and from 27.76 to 20.62 in group 2 (–26.06%). IPSS improved significantly (p < 0.001) in both arms, but more in group 1. PSA and white blood cell count decreased significantly (p < 0.007) only in group 1. The MPFR improved more in group 1 (p < 0.005). Conclusion: Profluss is a triple therapy that is safe and well tolerated. It ameliorates symptoms associated with IIIa CP/CPPS.

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