Francesco Cappellano, MD
Francesco Cappellano, MD
Specialties: Consultant Urology & Neurourology, Urodynamics
Consultant Urology and Neurourology, Urodynamics
FEBU (Fellow of European Board of Urology)
Dr. Cappellano received his Medical Degree and Board of Urology with honours from Naples University (Italy). He completed his clinical and surgical training in Urology and Neurourology at University of California San Francisco (USA), AZM Maastricht University (NL) and Policlinique du Park Rambot – Aix en Provence (FRA).
Fellow of European Board of Urology since 1998 and Professor of Urology and Neurourology at Verona University (Italy). Visiting professor at Milano University (Italy) and King Abdulaziz University (KSA).
Head of Neurourology and Functional Urology in Milano for 17 years (Multimedica Clinic and Scientific Research Institute) and then in Abu Dhabi (Nation Hospital – Medical University of Vienna International). In his career, he gained wide experience and skills covering all fields of open and endoscopic urologic surgery and Urogynaecology.Diagnostics is part of his experience including Doppler US and simple/ invasive urodynamics procedures.
His main interest is in Neurourology field, dealing with functional Urology, urinary and faecal incontinence, chronic pelvic pain and urological dysfunctions related to neurological diseases involving the urinary tract. During his career, he performed more than 800 permanent implants of sacral roots and pudendal nerve neuromodulators. He has been one of the pioneers of neuromodulation in Europe, performing his first implant in 1994 and teaching neuromodulation to more than 100 physicians worldwide.
He also pioneered the posterior tibial nerve neuro stimulation (PTNS) in 1998.
He has been Treasurer of Italian Society of Urodynamics and served in this Society for 17 years as a member of the Board Committee.
He developed new techniques of peripheral pharmacological neuromodulation for chronic pelvic pain, utilising neurophysiology for peripheral nerve blocks.
Dr. Francesco is expert in diagnosis and therapy of urinary and faecal incontinence, chronic pelvic pain and erectile dysfunctions related to neurological and non-neurological diseases.
He is member of MIPS, EAU, ICS, SIUD and International Member of American Urologic Association.
Dr Cappellano authored more than 100 papers on National and International peer reviewed journals and 5 book chapters on Functional Urology and Neurourology. He has been Chairman and gave presentations in many International Congress worldwide. He won also 5 Prizes for the best original paper presentation in National and International congresses.
Frequently asked questions
What is a Urologist?
Urologists diagnose and treat diseases of the urinary tract in both men and women. They also diagnose and treat anything involving the reproductive tract in men.
Urinary tract infections (UTIs) are common infections that can affect the bladder, the kidneys and the tubes connected to them.
Anyone can get them, but they’re particularly common in women. Some women experience them regularly (called recurrent UTIs), UTIs can be painful and uncomfortable.
Symptoms of UTIs
Infections of the bladder (cystitis) or urethra (tube that carries urine out of the body) are known as lower UTIs. These can cause:
- A need to pee more often than usual
- Pain or discomfort when peeing
- Sudden urges to pee
- Feeling as though you’re unable to empty your bladder fully
- Pain low down in your tummy
- Urine that’s cloudy, foul-smelling or contains blood
- Feeling generally unwell, achy and tired
What is Pelvic Pain?
Chronic pelvic pain is one of the most common medical problems among women. Twenty-five percent of women with CPP may spend 2-3 days in bed each month. More than half of the women with CPP must cut down on their daily activities 1 or more days a month and 90% have pain with intercourse (sex). Almost half of the women with CPP feel sad or depressed some of the time.
Despite all the pain CPP causes, doctors are often not able to find a reason or cure to help these women.
CPP is any pelvic pain that lasts for more than six months. Usually the problem, which originally caused the pain, has lessened or even gone away completely, but the pain continues.
What are the treatments for Chronic Pelvic Pain?
Pudendal Peripheral Nerve Block
Pudendal nerve blocks are a minimally invasive, non-surgical treatment for chronic pain. These nerve blocks can help in the diagnosis of chronic pelvic pain conditions such as vaginal pain, penile pain, scrotal pain, or perineal pain. In addition, this pain management technique can also provide therapeutic relief by reducing pain signals originating from these nerves.
The pudendal nerve is prone to damage either by compression or stretch. Common scenarios where this may occur include trauma, prolonged/difficult/traumatic vaginal childbirth, or chronic straining during defecation caused by constipation. Pudendal nerve entrapment, also known as Alcock canal syndrome, is less rare and is associated with professional cycling or repetitive trauma on perineal area or wrong posture.
Systemic diseases such as diabetes and multiple sclerosis can also damage the pudendal nerve.
How It Works
A pudendal nerve block is performed with neurophysiology guidance to increase the accuracy and safety of this procedure.
- You will be asked to lie on your stomach.
- Your lower back and buttocks will be cleaned with an antiseptic, and a sterile drape will be placed.
- Your physician will direct a guide needle toward the intended target area under EMG ( C-MAP ) guidance. Bony landmarks will help facilitate safe placement of the needle.
- A local anesthetic and a steroid (cortisone) will be administered in close proximity to the nerve to block signals from reaching the brain. The cortisone serves as an anti-inflammatory under the assumption the nerve is inflamed or irritated. The needle is then flushed and withdrawn, and a dressing is placed over the point of needle entry.
This procedure is safe. However, with any procedure, there are side effects, risks, and possibility of complications. The most common side effect is temporary pain at the injection site. Other less common risks include bleeding, infection, or injection into blood vessels or vital organs. Fortunately, serious side effects and complications are uncommon. Injections of anti-inflammatory steroid medications along with local anesthetic or local anesthetics alone can provide slow relief of nerve pain over three to four months. The bulk of nerve-pain patients respond to injections. Radio frequency ablation can be helpful as well.
What is vasectomy?
Vasectomy is the procedure of choice for men who do not want to father any children (or any additional children). It is indicated for any fully informed man and can be carried out as an outpatient procedure. If the patient has previous scrotal surgery or has any other possible complicating factors (e.g. a needle phobia), the procedure can be carried out under a short general anaesthetic. The non-scalpel vasectomy (NSV) is an innovative approach to exposing the vas deferens tubes in the scrotum using two specialized surgical instruments. NSV, as compared to traditional incision technique, results in less bleeding and hematoma, less infection, and pain, and a shorter operative time.
PROSTATE CANCER SYMPTOMS
Urinary symptoms of prostate cancer
Because of the proximity of the prostate gland in relation to the bladder and urethra, prostate cancer may be accompanied by a variety of urinary symptoms. Depending on the size and location, a tumor may press on and constrict the urethra, inhibiting the flow of urine. Some prostate cancer signs related to urination include:
- Burning or pain during urination
- Difficulty urinating, or trouble starting and stopping while urinating
- More frequent urges to urinate at night
- Loss of bladder control
- Decreased flow or velocity of urine stream
- Blood in urine (hematuria)
Other prostate cancer signs & symptoms
Prostate cancer may spread (metastasize) to nearby tissues or bones. If the cancer spreads to the spine, it may press on the spinal nerves. Other prostate cancer symptoms include:
- Blood in semen
- Difficulty getting an erection (erectile dysfunction)
- Painful ejaculation
- Swelling in legs or pelvic area
- Numbness or pain in the hips, legs or feet
- Bone pain that doesn’t go away, or leads to fractures
- Urinary and fecal incontinence (Incontinence)
- Urinary retention
- Pelvi-perineal dysfunctions: (obstructed urination and defecation, male Erectile Disfunction)
- Chronic pelvic pain (CPP)
- Interstitial Cystitis – Pain Bladder Syndrome (IC/PBS)
- Urinary stones
- Recurrent urinary tract infections (UTI)
- Chronic prostatitis in male
- Multichannel urodynamic tests (uroflowmetry, cystometry, pressure/flow study, urethral pressure profile, US post voiding residual evaluation, pelvic floor EMG)
- Diagnostic/operative flexible and rigid cystoscopy
- Somato Sensorial Evoked Potentials (SSEPs) , pelvic floor EMG, sacral area reflexes (performed by neurophysiologist)
- Rectal manometry (performed by coloproctologist)
- ColorDoppler US for ED and infertility
- Pelvic floor electrical stimulation (FES) and bio-feedback (BFB)
- Posterior tibial neuro stimulation (PTNS) invasive and transcutaneous
- Clean intermittent catheterization (CIC)
- Trans cutaneous sacral and pudendal neurostimulation
Therapeutic Minimally Invasive Therapy
- One day Surgery (circumcision, vasectomy, hydrocelectomy, varicocele, TURB, TURP, endoscopic lithotripsy of renal and bladder stones, penile surgery for erectile dysfunction)
- Sacral roots neuromodulation for urinary and fecal incontinence, retention and CPP
- Pudendal nerve neuromodulation for urinary and fecal incontinence, retention and CPP
- Pudendal and obturator muscle nerve block for pharmacologic modulation of CPP
- Pulsed radiofrequency of pudendal nerve for CPP
- Intravesical instillation of drugs for Interstitial Cystitis