bluuebunny/crossref_metadata_2025 huggingface dataset:
Human Biobank in Uro-Oncological Research
Authors: Sacco E. , Pinto F. , Brescia A. , Pastore G. , Gardi M. , Volpe A. , Bassi PF.
Published: June 2018

Purpose

Uro-oncological translational research requires clinical data and human biological tissues collected within a biological tissue bank (BTB). We are hereby outlining ethic-legal, methodological and technical issues of a BTB establishment process, focusing particularly on prostate cancer and Italian setting.

Materials and Methods

Review of literature data, and national and international regulations and guidelines; direct field experience of urological BTB; counseling of the different professionals involved.

Results

Within a BTB establishment process, it is of utmost importance to protect the donors’ privacy and rights through the programmatic adoption of the following procedures: 1) informed consent; 2) confidentiality protection thanks to anonymity of biological specimens and use of an “honest broker” method; 3) identification of a single responsible researcher; 4) dedicated and protected location; 5) approval of the Ethical Committee. There are two main organizational models of BTB: “systematic”, i.e. collecting specimens from all patients and through the same methodology; “project-driven”, i.e. prospectively selecting patients for a specific study and using the specific methods required by researchers. In the preliminary step it is necessary to establish detailed protocols of sampling and crioconservation techniques, and methods of validation and quality control. For prostate tissue sampling, several techniques have been described such as specimens of alternate slices, macro dissection, Tru-Cut.

Conclusions

Today BTBs are necessary in order to support molecular and translational research in uro-oncology and to overcome the limits of the research based only on clinical-pathological data. Ethic-legal and methodological issues related to BTBs are still requiring specific legislation and standardization of techniques.
Effect of an LH-RH analogue on adhesion molecules in human prostate cancer cells
Authors: Angelucci C. , Iacopino F. , Sica G.
Published: June 2018

Background

The reduction in or the loss of the cell-cell adhesion often characterizes epithelial tumor initiation and progression. In the present study, we investigated the effects of the LH-RH analogue Leuprorelin acetate (LA), alone or associated with Dihydrotestosterone (DHT), on the expression of the adhesion proteins E-cadherin, α-, β- and γ-catenin in androgen-sensitive (LNCaP) and -insensitive (PC-3 and DU-145) prostate cancer cells.

Materials and Methods

Protein expression was evaluated by Western blotting on cells treated for 48 h with LA (10-11 or 10-6 M) and 10-9 M DHT, alone or combined.

Results

In LNCaP cells, all the above mentioned molecules are expressed. PC-3 cells lack α-catenin, while DU-145 cells only express β- and γ-catenin. In both LNCaP and PC-3 cells two truncated forms (97 and 35 kDa) of E-cadherin are present other than the functional protein (120 kDa). In LNCaP cells, no significant changes in E-cadherin (120 and 97 kDa) level were produced by DHT, while the 35 kDa fragment was reduced by 34%. LA increased the full length E-cadherin (26–30%) as well as the two fragments (30–49%). The addition of DHT to LA significantly reduced the analogue-induced E-cadherin raising. In LNCaP cells β- and γ-catenin were up-regulated either by DHT (24% and 20%, respectively) or LA (up to 18% and up to 40%, respectively), while the expression of α-catenin was not modified. The combined DHT/LA treatment results in a less marked increase in β- and γ-catenin levels. In PC-3 cells no changes in adhesion molecule expression were produced by LA treatment, while in DU-145 cells the analogue determined an appreciable reduction in β- (20%) and γ-catenin (up to 35%) levels.

Conclusions

The up-regulation of E-cadherin, β- and γ-catenin in LNCaP cells by LA may be considered as another feature of the direct antitumor LH-RH analogue activity, as it may contribute to the maintenance/restoration of the normal architecture of prostate epithelium. The LA-induced modifications of catenins in DU-145 cells are worth some further investigations.
Notes on the tumorigenesis of bladder urothelioma
Authors: Bono A. V.
Published: June 2018

Bladder urothelioma is a common and increasingly frequent tumor, which most of the times involves initially the bladder mucosa only. Urotheliomas can be superficial, with low malignant potential despite their high relapsing activity, and highly aggressive ab initio. A series of events are known to influence urothelioma genesis, growth, cell interactions and apoptosis. Some initial constant changes involving chromosome 9 occur in the urothelium, whereas the 20–30 % of cases also show an alteration on chromosome 20, which is likely to result in marked biological aggressiveness. The transformation of normal urothelium into hyperplastic, and then neoplastic, urothelium is secondary to a wide range of molecular changes, which are here summarized.
Innovations in superficial bladder cancer treatments. Review
Authors: Racioppi M. , Volpe A. , Falabella R. , Cappa E. , D'Agostino D. , Pinto F. , Bassi PF
Published: June 2018

Bladder cancer treatment is a challenge for both urologists and oncologists. Particularly during these last years many changes have been made in the management of superficial bladder cancer.

In the case of superficial bladder cancer, intravesical instillation of chemo/immunotherapeutic agents after transurethral resection is the standard. The treatment goals include: complete removal of the initial tumor, prevention of recurrences and inhibition of disease progression.

This work aims at reviewing the new developments in the therapeutic field of superficial bladder cancer. A growing trend involves the use of multimodality treatment to obtain the activation of the host immunity against the tumor, and to enhance the cytotoxic effects of chemotherapeutic agents.

The new therapeutic modalities, which are under preclinical and clinical investigations, are showing promising results.
Peyronie's Disease: State of the Art and Future Perspectives
Authors: Gulino G. , Sasso F. , Falabella R. , Racioppi M. , Sacco E. , D'Onofrio A. , Bassi P.F.
Published: June 2018

Peyronie's disease (PD) is characterized by the onset of a fibrous plaque within the tunica albuginea of the penile corpora cavernosa, resulting in pain and bending during the erection, which can make the intercourse difficult or impossible. Evidence from literature supports the autoimmune etiology of PD, and suggests genetic and familiar conditions, penile traumatisms and history of genital tract diseases as risk factors, even though no definitive conclusions arise about the pathogenesis of the disease. Few randomized trials demonstrated that medical therapies, such as Vitamin E, Colchicine, Potassium amminobenzoate, Tamoxifen and injection therapy with Verapamil are effective in stabilizing the acute phase of the disease. Extracorporeal shock wave therapy (ESWT) and ionophoresis cannot be considered as first line or gold standard therapies. Satisfactory results have been published about Nesbit operation in large number of cases with low-stage disease, whereas plication procedures have shown significant rates of relapse. High incidence of long-term penile retraction have been reported in high-stage disease treated with plaque incision and simple graft insertion. Malleable, soft or inflatable prostheses combined with graft implant have given the best results in terms of penile straightening and lengthening and patients’ satisfaction. In conclusion, the PD etiopathogenesis hasn't been clearly understood-yet, no medical therapy is fully effective; surgery remains therefore the gold standard in case of severe deformity and/or erectile dysfunction.
Ligation of the native ureter in kidney transplant
Authors: Capocasale E. , Busi N. , Mazzoni M.P. , Valle R. Dalla , Ferreri G. , Sianesi M.
Published: June 2018

The urinary tract reconstruction in renal transplantation is usually performed by a ureterocystoneostomy according to Gregoire-Lich technique. In selected patients, native ureteral ligation with nephrectomy was done when end-to-end anastomosis for ureteroureterostomy was performed. Recently, some Authors have proposed the ligation of the native ureter without nephrectomy. We report our experience in the ligation of the native ureter with no associated nephrectomy.

Materials and Methods

In 978 renal transplantations performed from April 1986 through December 2006, we evaluated 68 recipients (69.5%) who underwent ureteral ligation without nephrectomy. Mean diuresis was 314 cc/day (range 0–1200 cc/day). Follow-up was 1 to 187 months.

Results

Only one patient (1.5%) required native nephrectomy for fever and abdominal pain. None of the other patients showed infections involving native kidney or flank pain during the follow-up.

Discussion and Conclusion

Our experience confirms the safety and feasibility of native ureter ligation without omolateral nephrectomy. Nephrectomy is indicated in the case of coexistent intrinsic renal disease, such as non-treatable nephrovascular hypertension, symptomatic polycystic kidney disease, chronic renal infection.
Nephron-sparing surgery versus radical nephrectomy in the treatment of renal cell carcinoma up to 7 cm
Authors: Antonelli A. , Zani D. , Nicolai M. , Cozzoli A. , Zanotelli T. , Perucchini L. , Cunico S. Cosciani , Simeone C.
Published: June 2018

Purpose

To compare the oncological outcome of nephron-sparing surgery versus radical nephrectomy in renal cell carcinoma up to 7 cm by retrospectively reviewing our surgical experience.

Materials and Methods

Data collected from 1290 consecutive patients, who underwent surgery for renal carcinoma, have been stored since 1983 into a dedicated database. The cases with unilateral carcinoma up to 7 cm, pT1a/pT1b/pT3a N0/Nx M0, followed up for a minimum of 12 months if disease-free were reviewed.

Results

732 patients were selected (mean follow-up: 72 months); 329 had a tumor less than 4 cm in diameter (182 cases of nephron-sparing surgery, 147 cases of nephrectomy), while for 403 of them the tumor was 4 cm or more (57 cases of nephron-sparing surgery, 346 cases of nephrectomy). The comparison between tumors less and equal to/more than 4 cm showed worse progression and disease-free survival rates for the latter, even though the type of surgery (nephron-sparing or radical) had no significant impact. Patients with extracapsular carcinoma >4 cm, treated with nephron-sparing surgery, had a particularly poor prognosis.

Conclusions

The conservative management can be cautiously suggested for renal cancers up to 7cm, since the prognosis worsens proportionally with the diameter increase, with no statistical difference for both nephron-sparing and radical surgery. Nephron-sparing surgery proved to be the suitable treatment modality also for pT3a tumors measuring <4 cm, whereas when the tumor size increases, an adequate intraoperative evaluation of peritumoral tissues is essential to rule out fat infiltration. These results comply with the few similar studies available in literature, and suggest the possibility of designing a prospective study aiming at comparing conservative and radical surgery in the management of renal carcinoma up to 7 cm.
Blind Traumas of the Scrotum: Three Case Reports
Authors: Ventimiglia B. , Santangelo G. , Failla F. , Consoli S.
Published: June 2018

The blind traumas of the scrotum are an uncommon event; references, iconography and descriptions of the clinical development of scrotal syndromes are poor. The scrotum and the didimal or funicular structures are often involved in different conditions. The authors are reporting on three interesting cases (for patients’ age, mechanism of traumatism and anatomic damage), gathered from a series of 12 cases of blind traumas of the scrotum, observed during 2 years (2005–2006). They include the iconography related to each single case, and emphasize the uncertain role of ultrasonography with color Doppler for a correct diagnosis.

The clinical evolution and the long-term damage to gonad functionality are presented.
Balanitis Xerotica Obliterans
Authors: Calcagno C.
Published: June 2018

Balanitis xerotica obliterans (BXO), first described by Stuhmer in 1928, is a chronic, progressive, atrophic, sclerosing process involving prepuce, glans and urethra. Its aetiology is unknown.

After a short terminological excursus and a review of the aetiological hypothesis, we have focused on BXO in daily urological practice.

We are here describing the clinical presentation and its differential diagnosis with premalignant and malignant lesions of the penis. We tried to define the relationship between BXO and squamous cell carcinoma of the penis. Particular attention was then cast on urethral stenosis.

Finally, we focused on the treatment of BXO: corticosteroid local therapy as first line treatment or as adjuvant therapy after circumcision, surgical therapy including circumcision, laser therapy of the glans lesions, meatoplasty in the stenosis of the anterior urethra. We also stressed the need for histological examination of the preputial specimen for a correct follow-up and for medicolegal reasons.
Amikacin: A Novel Modulator of Vesical and Prostate Efferences. An in vitro Experimental Study
Authors: Gardi M. , Nigro F. , Ragazzi E. , Volpe A. , Totaro A. , Sacco E. , Pinto F. , Bassi PF.
Published: June 2018

The autonomic efferent neurotransmission to the bladder and prostate smooth muscle is a potential target for drug therapy of specific low urinary tract disfunction (LUTD). Since amikacin and other amynoglicosides were reported to affect neurotransmission by a pre-junctional mechanism, we investigated the effect of amikacin on isolated rat and human detrusor smooth muscle contraction and on isolated rat and human prostate contraction, to further evaluate its potential relaxant properties.

Materials and Methods

Samples of detrusor smooth muscle and prostate tissue, obtained from 97 rats and 16 patients undergoing surgery, were studied through the measurement of isometric contraction induced by electrical field stimulation (EFS) and other pharmacological stimuli in the presence or absence of 1mM amikacin in a low-Ca medium.

Results

Amikacin 1 mM significantly reduced contraction of isolated rat and human detrusor muscle and prostate, achieved with pre-junctional stimulation, while no significant effect was observed on contraction induced by pharmacological post-junctional stimulators. EFS contraction inhibited by amikacin was restored after addition of calcium chloride. The amikacin effect was comparable to the effect of magnesium ions, which are known to exert a pre-junctional inhibition of neurotransmitter release.

Conclusions

Amikacin significantly inhibited rat and human detrusor and prostate contraction evoked by pre-junctional stimulation in vitro, suggesting a depressant effect on autonomic efferent neurotransmission. Further pharmacokinetics studies and researches on related compounds may hold potential for future development in the treatment of specific low urinary tract disfunction (LUTD).
History and Evolution of Dorsal Onlay Urethroplasty for Bulbar Urethral Stricture Repair using Skin or Buccal Mucosal Grafts
Authors: Barbagli G. , Lazzeri M.
Published: June 2018

Objectives

To illustrate the history and the evolution over time of bulbar dorsal onlay urethroplasty, comparing outcomes when using buccal mucosa or skin grafts.

Materials and Methods

Ninety-four patients underwent bulbar urethral reconstruction using two dorsal onlay techniques, namely augmented anastomotic urethroplasty and dorsal onlay graft urethroplasty. Preoperative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry and urethrography. Thirty-four patients underwent augmented anastomotic urethroplasty using penile skin (10 cases) or buccal mucosa (24 cases) grafts. Sixty patients underwent dorsal onlay graft urethroplasty using penile skin (38 cases) or buccal mucosa (22 cases) grafts. Forty-eight out of 94 patients received skin grafts and 46 buccal mucosal grafts.

Results

Sixty-four (68%) out of 94 cases were successful, whereas 30 (32%) failed. The 34 augmented anastomotic urethroplasties provided successful outcomes in 24 cases (70.6%), but poor outcomes in 10 (29.4%) cases. The 60 dorsal onlay graft urethroplasty proved to be successful in 42 cases (70%), failing in 18 (30%) cases. Twenty-eight (58.3%) out of 48 penile skin grafts were successful and 20 (41.7%) failed. Thirty-six (78.3%) out of 46 buccal mucosa grafts were successful and 10 (21.7%) failed. The 30 failed cases were then treated with internal urethrotomy in 14 cases (46.7%), perineal urethrostomy in 8 cases (26.7%), two-stage repair in 4 cases (13.3%), and one-stage repair in 4 cases (13.3%).

Conclusions

The dorsal onlay technique used for bulbar urethral stricture repair has changed over time. In our experience, the buccal mucosa seems to be the best substitute graft material for bulbar urethroplasty using dorsal approach.
Clinical evaluation of nuclear matrix protein 22 as urinary marker of transitional cell carcinoma of bladder
Authors: Liotta R.F. , Mangiapia F. , Tarantino M.L. , Di Meo S. , Mirone V. , Pavone C.
Published: June 2018

Objectives.

Biomarkers (BTA, NMP22, FDP etc.) have been and continue to be evaluated as adjuncts or substitutes for cystoscopy, which is invasive and uncomfortable for some patients. Nuclear matrix protein-22 (NMP22) is involved in the regulation of nuclear processes. The main objective of the present study is to evaluate the clinical utility of urinary NMP22 as a tumor marker in the follow-up of transitional cell carcinoma (TCC) of the bladder.

Materials and Methods.

The study included 62 patients undergoing follow-up, who had had TCC of bladder but who were disease-free at the beginning of the study, as confirmed by cystoscopy. Urine samples were collected for urinary cytology and NMP22 test before the cystoscopy. All samples were processed according to the instructions provided with the manufacturer's kit instructions.

Results.

12 cases of TCC recurrences were detected with biopsy. Cystoscopy was positive in 8 cases, NMP22 test was positive in 11 cases, and in only one case the cytopathology yielded positive results. In 14 cases NMP22 resulted as false positive.

Conclusions.

Urinary NMP22 appeared to be a potential tumor marker for detecting TCC of the bladder, which might rise the sensitivity of cystoscopy especially in high-grade cancer surveillance more than cytology might do.
Tadalafil versus sildenafil citrate in the treatment of ED: Italian patients’ preferences and explanatory notes
Authors: Fusco F. , Lembo A. , Ludovico G.M. , Farina F. Pirozzi , Montorsi F. , Fabris G.F. Menchini , Soli M. , Scarpa R. M. , Gentile V. , Motta M. , Spera E. , Casarico A. , Sicuteri R. , Rossi A. , Mirone V.
Published: June 2018

This is an open, multicentre, randomized, crossover study having the aim to evaluate the preference for sildenafil citrate or tadalafil in a population of Italian patients affected by ED, and to compare the efficacy and safety of these two drugs.

Material and Methods.

From October 2003 to November 2004, thirteen Italian centers enrolled ED patients (age >18) being in steady and naïve relation to ED treatment, both through PDE5 inhibitors and any other treatment option. These patients were randomized to sildenafil or tadalafil for 12 weeks, after which they were switched to the alternative treatment for a further 12 weeks. The preference was evaluated through the Treatment Preference Question (TPQ): “During this clinical trial you have taken tadalafil and sildenafil for the treatment of erectile dysfunction. Which medication do you prefer to take for the next 8 weeks of treatment?”. Moreover, patients were asked to express their preference as “strong” or “moderate” and to answer some questions to clarify the reasons behind their preference. SEP and IIEF-EF questionnaires were used for a comparison of efficacy.

Results.

167 patients were enrolled, 144 of whom completed both treatment periods. On being asked the TPQ, 75% of patients (n=108) decided to continue treatment with tadalafil, in particular because it made it possible to have an erection many hours after taking the medication (first or second preference reason for 64.8% of patients), while 25% (n=36) preferred sildenafil (p=0.001). Both drugs improved the IIEF-EF and SEP scores compared to baseline, with a slightly but significantly greater improvement with tadalafil for both parameters.

Conclusions.

Tadalafil and sildenafil are both effective and well tolerated. Most of the patients prefer tadalafil thanks to the possibility of having sexual intercourse many hours after taking the medication.
Vesico-sphincter dysfunctions in Pure Cerebellar Syndrome (PCS): a possible basis for the study of anatomo-functional correlations
Authors: Pea U. , Zago T. , Areta L. , Marzorati G.
Published: June 2018

The neurological polymorphism of Pure Cerebellar Syndromes (not including the heredodegenerative patterns) led the Authors to try to verify the possible correlations between neurological damages and urodynamic findings.

Material and Methods.

From 2001 to 2006 thirty patients affected by PCS were studied. They underwent several neurological and urological investigations, including videourodynamics.

Results.

Sixteen cases (76%) showed urinary incontinence due to non-inhibited detrusor contractions, with no evidence of vesico-sphincter dyssynergia; the remaining patients showed a moderate degree of incoordination.

Conclusions.

The authors highlight the basic role of cerebellum in modulating the motor activities and the coordination of the bladder-sphincter structures, also in the light of the outcomes gathered in these patients, who were not suffering from other superior structure deficiencies.
Angiomyofibroblastoma of the Spermatic Funiculus. A Case Report of this Lesion of the Spermatic Funiculus
Authors: Calabrò G. , Vallone A. , Vitale F. , Calabrò V. , Pizzarelli M. , Spampinato A.
Published: June 2018

The authors are hereby presenting a rare case of angiomyofibroblastoma of the funiculus in a 20-year-old patient, having a non-aching tumefaction at the left region of the scrotum.

This tumefaction was solid and non homogeneous, both on ultrasonography and MRI, of about 5cm in diameter, fully separated from the testicle. The markers were all negative. We proceeded with surgical treatment of the neoformation. It is mandatory to include this lesion within the differential diagnosis of testicle masses. The case is presented for its absolute histopathologic rarity and for the difficulty in diagnosis.
Phytotherapy in urology
Authors: Dalfrà S. , Bassi P.F.
Published: June 2018

Complementary and alternative medicine (CAM) includes various practices, measures and products which are not presently considered as part of the conventional (mainstream) medicine. Herbal products, vitamins, minerals and amino acids are increasingly popular as dietary supplements for the treatment, improvement and prophylaxis of urological diseases, and as therapeutic options to improve general health and well-being.

As these products are available for free without prescription, conventional healthcare providers are often unaware that their patients are using CAM. A particular attention is paid to herbal products by the public. For this reason it is essential to know that some herbal supplements may act in the same way as chemical drugs, and that the fact that they originate ‘from nature’ does not mean that they are safe and/or with no potential harmful effects and/or toxicity. The possible interactions with conventional medications and contamination with prescription drugs and metals have been reported. The active components of many phytotherapeutic preparations and their mechanism(s) of action are still being determined and evaluated. There is scientific evidence for the effectiveness of some treatments, but for most of them, many important key questions still need to be answered through basic research and well-designed studies, according to established guidelines. Because of the increasing popularity and use of Phytotherapy, urologists should not ignore it, and be well informed about its benefits and potential risks.
Calcium and magnesium in male reproductive system and in its secretion. Part II within-subject variability in human seminal plasma and spermatozoa
Authors: Valsa J. , Skandhan K.P. , Avni K.P.S. , Amith S.
Published: June 2018

This study was undertaken to find out what, if any, within-subject variability exists in semen parameters, and calcium and magnesium levels in seminal plasma and spermatozoa. Significant changes (p<0.05) were found in semen volume and in the percentage of sluggish motile spermatozoa. No other significant changes were seen in semen parameters or in calcium or magnesium in spermatozoa and seminal plasma.
Chronic prostatitis and PSA values
Authors: Liotta R.F. , Tarantino M.L.
Published: June 2018

Objectives.

There is evidence of a clinical correlation between chronic prostatitis and elevated serum levels of prostate specific antigen (PSA). In the present study a system was developed to stage inflammation in benign prostate hyperplasia (BPH), which correlates with serum PSA.

Materials and Methods.

We retrospectively studied 98 patients undergoing transurethral resection of prostate. In all patients, histological sections of prostate showed BPH and inflammatory cell infiltration, which could be graded as G1, G2 and G3, according to involvement of epithelium. PSA levels were assessed pre- and postoperatively by the Immulite 2000 PSA assay.

Results.

The difference in mean serum PSA values between groups G1 and G3 was highly significant (G1 = 3.3±2.1; G3 = 7.1 ±3.9 ng/mL; p<0.05). Mean age, prostatic weight and PSA density were similar in the three groups (p<0.05).

Conclusions.

We concluded that in patients with BPH and prostatitis on pathological examination there is an associated PSA elevation when glandular epithelium is disrupted.
Is phlebography crucial in Tauber varicocele sclerotherapy?
Authors: Pecoraro G. , Motta L. , Olivo G. , Bertoloni R.
Published: June 2018

Objectives.

Our aim was to discover whether it is possible to eliminate retrograde phlebography in the treatment of varicocele by using Tauber procedure.

Methods.

We treated 102 consecutive left varicocele patients between November 2003 and May 2007. In 72 patients (Group A) we used the Tauber procedure, without performing preliminary retrograde phlebography, and injecting saline solution instead of contrast medium; in 30 patients (Group B) we performed the standard Tauber procedure. We followed up with scrotal color Doppler Ultrasonography and spermograms at 6 months.

Results.

The patients who underwent the Tauber procedure without phlebography (Group A) obtained results similar to those treated with phlebography (Group B). With our technique, surgical time and costs are reduced and, most importantly, exposure to radiation is avoided.

Conclusions.

We believe that Tauber procedure for the treatment of varicocele can be performed without retrograde phlebography.
Synchronous bilateral percutaneous nephrolithotomy (PCNL)
Authors: Gigli F. , Cerruto M.A. , Zattoni F.
Published: June 2018

Background.

The management of bilateral renal stones still represents a therapeutic challenge and synchronous bilateral percutaneous nephrolithotomy (PCNL) appears to be a well tolerated, safe and relatively rapid procedure with a favorable cost-benefit ratio. The purpose of the present study is to report our experience in the synchronous percutaneous treatment of bilateral renal stones.

Methods.

We retrospectively evaluated clinical files from 4 consecutive patients (BS, BE, OCB, FL), who underwent a synchronous bilateral PCNL, performed by the same operator (ZF), for the management of renal persistent and/or recurrent stones after extracorporeal shock wave lithotripsy, or other surgical maneuvers. From each patient's file we recorded a clinical history, any peri- and post-operative complication, any therapeutic resolution employed and the outcomes in terms of stones persistence/recurrence.

Results.

Overall, 3 men (BS, BE, FL) and 1 woman (OCB), their age ranging from 31 up to 76 years, consecutively underwent synchronous bilateral PCNL. In 75% of cases a calcium-oxalate nephrolithiasis was found. We did not find any peri- or post-operative complication. All patients were stone-free after a mean follow-up of 12 months (range: 3–24 months).

Conclusions.

Synchronous bilateral PCNL is a relatively safe procedure; it may be performed in selected patients without increasing the morbidity of this surgical maneuver. The simultaneous treatment of the contra-lateral kidney may be taken into account only when the PCNL of the first side has been performed quickly and easily without any peri-operative complication.
Putative tissue markers in prostate cancer
Authors: Montironi R. , Cheng L. , Mazzucchelli R. , Santinelli A. , Bono A. , Lopez-Beltran A.
Published: June 2018

A variety of putative prostate cancer markers have been described in human serum, urine, seminal fluid, and histological specimens. These markers exhibit varying capacities to detect prostate cancer and to predict disease course. In order to be considered markers for diagnosis or prognosis of disease course, and to be brought forward for large-scale clinical evaluation, they should fulfill several criteria. Firstly, there should be a biological or therapeutic rationale for choosing the marker, or at least a consistent association with disease presence, disease characteristics such as stage, or disease aggressiveness. Secondly, there should be an assessment of the strength of marker association with disease outcome. Thirdly, the marker should be assessed as an independent predictor in a multivariate analysis.
Minimal invasiveness of radical laparoscopic prostatectomy: dreams or reality?
Authors: Greco F. , Wagner S. , Hamza A. , Fornara P.
Published: June 2018

To determine the systemic response to extraperitoneal laparoscopic (eLRP) and open retropubic radical prostatectomy (RRP).

Materials and Methods.

In all, 430 patients who had eLRP (200) or open RRP (230) were recruited; patients in both groups had similar preoperative staging. In addition to peri-operative variables (operative duration, complications, blood loss, transfusion rate, hospitalization, catheterization), oncological data (Gleason score, pathological stage, positive margins) were also compared. The extent of the systemic response to surgery-induced tissue trauma was measured in all patients, by assessing the levels of acute-phase markers C-reactive protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6) and IL-10 before, during and after RP.

Results.

The duration of surgery, transfusion rate, hospital stay and duration of catheterization were comparable with those of previous studies. There was an increase in IL-6, CRP and SAA but no change in IL-10, and no differences between eLRP and RRP over the entire period assessed.

Conclusion.

The invasiveness of eLRP could not be substantiated objectively on the basis of the variables measured in this study. The surgical trauma and the associated invasiveness of both methods were equivalent.
Bladder and buccal mucosa graft in urethral stricture reconstruction
Authors: Marzorati G. , Ghinolfi G. , Pachera F. , Meazza A.
Published: June 2018

Purpose.

Our aim was to determine the success of urethroplasty using a free graft of buccal or bladder mucosa for the treatment of complex anterior urethral stricture in adults.

Materials and Methods.

From October 2000 to February 2005, 11 patients with complex anterior urethral stricture underwent substitution urethroplasty, using mucosal grafts, 6 buccal and 5 bladder.

Results.

The mean follow-up time was 50 months for 8 out of 11 patients (range 24 to 72). The procedure was successful for 6 patients (75%). Urethral stricture recurred in 2 patients (25%) and was treated by urethrotomy or meatoplasty with positive outcomes.

Conclusion.

Our limited experience with the reconstruction of a complex stricture of the anterior urethra confirmed that buccal and bladder mucosa grafts are excellent materials for substitution urethroplasty but that case selection is important.
A rare case of fibroepithelial polyp of the proximal urethra in a young woman
Authors: Oxenius I. , Vacirca F.
Published: June 2018

Fibroepithelial polyps are benign epithelial tumours which are rare in adults. In females they usually arise from the distal part of the urethra and protrude through the external meatus. We report a case of a twenty-seven-year-old woman, presenting with painless terminal gross haematuria, affected by a neoplasm located in the proximal urethra near the bladder neck. Transurethral resection was performed. Endoscopic image of the tumour and histopatological details are shown.
High-intensity focused ultrasound and prostate cancer: technology, state of the art and future
Authors: Vespasiani G. , Asimakopoulos A.D. , Agrò E. Finazzi , Virgili G.
Published: June 2018

Background.

The potential applications of the high-intensity focused ultrasound (HIFU) as a minimally invasive therapy of the localized prostate cancer explain the growing interest of the urologic community towards this technique. HIFU has been assessed for its role in the treatment of localized prostate cancer in patients who otherwise would not have benefited from surgery, and in local recurrences after radiation failure.

Methods.

Relevant information on HIFU treatment was identified through a literature search of published studies.

Results.

High biochemical efficacy, excellent tumor local control and favorable mid- and long-term oncological data with a low morbidity rate have been shown in many series of patients.

Conclusions.

Although HIFU is a recent and emerging technology, it has been well studied and developed to a point that HIFU will undoubtedly be an effective alternative to radiation therapy.
Methodology of clinical trials for non-muscle infiltrating bladder cancer. Objective evaluation: standardization requirements
Authors: Volpe A. , Racioppi M. , D'agostino D. , Cappa E. , Gardi M. , Totaro A. , Sacco E. , Pinto F. , Bassi P.F.
Published: June 2018

The formulation of proper evaluation criteria after superficial bladder cancer therapy poses several methodological problems that are often peculiar to the disease. The Achilles’ heel of many trials is possibly found in the criteria used for the evaluation of the trial outcomes. As a consequence of that, total agreement regarding the criteria for response and the evaluation of response is needed. The adoption of standard response criteria should be given high priority. Uniform response criteria should be chosen because they meet standards of reliability and statistical validity. Thus, the criteria must be reproducible, and they should correlate with some measures of patient's benefit, such as quantity and quality of survival. A proposal of standardization in superficial bladder cancer clinical trials is presented based upon current knowledge on the methodology for conducting clinical trials and upon the experience coming from major clinical research groups.
Renal cell carcinoma associated with incidental presentation of renal artery aneurysm: surgical management
Authors: Zani D. , Arrighi N. , Antonelli A. , Cunico S. Cosciani , Simeone C.
Published: June 2018

The Renal Artery Aneurysm (RAA) is a relatively uncommon vascular lesion. A renal artery disease coexisting in patients with Renal Cell Carcinoma (RCC) is an even more infrequent clinical presentation. We reported on the treatment of a rare case of incidentally intraoperative renal artery aneurysm discovered during a nephron-sparing surgery for RCC. After the surgery the patient did not need hypertension therapy any longer. This event is well-known, in fact a number of possible contributions to a renin-mediated hypertension management has been postulated.
Adenoid cystic/basal cell carcinoma of the prostate: case report
Authors: Tonini G. , Rosini R. , Teppa A. , Aulenti V. , Kalantary F. , Tosana M. , Bianchi D. , Zorzi F.
Published: June 2018

Although most prostate carcinomas belong to the conventional acinar type, unusual variants have been reported. The adenoid cystic/basal cell carcinoma of the prostate is a rare tumor with distinctive histopathologic features. There are quite few publications in the literature concerning the diagnosis, treatment, and prognosis of this neoplasm.

Methods.

A 71-year-old man had an increased PSA value (5.11 ng/dL); the prostatic biopsy examination was positive for adenoid cystic/basal cell carcinoma. For this reason we proceeded with radical prostatectomy. The histology examination showed an acinar conventional carcinoma and adenoid cystic/basal cell carcinoma. At eight months the patient did not show any recurrence.

Conclusions.

Various histologic and immunohistochemical features are helpful in recognizing the adenoid cystic/basal cell carcinoma of the prostate. Clinically, the only difference from a conventional adenocarcinoma is that the PSA value is usually normal or only slightly increased. This tumor has a biological potential that can result in metastases in some cases; the current treatment consists primarily in the surgical resection. A close, long-term follow-up is strongly recommended.
Endocavitary Prophylaxis of Superficial Urothelial Bladder Tumours: New Compounds
Authors: Bartoletti R. , Cai T.
Published: June 2018

Bladder urothelial carcinoma is the fourth most frequent cancer among European men, accounting for about 7% of the total cancers. Transurethral resection (TUR) is usually indicated as the standard treatment for non-muscle invasive bladder cancer (NMIBC). However, TUR is unable to guarantee a complete eradication of Ta, T1 tumors with a recurrence rate ranging from 50 to 70%, and a progression rate to muscle invasive disease ranging from 10 to 15%.

Methods

The European Association of Urology guidelines recommend adjuvant intravesical chemotherapy after definitive diagnosis of intermediate/high risk NMIBC to reduce both recurrence and progression of the disease. To provide a comprehensive review of intravesical treatment options for NMIBC, we performed a search of the PubMed database for articles between 1980 and 2009 that reported on intravesical agents for treating this disease.

Results

A critical analysis of the findings resulting from large multicenter trials, phase I, II, III studies for pertinent novel agents and from review articles was carried out. We focused on the following issues: 1) the role of the treatment with Bacillus Calmette-Guérin (BCG) and the need of maintaining the drug schedule (with or without interferon-alpha); 2) the correct timing of adjuvant immuno- and chemotherapy; 3) the use of the novel chemotherapeutic agents; 4) the use of the novel technique of chemotherapeutic agents administration, with a particular interest on electromotive administration of mitomycin.
Brachytherapy in Prostate Cancer: The use of QuickLink® System Within the Real-Time Technique. A New Technique is Presented
Authors: Gastaldi E. , Chiono L. , Gallo F. , Schenone M. , Ninotta G. , Cortese PL. , Chiarlone R. , Ghiso G. , Giberti C.
Published: June 2018

Introduction

Brachytherapy with real-time technique allows the ultrasound transperineal implant of needles and the release of I125 seeds in the prostate, with intraoperative dosimetry carried out by a special software. After performing this seed-releasing technique on 160 patients, we present 15 cases treated with strand seeds using the QuickLink®system.

Materials and Methods

Inclusion criteria: CaP clinical stage T1-T2, PSA ≤10 ng/ml, prostate volume ≤ 50g, Gleason score ≤3+3=6, Q maximum >13–15 ml/sec., and I-PSS score <10.

Methodical

In ultrasound-guided transrectal technique the needles are inserted near the prostatic capsule. A 5mm section plan is performed; the computer allows identifying the contours of prostate, rectum, urethra, and the position of needles to be inserted. The total activity is defined, as well as the number and location of the sources to be included; isodoses are calculated, the correct position of seeds and spacers is printed. The strand seeds are prepared on the basis of this scheme, using the QuickLink® system, and placed into the prostate tissue.

Results

The QuickLink® system allows reducing the operative time (110 min, range 95–125). The pelvic CT assessing the post-planning has shown a more regular distribution of seeds. The cut-off of D90≥140 Gy was reached in all patients, with doses at urethra and rectum within the prescribed limits.

Conclusions

The brachytherapy real-time with strand seeds QuickLink® combines the flexibility of planning intraoperative real-time with a faster process, and less tendency for the relocation of the seeds.
Segmental Testicular Infarction. Report of Two Clinical Cases and Literature Review
Authors: Calcagno C. , Russo G.
Published: June 2018

Segmental testicular infarction is rare. To the best of our knowledge forty cases are reported in literature. We present two cases of segmental testicular infarction with different etiology. The first case was observed after herniorrhaphy and varicocelectomy. The second one occurred after acute epididymitis. Both cases have been treated without radical orchiectomy. We have also reviewed the pertinent literature in terms of differential diagnosis, etiology and management, with particular regard to testicular sparing.
Scrotal Masses: Considerations on two Cases of Epididymal Tumors
Authors: Minervini M.S. , Marzi M. , Piras P. , D'Alpaos M. , Paiusco A. , Stener S. , Ambrosi S.
Published: June 2018

The scrotum is a fibromuscular sac that contains the testis, epididymis, spermatic cord and the associated fibrous coatings. All these components can be affected by different variety of pathologic phenomena, including congenital, inflammatory and neoplastic events. When a scrotal mass is observed, there are two basic questions to be answered, i.e. if the mass is intratesticular or extratesticular, and if it is of cystic or solid nature. Apart from a few rare exceptions, intratesticular solid masses should be considered malignant, while extratesticular masses with liquid content are generally benign.

Case Reports

Two cases of tumor are hereby presented: they originated from the epididymis, and their clinical presentations did not allow making a differential diagnosis between benign and malignant tumor during the preoperative examinations. After presenting the diagnostic doubts to patients, and once obtained their informed consent, surgeries were performed allowing for a precise histological diagnosis, and at the same time, proving to be also valid therapeutic tools.
Integrated Treatment with Hyperthermia and Chemotherapy for Non-Muscle Invasive Bladder Cancer
Authors: Racioppi M. , Cappa E. , Volpe A. , D'Agostino D. , Bassi P.F.
Published: June 2018

Oncology-applied hyperthermia is a very old form of therapy. In recent years hyperthermia has been investigated with the aim of improving the treatment for non-muscle invasive bladder cancer to prevent relapse and disease progression, in association with mitomycin-C, a well-known chemotherapeutic agent, to enhance its effect. Target patients are those with non-muscle invasive transitional cell carcinoma, showing medium (Ta-T1, G1–2, multifocal, diameter >3 cm) or high (T1, G3, multifocal or rapidly relapsing, CIS) risk for recurrence or progression.

The treatment may be prophylactic following tumor eradication, or ablative when tumor cannot be otherwise eradicated.

Several studies have shown the benefits of thermochemotherapy with lower risk for relapse than other treatment options, and 66–80% complete responses following ablative treatment. This association of treatments has a synergic therapeutic effect, higher than administering hyperthermia and drug therapy as single treatment.
Synchronous Urinary Tract Metastases from Breast Cancer
Authors: Pastore A.L. , Palleschi G. , Tubaro A. , De Nunzio C. , Stoppacciaro A. , Silvestri L. , Serafini G.M. , Stagnitti F. , Carbone A.
Published: June 2018

Breast carcinoma has a metastatic potential to any organ system. However, breast carcinoma metastases to the urinary tract have very rarely been described. The authors present the case of a patient with a synchronous right ureteral and vesical metastasis of a breast cancer. This is the unique case reported in Literature of synchronous urinary metastatic localization from breast invasive lobular carcinoma.
Role of the Vesico-Urethral Anastomosis Biopsy in the Diagnosis of Local Recurrence following Radical Prostatectomy. Our Experience
Authors: De Luca S. , Randone D.F.
Published: June 2018

In the long-term there is biochemical evidence of recurrent prostate carcinoma in approximately 40% of patients after radical prostatectomy (RP). Detecting the site of recurrence (local vs distant) is critical for defining the optimum treatment. Pathological and clinical variables (Gleason score, involvement of seminal vesicles or lymph nodes, margin status at surgery, and especially the timing and pattern of PSA recurrence) may help to predict the site of relapse. Transrectal ultrasonography (TRUS) of the prostatic fossa in association with TRUS-guided needle biopsy is considered more sensitive than a digital rectal examination for detecting local recurrence, especially if PSA levels are low. Although it cannot detect minimal tumor mass at very low PSA levels (<1 ng/mL), TRUS biopsy is presently the most sensitive method for detecting local recurrence. Nevertheless, the conclusive role of biopsy of the vesico-urethral anastomosis remains unclear. However, [11C]-choline tomography (which is better than conventional imaging for detecting metastatic tumor) has low detection rates for local disease and is considered complementary to TRUS in this setting. Patients with a high PSA after RP may be managed with external beam salvage radiotherapy. An initial PSA of <1 ng/mL, Gleason score < 8 and radiation dose of 66–70 Gy seem to be key factors in determining success. Although a positive TRUS anastomotic biopsy may predict a better outcome after radiation therapy, the need of taking a biopsy in the event of PSA failure remains under investigation. The value of salvage radiation to the prostatic bed for PSA-only progression after RP remains in question.