bluuebunny/crossref_metadata_2025 huggingface dataset:
Prostate Cancer: Transrectal High-Intensity Focused Ultrasound for the Treatment of Local Recurrence after Radical Prostatectomy or Radiotherapy
Authors: Tasso M. , Varvello F. , Ferrando U.
Published: June 2018

Objectives

To evaluate the efficacy and safety of transrectal high-intensity focused ultrasound (HIFU) as salvage therapy for locally recurrent prostate cancer after external beam radiotherapy or recurrences located in the region of vesicourethral anastomosis after radical prostatectomy.

Methods

Transrectal biopsy of the prostate (recurrence after radiotherapy) or in the region of vesicourethral anastomosis (recurrence after prostatectomy) was performed in all cases at the time of biochemical relapse. Only patients with positive biopsy were treated. Systemic disease was excluded by PET-CT and bone scan. All treatments were carried out under spinal anesthesia. The device used was Ablatherm (EDAP, Lion, France). The patients were followed with PSA measurement every 3 months and clinical examination every 6 months. In case of biochemical relapse we performed re-biopsy.

Results

From 2002 to 2008 we treated 19 patients with local recurrence after radiotherapy. The mean follow-up was 30 months for each patient (range 6–72 months). 9 patients (47%) are disease-free at last follow-up, with PSA < 1 ng/mL. 9 patients experienced biochemical failure: 8 were treated with androgen deprivation, 1 with salvage prostatectomy. 2 patients died of the disease. Adverse events related to HIFU included 1 rectourethral fistula (observed before the use of specific parameters dedicated to this patient population) and mild incontinence (2–3 pads/die) in 4 patients. From 2002 to 2008 we treated 27 patients with a local recurrence after radical prostatectomy. Mean pre-HIFU PSA was 2.17 ng/mL (range 0.5–8 ng/ml); the Gleason score ranged from 5 to 8. All patients reached a minimum follow-up of 20 months (range 20–80 months). Median PSA nadir was 0.2 ng/ml. The disease-free rate was 51% (14/27); these patients have a median PSA of 0.2 ng/ml at last follow-up. 81% (22/27) of control biopsies were negative. There were no intra-operative or post-operative complications.

Conclusions

The small number of patients in our series limits our ability to draw any definitive conclusions. We believe that HIFU may be a potentially useful treatment option for patients who develop prostate cancer recurrence after external beam radiotherapy or in the region of vesicourethral anastomosis after radical prostatectomy. The procedure is safe, side effects are acceptable and do not add significant morbidity to the previous radical treatment. HIFU lesions are targeted only to the area of recurrence. It is important to remember that, in case of failure, the patient can undertake any other therapies.
Robot-Asssisted Laparoscopic Radical Prostatectomy (Ralp). Oncological and Functional Findings after 90 Cases
Authors: Giberti C. , Schenone M. , Cortese P. , Gallo F. , Gastaldi E , Ninotta G.
Published: June 2018

The RALP is the most modern technology available for the treatment of intracapsular prostate cancer (CaP), which can produce a shorter learning curve and better results than the traditional techniques.

Methods

Between March 2005 and March 2008, 90 patients (64.3 ys, range 52–71) with intracapsular CaP underwent RALP at our institute. Before surgery the patients underwent routine examinations and filled in IIEF, IPSS and EORTC-QLQC30/PR 25 questionnaires. Patients were followed up with PSA assay, physical examination and compilation of the questionnaires. Median follow-up was 12.5 months (range 1–35 months).

Results

Mean operative time was 230 min. Discharge and catheter removal were at day 7.4 and 8.2, respectively, after surgery. Pathological staging reported pT2 and pT3 in 57 (63%) and 33 patients (37%), respectively. Positive surgical margins were assessed in 30 patients (33%), particularly 8.7% in pT2 tumors. The one-year biochemical disease-free survival rate was 90%. Regarding the functional results, 81 patients (90%) were perfectly continent while a mild and a moderate incontinence were reported in 7 (8%) and 2 (2%) patients, respectively. Mean IPSS score decreased from 8 to 4; among the patients who underwent bilateral nerve sparing RALP and no adjuvant therapy, 31 (70.4%) reported satisfactory sexual intercourses. Concerning postoperative quality of life, mean EORTC-QLQC30/PR 25 questionnaires scores were very similar before and after RALP.

Conclusions

After 90 cases of RALP the oncological and functional results are definitely promising. However, a wider number of patients and a greater follow-up are needed to confirm these data particularly as regards the functional results.
Is Prophyilaxis Necessary after Urodynamic Tests? Our Experience
Authors: Pizzorno R. , Canepa G. , Simonato A. , Esposito M. , Montanaro T. , Maffezzini M. , Carmignani G.
Published: June 2018

Urodynamic studies should be performed only on patients with sterile urine. The use of prophylaxis after urodynamic investigation is debated (positive urinoculture in 9 to 15% of cases). The Units of Urodynamics at the Urological Clinic of the University of Genoa and of the Galliera Hospital of Genoa assessed the prevalence of bacteriuria on a sample of 336 patients (314 females and 22 males), average age 62.3, between January and December 2006.

All patients with sterile urine before examination underwent a complete urodynamic test. Concomitant diseases were: diabetes (7.7%), multiple sclerosis (3.5%), Parkinson's disease (1.2%), urinary retention treated by autocatheterism (1.2 %). Urinoculture was performed seven days after the urodynamic study. All patients were asymptomatic; 40/336 urinocultures were positive (E. coli 80%, Proteus M. 10%, other 10%). The prophylaxis does not eliminate but only reduces post-urodynamic infections; we believe that the cost-benefit ratio is unfavorable.
Vesical Sequelae of Transverse Myelitis. Long-Term Urodynamics Observations in Adult Patients
Authors: Pizzorno R. , Simonato A. , Esposito M. , Montanaro T. , Carmignani G.
Published: June 2018

Transverse myelitis is a rare autoimmune inflammatory disease often secondary to viral infection of the spinal cord; it frequently has vesico-sphynteric complications. Between January 2000 and December 2005 we performed urodynamic examination on 13 consecutive patients (7 females and 6 males) with previous diagnosis of transverse myelitis. Mean age was 54.5 years; transverse myelitis had been diagnosed a mean of 6.3 years earlier; etiology of myelitis was viral infection in 5 cases, autoimmune in 3 cases, insect bite in 1 case, unknown in 4 cases. The neurological sequelae included paraparesis in 3 cases and tetraparesis in 2 cases. Symptoms: dysuria 46%, slow stream 15%, pollakiuria 23%, urgency 30%; urge incontinence 38%, stress incontinence 15%. 3 patients performed 4 clean intermittent catheterisms (CIC), 2 patients 2 CICs. Eight patients had maximum cystometric capacity above 350 mL, the others had a mean capacity of 223 mL. Four patients showed no bladder sensitivity. Voluntary micturitional reflex was observed in 4 patients. Detrusor overactivity was diagnosed in 9 patients, 10 patients had mean residual post-micturition (RPM) of 218 mL, 2 patients showed detrusor-sphincter dyssynergia, 2 patients were found to be obstructed at pressure-flow study. Urodynamic follow-up is indicated in these patients with or without neurological complications (possibility of detrusor overactivity, urinary retention, detrusor-sphincter dyssynergia); the follow-up personalizes the diagnosis and therapy, and prevents complications.
“ReMeEx”, The Adjustable-Tension Suburetral Sling in the Treatment of Stress Urinary Incontinence Due to Intrinsic Sphincteric Dysfunction (Type III)
Authors: Cortese P. , Gallo F. , Gastaldi E. , Schenone M. , Ninotta G. , Giberti C.
Published: June 2018

The anti-incontinence methods “tension free” may be insufficient in the treatment of stress urinary incontinence (IUS) due to intrinsic sphincteric dysfunction (ISD). We report our findings on the use of the suburetral sling with adjustable tension “Remeex” sistem in the treatment of 24 patients.

Methods

Between May 2002 and February 2008, 24 patients with IUS of type III, were subjected to suburetral sling “Reemex.” Positioning. The intervention provides a vaginal access to the positioning of suburetral sling and an access to the positioning of a varitensor which the wires are connected at the sling seats, recovered by the passage of a Stamey needle carrier of. The average operative time was approximately 70 minutes, the resignation was in I-II day. The tension of the sling was adjusted the day following intervention by turning the screw connected to the varitensor. Patients were followed with physical examination and completed the Korman's questionnaire about the quality of life.

Results

At a follow-up average 30 months, 21 patients (87.5%) were perfectly continent with improvement of quality of life. Among the complications, wound infection occurred in 2 patients (8%); 1 (4%) with mild recurrence IUS; 1 (4%) reported “de novo” urgency, 1 (4%) reported urinary retention.

Conclusions

Our data show that the use of the suburetral sling “ReMeEx” is a effective option in the treatment of IUS due to ISD which is a condition often secondary to urogynecologic surgery and refractory to common techniques antincontinence.
Using Computed Tomography to Predict in Vivo Stone Chemical Composition
Authors: Tiscione D. , Ruggera L. , Beltrami P. , Cerruto M.A. , Cielo A. , Gigli F. , Zattoni F.
Published: June 2018

Objectives

Several authors hypothesized the usefulness of the non-contrast helical computed tomography (NCHCT) with the determination of stone Hounsfield Unit (HU) values in order to predict urinary stone compositions. Preoperative knowledge of stone composition might be interesting in pre-operative decision-making process. The aim of this study was to evaluate the possible correlation between stone chemical composition and correspondent stone HU value in an in-vivo experience.

Methods

Forty patients with urinary stones were preoperatively studied with abdominal NCHCT, where stone HU values were reported. Stone chemical composition was obtained in each patient, using the colorimetric method. The HU value of each stone was compared with the correspondent chemical analysis.

Results

The median HU values of calcium oxalate (n=10), mixed calcium oxalate and phosphate (n=19), calcium phosphate (n=2), uric acid (n=6) and mixed uric acid and calcium oxalate (n=3) stones were 1060 HU [interquartile range (IQR) 743.75–1222.5]; 900 HU (IQR 588.5–1108.5); 774 HU (range 720–828); 371 HU (IQR 361.25–436.25) and 532 HU (range 476–626), respectively.

Conclusions

Our results confirmed a statistically significant difference of the HU values between calcium and pure uric acid calculi, suggesting a correlation between stone chemical composition and CT-density. Hounsfield unit
Disease Progression in Bladder Cancer: Which Developments since 1994
Authors: Varca V. , Simonato A. , Traverso P. , Romagnoli A. , Venzano F. , Esposito M. , Rikani E. , Ambruosi C. , Carmignani G.
Published: June 2018

Objectives

The introduction of PSA in clinical practice has resulted in decreasing the death rate form prostate cancer and in a downward shift of the pathological stage in radical prostatectomy specimens. This seems not to be the case for bladder cancer. In order to verify this assumption, we have reviewed the charts of the patients operated on of radical prostatectomy and radical cystectomy between 1994 and 2006.

Methods

456 and 491 consecutive patients, respectively, underwent radical cystectomy and radical prostatectomy with bilateral lymph nodes dissection. We excluded all the patients who had received neoadjuvant treatment or did not undergo node dissection. The patients were divided into two consecutive groups according to the year of treatment: group 1 included pts treated from 1994 to 2000, and group 2 pts from 2001 to 2006. The histopathological findings of the two groups of pts were compared. The difference among TNM systems has been balanced evaluating histopathological reports critically and converting them to the 2002 edition.

Results

For patients with prostate cancer, those in group 2 had a decrease in the incidence of extracapsular extension and lymph nodes invasion. The bladder cancer patients belonging to group 2 had a greater number of T2, but there was an increased number of pN+ in this group.

Conclusions

Even if there is a decline in locally advanced disease in patients with bladder cancer, our retrospective analysis did not show a comparable success in early diagnosis as it did for prostate cancer. There is undoubtedly an increase in the lymph node dissemination, whether this is due to a more extended lymph node dissection or to a premature dissemination remains questionable. Public awareness regarding bladder cancer and its risk factors is limited, but several studies have reported that a delay in diagnosis of invasive bladder cancer is an adverse prognostic factor. A higher care in the development of new diagnostic markers for bladder tumors and especially in the screening protocols together with an earlier radical therapy could hopefully improve the management of such a pathology, as it happened for prostate cancer.
Multilocular Cystic Renal Cell Carcinoma: Our Experience
Authors: Manini C. , Vella R. , Di Primio O.G. , Vercesi E. , Cortese F. , Marino G.
Published: June 2018

Multilocular cystic renal cell carcinoma is now recognized as an independent pattern by WHO; it is a rare malignancy with a predominantly cystic growth, characterized by very low oncologic evolution and then susceptible to conservative treatment. In the kidney cystic masses of different origin may arise, i.e. due to malformation, acquired disease or tumor. Renal neoplastic lesions may have a cystic or pseudocystic component. There are also four types of neoplasm with a predominantly cystic growth, including the multilocular cystic carcinoma, which are macroscopically very similar and impossible to differentiate through diagnostic pre-operative images. The Authors present four cases of multilocular cystic renal cell carcinoma diagnosed in the 2000–2007 period, with special reference to diagnostic difficulties and to pre- and intra-operative features of the neoplasm. In conclusion, the extemporaneous histological preoperative diagnosis of multilocular cystic renal cell carcinoma is not possible because it requires extensive sampling; furthermore, the final histological diagnosis sometimes needs particular immunohistochemical procedures to be confirmed.
Testicular Localization of Extranodal Multifocal Non-Hodgkin Lymphoma. Report of Two Cases, Review of the Literature and Clinical Considerations
Authors: Chierigo P. , Nicolardi L. , Rahmati M. , Lazzarotto M. , Brotza D. , Bassan F. , Franzolin N.
Published: June 2018

The aim of our study is to describe two cases of testicular localization of non-Hodgkin Lymphoma associated with the involvement of other extranodal organs, and to investigate the possible causes of this association according to the evidences found in literature. Non-Hodgkin Lymphoma is extranodal in 25% of cases. Most of the times the organs involved are stomach, bowel, skin, central nervous system. About urological localizations, the most common is testis. Very rare is to find lymphoma in kidney, prostate, urinary bladder, and ureter. Testicular lymphoma is about 5% of testis malignancies; it is more frequent in the 7th and in the 8th decade. Metastases of testicular non-Hodgkin lymphoma are described also many years later, and also in distant organs. Primary forms are usually “diffuse large B cell”, a high-grade histotype; metastatic ones often show Burkitt cells. The standard therapy used for non-Hodgkin Lymphomas does not reach testis and central nervous system, so that these sites are called “Therapeutic Shrines”. Therefore, in order to prevent testicular localization, it is necessary to use radiotherapy, and for nervous system prophylaxis it is necessary to administer intrathecal chemotherapy. More than one localization of non-Hodgkin lymphoma simultaneously found may indicate not only a metastatic spread, but also a multicentric origin. We describe two patients who had one testis removed because of a big mass that turned out to be a non-Hodgkin lymphoma. The first patient had been treated for a non-Hodgkin lymphoma of maxillary sinus 20 months before. The second patient showed contemporary involvement of other organs. In both cases the different localizations of non-Hodgkin lymphoma showed the same histological features and cellular immunophenotype. It is important to underline that in the former patient staging TC, repeated many times, had always been negative, but physical examination of testis had been omitted, so that sinonasal localization, assumed to be the first one, really might have been the spread of an undetected testis lymphoma. In conclusion, in case of extranodal non-Hodgkin lymphoma or any other malignancies, manual or ultrasound examination of testis should never be omitted, because standard techniques of staging (TC, RMN, PET) cannot explore this organ.
A Rare Case of Female Splenogonadal Fusion
Authors: Arancio M. , Marchetti C. , Landi G. , Mina A. , Delsignore A. , Marcato M. , Martinengo C.
Published: June 2018

Splenogonadal fusion (SGF) is a rare congenital abnormality in which there is a fusion between spleen and gonad. Approximately 150 cases have been described in world literature.

SGF can be continuous, where there is a connection between ectopic and orthotopic spleen, and discontinuous, with no connection. In our paper we report a case of SGF in a 36-year-old female with ultrasound and MR findings of space-occupying lesion in lower abdomen, and a review of the literature.
The Use oF Flexible Cystoscope in Posterior Urethroplasty
Authors: Palminteri E. , Berdondini E. , Maruccia S. , Poluzzi M. , Vecchio D. , Molon A.
Published: June 2018

We present our experience with a simplified anastomotic posterior urethroplasty to highlight the necessity and usefulness of ancillary reconstructive maneuvers. We reviewed the records of 46 patients who had undergone anastomotic repair of posterior urethral strictures due to pelvic trauma between 2000 and 2007. Mean patient age at surgery was 43 years. Average stricture length was 2.3 cm. Repair was performed with a progressive perineal anastomotic procedure using flexible cystoscope by means of transcystostomic approach: after mobilization of the bulbo-membranous urethra and the corporal splitting, the prostatic apex is well visualized and the membranous urethra is sectioned proximally; the flexible cystoscope by means of transcystostomic approach facilitates to find the proximal urethral lumen and to perform the bulbo-prostatic anastomosis. Mean follow-up was 32 months. Of 46 cases, 40 (87 %) were successful and 6 (13 %) failed with recurrence of the stricture. Urinary incontinence did not develop in any patients.

The operative details and maneuvers facilitate the preparation of the bulbo-membranous urethral tract and prostatic apex, and simplify the performance of the anastomotic repair.
Transperitoneal Laparoscopic Radical Nephrectomy for a 12 cm Renal Mass
Authors: Parma P. , Samuelli A. , Guatelli S. , Luciano M. , Dall'Oglio B. , Bondavalli C.
Published: June 2018

Laparoscopic radical nephrectomy is now considered a standard of care for patients with T1 renal carcinoma not suitable for nephron-sparing surgery. In the hands of experienced laparoscopic urological surgeons also T2 renal cell carcinoma can be approached through the laparoscopic technique. We present the video of a radical laparoscopic nephrectomy in a patient with a 12cm renal mass of the right kidney. We chose the transperitoneal approach; the operative time was 240 minutes. There were neither intra- nor post-operative complications. The patient was discharged at day 4 postoperatively.
Combined Endoscopic and Surgical Technique for the Repair of Posterior Traumatic Urethral Stricture
Authors: Romano G. , De Angelis M. , Barbagli G.
Published: June 2018

The aim of this study is to show and evaluate the combined procedure, which uses an endoscopic suprapubic access and a surgical perineal access to repair posterior urethral stricture secondary to traumatic pelvis fracture.

Material and Methods

In the period from January 1989 to December 2007 eighty-nine patients underwent urethral surgery for post-traumatic posterior urethral stricture. From January 2003 all patients underwent combined endoscopic and surgical technique. According to this technique, the patient is placed in simple lithotomic position with the calves carefully placed in Allen stirrups. Two surgical teams work simultaneously. A middle-line perineal incision is made and the bulbar urethra is isolated proximally and the membranous urethra is transected at the strictured site. At the same time the second surgical team performs an endoscopic suprapubic access placing the “Amplatz” sheath, previous progressive dilation to 20/22 Ch. By using a rigid or flexible cystoscope the operator follows endoscopically the bladder neck and reaches the stenotic site performing an anterograde urethroscopy. At this point the perineum is transilluminated by the endoscope and the surgeon can easily identify the proximal urethral end. A soft guide wire is inserted at this point into the urethra through the endoscope to facilitate the dilation till a nose speculum can be inserted. At this point an end-to-end anastomosis is performed. A Foley 18 Fr catheter and a suprapubic cystostomy are left in place for 1 month; a voiding cystourethrography is then performed.

Results

The bulboprostatic anastomosis shows better results (65% of success) if compared with the other techniques (Badenoch, two stage urethroplasty, perineal urethrostomy). A definite increase in the success rate (10%) has been evident in the last five years, simultaneously to the use of combined technique.

Conclusions

The combined perineal and suprapubic access, in post-traumatic posterior urethral strictures repair, allows achieving a better and easy location and a better preparation of the proximal urethra. The final target is to obtain a better bulboprostatic anastomosis, with better results confirmed by long-term follow-up. In particular, the endoscopic management of the suprapubic access is possible and of minor invasiveness to the patient.
Sexual Activity and Urinary Incontinence in Women
Authors: Minaldi G. , Ventimiglia B. , Finocchiaro M. , Fanzone I. , Tsirgiotis A. , Spitaleri F. , Di Marco G. , Ranno S.
Published: June 2018

Urinary incontinence during sexual intercourse refers to overactive bladder (OAB) syndrome and it is divided in incontinence during penetration and during orgasm. 480 women with low urinary tract symptoms (LUTS) were divided in a) affected by probable genuine stress incontinence, b) probable Urge-stress incontinence, c) probable Urge Incontinence, to specify incidence.

Materials and Methods

In Group C (186 women) 36 women, age range 24 to 56 years, with urinary incontinence only during sexual intercourse, were selected: 16 during orgasm (group I), 20 during penetration (group II). These patients filled in specific validated questionnaires (ICI-9), urinary recordings and, after urine exam, they underwent US study of urinary tract with post-micturition evaluation. The patients with other urological diseases or pelvic prolapse in stage II of POP-Q or higher were excluded. Patients were referred to physiatric evaluation and urodynamic exam with cystomanometry and perineal EMG, with provocative tests and after pressure-flow study.

Results

Cystocele was found in 4 out of 16 women in Group I, and in 6 out of 20 in Group II. No patients showed basic detrusor hyperactivity during cystomanometry. In Group I: 50% had detrusor hyperactivity and 18.75% had prolonged perineal relaxation. In Group II 30% had detrusor hyperactivity and 35% had prolonged perineal deficit. Results suggest parasympathetic deficiency in Group I and sympathetic deficiency in Group II.
Radical Cystectomy for Transitional Cell Carcinoma with Orthotopic Neobladder in Renal Transplant Recipients: Surgical Procedure, Functional and Therapeutic Evaluation
Authors: Zani D. , Simeone C. , Arrighi N. , Perucchini L. , Antonelli A. , Setti C. , Sandrini S. , Cancarini G. , Cosciani Cunico S.
Published: June 2018

Introduction

Transitional Cell Carcinoma (TCC) shows a high prevalence in renal tranplant recipients, nevertheless urinary reconstruction by way of orthotopic neobladder is rarely reported.

Patients and Methods

Two kidney transplant patients (1 man and 1 woman) affected by TCC underwent radical cystectomy and urinary reconstruction by neobladder according to the “Vescica Ileale Padovana” technique.

Results and Discussion

No patients claimed incontinence or urine retention. The spherical rebuilding assured an adequate bladder capacity and a low endovesical pressure. After 48 months one patient died because of disease progression. The first relapse was detected in ureter two years after cystectomy. The other patient is still alive after 40 months and in good health conditions.

Conclusions

This anecdotal report suggests that the “Vescica Ileale Padovana” technique could be useful in renal transplant recipients with TCC. A possible role of Rapamycin on our results cannot yet be excluded.
A Rare Case of Hematuria from Colonic Adenocarcinoma Spreading to the Bladder via the Stented Ureter
Authors: Giuliani A. , Cristini C. , Di Pierro G.B. , Demoro M. , Scimò M. , Galati G.
Published: June 2018

Background

The direct extension of advanced tumors from adjacent organs to the bladder is not uncommon. Secondary bladder involvement through hematogenous and/or lymphatic metastases and implant of cells by tumors involving higher urinary tract via the ureter are rare. Therefore, the histological resemblance between primary bladder adenocarcinoma and colorectal adenocarcinoma can be a dilemma for pathologists.

Methods

A 67-year-old female underwent total right hemicolectomy for ascending colon adenocarcinoma. After a 20-month follow-up the lesion was removed (which was histopathologically similar to the previous colon cancer) and the patient underwent ureteral stenting because of a mass in the right internal iliac nodes with homolateral hydronephrosis. Subsequently intermittent gross hematuria urged on performing cystoscopy detecting a non-papillary mass situated above the right ureteral orifice, previously revealed on ultrasonography and CT scan.

Results

A TURBT was performed. Histopathologically the mass, partially covered by intact urothelium, consisted of tubular and pseudoglandular structures intermixed with solid foci of mucin-producing signet-ring-cells-type adenocarcinoma, very similar to the original colon cancer. The tumor base was healthy. Immunohistochemically stains for cytokeratin 7 (CK7) and cytokeratin 20 (CK20) presented multifocal positivity, suggesting the colorectal origin of the neoplasm.

Conclusions

In order to optimize the therapeutic options, it is important to distinguish the primary disease of the bladder from other causes of hematuria, and achieve a correct differentiation between primary enteric-type adenocarcinoma of the bladder and secondary colorectal adenocarcinoma involving the bladder, these entities being morphologically indistinguishable. Therefore, in patients with history of colonic adenocarcinoma, the presence of a subsequent bladder tumor should be considered as an eventuality of a secondary disease.
State of the Art and Controversies in the Treatment of Testis Germ-Cell Tumors (TGT)
Authors: Salvioni R. , Nicolai N. , Necchi A. , Torelli T. , Piva L. , Stagni S. , Catanzaro M. A. , Biasoni D. , Milani A.
Published: June 2018

Many different, intersecting strategies are available for managing germ-cell cancers, particularly in early-stage disease. Which is ‘right’ remains a matter of debate, and requires balancing efficacy against late effects, bearing in mind the complexity of treatment strategies and the available expertise.
Small Volume (<0.5 cc) Prostate Cancer: Characteristics and Clinical Implications
Authors: Galosi A.B. , Lacetera V. , Cantoro D. , Parri G. , Mazzucchelli R. , Montironi R. , Muzzonigro G.
Published: June 2018

Introduction

It is not well known how many Small Volume Prostate Cancers (SVPC) may host high grade (Gleason pattern 4/5) or have extraprostatic extension in particular in the national setting. Features of SVPC are very interesting since they raise controversies in diagnosis and have important clinical implications in treatment strategies. The diagnosis may be difficult and the treatment ranges from active surveillance to radical surgery. AIM. We evaluate clinical and pathological features of SVPC in surgical specimens of patients who underwent biopsy and radical prostatectomy.

Methods

We analysed a consecutive series of 849 radical prostatectomies performed between 2005 and 2008. Inclusion criteria were: biopsy specimen available, pathological tumor volume analysis according to standard criteria, whole-mount section 3 mm step analysis according to Stanford protocol, clinical parameters (PSA, DRE, number of core biopsy taken). Exclusion criteria: any hormonal manipulation before surgery and cT1A/B stage. Data were analysed using SPSS for statistical comparison.

Results

238 patients were evaluated. SVPC<0.5 cc was observed in 58 (24.3%). Overall in 17/58 (29.3%) a clinical/pathological relevant disease was observed. In 16/58 (27.5%) pathological Gleason Score (GS) was 7–8, in 5/58 (9%) pathological stage was T3. The number of tumor foci was >1 in 78.3%, tumor-involving in both lobes in 55%. Unifocal disease was observed in 22%. Clinically relevant disease is significantly associated with total cancer volume (0.20 versus 0.31, p 0.007), but not to tumor foci (2.5 versus 2.0). PSA, age, no. of positive cores, DRE were not predictive of clinical relevant disease. Six of 17 (35%) cases with SVPC - who were in the low risk category (PSA <10, biopsy Gleason score <7 and negative DRE), had clinical relevant disease.

Conclusion

SVPC are clinically relevant in 29.3% since they have a Gleason pattern 4 (27.5%) or have only pathological T3 (9%). Early diagnosis techniques and treatments have to consider that SVPC prostate cancer may contain high risk disease in 1/4 of cases. Clinical parameters are not useful to accurately detect high risk SVPC.
Early Clinical Experience with Different Mesh in Correction of High-Degree Cystocele
Authors: Dente D. , Paniccia T. , Petrone D. , Gaspari G. , Tucci C. , Rossetti R. , Pompa P.
Published: June 2018

Background

Cystocele is connected to an ingravescent relaxation of uretrovesical support system. During surgical correction of this disease, a mesh has been introduced to strengthen weak tissue. The aim of the study was to compare different material aspects and various devices.

Methods

From June 2002 to December 2008, 80 patients underwent surgical correction for high-degree cystocele. None of the patients had stress-incontinence. All the patients were studied with cistography and urodynamic test. Three different kinds of mesh were employed, such as: Goretex (26 pt.), Prolene (27 pt.), Bovine Pericardium (27 pt.). During surgery the mesh have been modelled if necessary and fixed by detached sutures.

Results

By comparing the devices: in Goretex group there were excellent results about anatomical correction, in the follow-up too (6 months), good continence and an improving of quality of life; in Prolene group no post-surgery complication, 3 pts. referred urge incontinence resolved in about 3 months. After 6 months a subset of patients reported sensation of foreign vulvar body and moderate dyspareunia; in Bovine Pericardium group we had an intra-operatory difficulty, for its softness a high risk to tear the net itself. No post-surgery complications. No urinary symptoms. After 3 months 5 of the patients referred a sensation of foreign vulvar body and dyspareunia. After 6 months, 4 patients still have the same sensation.

Conclusion

We hypothesize that Goretex mesh is an excellent device for its operator manageability, good anatomical results, and good tolerability. Further investigation is warranted to determine the effect of each of these techniques.
The Accuracy of Tissue Resonance Interaction Method Probe (Trimprob Tm) in Non-Invasive Diagnosis of Prostatic Cancer. Analysis of the Results of 782 Patients
Authors: Di Viccaro D. , Perugia G. , Cerulli C. , Olivieri V. , Bova G. , Balla J. , Zanza C. , Teodonio S. , Liberti M.
Published: June 2018

The aim of our study was to evaluate the real utility of the TRIMprob test before TRUS-guided biopsy approach, putting in relation the number of positive tests of the TRIMprob with the number of positive prostate biopsies that were performed successfully. Sensitivity, Specificity, PPV (Positive predicted value), NPV (Negative predicted value) of the TRIMprob test were analyzed with statistical software package for Social Sciences (SPSS Inc, Chicago, Illinois USA).
Low-Risk Bladder Tumors: How Accurate are the EORTC Risk Tables?
Authors: Passalacqua D. , Serretta V. , Ruggirello A. , Giamo R. , Daricello D. , Aragona F. , Allegro R. , Melloni D.
Published: June 2018

Introduction

The European guidelines classify primary bladder tumors of Ta category and G1–2 grade as low risk tumors when single or less than 7 in number and 3 cm in diameter. The aim of the present paper was to evaluate the usefulness of EORTC Risk Tables when applied to non-selected patients in daily clinical practice.

Material and Methods

In the present retrospective study 129 consecutive patients affected by primary bladder tumors category Ta and Grade G1–2 have been considered. The median follow-up was 48 months. Bladder tumors were TaG1 in 69 (53.5%) patients, TaG2 in 60 (46.5%), single in 82 (63.6%) and multiple in 47 (36.4%) cases. Fifty-one patients (39.5%) received adjuvant intravesical chemotherapy.

Results

At a median follow-up of 48 months, 70 (41.8%) patients recurred. Recurrence occurred in 43.5% of TaG1 versus 66.7% of TaG2 tumors (p=0.003), in 50% of single tumors versus 61.7% of multiple (p=0.096), in 41.2% of patients receiving adjuvant chemotherapy versus 62.8% of untreated patients (p=0.007). Progression to G3 grade, T1 category and muscle invasive tumor occurred in 3%, 10% and 2% of cases, respectively.

Conclusions

The EORTC Risk Tables can be applied in common clinical practice to unselected low-risk patients.
Ureteroscopy of Ureteral Stones: Our Experience
Authors: Polledro P. , Rosso D. , Moiso A. , Borsa R. , Rossi R. , Ambruoso G. , Cordara G. , Aimè G. , Filocamo M. T. , Fontana G.
Published: June 2018

Introduction and Objectives

ureteroscopy is now a widely used procedure in urology. Technological advances in endourology are used to manage the majority of ureteral stones (1). In this study we evaluated retrospectively our cases of ureteral lithiasis treated by ureteroscopy.
Seminal-Sparing Cystectomy in Benign Diseases of the Bladder
Authors: Pavone C. , Di Gregorio L. , Abbadessa D. , Scuto F.
Published: June 2018

Purpose

Seminal-sparing cystectomy is reported in literature only with reference to oncological conditions. However, it can be applied also in non-neoplastic conditions in young patients with good renal function. In the present report we will describe our experience in this field, with special reference to erectile function, urinary continence, fertility and feasibility.

Materials and Methods

Between 2000 and 2009 we have treated five patients with seminal-sparing cystectomy for benign conditions, namely sclerosing cystitis, tuberculosis and a benign paraganglioma. All patients underwent a complete diagnostic evaluation including CT of upper abdomen and pelvis, and bone scintigraphy. Digital rectal examination was normal, PSA less than 2.5, with a free to total ratio above 25%. Cystectomy was performed, leaving in situ vas deferent, seminal vesicles, neurovascular bundles and prostatic capsule. Finally, an orthotopic bladder was performed. The ileal segment was anastomized to the prostatic capsule.

Results

All patients had uneventful recoveries and were continent within 2 weeks from the operation. Erectile function was maintained in all cases; in one patients fertility was preserved.

Conclusions

In our experience, seminal-sparing cystectomy showed satisfactory clinical and functional preliminary results in selected patients. Young males, for whom maintenance of bladder function and sexual activity have a great impact on their quality of life, can be offered this alternative surgical procedure.
Aminolevulinic Acid in Diagnosis and Treatment of Bladder Urothelial Carcinoma
Authors: Gatti L. , Pesenti N. , Zani D. , Cristinelli L. , Antonelli A. , Simeone C. , Cunico S. COSCIANI
Published: June 2018

It might be difficult to diagnose either bladder's flat lesions, such as CIS, or small papillary lesions using white-light endoscopy.

Neoplastic cells can be differentiate from the normal bladder mucous membrane by using Hexyl-ALA. Hexyl aminolevulinate produces protoporphyrin's overstock inside cancer cells causing a clearly visible red fluorescence when these are hit by a predetermined wavelenght light. The purpose of this study is to evaluate effectiveness of PDD (photodynamic diagnosis) by using Hexyl-ALA to identify and treat bladder's surface cancer.

This study considers 39 patients (33 men and 6 women) from November 2008 to January 2009. On these patients were taken, previous filling of their bladders with hexyl aminolevulinate solution, 106 hystological samples (among these: 38 were first step diagnosis, 15 were a second look and 53 were taken for a relapse suspect). The 72.6% of these samples (77) were positive for cancer, while the 27,4% (29) was normal.

Of those 77 samples, 30 were discovered to be positive exclusively by using PDD and include CIS (66.6%), Ta G1–2 (20%), reactive hyperplasia (3.3%) and incipient papillary neoplasia (10%). (Anatomopathologist described the last two lesions as partial nuclear alterations not fullfilling the criteria of pathology). This research proves that, among other diagnostic methods, photodynamic diagnosis has a higher sensibility, although the specificity is lower.
Metastatic Hormonorefractory Prostate Cancer: Treatment of Disease Progression after Taxanes Based Chemotherapy
Authors: Verze P. , Longo N. , Creta M. , Di Lorenzo G. , Imbimbo C. , Arcaniolo D. , Vivaldi O. , Riccio R. , Mirone V.
Published: June 2018

Introduction

Taxanes represent the most active first-line treatment for metastatic hormone refractory prostate cancer. However, most patients progress while receiving taxanes-based treatment and require a second-line approach. The aim of the present study was to evaluate the activity and the safety of the combination of bevacizumab and taxanes in patients with metastatic, hormone refractory prostate cancer with evidence of disease progression after a previous docetaxel-based chemotherapy.

Methods

Twenty patients were enrolled into the study protocol. Treatment consisted of bevacizumab (10 mg/kg) plus docetaxel (60 mg/m2) administered every three weeks. Biochemical and objective responses, progression-free survival, overall survival, and toxicity were evaluated.

Results

55% of patients had a PSA reduction > 50%, 10% had a PSA reduction > 25% to 49%, 10% had a PSA reduction < 25% or a PSA increase <25%, and 25% had a PSA increase > 25%. Three patients with measurable disease had an objective response. Median progression-free survival and median overall survival were 4 months and 9 months, respectively. Treatment was well tolerated.

Conclusions

The combination of bevacizumab and docetaxel is active and well tolerated in patients with metastatic hormone refractory prostate cancer with evidence of progression after a previous docetaxel-based chemotherapy.
Immunity and Cancer: The Role of PSA igM Immune Complexes for Prostate Cancer
Authors: Zani D. , Costa S. , Beneduce L. , Fassina G. , Simeone C. , Cunico S. Cosciani
Published: June 2018

Immunoediting is a new concept in cancer surveillance. Immunity is involved in detecting cellular waste, and taking off transformed cells. In particular, natural IgM antibodies play an important role in immunosurveillance mechanisms against transformed cells in humans.

Scientific evidence indicates that biomarkers for different types of cancer, such as liver and colorectal cancer, circulate in blood associated with immunoglobulin M (IgM) to form complexes that improve diagnosis in comparison to circulating free biomarkers. In prostate cancer it has been demonstrated that testing for serum levels of the PSA-IgM immune complex improves the diagnostic performance of total PSA. Preliminary reports indicate that the combination of PSA-IgM with total PSA is the best approach to reduce the number of negative prostatic mapping thus improving the diagnosis of prostate cancer.
Antibiotic Prophylaxis in Prostate Biopsy
Authors: Serretta V. , Catanese A. , Ruggirello A. , Scuto F. , Melloni D.
Published: June 2018

Introduction

Prostate biopsy is nowadays one of the most frequent diagnostic procedures in urology. The incidence of bacteraemia, bacteriuria and infective complications is higher after the transrectal procedure than after the transperineal one. A survey demonstrated that 98% of the urologists in USA use antibiotics to prevent infective complications. The transrectal prostate biopsy is the only diagnostic intervention procedure in urology for which an antibiotic prophylaxis is recommended, also for low-risk patients, by the guidelines of the European Association of Urology. If the perineal route is adopted, the antibiotic prophylaxis is recommended only in high-risk patients.

Materials and Methods

The patient should preferably receive an evacuative enema to achieve a rectal cleansing and to ameliorate the diagnostic accuracy of transrectal ultrasound. A survey in the US demonstrated that an evacuative enema with saline solution is adopted by more than 80% of urologists. Criteria for antibiotics choice. The majority of bacteraemias are transitory, asymptomatic and self-limiting. On the other side, bacteriuria can persist for several days. Antibiotics must achieve high drug concentrations not only in plasma and tissue but also in urine. Symptomatic infections are generally caused by E. Coli and less frequently by the Streptococcus faecalis. Nevertheless, other agents as Klebsiella and Chlostridium, although rare, might cause severe infections. Thus, prophylaxis needs antibiotics at large spectrum and a single agent may not be enough for high-risk patients. Risk determination and drug schedules. It is essential to point out the infective risk of the patient. The choice of the drug, the timing and schedule of antibiotic prophylaxis are still object of debate. Several randomized studies have been conducted with contradictory results.

Results

The antibiotic prophylaxis should be tailored according to patients’ infective risk and to the procedure adopted. It is able to reduce infections rate after transrectal biopsy below 5%. The adoption of periprostatic anesthesia and the number of cores can influence the incidence of infective complications. Commonly, one-three days oral administration of fluoroquinolone is adopted. A single-dose prophylaxis can be also used with favorable results. Tolerability and route of administration should be taken into account, and also costs should be considered.

Conclusions

Considering the low cost of antibiotics adopted as short-term prophylaxis and the high cost of the treatment of infective complications, it seems reasonable to provide antibiotics prophylaxis for all patients at high risk for infective complications and for all cases submitted to transrectal prostate biopsy.
Comparison of Three Kinds of Mid-Urethral Slings for Surgical Treatment of Female Stress Urinary Incontinence
Authors: Zhong Chen , Yuan Chen , Guang-hui Du , Xiao-yi Yuan , Jia Wu , Xiao-yong Zeng , Zhi-quan Hu , Dan Cai , Wei-min Yang , Zhang-qun Ye
Published: June 2018

Aims

A study was conducted to compare the efficacy and complications of tension-free vaginal tape (TVT), transobturator vaginal tape inside-out TVT-0 and transobturator vaginal tape out-inside (TOT) procedures for the surgical treatment of female stress urinary incontinence SUI.

Methods

This study is a prospective randomized trial involving 187 women with primary SUI; 77 received TVT, 65 received TVT-O, and 45 patients were treated with TVT-0 between June 2002 and December 2009. Before the operation, a complete medical history was taken and a gynecologic examination was performed, including subjective symptoms, history and urodynamic studies. Postoperative data included mean operation time, days of hospitalization, postoperative complications and efficacy evaluation. Therapeutic effect was assessed by presence or absence of incontinence when abdominal pressure increased.

Results

The history, physical examination and urodynamic studies among the three groups have no significant difference (P>0.05). The total cure rate was 91.4%. The cure rate in TVT, TVT-O and TOT groups were 90.9%, 92.3% and 91.1%, respectively. There was no significant difference (P>0.05). Mean operative time showed no significant difference between TVT-O and TOT groups, but both were significantly shorter than TVT group (26.90±16.80, 20.00±13.50 vs 48.20±21.90). The mean postoperative hospital stay showed no significant difference between TVT and TVT-O groups, but both groups were significantly longer than TOT group. Mean postoperative hospital stay of TVT, TVT-O and TOT were 5.00±2.40 days, 4.00±2.20 days and 2.30±0.80 days, respectively. The complication rate in TVT, TVT-O and TOT groups was 15.60%, 9.20% and 8.90%, respectively. In TVT group, 4 patients experienced bladder perforation, postoperative dysuria or retention occurred in 7 cases and was cured by urethral dilation, hematomas of retropubic space in 1 patient. No bladder injury occurred in TVT-O and TOT group, 3 patients had postoperative dysuria or retention and 3 patients had transient dysfunction of both lower limbs postoperatively in TVT-O group, 2 patients had postoperative dysuria or retention and 2 patients had transient dysfunction of both lower limbs postoperatively in TOT group.

The three tension-free urethral suspension techniques have similar efficacy, all of them are safe and effective procedures for the treatment of female SUI. Compared with TVT, TVT-O and TOT are simpler, less invasive and have fewer complications.
Multiple Non-Responding ESWL Lithiasis in Ectopic Pelvic Kidney: Laparotomic Surgical Management
Authors: Rahman D. Abed El , Zanetti G. , Cozzi G. , Cozzi LA. , Rahman S. Abed El , Maggioni A. , Rocco F.
Published: June 2018

A 34 year-old male with multiple lithiasis of ectopic pelvic left kidney, which for 5 years had been causing pain in the left iliac region irradiating to ipsilateral inguinal region and testis. 4 ESWL treatments were unsuccessful. The diagnostic imaging (Angio-CT + Uro-CT) showed ectopic pelvic left kidney with abnormal vascularisation, characterised by multiple lithiasis extending in total area of 4×2 cm with shorter ureter. Right kidney was in normal position. A left pyelocalicolithotomy after DJ stent positioning was performed.