bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seminal Vesicle Biopsy
Authors: Mari M. , Ambu A. , Bollito E. , Bellina M. 
Published: June 2018

Nowadays, because of early diagnosis of prostate cancer (PC) and the widespread use of nomograms to predict pathological stage of the tumour, seminal vesicle biopsy is considered as a useful tool only in case of clinical suspicion of seminal vesicle invasion. On the other hand, in last years some authors described their experience in less demolitive surgical procedures for PC, such as seminal sparing radical prostatectomy, in an attempt to improve both postoperative urinary continence and sexual function, as reported by Hauri and Montie, respectively. Patients, who may undergo to such procedure, could benefit from preoperative seminal vesicle biopsy, instead of rely on probability of seminal vesicle invasion indicated by nomograms only. From November 2001 to June 2003, 135 patients with negative rectal examination and PSA ≤10, with no contraindications to radical prostatectomy, underwent transrectal ultrasound guided seminal vesicle biopsy at our Institution. We performed seminal-monolateral nerve sparing radical prostatectomy in patients with monolateral PC, Gleason score <7 and <4 positive biopsy cores, without seminal vesicles involvement. Patients with seminal vesicle invasion were addressed to radiotherapy. Seminal vesicles biopsy showed in our hands good feasibility and low morbility; it was in general well tolerated by the patients. All biopsy cores were adequate for histological examination. Among patients with PC diagnosis, only one patient (4%), with serum PSA = 5 ng/mL and Gleason score = 6, had seminal vesicles involvement. We performed seminal-nerve sparing radical prostatectomy in 21 patients, neither histological examination on frozen section nor final pathology showed seminal vesicle invasion in any case. Real usefulness of seminal vesicle biopsy remains controversial, but due to its good feasibility and low morbility it may play a role in the staging of selected patients.
The Role of an Extended 24 Cores Biopsy in Patients with Clinically Suspected Prostate Cancer and Prior Negative Biopsy
Authors: Ciaccia M. , Prayer-Galetti T. , Dal Moro F. , Pinto F. , Gardiman M. , Sacco E. , Fracalanza S. , Betto G. , Pagano F. 
Published: June 2018

The aim of this study is to evaluate the role of an extensive “saturation biopsy” in patients at increased risk for prostate cancer with previously negative biopsies, HGPIN or ASAP diagnosis. Materials and Methods We performed an extensive 24 cores biopsy with spinal anaesthesia in 168 patients with at least 1 prior negative biopsy and persistently high PSA and/or abnormal digital rectal examination or with a ASAP or HGPIN diagnosis at previous biopsy. Results A total of 55 patients were diagnosed having prostate cancer for an overall diagnostic yeld of 33 %. Specifically, cancer was detected in 79% of ASAP, 32% of HGPIN and 28% of prior negative biopsies. 31 patients underwent radical retropubic prostatectomy. There was no correlation between number of positive biopsy cores and pathological stage or pathological Gleason score. A high concordance was found between clinical and pathological Gleason score. Conclusions Extensive biopsy can be considered a safe and effective diagnostic tool in men at risk for prostate cancer with previous negative biopsies. This procedure comes out to be particularly useful also in patients with a prior ASAP or HGPIN.
Laparoscopic Extraperitoneal Radical Prostatectomy: The First 120 Cases Performed
Authors: Martina G. , Scuzzarella S. , Giumelli PL. , Remoti M. , Caruso G. 
Published: June 2018

The present study describes the training approach that a laparoscopy naive general urologist working in a non teaching hospital employed to successfully learn to perform laparoscopic extraperitoneal radical prostatectomy and describes the results obtained in the first 120 cases performed. Methods The urologist assisted an experienced laparoscopic surgeon for a total of 20 extraperitoneal radical prostatectomies. During this time he modified his technic of performing open radical retropubic prostatectomy to facilitate the acquisition of the laparoscopic technics. Intracorporeal suturing was learned with the aid of a pelvic trainer. Results The operating time progressively decreased during the learning curve. The mean duration of surgery was 160 minutes. There were 2 conversions to open surgery due to failure to progress. Conclusions Laparoscopic extraperitoneal radical prostatectomy can be successfully learned by a general urologist with no prior laparoscopic experience.
Laparoscopic Radical Nephrectomy: A Single Center Experience
Authors: Sicuro O. , Veneziano P. , Sidari V. , Arcudi L. , Carbone L. , Ierace M. , Malara G. , Sgrò E. , Veneziano D. , Cozzupoli P. 
Published: June 2018

Renal cell carcinoma has become one of the most important indications for urological laparoscopic surgery. The laparoscopic technique combines the benefits of a minimal invasive approach with basic surgical principles. We report our experience with 52 procedures. Materials and methods Between June 2000 and December 2003 we performed 52 transperitoneal laparoscopic radical nephrectomies for clinical stage T1-T2 renal cell carcinoma. Median age of patients was 59 yrs (range 31–77 yrs). The mean tumor size was 5.4 cm (range 3–12 cm). Results In three patients (5.7%) conversion to open surgery was necessary. The mean operating time was 215 min (150–305 min). Post-operative hospitalization was 5.1 days (3–11 days). Median follow-up was 19.5 months (3–36 months). No cases of local recurrence or port metastasis occurred during observation. Conclusions In our center, a transperitoneal laparoscopic approach with the removal of intact specimens in endobags has become the standard treatment for stage T1-T2 N0 M0 renal cell carcinoma.
The Prognostic Importance of Prostate-Specific Antigen in Monitoring Patients Undergoing Maximum Androgen Blockade for Metastatic Prostate Cancer
Authors: Kiper A. , Yigitbasi O. , Imamoglu A. , Tuygun C. , Turan C. 
Published: June 2018

The changes in serum prostate-specific antigen (PSA) concentrations can be used as a prognostic factor in patients undergoing maximum androgen blockade for metastatic prostate cancer. Materials and methods One hundred and forty-nine patients followed-up in our department were classified into four groups based on PSA changes. Group 1, those with a normalization of PSA levels within the 1st 3 months; group 2, those with a normalization of PSA levels between months 3 and 6; group 3, those with a reduction in PSA levels, but not reaching the normal range; group 4, those with no reduction in PSA levels. The gleason scores and the number of bone metastases were also compared between the groups. Results The time to progression was significantly delayed in group 1 (mean: 23.3 months) compared to that of group 2 (mean: 16.9 months) (p<0.02). The time to progression in group 3 (mean: 8.45 months) was significantly shorter compared to groups 1 and 2 (p<0.001). In addition, in patients with gleason scores 5–7 (grade 2) and gleason scores >7 (grade 3) and in group 1, the time to progression (mean: 21.2 months) was significantly delayed compared to those with the same gleason scores but in group 2 (mean: 13.4 months) (p<0.001). Conclusion The reduction in PSA levels is more important than gleason scores in determining the time to progression. Early normalization of PSA levels delays the time to progression, and when combined with gleason scores, PSA is an important prognostic factor in predicting the success of the therapy.
Variations PSA Value in Patients Candidate to Biopsy of the Prostate
Authors: Galuffo A. , Serretta V. , Di Gregorio L. , Scuto F. , Bertolino V. , Ruggirello A. , Allegro R. , Ascoli R. , Pavone-Macaluso M. 
Published: June 2018

Subclinical infections of the prostate can increase the prostate-specific antigen (PSA) values in patients with normal digital rectal examination. This study aimed to evaluate the role of short-term antimicrobial therapy in reducing the PSA value in patients as candidates for transrectal biopsy. Fifty-eight patients with negative digital rectal examination and PSA values between 4 and 20 ng/mL were included in the study. Antibiotics were administered to all patients for 3 weeks, and the PSA was reassessed 10 days after the end of the treatment. Patients were subsequently submitted to prostate biopsy. A reduction in PSA was detected in 34 patients (59%). Mean percentage reduction was 32%. In only six patients (10%) did the PSA return to normal levels. Prostate biopsy revealed prostate cancer in 26 patients (45%). Prostate cancer was not detected in patients with PSA levels above 4 ng/mL. Prostate biopsy can be avoided only in a small number of patients showing the normalization of PSA levels after short-term antimicrobial therapy. These patients should be strictly monitored with frequent PSA determinations.
Role of Shock wave Therapy in Peyronie's Disease
Authors: Aresu L. , Ballario R. , Beltrami P. , Ruggera L. , Schiavone D. , Artibani W. 
Published: June 2018

Shock wave therapy (ESWT) for the treatment of Peyronie's Disease (PD) is still controversial. The aim of this study is to evaluate the efficacy of shock wave therapy in patients candidates for surgical treatment of stable PD for at least 12 months. 238 patients affected by PD were treated with ESWT since January 2000. We selected those patients (65 cases) who were having a stable disease for at least 12 months, previously treated unsuccessfully with different therapy (pharmacological, ionophoresis or infiltrations), and with an adequate follow-up. The parameters considered were the size modification of the lesion, the reduction of the penile deviation and the overall satisfaction for reaching an adequate sexual activity after the ESWT treatment. All patients received a 3000 shock waves treatment in 4 occasions during 2 weeks according to the institutional protocol. All the study patients reported to have an inadequate sexual function before the ESWT treatment. The mean age was 57 years, the penile deviation varied between 30° and 90° and the average follow-up was 18 months. In 43 cases (66%) the ultrasounds revealed a significant reduction of the penile deviation and 39 patients (60%) reported to have reached an adequate sexual activity after the ESWT treatment. ESWT represents a valid option in the treatment of PD considering that the patients’ main goal is to regain a satisfactory sexual activity. Therefore this non-invasive treatment should be included in the therapeutic guidelines of PD together with other non-surgical treatments.
Spontaneous Rupture of the Kidney
Authors: Pecoraro G. , Olivo G. , Motta L. , Frigo M. 
Published: June 2018

The rupture of the kidney with the formation of an extracapsular hematoma in the renal cavity but no evidence of external trauma or other obvious renal cause, is an uncommon finding, most often requiring urgent surgery. An underlying renal pathology, often a renal tumor, should always be suspected. This article describes the case of a 57-year-old male patient who was admitted for severe left flank pain and presented with signs of peritonism, microscopic hematuria and low hemoglobin levels; an emergency left subcostal laparotomy was performed, with removal of the hematoma and enucleation of a partially open mid-renal mass; the kidney was spared. Histology showed a WHO type I, Fuhrman grade 2, papillary renal cell carcinoma. The article deals further with frequency, presentation, type and treatment of the pathology underlying the spontaneous rupture of the kidney, particularly with regard to renal carcinoma.
Benign Prostatic Hypertrophy: A Progressive Pathology. Hypothesis for a Preventive Therapy
Authors: Sciarra A. , Cristini C. , Gentilucci A. , Iannotta L. , Parente U. , Di Pierro G.B. , Antonini F. , Alfarone A. , Di Silverio F. 
Published: June 2018

The purpose of this review is to enhance prevention as a new key aspect in the treatment of BPH. The concept of BPH as a progressive disease helps to adopt new approaches to patient evaluation and treatment. The disease progression, with respect to the risk of bladder function complications and alterations, to the progression of symptoms, and to the deterioration of the quality of life, leads to new ways of treating patients through a preventive as well as a symptomatic approach, thanks also to the identification of some parameters associated with the risk of BPH progression, i. e. the prostate volume and the serum PSA. Furthermore, the concept of progression helps the clinician to identify different classes of BPH patients with different indications of medical treatment. The PLESS, ARIA and MTOPS multicentric studies point out the preventive potential of the therapy based on 5 alpha-reductase inhibitors (finasteride and dutasteride) or their combination with alpha-1 adrenergic blockers. Only a long term evaluation (4 years or more) can lead to the identification of statistically and clinically significant outcomes for the BPH preventive therapy.
L-Propionil Carnitine (LPC) is a Propionic Outcome of Carnitine
Authors: Mantovani F. , Castelnuovo C. , Paparella S. , Inneo V. 
Published: June 2018

L-Propionil Carnitine (LPC) is a propionic derivative of Carnitine. It enhances mitochondrial activity, fat acids and free radical metabolism; it could therefore prove effective in preventing chronic oxidative diseases such as Cavernous fibrosis, which results essentially from an increase in endothelin, and a decrease in nitric oxide (NO) and prostaglandins (PGEi), as it occurs with hypoxia. An incidence of about 15% of segmentary cavernous fibrosis is reported as a consequence of, at least, a 72-hour catheterization. The physiopathology of the syndrome is still uncertain, but strongly related to vasculitis. We carried out a 15-month double-blind, prospective, randomized placebo-control study on 240 patients (age range: 42–68 years) on the possibility of preventing fìbrosis through LPC; study follow-up at 6 months, drug dose: 2g/day p.o. Cavernous fibrosis was reported in 11% of LPC treated patients, and 14% of the placebo group (p = l). Any kind of prevention, even if with poor outcomes as in our experience, should be usefully considered and improved.
Testicular Cancer. Open Questions: Prevention, Early Diagnosis and Infertility
Authors: Menditto V.G. , Polito M. , Muzzonigro F. , Minardi D. , Muzzonigro G. 
Published: June 2018

Testicular cancer is the most common malignancy in men aged 15–35 years. Histologically testicular germ-cell tumors have two main subtypes: pure seminoma and non-seminoma. Knowing the histopathological tumor type and detecting the relevant prognostic factors helps to guide the subsequent therapeutic course. At present there are no recommendations for testicular cancer screening in healthy young men, even among men showing high risk; however, a testicular cancer should be diagnosed as soon as a young man presents with suggestive signs and symptoms. Furthermore, thanks to highly effective treatments including surgery, chemotherapy, and radiation therapy, it is very important to effectively manage secondary prevention and improve these patients’ quality of life. Secondary prevention of relapses or secondary malignancy onsets should be carried out through a regular follow-up of the patient; in selected cases of positive family history, it is possible to perform genome-wide analyses aiming at searching the genes possibly causing testicular germ-cell tumor in affected first-degree male relatives. Long-term therapies can yield infertility and sexual dysfunction, issues gaining more and more importance from a clinical point of view. Sperm cryopreservation should be systematically offered to all requiring patients; moreover, screening for gonadal dysfunction should be considered in the follow-up of testicular cancer survivors, with the aim of hormone supplementation in symptomatic patients. (Urologia 2007; 74: 8–14)
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.
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.
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.