bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
“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.
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.
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.