bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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. Summary 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.
Treatment of Acute Iatrogenic Cystitis Secondary to Bladder Chemo-Immuno-Instillation or Pelvic Radiotherapy
Authors: Sommariva Monica L , Sandri Sandro D. , Guerrer Chiara S. 
Published: June 2018

The onset of cystitis during intravesical chemo-immunotherapy for the treatment of non-muscle invasive transitional cell bladder tumor, or after pelvic radiotherapy mainly for prostate cancer, is a frequent clinical situation, not easily manageable due to the lack of responsiveness to symptomatic drugs, often resulting in discontinuation of cancer treatment in many cases. The similarity of symptoms with those of the painful bladder syndrome, otherwise called interstitial cystitis, has led us to use the same treatment with intravesical sodium hyaluronate in order to obtain an improvement of symptomatology. We therefore performed a prospective study on 55 consecutive male symptomatic patients, aged from 54 to 81 years: 11 after radiotherapy, 17 after BCG and 27 after Mitomicyn C bladder instillations, 12 of whom in combination with bladder hyperthermia. All subjects underwent bladder instillations with sodium hyaluronate 40 mg in 50 mL weekly for 8 to 24 weeks depending on the time needed to the resolution of the symptoms. During the first 4 weeks 32 mg of dexamethasone were also instilled intravesically, mixed with hyaluronate, in order to obtain a stronger anti-inflammatory activity due also to its higher capacity of penetration in the bladder mucosa. The symptoms intensity was evaluated through a Visual Analogue Score (VAS) of the discomfort and pain perceived from 0 to 10, and bladder capacity was recorded with micturition diary before and after the treatment. After 16 weeks VAS improved in every case of chemical cystitis from an initial mean value of 8.6 to a final mean value of 1(with 3 as a maximum value recorded). The difference was highly significant (p <0.001). Bladder capacity increased in all cases of chemical cystitis from a mean value of 56 to 276 mL with a highly significant improvement (p <0.001) and in all cases of post-actinic cystitis from a mean bladder capacity of 89 to a final mean value of 239 mL, with a significant improvement (p= 0.05). We did not observe any side effect due to our treatment. Therefore, we can conclude that bladder instillation with sodium hyaluronate for at least 8 weeks and dexamethasone in the first 4 weeks can solve the symptoms of iatrogenic cystitis secondary to chemo-immunotherapy or pelvic radiotherapy, without incurring in side effects. To our knowledge this treatment has never been published before in scientific medical literature.