bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complete Intermittent Androgenic Deprivation in Prostate Cancer: Our Experience
Authors: De Dominicis C. , Michetti P.M. , Musy M. , Orsolini G. , De Mayo E.E. , Fraioli A. 
Published: June 2018

Our study aimed at a retrospective evaluation of clinicAL/biochemical progression in prostate cancer patients treated with intermittent androgenic deprivation (IAD) after a period of continuous cut off (CAD). Methods From 1996 to 2003 40 patients have been screened. 8 (gr.A) with increased PSA after radical prostatectomy (pT2N0M0); 32 (gr.B) had no surgical treatment due to age or other pathologies (Gleason ≤ 8). Patients have been monitored dosing out PSA every 3 months. CAD has been applied for an average period of 40 ± 10 months (med. 36). IAD has been performed by an “off” stage of interruption, alternately with an “on” stage of treatment. The cut-off for the suspension/resumption of therapy has been 0.4 ng/mL of PSA for group A and 3 ng/mL for group B. All patients have been received at least 3 cycles of therapy, each including “on” and “off” stages. Results After an average follow-up of 48 ± 12 months (med. 42) since the beginning of IAD, the progression-free survival has been 100% for group A and 96.8% for group B. The intermediate time of stage “off” during IAD pointed out a progression increment from the first cycle (51.6% gr. A, 46.6% gr. B) to the third cycle (73.5% gr. A, 76% gr. B). Conclusions The study pointed out that the actual average time of pharmacological treatment has been 47% for the period CAD+IAD and 31.5% for IAD only, keeping the PSA always near the nadir. Besides keeping the progression close to 0, we obtained an appreciable saving on the pharmacological costs and an improvement in the quality of life of patients due to the regression of the side-effects of therapy during stage “off”. Nevertheless it is still controversial in the Litterature on the pharmacological procedure to adopt, on the more suitable values of cut-off in PSA and on the timing of monitoring of patients.
The Prognostic Value of P53 in Predicting of Bladder Carcinoma
Authors: Pavone C. , Serretta V. , Galuffo A. , Vella M. , Allegro R. , Morello V. , Porcasi R. , Tomasino R.M. , Pavone-Macaluso M. 
Published: June 2018

The prognostic value of p53 in predicting recurrence and progression of superficial transitional cell carcinoma of the bladder (TCCB) is still uncertain. Materials and methods P53 expression was retrospectively assessed in 160 patients. At a median follow-up of 45 months, (up to years) 84 patients (53%) recurred and 13 (8%) progressed. Adjuvant intravesical chemotherapy after TUR was adopted in 51 patients (32%). The correlations between p53 and G-grade, T-category, risk of recurrence and progression, and intravesical chemotherapy were investigated. Similarly, the correlations between variations in grade and stage at recurrence and modifications in p53 expression were also studied. Results Seventy-nine patients (49%) were negative for p53. P53 was expressed in 84% of G3 tumors and in 65% of T1 lesions. A significant correlation between p53 expression and G-grade (p<0.0001) and T-category (p<0.0001) of the tumor was found. Eight-four patients (53%) recurred and 13 (8%) progressed. No correlation was found with recurrence and response to intravesical chemotherapy. P53 expression resulted correlated to progression in T1 tumors (although was not independent from G-grade). Conclusion According to our experience, p53 expression is not independent from grade and stage of superficial TCCB. A significant correlation between p53 expression and progression, not independent from G-grade, was detected only in T1 tumors.
Bilateral Pyelocutaneous Ileal Conduit in a Diffuse Neoplasia of Urinary Tract
Authors: Leoni S. , Loreto A. , Zuliani C. Guatti , Mora A. , Rossi R. , Bedogni G. , Spatafora S. 
Published: June 2018

We present a surgic solution that we adopted in a case of diffuse neoplasia from the upper urinary tract to the bladder and the prostatic urethra. Case 67 year-old male, has been submitted to bladder mapping with results of diffuse CIS and sequential immunotherapy with BCG. The three month control had pathological findings of CIS in the bladder and in the prostatic urethra. The staging has shown neoplasia in both kidneys. We had performed a cystoprostatectomy with a bilateral ureterectomy and cleaning of the intrarenal tissue. We had performed a bilateral pyelocutaneous ileal conduit in accord with Holland. Results The kidney parameters at 6 months were normal and the patient was well. The control, in general anesthesia with a pediatric gastroscope, in the pelvis and calyx with x-ray facility, didn't show a recidive in the kidney. Otherwise in annual control a little neoplasia in the right kidney was found. In the successive control at 18 and at 24 months we had found no signs of neoplasia. Conclusions Despite this extreme case, in which the neoplasia is in all of the urinary tract, it is possible to preserve the kidneys, to have a good oncological result and to preserve the renal function with a good quality of life, to avoid or to delay the bilateral nefrectomy.
Flexible Endoscopic Extraction of Clinically Significant Fragments after Eswl
Authors: Defidio L. , Piccolotti D. , De Dominicis M. , Santini V. , Nesci L. 
Published: June 2018

Residual fragments after ESWL which are clinically significant are a clear indication to their removal. The flexible endoscopic extraction represents the method of choice for its minimal invasion. We report a case of residual fragments after ESWL with recurrent colics and hydronephrosis treated with a double J stenting. Ten fragments were removed retrograde with a flexible ureteroscope and a nitinol basket. We used a ureteral sheath to facilitate the many reintroduction of the instrument. We believe this technique is to be considered as the first choice treatment for this kind of pathology.
Percutaneous Treatment of Uretero-Intestinal Stenosis with Acucise®: Preliminary Experience
Authors: Orsi F. , Penco S. , Matei V. , Bonomo G. , Monfardini L. , De Cobelli O. 
Published: June 2018

The incidence of stenosis of uretero-intestinal anastomoses is about 5–10%. The most relevant effect of this post-surgical complication is the progressive renal function deterioration. Infections, ureteric ischemia, perianastomotic urinary extravasation and apposition of two different types of mucosa are the main causes of this complication. Several options are available for the treatment of these strictures: surgery, ureteral stenting, balloon dilation, endoscopic electrocautery or laser incision. The Acucise® catheter system combines diatermic incision with balloon dilation. Material and methods 9 stenosis of uretero-intestinal anastomoses have been treated with Acusise® endoureterotomy in 7 patients. All the patients underwent to radical cistectomy with urinary diversion for oncological disease. The diagnosis has been obtained with US and/or CT examination. Residual renal function has been assessed with sequential renal scintigraphy. The procedure includes two parts: percutaneous pleacement of nephrostomic catheter with distal part inside the neo-bladder and, after 15 days, treatment with Acucise®. The incision was performed with 75W activation of the cutting wire during inflation of the balloon at the level of stenosis. Results Mean follow-up is about 5 months so we can't consider the long term effects of the treatment but our preliminary results are interesting, with an adequate patency of the anastomoses in 8/9 cases at CT scan. The procedure, performed under fluoroscopic control and local anaesthesia, resulted ease and safe with low procedural complications. Conclusions If long term results will be confirm, Acucise® could be suggested as first-line treatment in these situations; surgery should be indicated in case of minimally invasive procedure approach.
Hereditary Predisposition and Prostate Cancer
Authors: Sacco E. , Prayer-Galetti T. , Pinto F. , Ciaccia M. , Fracalanza S. , Betto G. , Pagano F. 
Published: June 2018

A genetic component in prostate cancer (PCa) has been recognized for decades, and much evidence has been accumulated in favor of a significant, but heterogeneous hereditary component in PCa. Purpose We studied the incidence of the familial and hereditary forms of PCa in our population of patients with a diagnosis of PCa clinically localized and age at diagnosis <65 yrs. Materials and methods: We administered a questionnaire to 667 patients submitted to radical prostatectomy from July 1978 to December 2002, obtaining a complete familial oncological anamnesis in 499 patients. The patients were followed-up until death or until 30 June 2004. Patients were classified into three categories according to Carter: familial, hereditary and sporadic PCa. Results A positive family history for PCa was found in 72 patients (14.4%). In 15 patients (3%), we observed a hereditary form of PCa and in 57 patients (11.4%) a familial form. Patients with hereditary PCa had a lower age at diagnosis (55 yrs). Genealogical pedigrees ruled out mendelian dominant autosomical transmission. No difference was found in the preoperatory, clinical and pathological features among the three PCa groups. A statistically significant familial association was found between PCa and cancer of breast and uterus. Conclusions This study supports evidence of a hereditary predisposition to PCa and the suggestion that an excess familial risk of PCa is due to the inheritance of multiple moderate-risk genetic variants.
Results of a Phase I-II Pilot Study with Intravescical Gemcitabine in Superficial Bladder Cancer (Ta-T1)
Authors: Serretta V. , Galuffo A. , Parrinello M. , Ruggirello A. , Daricello G , Pavone C. , Pavone-Macaluso M. 
Published: June 2018

To study the ablative activity of intravescical gemcitabine against superficial transitional cell carcinoma of the bladder at different doses and concentrations. Methods Twenty-seven patients were treated with intravescical gemcitabine after transurethral resection, during which one to three papillary marker lesions were left unresected. Starting 14 days after transurethral resection, six gemcitabine instillations were given at weekly intervals. Gemcitabine, diluted in 50 mL of saline solution and maintained for 2 hr, was given at a dose of 500, 1000 and 2000 mg in groups of nine patients each. A complete response (CR) was defined as negative cutologycystoscopy and biopsy findings. Results Of the 27 patients, one was lost to follow-up, and of the remaining 26 patients, six (23%) achieved a CR. A CR was achieved in one patient (12.5%), in two patients (22.2%) and in three patients (33.3%) at dose of 500, 1000 and 2000 mg, respectively. A partial response was obtained in two additional patients (22%) at a dose of 500 and 1000 mg. Bladder Tis was diagnosed in two patients with a CR at 8 and 3 months, respectively. Systemic and local tolerability was excellent, and the interruption of treatment was not required. Conclusions Our experience has shown the good tolerability and the potential efficacy of intravescical gemcitabine against recurrent transitional cell carcinoma of the bladder. Gemcitabine could be proposed, if our results are confirmed by larger studies, as a second-line therapy in patients who cannot tolerate more aggressive intravescical therapy.
Retroperitoneal Fibrosis, Today: An Updating of Knowledges on this Subjet
Authors: Alberti C. , Mediago M. , Chiapello G. , Bernardi D. , Arena G. 
Published: June 2018

Retroperitoneal fibrosis (RPF) is characterized, at first, by a replacement of the normal retroperitoneal tissue by an active granulomatosis inflammation (cellular phase), and at a later stage by a fibrous scar tissue (established fibrotic phase). The aetiology of secondary RPFs includes several drugs (notably methysergide, ergotamine, pergolide, hydralazine), both chronic atherosclerotic aortitis-periaortitis and inflammatory aortic aneurisms, autoimmune diseases such as different forms of systemic vasculitis and collagen diseases, histiocytosis such as Erdheim-Chester syndrome, desmoplastic reactions to retroperitoneal malignancy carcinoid syndrome, retroperitoneal accidentally and surgically occurred traumas, abdominal radiation therapy. On the contrary, the causes of idiopathic RPF remain uncertain; its pathogenesis is associated to immuno-mediated mechanisms. The inflammatory process can involve retroperitoneal vessels, ureters, peri- and pararenal spaces, mesenteric small intestine, duodenum, psoas muscles, and can spread to mediastinal space. Diagnosis and characterization of the polyphase inflammatory evolution require integrated approaches including laboratory tests, morpho-functional imaging and, sometimes, histopathologic assessment. In the early stages, the management of RPF ranges from the removal of identifiable etiologic agents to the interfering with the inflammatory immuno-mediated process by means of several drugs. Unfortunately, many effective immunosuppressive drugs induce adverse reactions unrelated to their specific immunosuppressive action; this is the reason why the biopharmacology research today is struggling towards the identification of molecular targets having their expression restricted to immune cells and/or cytokines. Moreover, the progression of atheromatous aortitis to RPF could be prevented by statins which are able to interfere with the inflammatory pathway as well as to induce the well-known reduction in the levels of atherogenic lipoproteins. In the late established fibrotic stage, either open surgery or endourologic, laparoscopic procedures are performed; nevertheless neoadiuvant and adiuvant corticosteroid-immunosuppressive treatments are mandatory in order to avoid any relapse of the disease.
Clinical Insignificant Residual Fragments (CIRF) after Extracorporeal Lithotripsy: Implications and Treatment
Authors: Merlo F. , Cicerello E. , Anselmo G. 
Published: June 2018

The stone-free status depends on the appropriate selection of the urologic treatment according to the stone and excretory tract characteristics, and/or to the patient parameters. Although the gold standard for the treatment is the stone-free status, the authors believe that the presence of non-infected, nonobstructive, asymptomatic residual fragments, smaller than 4–5 mm, can be treated with an adequate medical therapy in order to prevent stone growth. Further urological treatment is recommended if the clinical indications for stone removal persist.
Testis Sparing Microsurgery
Authors: Rolle L. , Timpano M. , Destefanis P. , Bosio A. , Fiori C. , Tamagnone A. , Demaria C. , Vigna D. , Ceruti C. , Negro C. , Burlo P. , Fontana D. 
Published: June 2018

The unexpected detection of non palpable hypoechoic testicular lesions has become more frequent thanks to the increased use of trans-scrotal ultrasound (US): patients are often asymptomatic and the objective examination reveals no palpable masses. The different diagnostic, therapeutic approaches vary from radical orchifunicolectomy to simple US follow-up, although the guidelines on the management of these lesions are not defined, yet. The article shows our series of patients with hypoechoic testicular lesions who underwent surgical exploration, with the aid of the operating microscope and histologic test. Materials and Methods 6 patients in total underwent microsurgical exploration of non palpable hypoechoic testicular lesions, from April 2003 to December 2004. Results 4 out of the 6 cases were a left-sided testicular lesion, whereas the 2 remaining cases revealed a right-sided lesion [hypoechoic areas mean size = 3.9 mm (range 2.5 – 16)]. The lesions in all patients could be easily identified and successfully excised thanks to the microsurgical technique. The intraoperative frozen section examination (FSE) showed a benign lesion in 5 cases and an intratubular germ cell neoplasia (ITGCN) in one. Patient with ITGCN underwent radical orchiectomy. The final histological analysis confirmed the frozen section examination report for all the 6 cases. Patients were clinically and ultrasonographically evaluated with a mean follow-up of 15 months. No complication occurred. Conclusion Microsurgical exploration of the testis combined with FSE represents a safe, effective and reliable technique in case of non palpable hypoechoic testicular lesions. This approach leads to significant advantages and should be considered especially in patients with a solitary testis or presenting bilateral lesions, and wishing to father a child.
Modified Nesbit Procedure: An Easy and Effective Technique
Authors: Rolle L. , Timpano M. , Ceruti C. , Tamagnone A. , Destefanis P. , Fiori C. , Demaria C. , Vigna D. , Negro C. , Fontana D. 
Published: June 2018

This paper reports the results of a modified Nesbit procedure, designed to increase precision and to simplify the correction of penile congenital or acquired curvatures. Materials and Methods 58 patients in total were considered candidates for surgical treatment of penile curvature, and underwent a modified corporoplasty procedure involving plication suture on the convex aspect of the penis before tunica albuginea resection. Hospital records and follow-up data were retrospectively reviewed. Results 37 patients were affected by congenital penile curvature (mean angle: 48 degrees - range 40 to 90); they reported difficult vaginal penetration. Another 21 patients suffered from Peyronie's disease, with mean angle penile deformity of 48 degrees (range 40 to 60), but no hourglass deformity or hinge effects. All patients had spontaneous and full erections. Mean operative time ±SD was 62±15 minutes. No intra-operative complications were reported. Penile curvature was completely corrected in all cases. Neither residual curvatures nor hypercorrections were recorded. Regarding erectile function, which was evaluated in the Peyronie's disease group, pre-operative average International Index of Erectile Function-5 score was 17.83±4.17, whereas post-operatively it was 19±4.63 (p >0.036). With regard to overall satisfaction, 3 patients (5%) with Peyronie's disease were unsatisfied. Conclusions This modified corporoplasty procedure has resulted in an improved straightening outcome thanks to the possibility of performing tunica albuginea excision only after the surgeon has made and verified the exact correction in real time. A slight but statistically significant improvement in erectile function was observed in patients with Peyronie's disease.
Epidural Post-Operative Analgesia in Major Urologic Surgery: Our Experiences
Authors: Fasciolo A. , Parodi E. , Zanghi A. , Buscaglia V. 
Published: June 2018

Pulmonary, cardiovascular, gastrointestinal and urinary dysfunctions are among the physiologic outcomes of surgical lesions and stress, as well as metabolic, muscular and neuroendocrine disorders. Our purpose is to prevent such complications in order to optimize the healing process and improve the patient's satisfaction through the application of a post-operative codified analgesia protocol allowing the combined use of local anaesthetics and morphine by both epidural bolus injection and elastomeric pump. All the patients enrolled underwent the same anaesthetic program: the data processing emphasizes the satisfactory analgesic results of the treatment. More than 80% of the patients did not feel pain at awakening, up to 98.5% during the following hours; one patient only was still complaining 96 hours after surgery. This excellent analgesic function results in an extremely low rate of severe post-operative complications, despite the fact that patients underwent radical and often prolonged surgery (31% was affected by severe systemic pathology). We encountered a negligible and easy-to-treat complication rate secondary to the analgesic technique or to the infused drugs; the epidural analgesia proved effective in the healing process, with high satisfaction of clinicians and patients. This represents for sure a fundamental alternative to the various methods described in literature.
Percutaneous Treatment of the Obstructive Uropathy
Authors: Orlacchio A. , Laviani F. , Simonetti G. 
Published: June 2018

Purpose to analyse the technical aspects, the patient's selection criteria, and some useful tactics to reduce the complications of percutaneous nephrostomy and of other interventional procedures to temporarily treat obstructive uropathy (OU), such as double J stent insertion, dilatation of the stricture using high-pressure balloon catheters, removal of renal or ureteral calculi, fistulas treatment. Materials and Methods a fluoroscopy table and an ultrasonographic guidance are key elements. Two techniques are employed, either the Seldinger type (wire-guided catheters) or the trocar needle type. Sole contraindication: uncorrectable severe coagulopathy. Most important risk factors are: dendritic calculus, non corrected high blood pressure, obesity, small size kidney, severe scoliosis. Results high technical success of the procedure in case of dilated collecting systems (98%); it is minor without dilatation (85%). Conclusion percutaneous nephrostomy is indicated in 87% of obstructive uropathy cases. It represents the basic technique allowing other interventional procedures to treat obstructive uropathy; it should be performed by most radiologists following an adequate training with technique and materials.
An Alternative dosing Regimen with Tadalafil 3 Times/Week in the Treatment of Erectile Dysfunction: Italian Data from the SURE Study
Authors: Mirone V. , Imbimbo C. , Rossi A. , Sicuteri R. , Valle D. , Fusco N. Longo EF. 
Published: June 2018

Aim. To evaluate the preference for 2 dosing regimens of tadalafil 20 mg, on demand or 3 times/week, in Italian men affected by erectile dysfunction (ED). Materials and Methods. SURE is a multicenter, crossover, open-label study, involving 94 urology centers in Italy. Patients aged 18 or more, affected by ED for at least 3 months were enrolled into the study and randomized to a tadalafil 20 mg treatment on demand or 3 times/week for 5–6 weeks. After a 1-week washout period, patients were crossed over to the alternate regimen for 5–6 weeks. A treatment preference question (TPQ) was used to determine the preferred treatment regimen. IIEF and SEP questionnaires were used as efficacy measures. Results. 1058 men, mean age 54.8 years, were randomized to treatment. Overall, 59.1% of patients preferred the on-demand regimen and 41.9% preferred the 3 times/week dosing regimen. Both regimens were efficacious and well tolerated. Conclusions. Tadalafil is effective and well tolerated whether used both on demand and three times/week. Patients should be given the possibility to choose the best treatment regimen according to personal needs and preferences. (Urologia 2007; 74: 30–6)
Evolution and progress in bladder replacement
Authors: Fontana D. , Destefanis P. , Cugiani A. 
Published: June 2018

Nowadays, the first choice after radical cystectomy both in male and in female patients is no more urinary diversion, but bladder replacement surgery through orthotopic reconstruction. In 2006 we carried out a mail interview among Italian Urology Departments about urinary diversions and orthotopic neobladders; the choice for orthotopic neobladder had increased compared to a previous interview administered five years before. As far as the type of orthotopic neobladders are concerned, it was evident that Italian urologists prefer to use the ileal reservoir, preferably the Studer's neobladder, followed by VIP; the use of Camey II is decreasing while Y-neobladder has gained many consents, being preferred to Hautmann's reservoir. The findings of this interview suggest that the ideal orthotopic neobladder hasn't been proposed, yet, and that Italian urologists are still looking for easier and more reliable solutions.