Abstract: The excision of the renal tumor with a substantial margin of healthy parenchyma is considered the gold standard technique for partial nephrectomy. However, simple enucleation showed excellent results in some retrospective series. We compared the oncologic outcomes after standard partial nephrectomy and simple enucleation.
Abstract: What's known on the subject? and What does the study add? Treg overexpression has been demonstrated in several neoplasms, including liver, breast, pancreas and melanoma, while it has not been well evaluated in renal cancer. In renal cancer patients versus controls we found an increased expression of these cells, especially in tumour-infiltrating lymphocytes. Moreover, Treg frequency significantly correlated with pathological stage, nuclear grade and prognostic models.
Abstract: Study Type - Therapy (individual cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Tumour enucleation was demonstrated to be an oncologically safe conservative treatment for small renal masses in agreement with the EAU guidelines. Nevertheless, the theoretical increased risk of positive surgical margins and local recurrence, led some authors to hypothesize a possible key role of laser or diathermy ablation of the tumour bed to free the kidney parenchyma from any tumour cells that extended in the kidney parenchyma. Our pathological and clinical results showed that tumour enucleation with no ablation of the tumour bed (e.g. diathermy, argon beam or Nd-YAG laser) can ensure negative surgical margins and it is not associated with an increased risk of local recurrence.
Abstract: The aim of the present study was to evaluate how serum testosterone level (T) can affect urinary continence and erectile function in patients undergoing radical prostatectomy (RP). We included 257 patients with clinically localized prostate cancer, those who had filled out preoperative quality of life questionnaires (University of California, Los Angeles Prostate Cancer Index, International Index of Erectile Function (IIEF)), and those who had T and total PSA sampled the day before surgery. We calculated correlations between T and age, body mass index (BMI), PSA, urinary function or bother (UF, UB) and sexual function or bother (SF, SB) and IIEF-5 in the whole population and in sub-populations with normal (> or =10.4 nmol l(-1)) and low (<10.4 ng ml(-1)) T using Pearson's and Spearman's correlation coefficients. We evaluated differences in these parameters between patients with low and normal T using the unpaired samples t-test and Mann-Whitney test, and finally the correlation between UF and SF, UB and SB, and between PSA and T in the overall population, and separately in patients with low and normal T using the Pearson's correlation coefficient. Mean preoperative T was 13.5 nmol l(-1) and 23.7% of patients presented a low T. Mean age, mean BMI and mean preoperative total PSA at RP were 64.3 years, 25.9 kg m(-2) and 9.0 ng ml(-1), respectively. BMI was negatively correlated with T in the overall population (r=-0.266; P=0.02); moreover, patients with normal T presented lower BMI compared with patients with low T (25.7 vs 27.6: P=0.02). We found a significant correlation between SF scores and T in patients with normal T (r=0.1777: P=0.05). SF was significantly higher in patients with normal T compared with those with low T (74.8 vs 64.8: P=0.05). Furthermore, UF and UB were significantly correlated with SF (r=0.2544: P<0.01) and SB (r=0.2512: P=0.01), respectively, in men with normal T. Serum T was significantly correlated with PSA in men with low T (r=0.3874: P=0.0029), whereas this correlation was missed in the whole population and in men with normal T. The correlation between preoperative PSA and T in men with low T is in agreement with the 'saturation' model proposed by Morgentaler. The correlation between basal T and preoperative erectile function and urinary continence underlines the importance of assessing T before RP.
Abstract: The aim of our study was to analyze the role of perineural invasion (PNI) as a predictive parameter of outcome after radical prostatectomy (RRP) in pathologically organ-confined prostate cancer (PCa) and to assess its possible correlation with other well-known prognostic features.
Abstract: A new edition of the TNM was recently released that includes modifications for the staging system of kidney cancers. Specifically, T2 cancers were subclassified into T2a and T2b (< or =10 cm vs >10 cm), tumors with renal vein involvement or perinephric fat involvement were classified as T3a cancers, and those with adrenal involvement were classified as T4 cancers.
Abstract: Although cancer-associated fibroblasts (CAF) are key determinants in the malignant progression of cancer, their functional contribution to this process is still unclear. Analysis of the mutual interplay between prostate carcinoma cells and CAFs revealed a mandatory role of carcinoma-derived interleukin-6 in fibroblast activation. In turn, activated fibroblasts through secretion of metalloproteinases elicit in cancer cells a clear epithelial-mesenchymal transition (EMT), as well as enhancement of tumor growth and development of spontaneous metastases. CAF-induced EMT leads prostate carcinoma cells to enhance expression of stem cell markers, as well as the ability to form prostaspheres and to self-renew. Hence, the paracrine interplay between CAFs and cancer cells leads to an EMT-driven gain of cancer stem cell properties associated with aggressiveness and metastatic spread.
Abstract: The oncologic safety of blunt tumor enucleation (TE) of renal cell carcinoma (RCC) depends on the presence of a continuous pseudocapsule (PS) around the tumor and on the possibility of obtaining negative surgical margins (SMs).
Abstract: This study aimed to evaluate the authors' initial experience with antegrade stenting. It focused on the success rate, time required for stent insertion, possible complications, and relative solutions in the first 44 procedures.
Abstract: We investigated the expression of the 2 spliced variants of the CXCR3 receptor (CXCR3-A and CXCR3-B) and their ligands (MIG, IP-10 and I-TAC) in patients with renal cell carcinoma according to conventional prognostic factors and the necrosis pattern.
Abstract: Tumor enucleation consists of excising the tumor by blunt dissection following the natural cleavage plane between the peritumoral pseudocapsule and the renal parenchyma without removing a visible rim of healthy renal tissue. In the very recent years, the urological current opinion have changed from a wide skepticism against tumor enucleation to a wider level of acceptance based on the lack of correlation between the width of the resection margin and the risk of disease progression/local recurrence and on larger retrospective series on tumor enucleation with longer follow up. The aim of the present review is to report the technique of tumor enucleation, discuss some technical aspects that can vary between centers and to summarize the oncological and surgical results of this technique for the conservative treatment of RCC in the last 10 years; finally, to briefly present the pathological findings on pseudocapsule and surgical margins prospectively evaluated after tumor enucleation.
Abstract: After long term disease free follow up (FUp) patients reconsider quality of life (QOL) outcomes. Aim of this study is assess QoL in prostate cancer patients who are disease-free at least 5 years after radical prostatectomy (RP).
Abstract: A 64-year-old man was treated with brachytherapy for prostate cancer. Prostate-specific antigen (PSA) nadir was achieved at 3 months, while at 24 months PSA increased to 18.7 ng ml(-1). Re-biopsy and imaging revealed locally recurrent prostate carcinoma without metastasis. The patient was treated with salvage radical prostatectomy, and the surgical specimen underwent double-blind evaluation with RX scan and whole-mount histopathology sections. Radiology revealed an area without any seeds in the right base of the prostate, and pathologic assessment demonstrated adenocarcinoma involving the right base of the gland. This case is indicative of tumor relapse occurring for seed migration after good initial positioning.
Abstract: To present the oncological outcome of the antegrade radical prostatectomy in the whole series of consecutive patients treated over an 18-yr period, and to report the functional results and complications of the last 488 patients.
Abstract: Prostate cancer (CaP) represents a major leading cause of morbidity and mortality in the Western world. Elevated cholesterol levels, resulting from altered cholesterol metabolism, have been found in CaP cells. Seladin-1 (SELective Alzheimer Disease INdicator-1)/DHCR24 is a recently described gene involved in cholesterol biosynthesis. Here, we demonstrated the androgen regulation of seladin-1/DHCR24 expression, due to the presence of androgen responsive element sequences in its promoter region. In metastatic androgen receptor-negative CaP cells seladin-1/DHCR24 expression and cholesterol amount were reduced compared to androgen receptor-positive cells. In tumor samples from 61 patients who underwent radical prostatectomy the expression of seladin-1/DHCR24 was significantly higher with respect to normal tissues. In addition, in cancer tissues mRNA levels were positively related to T stage. In tumor specimens from 23 patients who received androgen ablation treatment for 3 months before surgery seladin-1/DHCR24 expression was significantly lower with respect to patients treated by surgery only. In conclusion, our study demonstrated for the first time the androgen regulation of the seladin-1/DHCR24 gene and the presence of a higher level of expression in CaP tissues, compared to the normal prostate. These findings, together with the results previously obtained in metastatic disease, suggest an involvement of this gene in CaP.
Abstract: The usual treatment options for clinically localized prostate cancer carry a significant risk of lasting side effects, including urinary, bowel, and sexual dysfunction, that can alter overall the patient's quality of life. The aim of this research is to evaluate the impact of treatment timing (age at time of treatment, follow-up duration, age at time of follow-up), pretreatment tumor characteristics (clinical stage, Gleason score, PSA), and posttreatment outcomes (hormonal status, biochemical recurrence), on health-related quality of life (HRQOL) among men who had undergone radical treatment for prostate cancer.
Abstract: We defined the prognostic role of tumor necrosis and its extent in nonmetastatic clear cell renal cell carcinoma. Also, we further investigated its pathogenesis by correlating this tumor feature with other pathological characteristics and molecular markers related to the von Hippel Lindau-hypoxia inducible factor pathway and to tumor proliferation.
Abstract: Chronic prostatitis/chronic pelvic pain syndrome is a major healthcare burden. Affected patient quality of life is poor and currently no investigated treatments have significant long-term benefit. We performed a preliminary investigation of the role of physical activity and its effects on select patients with chronic prostatitis/chronic pelvic pain syndrome.
Abstract: An 84-year-old patient presented with partial extrusion of a semirigid penile prosthesis, implanted 20 years earlier following a diagnosis of erectile dysfunction refractory to oral and injection therapy. Four years previously, the patient was diagnosed with bilateral obliterans arteriopathy limited to the iliac arteries and, two years later, with chronic renal failure. At presentation, the patient complained of lower urinary tract symptoms, and his body temperature was 39 degres C. Physical Examination, Urine Culture, and Blood Tests were performed; a spontaneous partial extrusion of the left rod of the penile prosthesis through a urethral erosion was observed. A manual removal of the eroded cylinder under local anaesthesia was achieved.
Abstract: The aim of study is to verify the aptitude of urodynamists to carry out an objective description of uroflowmetric parameters and to formulate a diagnostic suspicion by using merely the visual interpretation of uroflowmetry curves. An anonymous questionnaire including ten uroflowmetry curves was administered to urologists participating in the XXVI Congress of the Italian Society of Urodynamics (SIUD). To evaluate the accuracy in the description of uroflowmetry pattern, we asked to classify as "normal" or "abnormal" all uroflowmetry parameters; to assess the capability to outline a diagnostic suspicion, we requested to choose one out of six possible diagnoses. Inter- and intraobserver agreements were calculated. We overall recruited 105 questionnaires out of 300 urologists attending the SIUD Congress. Substantial interobserver agreement was obtained for maximum flow rate, average flow rate, flow time, and voiding time (K=0.79, 0.79, 0.77, and 0.72), whereas substantial intraobserver agreements were evidenced for maximum flow rate and flow time (K=0.70 and 0.63). We noted substantial agreement for the "No abnormalities" diagnosis (K=0.72), fair agreement for "Urethral stricture" (K=0.30), and slight agreement for both "Benign prostatic obstruction" and "Bladder outflow obstruction" (K=0.17 and 0.20); moreover, we reported a moderate intraobserver agreement (K=0.05) on diagnostic suspicion. Maximum flow rate, average flow rate, flow time, and voiding time are properly assessed by the large part of urodynamists. Flow curves from healthy men or from patients with urethral stricture or benign prostatic obstruction are easily recognizable. Long experience and daily practice may make the difference in the assessment of uroflowmetry curves.
Abstract: To evaluate the outcome in patients with clinically localized prostate cancer and pathologic Gleason score 8 to 10 disease treated by anterograde radical prostatectomy, either alone for node-negative disease or with early hormonal therapy for node-positive disease, and to characterize the prognostic significance of other pathologic variables.
Abstract: We present our findings in a series of patients treated with simple enucleation for RCC 4 to 7 cm in greatest dimension. We specifically report the incidence of local and systemic recurrence, and the disease specific survival rate.
Abstract: The Urinary Bladder Cancer (UBC) test is a marker that detects urinary fragments of cytokeratin 8 and 18. The aim of this study is to evaluate the usefulness of the pre and post operative UBC test to detect early recurrences of a bladder tumor in the first year after the transurethral resection of a bladder tumor.
Abstract: To evaluate the safety and efficacy of simple enucleation as a conservative treatment for pT1a RCC, and to report on the incidence of major complications, local recurrence, and progression-free and disease-specific survival rates.
Abstract: We present our findings in a series of T1a renal cell carcinoma treated with elective simple enucleation, specifically reporting the incidence of local recurrence, and progression-free and disease specific survival rates.
Abstract: To evaluate the incidence of positive surgical margins (and associated risk factors) in patients with localized prostate cancer at high preoperative risk of extracapsular disease treated using a modified anterograde radical retropubic prostatectomy technique. Positive surgical margins are an important risk factor for disease recurrence after radical prostatectomy, particularly in patients with extracapsular disease.
Abstract: This article describes an unexpected case of a giant neobladder stone in a female that was diagnosed incidentally for a concurrent ovarian disease, without clinical or instrumental evidence of neobladder over distension. In July 1989, M.A., woman, 39-years old, underwent radical cystectomy, saving the uterus and the ovaries, and orthotopic ileal bladder substitution. Twelve years later she had symptoms of diffuse abdominal discomfort for about one month, without noticeable urinary symptoms or urinary retention. Enhanced CT and a subsequent MRI showed the presence of a 10 x 12.5 x 19 cm capsulated ovaric mass with sharp edges and associated obstructive bilateral hydroureteronephrosis, and an oval-shaped stone with a 10 cm longitudinal diameter, which occupied the majority of the neobladder cavity. The patient underwent surgical operation to remove the ovaric mass (fibrotecoma) and to extract the giant floating stone by a neocystotomy. Its dimensions were 10.5 x 7 x 7 cm, weighing 760 g. The stone was triple phosphate on chemical-physical analysis. The case reveals that neobladder stones can be associated with very few symptoms and if an appropriate follow-up is not performed they can become of remarkable dimensions.
Abstract: To evaluate the toxicity of gemcitabine and cisplatin combination therapy in adjuvant regimen after radical cystectomy for muscle invasive bladder cancer.
Abstract: Renal endothelin-1 participates in sodium and water handling, and its urinary excretion is increased in sodium-retentive states. We compared the cortical and medullary renal expression of prepro-endothelin-1, endothelin-converting enzyme-1, and endothelin type A and type B receptors in patients who underwent nephrectomy after normal (108 mmol/d NaCl; n=6) or low (20 mmol/d NaCl; n=6) sodium diet and investigated whether sodium exerts a direct role on endothelin receptor binding in vitro. With normal sodium diet prepro-endothelin-1 mRNA was 3-fold higher in renal medulla than in cortex (P<0.01), whereas endothelin-converting enzyme-1 mRNA was equally distributed. Endothelin-1 receptor density was 2-fold higher in renal medulla than in cortex (P<0.05). Type B was the main receptor subtype in both regions. In the renal cortex, low sodium diet caused a 194% increase in prepro-endothelin-1 mRNA (P<0.05), whereas endothelin-converting enzyme-1 type B and type A receptors remained unchanged. In contrast, in the renal medulla the increase in prepro-endothelin-1 mRNA (+30%, P<0.05) was associated with a selective increase in type B receptor for both mRNA expression (+37%, P<0.05) and binding density (+55%, P<0.05). Increasing in vitro sodium concentrations between 154 and 308 mmol/L significantly enhanced type B receptor density (P<0.05) and affinity (P<0.05). In conclusion, during low sodium diet, renal prepro-endothelin-1 synthesis increases mainly in the renal cortex (where no changes in receptors occur), whereas type B receptor is selectively enhanced in the renal medulla. The range of sodium concentrations that are physiologically present in vivo in the renal medulla selectively modulate type B receptor density and affinity.
Abstract: Rapid testicular enlargement is usually strongly suggestive of tumor. Primary testicular infiltration due to amyloidosis is rare. We report a new case of primary testicular amyloidosis in a 72-year-old white man who presented with a short history of painless right testis enlargement.
Abstract: Circulating prostate cells can be detected in peripheral blood of patients with clinically localized or advanced prostate carcinoma. Traditionally, nested reverse transcriptase-polymerase chain reaction (RT-PCR) is used for this as a sensitive, but qualitative only, detection system. We developed a quantitative real-time RT-PCR method for measuring prostate-specific antigen (PSA) mRNA in peripheral blood of prostate cancer patients. A quantitative assay was developed using an external standard reference curve generated with RNA from the human prostate cell line LNCaP. Basal blood samples were collected from 44 patients without evidence of distant metastases and from 30 healthy controls. In 29 patients surgically treated with radical prostatectomy, the measurement of PSA mRNA was performed in blood samples collected before, at the end and 6 days after surgery. In 14 patients treated with radiotherapy, the measurements were repeated at 3-month intervals to evaluate time-related changes during therapy. The measurements were also performed for one year at 3-month intervals in one patient treated with anti-androgen therapy. We found detectable PSA mRNA in 14/44 (32%) basal blood samples. A wide range of values were observed in these patients, ranging from 0.5 to 1724 pg of total LNCaP RNA/ml blood. In patients undergoing radical prostatectomy, circulating PSA mRNA was detectable in eight patients in basal samples, and in seven of them also in blood specimens collected at the end of surgery, showing an increase in only two patients. In blood samples collected 6 days later, PSA mRNA was dramatically reduced in all patients, but still present in seven of them. In four patients, whose basal samples were negative, PSA mRNA was detectable in samples collected at the end of surgery and three of them were negative after 6 days. In patients who did not receive surgical treatment, a rapid decrease in PSA mRNA was demonstrated in five patients treated with radiotherapy and in one patient undergoing androgen deprivation. No detectable PSA mRNA was found in healthy controls. The levels of PSA mRNA in peripheral blood from patients with prostate carcinoma can be easily measured by this sensitive, quantitative and reliable procedure. This assay is a promising tool for the detection and follow-up of these patients.
Abstract: Radical nephrectomy is the treatment of first choice for unilateral renal cell carcinoma (RCC) with a healthy contralateral kidney; however, the current standard for dealing with RCC in patients with a solitary kidney, bilateral tumor and renal or systemic disease inducing a progressive impairment of renal function is nephron-sparing surgery.
Abstract: Motor patterns, intraluminal pressures, volume capacity, and histoanatomic characteristics were studied in full thickness specimens from ileal reservoirs (orthotopic ileal bladders) removed during corrective surgery. Contractile activity was recorded in situ before corrective surgery. Morphological examination was performed with both light and electron microscopy. Two populations of interstitial cells of Cajal (ICC) were identified: ICC at the level of the deep muscular plexus (ICC-DMP) and ICC at the level of the myenteric plexus (ICC-MP). The ileal reservoirs left as tubes generated phasic activity when filled with liquid, and all retained the ICC-MP; however, after extended periods (e.g., 8 yr), these reservoirs lost the ICC-DMP and were less responsive to distension. The detubularized ileal reservoirs were not responsive to distension and did not generate phasic activity; none had ICC-DMP and all had a disrupted ICC-MP network. In conclusion, motor patterns were found to be specific for each type of reservoir, and the two populations of ICC had characteristics specific for the type of bladder reconstruction.
Abstract: The purpose of this study was to investigate the accuracy of endorectal coil MRI in the local staging of prostate carcinoma. A total of 73 patients with biopsy-proven prostate carcinoma were examined at 0.5 T prior being submitted to radical prostatectomy. The gold standard was provided in all patients by findings at whole-mount sectioning of the surgical specimens. At pathology 28 patients had stage T2, 30 had stage T3a/b, and 15 had stage T3c lesions. Overall accuracy of endorectal coil MRI in defining local tumor stage was 82% (60 of 73 patients). Of 73 patients, 5 (7%) were underestimated and 8 (11%) overestimated. The sensitivity and the specificity of endorectal coil MRI in diagnosing capsular penetration were 95% and 82%, respectively. Seminal vesicle invasion was detected with 80% sensitivity and 93% specificity. Our data indicate that endorectal coil MRI is an accurate method for local staging of prostate cancer.
Abstract: The morphology of the mucosa of orthotopic ileal bladders in place for 3 months to 4 years was studied in biopsies obtained at random from 12 patients. A mucosal flattening, a reorganization of the lining epithelium and a disappearance of the fenestrated areas of blood capillaries were found. Enterocytes progressively stratified and acquired poorly differentiated features, along with loss of microvilli, reduction of the apical fuzzy glycocalyx and enlargement of intercellular spaces. Goblet cells at short-term evaluation were actively involved in mucous synthesis and secretion. Metabolic acidosis was slight both in short-term postoperative periods-under alkaline therapy- and in long-term postoperative periods-when therapy was suspended. It can be concluded that, firstly, urine contact determines in such reservoirs a condition of acute irritation and, secondly, environmental changes induce the ileal mucosa to develop a new phenotype probably better suited to a protective rather than absorptive function.
Abstract: Second stage reconfiguration of Camey I neobladder with intact ileal loop was performed in 3 patients due to poor functional results and associated complications requiring reintervention. Neoblasdder capacity increased from a mean volume of 240 to 593 mL, maximum endoluminal pressure decreased from a mean value of 86 to 29 mm water, and night-time incontinence uniformly disappeared. Loop detubularization and reconfiguration, therefore, results in marked improvement of the clinical and urodynamic characteristics of Camey I ileal neobladder.
Abstract: Studer ileal bladder substitute is a low pressure reservoir anastomosed to the membranous urethra. Suitable length of mesentery is necessary to allow the ileal loop to reach the urethral stump. However, reconfiguration by double folding of the detubularized ileal segment tends to move the inferior portion of the pouch away from the membranous urethra making more difficult, if not impossible, the ileo-urethral anastomosis. In order to avoid this technical limitation, we suggest a reconfiguration of the lowest portion of the pouch into the shape of a 5-cm-long funnel, which permits the loop to approach the urethral stump and therefore facilitates the ileo-urethral anastomosis. This technique has been successfully employed in 10 patients. Eight of them have clinical, radiological and urodynamic follow-up.
Abstract: Since January 1985, orthotopic ileal bladder substitution after radical cystectomy was performed in 64 male patients. The Camey I procedure was performed in 35 patients (group 1) and the Studer procedure in 29 (group 2). Clinical, metabolic and urodynamic evaluation was performed at regular intervals with a mean follow-up of 27 months for group 1 and 13.6 months for group 2. Patients with a Camey I bladder reconstruction presented smaller capacity and higher intraluminal pressure resulting in shorter voiding intervals and a practically uniform presence of enuresis, as opposed to those reconstructed with the Studer procedure. The incidence of ureteral reflux was also higher in group 1. Metabolic studies in both groups revealed a slight metabolic acidosis which was treated with oral alkalinization. It is concluded that detubularization of the terminal ileum creates a more favorable low-pressure reservoir.
Abstract: A 10-cm-long refluxing ureteric stump following nephrectomy in a woman with a neurogenic bladder was successfully treated endoscopically. The procedure consisted of endoluminal occlusion with a fibrin adhesive complex followed by meatal sealing by a submucosal injection of polytetrafluoroethylene paste.
