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ABSTRACT: Background: The endourological technique is a safe and effective approach in the treatment of large stones in the pediatric population with congenital malformations. Introduction: The VACTERL association is a group of congenital malformations that include vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula with atresia, renal defects, and radial upper limb dysplasia. Renal anomalies are found in approximately 90% of patients. Materials and methods: We present a case of a 7-year-old girl with VACTERL association and cloacal malformations, undergoing multiple surgeries with subsequent Mitrofanoff continent appendico-vesicostomy. She presented at our attention for centimetric left ureteral and inferior pyelo-calyceal stones. She underwent flexible ureteroscopy with laser lithotripsy of both stones. A ureteral catheter and a nephrostomy tube have been left at the end of the procedure. Results: The ureteral catheter was removed in the 2nd post-operative day, the tubes were removed after a nephrostogram in the 8th post-operative day. The patient is stone-free. No complications were observed in the post-operative time. Conclusions: Endoscopy is the method of choice for the management of pediatric urolithiasis with complex renal calculi, due to its low incidence of major complications and a high stone-free rate.
Urologia 01/2013;
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ABSTRACT: With no more than 60 reported cases, tumors of the seminal vesicles are rare. Because of poor and nonspecific symptoms diagnosis is often very difficult. This report presents a case of a 56-year-old man with right renal agenesis and intermittent hematospermia and bilateral cystic masses of the seminal vesicles. Transrectal biopsies of the cystic lesion revealed a papillary clear cell adenocarcinoma. The patient underwent radical prostatectomy and pelvic lymphoadenectomy. Lymph node metastases were found on histological examination. The patient received 4 cycles of chemotherapy and pelvic radiotherapy. He remains disease free 21 months after surgery. Radiological imaging in patients with hematospermia and hematuria will allow disease detection at earlier stages. Immunohistochemistry and histomorphology can be used for differential diagnosis. Surgery with clear margins offers the best chance to cure. Hormonal and radio-chemotherapy have a role as adjuvant and palliative treatment.
International Journal of Surgical Pathology 06/2012; · 1.00 Impact Factor
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ABSTRACT: Laparoscopic adrenalectomy is considered the treatment of choice in the surgical management of the most majority of the adrenal diseases. Nevertheless, one of the much discussed topics is the dimensional cut-off for the laparoscopic treatment and it is not clear if laparoscopy should be used in large adrenal masses.Introduction. Laparoscopic adrenalectomy is the goal standard in benign adrenal masses smaller than 6 cm, while its advantages in masses larger than this cut-off and in malignant lesions is still discussed.
We present six cases of laparoscopic adrenalectomy since November 2008 for masses between 7 and 15 cm; 4 men and 2 women. 3 right and 3 left. A complete adrenal endocrinological evaluation demonstrated that the lesions were not secreting tumors. All patients were studied with CT scan.The technique was performed using a flank approach with a 45° tilt. We used 5 trocars in patients who had the masses on the right side, and 4 in those who had the lesions on the left side. After creating an adequate pneumoperitoneum through an open access, the posterior peritoneum cutting, mobilization of the colon, medial dissection of the adrenal gland, and ligation of the main adrenal vein were performed. The adrenal gland was carefully dissected by Ultracision. The mass was extracted by endobag through an additional subcostal port. The mean operative time was 120 minutes. Blood loss was about 50 cc. The drainage was removed on day 2 after surgery and the patient was discharged on day 3. No postoperative complication occurred. The anatomopathologic exam gave evidence of myelolipoma and hemorrhagic cyst.
The benefits of the laparoscopic approach are widely demonstrated and consist of a shorter hospital stay, reduced morbility, decreased analgesic requirement, and reduced intraoperative blood loss. One of the most discussed topics is the dimensional cut-off and it is not clear if the laparoscopy approach should be used in large adrenal masses (considering the longer operative time and increasing blood loss). Many surgeons performed laparoscopic adrenalectomy for masses of up to 13 cm, thus demonstrating that this procedure is safe and effective. A limitation of laparoscopic approach for adrenal giant masses is the increased risk to treat an adrenal cortical carcinoma.
Our experience, supported by the literature, demonstrates that the laparoscopic adrenalectomy is a feasible and effective surgical technique also in the case of giant masses. Preoperative diagnosis has a predominant role to determine the contraindication of this technique (invasive adrenal carcinoma).
Urologia 11/2011; 78 Suppl 18:S54-8.
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Granelli Pietro,
Frattini Antonio,
Ferretti Stefania,
Salsi Paolo,
Campobasso Davide,
Moretti Matteo,
Capocasale Enzo,
Mazzoni Patrizia,
Cortellini Pietro,
Pietro Granelli,
Antonio Frattini,
Stefania Ferretti,
Paolo Salsi,
Davide Campobasso,
Matteo Moretti,
Enzo Capocasale,
Patrizia Mazzoni, Pietro Cortellini
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ABSTRACT: Urolithiasis is a frequent complication in a heterotopic reservoir and the surgical management could be a difficult problem. Open surgery is not recommended in patients with multiple previous surgeries. A less invasive technique, such as the endourologic procedures, would allow high stone-free rate and low surgical morbidity.
Stone formation in the reservoir is a well-known complication of urinary diversion. The incidence of lithiasis in patients with continent urinary diversion is reported as 12-52.5%. Most patients will have multiple physical factors, such as immobility, need for self-catheterization and poor urine drainage, so that it is not certain that an intestinal reservoir is the cause of stones on its own. The management of urolithiasis in continent urinary diversion can be challenging and could be a difficult problem to solve. A less invasive technique, such as the endourologic procedures, is desiderable, especially in patients with kidney transplant and low immune defence.
We present the case of a 59-year-old woman with previous history of spina bifida and with neurogenic bladder. At a pediatric age, she underwent incontinent urinary diversion using a sigmo-colic conduit. For several years she had been suffering from kidney stones and recurrent urinary infections, which led to a left nephrectomy for pyonephrosis, subsequent deterioration of renal function and dialysis. In 2004, we performed an atypical continent and self-catheterizable reservoir using the previous colic conduit detubularized and ileum-cecal tract with Mitrofanoff system conduit of 14 Fr size. Finally, kidney transplant was carried out as last surgical procedure. Recently she has come to our attention for multiple and large reservoir stones. Surgical Technique: preliminary exploration of the continent pouch with flexible cystoscope. Percutaneous access with Endovision° direct control through the afferent conduit with 8 Fr flexible ureteroscope. Dilation of percutaneous tract with pneumatic balloon and positioning 30 Fr Amplats sheet. Lithotripsy, with ultrasound and ballistic sources, was performed and the residual fragments were removed with grasping. At the end of the procedure, after controlling the complete clearance with flexible nephroscope and X-ray, a percutanous 12 Fr catheter and a 12 Fr Foley in the Mitrofanoff conduit were inserted.
No fever or increase serum creatinine were observed in the post-operative time. On day 3, we removed the percutaneous foley and after 7 days we performed a cystography with a normal pouch configuration; no leakage or residual fragments were observed. The woman was discarge and returned to usual self-catheterization. The first 3-month post-operative control was regular; no infections or pain were reported.
In special cases, like this one, the percutaneous procedure is preferred to open surgery for a best control of the pouch and a simple complete clearence of the fragments.
Urologia 11/2011; 78 Suppl 18:49-53.
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ABSTRACT: We present the case of a 37-year-old man with a thrombosed aneurysm of a segmental branch of the left renal artery, which was diagnosed after a radiological investigation for colic-like pain, and treated conservatively with endovascular approach.
After repeated episodes of colic-like pain in his left side with normal ultrasound of the urinary tract, A.R. (37 years old) undergoes a CT urogram of the abdomen, which shows a complete thrombosis of the middle third of the left renal artery, which is associated with hypoperfusion of the lower middle third of the kidney with suspected ischemia of the lower pole. In confirmation of the previous clinical scenario, we proceed with a urgent angiography, which identifies a pseudo-aneurysm, partially thrombosed, of the segmental branch of the left renal artery at the lower middle pole. During the hospitalization, the clinical picture is complicated by an unstable arterial hypertension associated with headache and nausea. A renal scintigraphy confirms a severe impairment of the renal function mainly at the level of the middle third of the lower left kidney. The total glomerular filtration rate sec. Gates was equal to 64.3 mL/min with a percentage breakdown of the global renal function of 28% to the right and 72% to the left. The location of the vascular defect argues for endovascular intervention in the attempt to preserve the remaining renal parenchyma. We proceed with a standard angiography with selective access to the left renal artery with a catheter via femoral artery Cobra 5Fx80 TERUSMO cm. The tortuosity of the thrombus and the angle of the aneurysm site prevent, despite several attempts, the passage of the guide wire for a possible stenting and fibrinolysis. We opt for the placement of 5 spirals at the aneurysm (Boston Soft GDC-10 SR 360 7mm x 15cm), in order to preserve the residual parenchyma, excluding the aneurysmal artery at risk of rupture and extent of the thrombus.
Immediately after the procedure, the clinical picture remained stable with complete remission of painful symptoms and with a good blood pressure control. At about 6 months, the renal scintigraphy shows a filtered global impairment of 70%, 30% for the left kidney, a slight improvement over the previous controls. The blood pressure remains within the limits with amlodipine 5 mg.
Renal artery aneurysms are uncommon and occur in approximately 0.09% of the general population. The etiopathogenesis at a young age is often dysplastic in nature and the diagnosis is made incidentally or during evaluation of related symptoms, being asymptomatic until they become complicated. Their treatment is proposed to prevent complications such as rupture or thrombosis. Given the extreme variability of presentation, the surgical technique, traditional or endoscopic, is at the surgeon's discretion. In our case, we opted for a conservative approach since the degree of renal parenchyma impairment and the patient's hemodynamic condition allowed to.
Urologia 11/2011; 78 Suppl 18:39-44.
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ABSTRACT: Testicular cancer is the most common malignancy in 20- to 34-years-old males. It has been stated that testicular cancer derives from a precocious lesion, the carcinoma in situ of the testis, also known as Intratubular Germ Cell Neoplasia (IGCN) or Testicular Intraepithelial Neoplasia (TIN). This lesion deserves great attention, because the diagnosis of CIS may lead to a precocious diagnosis of testicular cancer. Generally, the diagnosis of CIS is incidental. Every physician should know the management of this precocious lesion, as the correct management of CIS can lead to a decrease of the incidence of overt testicular cancer (the most frequent malignancy in young men). Moreover, the correct diagnosis and management of CIS can shorten the hospital stay, reduce the cost, and improve the social impact of the testicular cancer.
Acta bio-medica: Atenei Parmensis 08/2011; 82(2):162-9.
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ABSTRACT: Lichen sclerosus is a chronic immuno-mediated skin disease of the genital region in men and women. The treatment may be pharmacological or surgical, the choice depending on the extension of the involved area, the histological pattern and the level of functional disease complained by the patient. If the biopsy is negative for neoplastic degeneration the treatment may be pharmacological only. In our paper, we describe the case of a patient with vulvar disease and labial fusion, burial of the clitoris and severe introital stenosis. In this case, the treatment was surgical.
Acta bio-medica: Atenei Parmensis 04/2011; 82(1):51-7.
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ABSTRACT: The first laparoscopic adrenalectomy was performed and described by Gagner in 1992. Since then, this technique has become more and more widespread and there is common agreement in the literature that it is the gold standard for adrenalectomy. Laparoscopic adrenalectomy is indicated in benign adrenal masses, and it is routinely performed in masses smaller than 5 to 7 cm. The laparoscopic procedure in masses larger than this cut-off is discussed, although many investigators agree about its feasibility, safety and effectiveness. We present this case: man, 39 years old, large palpable mass in the right hypochondrium. Computed tomography scan (CT) suggested the diagnosis of giant adrenal myelolipoma (15x12x7 cm). Complete adrenal endoclinologic evaluation showed that the lesion was not a secreting tumor. Laparoscopic adrenalectomy was performed with good results.
Surgical laparoscopy, endoscopy & percutaneous techniques 08/2010; 20(4):288-90. · 1.23 Impact Factor
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ABSTRACT: Vanilloids are natural molecules identified in a plethora of foods normally ingested through the diet. They mediate apoptosis through a direct pathway (independent of TRPV-1, the receptor for vanilloids) and through an indirect pathway, i.e., thanks to the interaction with TRPV-1 and the successive intracellular calcium growth [Ca2+]i. Some vanilloids, such as capsaicin, dihydrocapsaicin and resiniferatoxin (the ultrapotent analogue of capsaicin, extractable from Euphorbia resinifera), may be considered as coenzyme Qantagonists: in fact, they inhibit the run of the electrons through the electron transport chain, so determining an excess of reactive oxygen species (ROS). A second effect of the interaction between the vanilloids and TRPV-1 receptor may be reported: it is the fast decrease of the transmembrane mitochondrial potential (delta psi m). Through the direct pathway, on the contrary, the vanilloids induce apoptosis also interacting with caspases, particularly caspase 1 and 3. On the whole, the vanilloids are able to lead to the intracellular calcium growth and consequently to the evidence of precocious and late elements of apoptosis.
Acta bio-medica: Atenei Parmensis 05/2009; 80(1):13-20.
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ABSTRACT: Radical prostatectomy is followed by postoperative pain, that can be linked to potential morbidity. Aim of this study is to compare efficacy of epidural infusion of ropivacaine and fentanyl versus intravenous administration of morphine in terms of reduction of pain and possible complications.
We have considered 73 consecutive patients who underwent a retropubic radical prostatectomy. For analgesia control we have considered the use of epidural infusion of ropivacaine and fentanyl (Group R) in 48 patients, compared to continuous intravenous administration of morphine (Group M) in 25 patients. Evaluation criteria have been: blood pressure, heart and breath rate, sedation state, nausea and vomit, entity of pain with VRS scale (Verbal Rating Score) at rest and in movement in the first 72 hours, canalization and need of additional analgesia.
VRS values were lower in Group R especially during movement, and need of additional analgesia was reported in one patient of Group R, and in three patients of Group M; assumption of morphine was interrupted in three patients. Epidural catheter was removed for malfunction in three patients, and seven patients complained for leg paresthesia.
Sedation resulted higher in group M. Mobilization in second day occurred with fewer difficulties for patients of group R, while canalization resulted delayed in group M. Results underlined a good analgesic cover in both groups. Advantages of epidural analgesia are represented by the use of smaller doses of opioids, fewer cardiocirculatory and respiratory side effects, lower incidence of nausea and vomit, early canalization and post-operative mobilization.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 04/2007; 79(1):7-11.
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ABSTRACT: We aim to report the results of the curative, non-palliative, treatment of resection of lung metastases that are secondary to renal cell carcinoma (RCC).
Between 1988 and 2004, a radical metastasectomy with curative purposes was performed in 20 (11 males and 9 females) patients with renal clear cell carcinoma (RCC) who had already undergone nephrectomy and subsequently metastasectomy of lung metastases. The mean age was 66,9 years (range 48-81 years).
the intraoperative mortality of patients undergoing surgical resection of lung metastases from RCC was 0%; 17 out of 20 patients returned at follow up; 9 patients died; the mean survival-time after nephrectomy was 64+/-42 months (range 7-132 months) and the mean survival-time after metastasectomy was 31+/-29 months (range 4-99 months); 4 out of 9 pts had pulmonary recurrence after surgery. 8 patients are still alive; the mean follow up after nephrectomy was 134+/-115 months (range 30-372 months) and 72+/-44 months (range 25-150 months) after metastasectomy. 1 out of 8 pts had a pulmonary recurrence that was treated by surgery.
the radical resection of lung metastases is a safe and effective treatment in selected RCC patients.
Acta bio-medica: Atenei Parmensis 02/2007; 78(1):41-5.
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ABSTRACT: Medullary sponge kidney (MSK) is an uncommon benign congenital disorder, generally asymptomatic. In symptomatic patients the diagnosis is usually made by excretory urography performed in the most frequent complications such as renal stones, urinary tract infections and haematuria. Excretory urography can be very characteristic, showing cystic collections of ectatic collecting ducts like "bunches of grapes" or "bouquet of flowers". When haematuria represents the only symptom, and radiographic findings are not characteristic of MSK, the differential diagnosis with a renal tumor can be very difficult. We report a case of MSK that underwent nephrectomy since clinical and radiological features mimicked a renal tumor.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 01/2006; 77(4):202-5.
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ABSTRACT: The most greater part of the tumors ureteralis are of malignant nature, they are verified especially in the elderly patient and they have a preference for the distal third of the ureter. Of the tumors benign ureteral, the emangioma is a very rare vascular neoplasm. The symptoms aspecificis of presentation are: hematuria, colic type pains, hydronephrosis and bladder inflammation. Thanks to the refinement of the radiological techniques (Urography, CTscan and eventually the ascending pyelography) and also to the simultaneous aid of the anatomopathologist, it is possible to obtain an accurate description of this pathology in a precocious stage in order to carry out a conservative approach. The peculiarity of the clinical case from us described depends on the fact that it deals with an occasional find, reaches our observation for appearance of severe hydronephrosis caused by ureteral stones, resolved him with methodic endoscopic.
Acta bio-medica: Atenei Parmensis 10/2005; 76(2):115-7.
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ABSTRACT: Uretero-vascular fistulae are rare. As compared to aortic, uretero-iliac fistulae are by far more frequent according to a 1:8 ratio. We present one case of uretero-prosthetic fistula in a man operated upon the resection of an aortobisiliac aneurysm and Dacron prosthetic graft; six years later, a blunt trauma to the body was followed by a threatening shock, resistant to medical measures. Two subsequent emergency operations allowed to a difficult diagnosis and a life-saving repair of the fistula. Some hypotheses on the pathogenesis of the condition are discussed as well as its clinical problems.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 07/2005; 77(3):151-2.
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ABSTRACT: To evaluate the comparative efficacy and morbidity of standard transurethral resection of prostate (TURP) and transurethral vaporesection (TUVRP) using four types of loops.
In a one-to-one randomized study, 50 patients with lower urinary-tract symptoms suggestive of bladder outlet obstruction and benign prostatic enlargement underwent TURP. Clinical data were collected using digital rectal examination, transrectal ultrasonography for evaluation of prostate volume, IPSS and IIEF-5 questionnaires, and serum prostate specific antigen concentrations. Intraoperative blood loss and fluid absorption were evaluated by measuring serum hemoglobin and respiratory alcohol concentration. Patients were followed at 3 and 18 months with evaluation of clinical symptoms, flow rates, residual urine volumes, and complications.
There were no significant differences in blood loss, intraoperative fluid absorption, procedure time, or weight of the resected tissue between standard TURP and TUVRP with the various loops. No significant complications (infections, urethral stricture, reintervention) were seen.
In this comparison of the clinical outcome and morbidity of standard TURP versus different loops for TUVRP, there were no significant differences in any of the parameters evaluated.
Journal of Endourology 12/2004; 18(9):897-900. · 1.85 Impact Factor
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ABSTRACT: Carcinosarcoma of the bladder is a very unusual neoplasm that arises more frequently in males with a greater incidence in the seventh decade of life. There are no patognomonic clinical findings or symptoms to address its presence. Symptoms, as for other bladder cancers, are fundamentally represented by haematuria and dysuria. It has a very aggressive clinical behaviour and it is histologically characterized by a malignant epithelial component associated with a sarcoma-like (sarcomatoid) component variably represented.
Acta bio-medica: Atenei Parmensis 05/2004; 75(1):74-6.
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ABSTRACT: A case of severe hemorrhage after TURP leading to hypovolemic shock and its successful management by superselective unilateral arterial embolization is described. The authors conclude that arterial embolization is a safe and effective procedure for severe prostatic hemorrhage that may be performed in selected cases when conservative means or fulguration of the prostatic fossa have failed to achieve the control of the bleeding. Adequate selection of the patients, correction of any underlying coagulation defects and a proper resection technique are surely the most important issues in preventing any postoperative bleeding.
Urologia Internationalis 02/2002; 69(4):318-20. · 0.99 Impact Factor
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ABSTRACT: Collecting duct carcinoma of the kidney is a rare and aggressive neoplasm of the distal collecting tube, often metastatic at the time of the diagnosis, for which there is no established therapy. We herein describe the case of a 65-year-old man with a renal cancer with a particular immunohistochemical pattern and pathologic aspect. The lesion was diagnosed as a tumor borderline between a urothelial carcinoma with intraductal spreading and a collecting duct carcinoma with calyceal and pelvic spreading. The patient is disease-free 11 months after diagnosis, after radical surgery with adjuvant chemotherapy (carboplatin and gemcitabine) and radiotherapy of a local recurrence. Owing to the common embryologic origin of collecting duct and transitional urothelial cells, several authors have reported an association between collecting duct carcinoma and urothelial cancer. The literature is reviewed to evaluate drugs active against urothelial cancer (like ifosfamide, paclitaxel, carboplatin and gemcitabine). This field should be investigated in the future, in the framework of a neoadjuvant or adjuvant chemotherapy able to support radical surgery for local and advanced collecting duct carcinoma.
Tumori 92(6):545-8. · 0.86 Impact Factor
