[Show abstract][Hide abstract] ABSTRACT: Between 27% and 53% of all patients who undergo radical prostatectomy (RP) or radiation therapy (RT) as the first-line treatment of prostate cancer (PCa) develop a biochemical recurrence. Imaging plays a pivotal role in restaging by helping to distinguish between local relapse and metastatic disease (i.e., lymph-node and skeletal metastases). At present, the most promising tools for assessing PCa patients with biochemical recurrence are multiparametric magnetic resonance imaging (mpMRI) and positron emission tomography (PET)/computed tomography (CT) with radio-labeled choline derivatives.
The main advantage of mpMRI is its high diagnostic accuracy in detecting local recurrence, while choline-PET/CT is able to identify lymph-node metastases when they are not suspicious on morphological imaging. The most recent advances in the field of fusion imaging have shown that multimodal co-registration, synchronized navigation, and combined interpretation are more valuable than the individual; separate assessment offered by different diagnostic techniques. The objective of the present essay was to describe the value of bimodal choline-PET/mpMRI fusion imaging and trimodal choline-PET/mpMRI/transrectal ultrasound (TRUS) in the assessment of PCa recurrence after RP and RT. Bimodal choline-PET/mpMRI fusion imaging allows morphological, functional, and metabolic information to be combined, thereby overcoming the limitations of each separate imaging modality. In addition, trimodal real-time choline-PET/mpMRI/TRUS fusion imaging may be useful for the planning and real-time guidance of biopsy procedures in order to obtain histological confirmation of the local recurrence.
No preview · Article · Jan 2015 · Abdominal Imaging
[Show abstract][Hide abstract] ABSTRACT: Stent-less procedure following ureterolithotripsy needs a definition for patient selection and procedure criteria. To mediate stenting versus no stenting, a retrospective study was performed to evaluate the insertion of an ureteral open-tip catheter for 24 hours.
From 2002 to 2006 255 ureterolithotripsy were performed (176 male - 79 female, mean age 51.5 y.o.). Stone was in the upper ureter in 101 cases, in the mid in 89 and the lower in 65. Patients were retrospectively separated into 3 groups: in Group A a stent was placed because of complicated lithotripsy and left for 15 days. In Group B an open-tip catheter was placed for 24 hours. In Group C no catheter was left. All patients were evaluated for symptoms as need of antalgic substances.
In Group A 134 patients were stented. The mean stone dimensions were 8.7mm. Flank pain was reported in 52 patients (38%) on post-op 15 days, 77 patients (57.4%) referred lower urinary tract symptoms, 2 patients reported hematuria. In Group B 105 patients (41.1%) were stented with open-tip catheter. The mean stone dimension was 6.3 mm. Pain was referred in 43 patient (40.9%) after the catheter removal. In 12 cases (11.4%) hospital readmission was necessary due to pain. Group C was represented by 16 patients (6.27%). Mean stone dimension was 6mm. No postoperative pain was reported. A statistical difference (p < 0.005) is significative comparing the operative time for the stent vs open-tip group.
No rules establish if it is correct to stent or to avoid this procedure, so trying to resolve the dilemma by inserting an open tip catheter for 24 hours seems a good response. The operating time is reduced for no stenting or positioning catheter vs stenting. To reduce immediate post-ureteroscopy complication placing an open-tip catheter for 24 hours seems to be a simple and cheap procedure.
No preview · Article · Mar 2009 · Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia