[Show abstract][Hide abstract] ABSTRACT: We report a case of a 75-year-old male with biopsy-proven prostate cancer and candidate for radical prostatectomy. The patient's medical history includes hypertension and atrial fibrillation in prophylactic treatment; however, he was suffering from recurrent paroxysmal episodes of supraventricular tachycardia. Abdominal magnetic resonance performed for prostate cancer staging detected a non-lymphatic inter-cavo-aortic mass of 42 × 37 × 43 cm. Results of biochemical screening confirmed the clinical diagnosis of symptomatic paraganglioma. The patient was subjected in a single robotic session for concurrent excision of the inter-aortocaval mass and radical prostatectomy with bilateral pelvic lymph-node dissection. During the procedure, there were no anesthesiological or surgical complications. The postoperative course was uneventful and the patient was discharged on postoperative day 5. Six months after surgery, his prostate-specific antigen level was undetectable and the abdominal magnetic resonance imaging was negative for local recurrence or metastasis of paraganglioma. No more episodes of tachycardia were reported or antihypertensive therapy was necessary.
Preview · Article · Jul 2015 · Canadian Urological Association journal = Journal de l'Association des urologues du Canada
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION AND AIMS: Chronic Kidney Disease (CKD) is an asymptomatic condition with insidious progression; new biomarkers for early diagnosis are needed. MicroRNAs (miRs) are short, non-coding RNAs controlling gene expression at post-transcriptional level. MiRs are involved in cell homeostasis and disease; they are highly stable in tissue and bio-fluids and easy to detect. More evidence is needed on the role of miRs in promoting CKD after Radical Nephrectomy (RN) for Renal Cell Carcinoma (RCC) and their potential as biomarkers for early diagnosis and follow-up. Whole transcriptome and candidate microRNA expression was assessed in patients (pts) undergoing RN for RCC: here we report preliminary data on the expression analysis of miR-200b which has been previously described as a mediator of renal fibrosis in hypertensive and diabetic nephropathy. METHODS: A total of 150 patients (pts) were divided into a discovery (n=48) and a validation cohort (n=102); living kidney donors (n=20) were used as controls. Exclusion criteria were: (1) eGFR ≤ 60 ml/min sec CKD-EPI creatinine equation 2009; (2) serum creatinine ≥ 1.2 mg/dl, proteinuria ≥ 30 mg/die; (3) coexistent diabetic/hypertensive nephropathy or primitive-secondary glomerulonephritis or polycystic disease (PKD) or nephrolithiasis; (3) metastasis at diagnosis; (4) current or previous nephrotoxic therapies (e.g. litium, chemotherapy for other tumors). Formalin Fixed Paraffin Embedded tissue blocks were reviewed by a pathologist: normal tissue adjacent (>3cm) to the RCC was used for the analysis. Renal cortex (10 glomeruli) and medulla were marked and isolated by manual microdissection. miR extraction was performed using Ambion (LifeTechnologies) Recover All Isolation Kit. MiR expression analysis was performed by Nanostring (nCounter Technology) and by Real-Time PCR (LifeTechnologies). RESULTS: Pts in the discovery cohort were stratified according to renal function calculated at 12 months from surgery: CKD pts (if eGFR ≤ 60 ml/min) and Normal Kidney Function (NKF) pts (if eGFR > 60 ml/min). No significant differences in miR-200b expression among cortex in CKD, NKF and donors were observed (p=0.26). On the contrary miR-200b was significantly overexpressed in medulla of CKD vs. NKF patients (Figure 1; p<0.007) CONCLUSIONS: miR-200b up-regulation may control genes involved in the early tubular-interstitial fibrosis before an overt eGFR decay. Further studies are currently ongoing to confirm our findings in our validation cohort and in urine samples from the same patients.
[Show abstract][Hide abstract] ABSTRACT: Urinary continence (UC) recovery remains bothersome for patients even after robotic radical prostatectomy (RARP). We described the first retropubic suburethral autologous sling created and placed during RARP. The surgical technique and preliminary data regarding its effectiveness in improving early UC recovery are presented.
Between November 2013 and February 2014, 60 patients who underwent RARP at a single high-volume center were prospectively randomized into sling and nonsling groups. Early UC was assessed at 5 days (time of catheter removal), 10 days, and 30 days postoperatively by the daily number of pads used and the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) score. Sling-related operative time and urethral erosion were also analyzed. Chi-square and independent sample t tests were used to investigate surgical and functional outcomes between groups.
Complete data were available for all patients. Mean±SD numbers of pads used daily in nonsling and sling groups, respectively, were 1.9±1.2 versus 1.7±1.4 (p=0.5) at 5 days, 1.8±1.3 versus 1.3±1.3 (p=0.1) at 10 days, and 1.1±1.2 versus 0.4±0.8 (p=0.01) at 30 days. At 1 month, mean±SD ICIQ-UI-SF scores in nonsling and sling groups, respectively, were 4.8±4.6 versus 1.8±3.4 (p=0.01); sling patients were associated with pad-free status (76% vs 46%, p=0.03). The advantage in UC recovery was also observed in sling patients at 3, 6, and 12 months postoperatively. Surgical time did not differ between groups, and in sling patients, no cases of urethral erosion or uroflowmetry suggestive of urinary obstruction were found. Limitations included the small sample size and the lack of assessment of morphological and urodynamic changes produced by the sling.
The suburethral autologous sling is technically feasible and may improve early UC recovery after RARP. These preliminary results should be confirmed in a larger sample of patients.
Preview · Article · Apr 2015 · European Urology Supplements
[Show abstract][Hide abstract] ABSTRACT: To evaluate technical feasibility and oncologic and functional outcomes of three different surgical procedures of nerve-sparing radical cystectomy (NS-RC) for the treatment of organ-confined bladder cancer at a single referral centre.
All consecutive cases of NS-RC carried out between 1997 and 2012 were retrospectively analysed. NS-RC included nerve-sparing cysto-vesicleprostatectomy (NS-CVP), capsule-sparing cystectomy (CS-C) and seminal-sparing cysto-prostatectomy (SS-CP). Peri-operative parameters and post-operative outcomes were analysed.
Overall, 90 patients underwent NS-RC, 35 (38.9 %) of whom received a NS-CVP, while 36 (40 %) and 19 (21.1 %) underwent capsule CS-C and SS-CP, respectively. No difference was registered comparing oncologic outcomes of the three different techniques; however, two local recurrences after CS-C were attributed to the surgical technique. Complete post-operative daytime and night-time urinary continence (UC) at 24 and 48 months was achieved in 94.4 and 74.4 % and in 88.8 and 84.4 % of cases, respectively. CS-C showed both the best UC and sexual function preservation rate at early follow-up (24 months). Overall, a satisfactory post-operative erectile function (IIEF-5 ≥ 22) was proved in 57 (68.6 %) and 54 (65.0 %) patients at 24 and 48 months, respectively. Significant difference was found when comparing sexual function preservation rate of NS-CVP (28.5 %) to that of CS-C (91.6 %) and SS-CP (84.2 %).
NS-RC for male patients accounted for 7.4 % of overall radical cystectomy. To a limited extent of the selected organ-confined bladder cancers treated, the three different procedures analysed showed comparable results in terms of local recurrence and cancer-specific survival. Both CS-C and SS-CP procedures provided excellent functional outcomes when compared to original NS-CVP.
Full-text · Article · Jan 2015 · World Journal of Urology
[Show abstract][Hide abstract] ABSTRACT: We report the case of a 50-year-old healthy man with early onset of micturition symptoms associated with an elevated total prostate-specific antigen. On physical examination, we found an enlarged prostate; a first-line ultrasound of the urinary tract revealed local disease which covered the entire small pelvis. A computed tomography scan confirmed the presence of a 12.5 × 11.0 × 9.5-cm multicystic prostatic mass, compressing the bladder and pelvic ureters, associated with right hydronephrosis. Renal function was preserved and prostatic biopsies was negative for malignant disease. The mass was completely removed through transvesical approach and histological analysis diagnosed a low-grade phyllodes tumour of the prostate. The patient was free of local recurrence and metastasis 36 months after surgery.
[Show abstract][Hide abstract] ABSTRACT: Aim:
Although previous studies assessed the effects of Serenoa repens, quercetin and β-sitosterol on inflammatory parameters, no randomized studies have tested the combination of these agents neither on BPH symptoms nor on the inflammatory pattern. The aim of this trial was to evaluate the effects of Difaprost® on voiding dysfunction, histological inflammatory alterations and apoptotic molecular mechanisms in BPH patients.
We included 36 patients affected by BPH with obstructive symptoms eligible for surgery. Patients were randomly assigned to two groups: 18 patients received Difaprost® for three months before surgery, and 18 patients did not receive any additional therapy and were scheduled for surgery. All patients receiving Difaprost® were evaluated with uroflowmetry with post-void residual volume (PVR) evaluation, serum PSA, and IPSS questionnaire before and after treatment. Moreover, we evaluated inflammatory patterns in prostatic specimens at final pathology.
Even without statistically significant differences on inflammatory pattern between patients receiving Difaprost® and controls, patients receiving Difaprost® had lower presence of edema and angiectasia at histological evaluation of prostate specimens. Moreover, patients included in the treatment group had a clinically significant reduction of PVR (46.1 vs. 25.2 mL; P=0.1) and a slight increase in Qmed (5.6 vs. 6.5 mL/s; P=0.9) after three months of chronic treatment with Difaprost®. No statistically significant differences were recorded in other clinical parameters between patients receiving Difaprost® and controls.
Although not statistically significant, patients treated with Difaprost® showed an improvement in voiding function compared to controls (namely, an increase in Qmed and a reduction of PVR). Future trials with a larger number of patients and a longer treatment period could be necessary to evaluate the clinical efficacy of Difaprost®.
No preview · Article · Jun 2014 · Minerva urologica e nefrologica = The Italian journal of urology and nephrology
[Show abstract][Hide abstract] ABSTRACT: To assess external genitalia sensitivity and sexual function in adult patients affected by Congenital Adrenal Hyperplasia (CAH) and submitted to Passerini-Glazel feminizing genitoplasty at paediatric age compared with a control group of healthy counterparts.
Inclusion criteria were: CAH, Passerini-Glazel feminizing genitoplasty, adult age, penetrative vaginal intercourse. Thermal and vibratory sensitivity of clitoris, vagina and labia minora were analyzed using the Genito-Sensory Analyzer (GSA). Psychosexual outcome was assessed with Beck's questionnaire for depression, Zung Self-rating Anxiety Scale (SAS), Female Sexual Distress Scale (FSDS) and Female Sexual Function Index (FSFI). Matched analyses were performed to compare patients' outcomes with healthy medical students as control group. All statistical tests were performed using the Statistical Program for Social Sciences (SPSS) - version 18.0 RESULTS: Twelve patients (12/120=10%) entered the study. Clitoral sensitivity, both thermal and vibratory, was significantly decreased in all patients compared with healthy controls (p<0.01). There was no difference in vaginal sensitivity, both thermal and vibratory. At FSDS 11 patients (91.6%) and 11 controls (91.6%,) described stable satisfactory relationship. All patients reported active sexual desire, good arousal, adequate lubrification and orgasm. No significant difference in FSFI global score and single domain scores was observed between CAH patients and healthy controls.
Although clitoral sensitivity in sexually active patients treated with Passerini-Glazel feminizing genitoplasty is significantly reduced compared to controls, sexual function in those patients is not statistically and clinically significantly different from healthy counterparts. Finally, one-stage Passerini-Glazel feminizing genitoplasty seems to allow normal adult sexual function.
No preview · Article · Aug 2013 · The Journal of urology
[Show abstract][Hide abstract] ABSTRACT: In surgically treated patients with renal cell carcinoma (RCC), the progression-free survival (PFS) rate may significantly change according to the progression-free postoperative period. To test this hypothesis, we set to evaluate the conditional PFS rate in surgically treated patients with RCC.
We evaluated 1,454 patients with RCC, surgically treated between 1987 and 2010, at a single institution. Cumulative survival estimates were used to generate conditional PFS rates. Separate Cox regression models were fitted to predict clinical-progression risk in patients who were progression free from 1 to 10 years after surgery.
During the immediate postoperative period, the 5-year PFS rate was 88%, and it increased to 92%, 94%, and 97% in patients who remained progression free at, respectively, 1, 5, and 10 years after surgery. At multivariable analyses, where patients with stage I disease were considered as a reference, the highest clinical-progression risk was observed at the eighth postoperative year in patients with stage II disease (hazard ratio [HR]: 2.9) and during the immediate postoperative period in patients with stage III to IV disease (HR: 5.5). In comparison with patients with grade I disease, the highest clinical-progression risk was observed at the fourth (as well as eighth) postoperative year in patients with grade II disease (HR: 5.7), sixth postoperative year in patients with grade III disease (HR: 7.2), and during the immediate postoperative period in patients with grade IV disease (HR: 8.5).
The postoperative progression-free period has an important effect on the subsequent clinical-progression risk. This aspect should be considered along with tumor characteristics to plan the most cost-effective follow-up scheme for surgically treated patients with RCC.
No preview · Article · Aug 2013 · Urologic Oncology
[Show abstract][Hide abstract] ABSTRACT: Objective
In oncologic surgery, secondary lymphedema of male external genital organs and upper or lower limbs frequently develops as a result of excision or mechanical obstruction of collecting lymphatic trunks. We evaluated whether the short-term and long-term outcomes of microsurgical treatment of limb and genital organs improves tissue drainage in patients with secondary lymphedema by restoring the pre-existing lymphatic networks or through new lymphangiogenesis.
Of 110 secondary lymphedema patients, microsurgery was performed in 45 hospitalized patients. Patients were aged 25 to 75 years, had at least third-degree lymphedema, no satisfactory results from previous physical or pharmacologic therapy, without primitive neoplasia, at least 1 year since the last postsurgical adjuvant oncological treatment, and <15 years since the previous primary oncologic lymphedema development. A microsurgical lymphovenous shunt of the spermatic cord (n = 7), a lymphovenous shunt of the lower limbs (n = 32), or lymphatic grafting of the upper limbs (n = 6) was performed. The male external genitals were treated through an innovative lymphovenous shunt of the lymphatic collectors in the pampiniform plexus of the spermatic cord. For lower limb lymphedema, the lymphatics were shunted to the collaterals or saphenous vein. For upper limb lymphedema, a shunt was performed between the lymph vessels of the jugular-supraclavicular area and those in close continuity with the axillary region. The patency of the new lymphatic pathways was assessed using Photodynamic Eye (Hamamatsu Photonic K.K., Tokyo, Japan) lymphography.
Six months postoperatively, 36 responding patients showed an almost complete recovery from secondary lymphedema. Lymphatic meshes, consisting of several lymphatic vessels merging into well-canalized and complex networks developing in the perianastomotic area or between the adjacent proximal anastomotic lymphatic collectors, were commonly observed in patients who positively responded to microsurgery. These complexes were never encountered in nonresponding patients or in normal, nonedematous tissue.
Long-term postsurgical recovery from severe secondary lymphedema requires canalizing the lymphatic collectors along their original flow pattern and developing perianastomotic meshes. Because this phenomenon can be observed with the same characteristics in different tissues, such as the spermatic cord and the inguinocrural, inguinoscrotal, inguinotesticular, and brachial regions, the development of meshes seems to reflect a generalized phenomenon of local lymphangiogenesis triggered by the microsurgical procedure.
[Show abstract][Hide abstract] ABSTRACT: Objective:
To test the hypothesis that spatial distribution of positive cores at biopsy is a predictor of unfavourable prostate cancer characteristics at radical prostatectomy (RP) in active surveillance (AS) candidates.
Patients and methods:
We examined the data of 524 patients treated with RP, between 2000 and 2012. All fulfilled at least one of four commonly used AS criteria. Regression models tested the relationship between positive cores spatial distribution, defined as the number of positive zones at biopsy (PBxZ) and tumour laterality at biopsy and two endpoints: (i) unfavourable prostate cancer at RP (Gleason score ≥ 4 + 3, and/or pT3 disease), and (ii) clinically significant prostate cancer (tumour volume ≥ 2.5 mL).
Unfavourable prostate cancer and clinically significant prostate cancer rates were 8 and 25%, respectively. Patients with more than one PBxZ had a 3.2-fold higher risk of harbouring unfavourable prostate cancer, and a 2.3-fold higher risk of harbouring clinically significant prostate cancer compared with their counterparts with one PBxZ (both P = 0.01). Patients with bilateral tumour at biopsy had a 3.3-fold higher risk of harbouring unfavourable prostate cancer and a 1.7-fold higher risk of harbouring clinically significant prostate cancer compared with their counterparts with unilateral tumour at biopsy (both P ≤ 0.04). Some of these results did not reach a statistically significant level, when the analyses were restricted to patients that fulfilled the most stringent AS criteria.
Positive cores spatial distribution at biopsy should be considered, when advising patients about AS. The addition of this predictor to AS inclusion criteria can help identifying patients at a higher risk of progression, and reduce the rate of inappropriate surveillance of aggressive tumours. However, the most stringent AS criteria (namely John-Hopkins criteria and Prostate Cancer Research International: Active Surveillance criteria) might not benefit from the addition of this predictor. This point warrants further investigation in future studies.
Full-text · Article · Jun 2013 · BJU International