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The Urologist

[3 followers] Follow
This is an Open Access Journal

Open Access journal
ISSN (Print) 2279-9419 - ISSN (Online) 2279-9419
Published by Auro.it - Associazione Urologi Italiani

[1 journal]

Laparoscopic intrafascial nerve-sparing radical prostatectomy for localised prostate cancer: effect of the bilateral and unilateral technique on the surgical and functional outcomes.
- Authors: Domenico Veneziano, Christopher Springer, Giovannalberto Pini, Paolo Fornara, Francesco Greco
  Abstract: Objectives: To investigate the surgical and functional outcomes in bilateral and unilateral nerve-sparing laparoscopic radical prostatectomy (nsLRP) in patients affected by localized prostate cancer. Materials and Methods: Between January 2005 and February 2011, 746 nsLRP were performed in our clinic. In all, 406 patients underwent a bilateral nsLRP and 340 patients underwent an unilateral nsLRP. Being all operations performed by the same well trained surgeon, the patients have been selected for a retrospective non randomized study. All patients presented at biopsy a localized prostate cancer. Demographic data, perioperative and postoperative measurements and outcomes were analysed and compared. Results: The operative time was 150.4±45.3 min for bilateral nsLRP and 110±25.2 min for unilateral nsLRP. Conversion to open surgery has never been necessary. The mean intraoperative blood loss was 320±90.4 ml and 245.6±71.8 ml in the bilateral and unilateral nsLRP groups with a transfusion rate of 2.8% and 1.5%, respectively (p<0.04). Postoperatively, any statistically significant difference was reported for Gleason score, distribution of tumor stages and frequency of positive margins in the two groups. At the 12th months, a complete continence was reported in 97.7% of patients who underwent a bilateral nsLRP and in 89.7% of patients of the unilateral nsLRP group (p=0.04). At that time, 69,9% in the bilateral nsLRP and 42.9% in the unilateral nsLRP groups reported the ability to engage in sexual intercourse (p< 0.02). Conclusion: Bilateral laparoscopic intrafascial nerve-sparing technique presents similar oncologic outcomes when compared to the unilateral nsLRP, but with superior functional outcomes with regard to urinary continence and sexual potency.
  PubDate: 2013-01-07
  Issue No: Vol. 1 (2013)
Congenital uncoiled epididymis in cryptorchid testicles. A rare intraoperative finding
- Authors: Costantino Leonardo
  Abstract: Introduction The relationship between gubernaculum and epididymis explains why undescended testis is so often associated with epididymal abnormalities.Uncoiling of a segment of the epididymal tubule with marked elongation of the epididymis has rarely been reported. Case report 2 cases with congenital uncoiling and elongation of the epididymal tubule associated with left undescended testis are reported. Conclusion Uncoiled epididymis, although a rare condition, should be considered during inguinal exploration for undescending testis in order to reduce possible damage to the frail epididymal tubule or incomplete procedures.
  PubDate: 2013-01-06
  Issue No: Vol. 1 (2013)
Feasibility and safety of en bloc transurethral resection of bladder
- Authors: Angelo Naselli, Franco Bertolotto, Francesco Germinale, Paolo Puppo
  Abstract: Feasibility, safety and recurrence rate of en bloc TUR resection was assessed in a cohort of 25 consecutive patients matched with 50 patients with similar clinical and pathological characteristics submitted to standard TUR in the same time frame, March - September 2010. No death or major surgical or medical complications occurred. Overall grade I – II, according to the Clavien Dindo classification, complications rate was 6/26 (28%) compared to 8/50 (16%) of the corresponding cohort (p 0.657). All patients completed 2 year follow up. 1 and 2 year recurrence rate was respectively 11/26 (42%) and 12/26 (46%) in the en bloc TUR group and 24/50 (48%) and 32/50 (64%) in the standard group (p 0.818 – 0.212)
  PubDate: 2013-01-06
  Issue No: Vol. 1 (2013)
Urodynamic pattern in locked-in syndrome patients
- Authors: Michele Potenzoni
  Abstract: Objectives: The “locked-in syndrome” is a rare neurological condition where patients present tetraplegia, numb and bilateral paralysis of the lower cranial nerves. Patients are conscious and can communicate with eyelid movements. To date specific urodynamic data are lacking in literature. The aim of this study was to evaluate voiding dysfunction in patients with locked-in syndrome and to correlate urodynamic and clinical data with voiding rehabilitation after catheter removing.Methods: We retrospectively analyzed urodynamic findings of 8 patients affected by classic locked-in syndrome. Each patient underwent urodynamic study (Cystomanometry, perianal electromyography and post-voiding bladder ultrasound) after the vascular or traumatic accident.Results: Our study demonstrated neurogenic detrusor overactivity in 5 patient, neurogenic detrusor underactivity in 3 patients. Five patients were able to void spontaneously after catheter removal and pharmacological therapy and in 2 cases a detrusor-sphincter dyssynergia occurred. Three patients underwent intermittent clean catheterization. Renal function was preserved at 6 months follow up and no patients experienced urinary tract infection.Conclusions: Filling and voiding dysfunctions in locked-in syndrome are multiple. Further study should be performed to delineate specific urodynamic pattern of these patients.
  PubDate: 2013-01-06
  Issue No: Vol. 1 (2013)
Clinical use of zoledronic acid in patients with bone metastases from prostate cancer.
- Authors: Andrea Fandella
  Abstract: Results of phase III trial were recently published: 643 patients with bone metastases have been recruited, they were randomized to receive double-blind zoledronic acid doses of 4 and 8 mg and placebo. This study demonstrated that the addition of zoledronic acid to conventional antineoplastic treatment leads to a statistically significant reduction of the probability of skeletal complication occurrence of 25% compared to placebo, a reduction in the total number of skeletal complications and an extension of about 5 months of median time to onset of the first skeletal event (Level of evidence IA). The recommended dose is 4 mg infused intravenously over 15 minutes. This study led to the deliberations in Italy and Europe of zoledronic acid in preventing skeletal complications in patients with bone lesions secondary to prostate cancer. It should be underlined that the data on the use of this drug are for patients with hormone-refractory disease. Based on this results, the effectiveness of the administration of zoledronic acid is now being investigated at an earlier stage of the disease - that is the so-called hormone sensitive phase - in combination with hormonal therapy, in order to assess the potential capacity to prevent complications (skeletal events) related to androgen deprivation, as well as to delay the onset of progression of bone metastases. In this regard, a phase III study was recently published, it was conducted on 106 men without evidence of metastases, coinciding with the beginning of androgen-deprived therapy, they were randomised to receive zoledronic acid or placebo intravenously every 3 months for a year, noting that in the group treated with the bipshosphonates, an increase in bone mineral density (BMD) was observed, while on the contrary, in the group receiving placebo, a decrease in BMD was found. These results, even though interesting, do not still allow the systematic use of zoledronic acid in these patients.
  PubDate: 2013-01-06
  Issue No: Vol. 1 (2013)