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Open Access journal
ISSN (Print) 2279-9419 - ISSN (Online) 2279-9419
Published by Auro.it - Associazione Urologi Italiani [1 journal]
- Conservative surgery of renal angiomyolipomas. Long-term follow-up.
Authors: Mauro Seveso, Luigi Castaldo, Gianluigi Taverna, Rodolfo Hurle, Alessio Benetti, Pierpaolo Graziotti
Abstract: Introduction The widespread use of abdominal cross-sectional imaging has increased the incidental detection of all renal masses, including angiomyolipomas (AMLs). AML has traditionally been considered a clinically benign lesion due to its lack of recurrence or metastases. Methods From March 1996 to December 2011, 416 patients underwent nephron-sparing surgery in our department. Of those patients, 29 exhibited histological diagnosis of AML (not associated to tuberous sclerosis). We recorded their treatments, outcomes and long-term follow-up. Ruling out the 12 cases who underwent surgery for renal cancer suspicion, in the remaining 17 cases the surgical approach was necessary respectively in 12 patients for the large size of the lesion (> 7 cm), in 3 patients for the solitary kidney, and in 2 patients for low back pain and macro hematuria. Results Major post procedural complications were anemia requiring blood transfusion in one case, incidental ureter injury in one case with solitary kidney whereas one patient experienced a renal colic and macro hematuria after 14 days: by angiography, an artero-venous fistula was identified and treated by selective embolization. Regarding follow-up, routinely we performed the first control at 3 months after surgery by contrast tomography followed by serial yearly abdominal ultrasound scans. Clinical follow-up was available for all patients with a median time of 67 months (range 3 to 189). Up to date, we haven’t recorded any long-term complication or recurrence. Two patients died of unrelated causes. Conclusion Our experience allows us to consider nephron sparing surgery as a reliable technique, with no major complications and assuring good functional results even after a long-term follow-up.
Issue No: Vol. 2 (2015)
- Is second trans-urethral resection always necessary in high-grade non
muscle-invasive bladder tumor' A retrospective single institute
Authors: Francesco Chiancone, Maurizio Fedelini, Clemente Meccariello, Luigi Pucci, Gaetano Battaglia, Paolo Fedelini
Abstract: Introduction Bladder cancer is the most common malignancy of the urinary tract and the 7th most common cancer in men and the 17th in women. According to current European Association of Urology guidelines, a routine second transurethral resection (RE-TURB) is mandatory in TaG3 and T1 tumors but the scientific evidence is weak. Methods The aim of this study was to evaluate the usefulness of RE-TURB for high-grade non muscle-invasive bladder tumor. From January 2010 to December 2013, 118 consecutive patients with high-grade non muscle-invasive bladder cancer RE-TURB in our center Results Cases without muscle in the specimen of the first TURB were excluded. Of the 118 cases, 11 (9%) had tumor in the RE-TURB specimen. Particularly, tumor was identified at the primary site in nine cases and outside only in two. Of the nine patients, seven had a cancer bigger than 3 cm at first TURB. The recurrence rate in cases without tumor at RE-TURB was 3% (2/107) in patients followed at 3 months, 6% (6/107) at 6 months and 9% (10/107) at 12 months. All recurrences occurred outside the scar of the primary tumor. Conclusion According to our experience, a RE-TURB could be not mandatory in all high-grade non muscle-invasive bladder tumor, especially if the resection is complete, performed including muscle tissue, and the primary lesion is less than 3 cm in its greatest dimension
Issue No: Vol. 2 (2015)
- Three-pieces inflatable penile prosthesis implantation with penoscrotal
approach and scrotal septum sparing technique: description and early
Authors: Enrico Conti, Francesco Varvello, Sergio Lacquaniti, Marco Camilli, Jacopo Antolini, Giuseppe Fasolis
Abstract: Objective Three pieces inflatable penile prosthesis implantation is the gold standard treatment for end-stage erectile dysfunction. The peno-scrotal approach is widely performed. We propose a new transverse penoscrotal approach avoiding the division of the scrotal septum. We called it Scrotal Septum Sparing technique (SSSt). The aim of the study is to evaluate if a less extensive dissection of scrotal tissue during three-pieces inflatable penile prosthesis implantation is feasible and leads to some benefit. Methods SSSt involves few simple modifications to the standard peno-scrotal approach: 1) after the scrotal skin incision the corpora are exposed separately avoiding the division of scrotal septum; 2) a window between the septum and the ventral side of corpus spongiosum is created with blunt dissection; 3) before the insertion into the corpora, one of the cylinders is passed through this window to overlay the connecting tubes with the scrotal septum. The following parameters were recorded: operative time, complications and time elapsed from surgery to the first self activation of the device. Results The mean operative time was 90 minutes. Sixty-one patients were implanted with SSSt. One patient had an intraoperative corporal perforation. 58 patients (95%) had a prompt healing of scrotal wound and could easily activate the prosthesis between 10 and 15 days after the procedure. 3 patients had small scrotal hematomas that delayed the device handling. Conclusions Our modification of the standard peno-scrotal approach reduces the scrotal tissues dissection. It appears safe and easily reproducible. It could lower postoperative scrotal swelling and pain, moreover provides good hiding of connecting tubes.
Issue No: Vol. 2 (2015)
- Incidental prostate cancer during trans-urethral resection of prostate:
should all the patients be diagnosed '
Authors: Ahmed Fouad Kotb, Mohamed Mohie Hashad, Tamer Mohammed Abou Youssif, Akram Assem, Asmaa Mohamed Ismail, Mohamed Adel Atta
Abstract: Objective The aim of our study was to report our experience with patients older than 70 years, incidentally diagnosed with prostate cancer during transurethral resection of the prostate for clinically suspected benign prostatic hyperplasia. Methods We retrospectively collected data of all patients who underwent TURP for benign prostatic hyperplasia along the last 10 years. Inclusion criteria were patients' age more than 70 years, non-suspicious findings during DRE and a preoperative serum PSA < 10 ng/mL. All patients with PSA >5 ng/mL should have undergone TRUS guided prostatic biopsy and proven to be negative for malignancy. Results The mean age of the patients was 75.7 years, the mean prostate volume was 55 grams, mean PSA was 5.6 ng/mL and mean PSA density (PSAd) was 0.1 ng/mL/g. Incidental prostatic cancer was detected on the final pathological examination for TURP specimen in 15 patients (16.7%). The Gleason grade for all patients was 3, with a score of 6. Larger prostate volume and higher preoperative PSA were the two factors significantly associated with incidental prostatic cancer diagnosis. Conclusions Increased preoperative serum PSA level and large prostate volume are significantly associated with a higher chance to detect incidental prostate cancer. Prostate cancer, diagnosed during TURP, in patients older than 70 years, with PSA less than 10 ng/mL and non-suspicious DRE is usually low grade, allowing safe management with active surveillance or watchful waiting. Therefore, laser vaporization, providing no tissue for pathological examination, may be a safe alternative interventional option for this group of patients.
Issue No: Vol. 2 (2015)
- Sequential treatment of idiopathic asthenozoospermia: Spergin ® Forte
-Spergin®Q10 combined efficacy
Authors: Maurizio Carrino, Francesco Chiancone, Luigi Pucci, Gaetano Battaglia, Clemente Meccariello, Paolo Fedelini
Abstract: Objective Several scientific evidence are available today for active ingredients, like Coenzyme Q10, L-arginine, L-carnitine, L-ornithine e L-citrulline. They play a fundamental role as substrata of energy metabolism in spermatozoa. The aim of this study is to assess the efficacy of the sequential treatment of Spergin®Forte (L-Arginine, Coenzyme Q10, L-Taurine, Vitamins C and E) and Spergin®Q10 (Arginine, Coenzyme Q10, L-Carnitine, L-Citrulline, L-Ornithine, Vitamin E) in patients with idiopathic asthenozoospermia. Methods In our open-label clinical trial fifty patients with idiopathic asthenozoospermia (WHO 2010), were enrolled. In the initial 30 days, a combination of active ingredients characterized by high doses of Arginine and Coenzyme Q10was administered to all patients. Subsequently a different association of active ingredients with lower doses of Arginine e Coenzyme Q10 was administered to the same patients for 90 days. Patients ‘compliance and side effects were evaluated monthly, routine blood exams were performed at baseline and after four months of treatment. Results The improvement of kinetic parameters of sperm cells were also confirmed after computerized analysis, with increase both in curvilinear velocity (from 22.98 ± 2.93 millimeters/s to 28.60 ± 6.19 millimeters/s, P <0.0001) and in linear velocity (from 9.53 ± 2,45 millimeters/s to 17.02 ± 2.77 millimeters/s, p <.0001) after the treatment. About the secondary end-point, it is interesting to note that a slight increase in sperm concentration (from 65.87x 106 ± 22,11 x 106 to 86.38 x 106 ± 26.46 x 106, P < 0,001) and of typical forms (from 40.30% ± 9.78% to 46.57% ± 8.29%, P<0,0001) were observed. No patient left the study due to major side effects. Conclusions The obtained results highlight that sequential administration of Spergin®Forte and Spergin®Q10 can play a positive role in treatment of idiopathic asthenozoospermia in infertile men
Issue No: Vol. 2 (2015)