The role of immune PSA complex (iXip) in the prediction of prostate cancer.

PURPOSE: To analyse the performance of iXip in the prediction of prostate cancer (PCa) and high-grade PCa. METHODS: A consecutive series of men undergoing MRI/FUSION prostate biopsies were enrolled in one centre. Indications for prostate biopsy included abnormal prostate-specific antigen (PSA) levels (PSA > 4 ng/ml) and/or abnormal digital rectal examination (DRE) and/or abnormal MRI. All patients underwent the evaluation of serum PSA-IgM concentration and the iXip ratio was calculated. Accuracy iXip for the prediction of PCa was evaluated using multivariable binary regression analysis and receiver operator characteristics (ROC) curves. RESULTS: Overall 160 patients with a median age of 65 (62/73) years were enrolled. Overall, 42% patients were diagnosed with PCa and 75% of them had high-grade cancer (Epstein ≥ 3). Patients with PCa were older and presented higher PSA levels, higher PIRADS scores and lower prostate volumes (PVs). On ROC analysis iXip presented an area under the curve (AUC) of 0.57 in the prediction of PCa and of 0.54 for the prediction of high-grade PCa. CONCLUSIONS: In our experience, immune PSA complexes are not predictors of PCa. iXip analysis should not be included in the diagnostic pathway of patients at increased risk of PCa.

Bipolar Plasma Enucleation of the Prostate: 5 Years Outcomes.

Background: Aim of our study is to assess outcomes and safety of button bipola transurethral enucleation of the prostate (B-TUEP) in patients with lower urinary tract symptoms (LUTS) caused by benign prostatic enlargement (BPE) in a single-center cohort study. Materials and Methods: All patients with LUTS caused by BPE undergoing button B-TUEP between May 2012 and December 2013 were prospectively enrolled in our study. Data on clinical history, physical examination, urinary symptoms, erectile function, uroflowmetry, and prostate volume were collected at 0, 1, 3, 6, 12, 24, 36, 48, and 60 months. Early and long-term complications were recorded. Results: Overall 50 patients were enrolled at baseline. Nine patients were excluded during the 5 years. All patients completed the procedure without severe complications. In terms of outcomes, improvement in International Prostate Symptom Score (IPSS) were sustained for all 5 years and mean difference from baseline at 5 years was 17 points. As well, improvements in Qmax (maximum urinary flow rate) were sustained for all 5 years and mean improvement at 5 years was 16 mL/second. Erectile function was slightly improved after surgery and maintained for the following 5 years. Conclusions: Our single-center study suggests that B-TUEP may have excellent outcomes at 5 years with no recurrence. Further multicentre studies should confirm our results.

Narrow Band Imaging reduces persistence of cancer in patients with pT1 high grade bladder cancer.

PURPOSE: To evaluate persistence rate on repeated transurethral resection of the bladder (re-TURB) 6 weeks after the first TURB in patients with pT1HG disease undergoing resection of the margins and bed on Narrow Band Imaging. MATERIALS AND METHODS: A consecutive series of patients undergoing TURB and a diagnosis of pT1 high grade disease were prospectively enrolled. On initial TURB patients underwent classic white light resection of the tumour followed by narrow band image (NBI) resection of margins and bed. After 6 weeks from the initial TURB, patients underwent a re-TURB under white light. Persistence rates on re-TURB were recorded. RESULTS: Overall 797 patients underwent TURB, out of them 126 patients with pT1 high grade disease were included in the study. The total number of lesions was 226 meaning 1.79 lesions per patient. On re-TURB 24/126 (19%) of the patients presented residual disease with a total of 28/226 (12%) lesions identified. All these patients presented a pTa residual disease. Out of them 8/21 (38%) presented bladder cancer on the resection bed and 13/21 (62%) presented bladder cancer on margins. CONCLUSION: Narrow Band Imaging trans-urethral resection of the bladder is an oncological effective procedure in the treatment of pT1HG disease. The procedure has a 19% of persistence rate which is inferior when compared to the available evidence on white light TURB. Further multicenter studies are needed in order to validate our results.

Bipolar plasma enucleation of the prostate vs. open prostatectomy in large benign prostatic hyperplasia: a single centre 3-year comparison.

BACKROUND: Aim of our study is to compare the surgery outcomes and safety of button bipolar enucleation of the prostate vs. open prostatectomy in patients with large prostates (> 80 g) in a single-centre cohort study. MATERIALS AND METHODS: All patients with lower urinary tract symptoms due to benign prostatic enlargement undergoing button bipolar enucleation of the prostate (B-TUEP) or open prostatectomy (OP) between May 2012 and December 2013 were enroled in our study. Data on clinical history, physical examination, urinary symptoms, erectile function, uroflowmetry and prostate volume were collected at 0, 1, 3, 6, 12, 24 and 36 months. Early and long-term complications were recorded. RESULTS: Overall, 240 patients were enroled. Out of them 111 patients (46%) performed an OP and 129 patients (54%) performed a B-TUEP. In terms of efficacy, both procedures showed durable results at three years with a reintervention rate of 7.5% in the OP group and 5% in the B-TUEP group. In terms of safety, B-TUEP presented less high-grade complications when compared with OP. CONCLUSIONS: In our single-centre study, B-TUEP represents a valid alternative to OP with excellent outcomes at three years. Further multicentre studies should confirm our results.

Is minilaparoscopic inguinal hernia repair feasible? A preliminary experience.

INTRODUCTION: Laparoscopy has rapidly emerged as the preferred surgical approach to a number of different diseases because it allows for a correct diagnosis and proper treatment. It seems to be moving toward the use of mini-instruments (5 mm or less in diameter). The aim of this paper is to illustrate retrospectively the results of an initial experience of minilaparoscopic transabdominal preperitoneal (miniTAPP) repair of groin hernia defects performed at two institutions. MATERIALS AND METHODS: Between February 2000 and December 2003, a total of 303 patients (mean age, 45 years) underwent a miniTAPP procedure: 213 patients (70.2%) were operated on bilaterally and 90 (28.7%) for a unilateral defect, with a total of 516 hernia defects repaired. The primary endpoint was the feasibility rate for miniTAPP. The secondary endpoint was the incidence of mini-TAPP-related complications. RESULTS: No conversions to laparoscopy or an anterior open approach were required. There were no major complications, while minor complications ranged as high as 0.3%. CONCLUSION: While limited by its retrospective design, the present study indicates that the minilaparoscopic approach to groin hernia repair is safe and effective, making miniTAPP a challenging alternative to laparoscopy in the approach to groin hernia repair.

¿Es el envejecimiento un verdadero factor de riesgo en las patologias urologicas en hombres y en mujeres? / Is aging a real risk factor for urological pathologies in men and women?

OBJETIVO: Con el progresivo envejecimiento de la población en los países industrializados, las patologías urológicas aumentan en número y crean un problema socio sanitario a la comunidad. Para investigar estos problemas hemos analizado retrospectivamente una muestra heterogénea de 283 pacientes, 134 hombres y 149 mujeres que han sido estudiados con métodos urodinámicos. MÉTODOS: De la muestra, las mujeres fueron divididas en 6 categorías y los hombres en 7 categorías, de acuerdo con el diagnóstico urodinámico. La distribución por edad se comparó con las de la población de la región del Lázio en Italia para calcular la "tendencia al riesgo". RESULTADO Y CONCLUSIONES: La patología más frecuente en los hombres fue la obstrucción de el cuello vesical asociada o no a hiperactividad detrusoriana y en mujeres la patología mas frecuente fue el cistocele asociado o no o a obstrucción urinaria. Hay un aumento considerable y muy significativo de las patologías urológicas en pacientes de edad avanzada. El riesgo relativo de las mujeres aumenta de 20 a 29 años, se estabiliza alrededor de los 50-69 años y decrece posteriormente. El riesgo se dobla aproximadamente cada 10 años desde los 20 hasta los 50. A la edad de 50-69 el riesgo es alrededor de 8 a 9 veces superior que a la edad de 20-29 y el doble que en mujeres con mas de 70 años de edad. El riesgo de los hombres es aproximadamente el doble cada 10 años que avanza su edad, los hombres entre 60 y 69 años tienen 25 veces mas riesgo de presentar estas patologías que los hombres entre los 20 y los 29 años. Los varones con mas de 70 años tienen alrededor de 40 veces un riesgo mayor (AU)