Minimally invasive surgical therapies (MISTs) for lower urinary tract symptoms (LUTS): promise or panacea?

ABSTRACT: The increasing importance of treatment of lower urinary tract symptoms (LUTS), while avoiding side effects and maintaining sexual function, has allowed for the development of minimally invasive surgical therapies (MISTs). Recently, the European Association of Urology guidelines reported a paradigm shift from the management of benign prostatic hyperplasia (BPH) to the management of nonneurogenic male LUTS. The aim of the present review was to evaluate the efficacy and safety of the most commonly used MISTs: ablative techniques such as aquablation, prostatic artery embolization, water vapor energy, and transperineal prostate laser ablation, and nonablative techniques such as prostatic urethral lift and temporarily implanted nitinol device (iTIND). MISTs are becoming a new promise, even if clinical trials with longer follow-up are still lacking. Most of them are still under investigation and, to date, only a few options have been given as a recommendation for use. They cannot be considered as standard of care and are not suitable for all patients. Advantages and disadvantages should be underlined, without forgetting our objective: treatment of LUTS and re-treatment avoidance.

Therapeutic targeting of classical and lectin pathways of complement protects from ischemia-reperfusion-induced renal damage.

Ischemia-reperfusion injury is the major cause of delayed graft function in transplanted kidneys, an early event significantly affecting long-term graft function and survival. Several studies in rodents suggest that the alternative pathway of the complement system plays a pivotal role in renal ischemia-reperfusion injury. However, limited information is currently available from humans and larger animals. Here we demonstrated that 30 minutes of ischemia resulted in the induction of C4d/C1q, C4d/MLB, and MBL/MASP-2 deposits in a swine model of ischemia-reperfusion injury. The infusion of C1-inhibitor led to a significant reduction in peritubular capillary and glomerular C4d and C5b-9 deposition. Moreover, complement-inhibiting treatment significantly reduced the numbers of infiltrating CD163(+), SWC3a(+), CD4a(+), and CD8a(+) cells. C1-inhibitor administration led to significant inhibition of tubular damage and tubular epithelial cells apoptosis. Interestingly, we report that focal C4d-deposition colocalizes with C1q and MBL at the peritubular and glomerular capillary levels also in patients with delayed graft function. In conclusion, we demonstrated the activation and a pathogenic role of classical and lectin pathways of complement in a swine model of ischemia-reperfusion-induced renal damage. Therefore, inhibition of these two pathways might represent a novel therapeutic approach in the prevention of delayed graft function in kidney transplant recipients.

US with contrast medium in the diagnosis of abdominal Castleman's disease.

Castleman's disease belongs to a heterogeneous group of rare lymphoproliferative disorders of uncertain cause. A literature review yielded 31 cases of Castleman's disease with an abdominal localization. Retroperitoneal, mesenteric and pelvic sites have been reported and the diagnosis was incidental in almost all cases and detected at US, CT scan or MRI and angiography. If the lymphadenopathy was less than 5 cm, centripetal, homogeneous contrast enhancement was apparent during CT scan or MRI, versus dyshomogeneous enhancement for a lymph node with a diameter above 5 cm. In our case, similar vascular behavior after administration of contrast medium was observed with ultrasound, CT scan or MRI. Further studies with ultrasound contrast media are needed to confirm this particular behavior in order to avoid the use of MRI and CT scans in cases of localized abdominal masses in the future.

[Aspiration versus aspiration plus ultrasonography-guided alcohol administration for simple renal cysts: recurrence and complications]. / Aspirazione versus aspirazione ed alcolizzazione ecoguidata delle cisti renali semplici: recidive e complicanze.

In this study the results of two percutaneous treatment of simple renal cysts are compared: aspiration alone versus aspiration and ethyl alcohol injection. Out of 40 patients, 17 have been treated with aspiration only and 23 with aspiration and ethanol injection. Recurrent disease has been observed in 88.2% of patients in the aspiration group and 30.4% in the aspiration and ethanol injection group. This difference is statistically significant as shown by the Kaplan-Mayer curve when evaluated by the Log-rank test, and this is sufficient to justify such treatment as a first quality choice.

Prospective randomized trial comparing high lumbotomic with laparotomic access in renal cell carcinoma surgery.

OBJECTIVE: We compared laparotomic with lumbotomic access in renal cell carcinoma (RCC) surgery by means of a prospective randomized trial, in order to evaluate differences in surgical time, blood loss, number of lymph nodes removed, duration of postoperative ileus and hospitalization, perioperative complications and progression-free and cancer-specific survival rates. MATERIAL AND METHODS: Between November 1991 and November 1996, 94 patients with RCC were recruited and randomly assigned to undergo surgery by lumbotomic (n = 50) or laparotomic (n = 44) access. All patients underwent radical nephrectomy and lymph node dissection. RESULTS: The mean surgical time was 59.1 min (range 20-140 min) and 84.4 min (range 40-180 min) for lumbotomic and laparotomic access, respectively (p < 0.01). Blood loss was 502 ml (range 200-1800 ml) for lumbotomic and 648 ml (range 200-2000 ml) for laparotomic access (p < 0.005). Mean hospital stay was 6.8 days (range 3-13 days) for lumbotomic and 8.2 days (range 5-15 days) for laparotomic access (p < 0.001). The perioperative complication rates were 6.1% and 13.6% for lumbotomic and laparotomic access, respectively. After a mean follow-up period of 7.5 years, cancer-specific and progression-free survival rates were 88% and 75%, respectively for lumbotomic and 88% and 72.7%, respectively for laparotomic access (p = NS). Multivariate analysis of risk factors showed that pathological stage was the best prognostic indicator of tumor progression, while other variables (age, tumor grade, surgical access, tumor size and incidental diagnosis of tumor) were not predictive of the prognosis of patients with RCC. CONCLUSIONS: During radical nephrectomy, control of the renal vessels is easier and faster with high lumbotomic access. The suggested risk of tumor cell spread due to manipulation of the kidney before vessel ligature was not confirmed in our study. Because of the shorter surgical time, lower blood loss, lower perioperative and late complication rates and shorter hospital stay involved, lumbotomic access should be preferred to laparotomic access in radical nephrectomy for RCC.