Transurethral resection of the prostate (TURP) vs GreenLight photoselective vaporization of benign prostatic hyperplasia: analysis of BPH6 outcomes after 1 year of follow-up.

The surgical treatment of benign prostatic obstruction is changing over the time, thanks the increase evidence about the successful role of laser techniques in this surgery. We aimed to compare prostatic GreenLight photovaporization (PVP) to bipolar transurethral resection of the prostate (TURP) with regard to lower urinary tract symptoms (LUTS) improvement through the evaluation of BPH6. We enrolled 220 consecutive subjects affected by LUTS. We performed a propensity score matching using prostate volume, peak flow and International Prostate Symptoms Score (IPSS). A total of 110 (55 TURP and 55 PVP) were analyzed. We found after 1 year of follow-up that the rate of subjects resulting in greater BPH6 recovery in the PVP group vs TURP (45.6% vs 18.2%; P=0.001). The TURP treatment showed greater catheterization time (4.67 vs 1.25; P<0.01) while PVP showed greater recovery experience (82.4 vs 58.2; <0.01). Postoperative ejaculatory dysfunctions were observed in both groups, 58.8% in TURP and 34.5% in PVP group. The multivariate logistic regression analysis, adjusted for preoperative variables, showed that PVP was independently associated with BPH6 recovery end point (odds ratio=3.77; P<0.01). This study showed data in favor of PVP. Although IPSS and peak flow improvements were similar, PVP showed better clinical outcomes.

Conservative treatment for T2-T4 bladder cancer with primary chemotherapy and radiotherapy: a pilot study.

AIMS AND BACKGROUND: After radical cystectomy, with or without pelvic radiotherapy, more than 50% of patients affected by infiltrating bladder cancer died of distant metastases. Polychemotherapy yields 25% complete remissions (CR) in patients with invasive transitional cell bladder carcinoma; although many concerns exist about the duration of such CR. This study was undertaken with the aim of evaluating the efficacy and safety of an integrated chemo-radiotherapeutic treatment, in order to broaden indications to a conservative surgical therapy. METHODS: Thirty-three consecutive patients with bladder urothelial cancer T2-T4, N0, M0, have been treated. Patients received neoadjuvant chemotherapy (rescue-M-VEC) consisted of methotrexate 30 mg/sqm plus folinic acid 15 mg after 24 h on days 1, 15, 22; vinblastine 3 mg/sqm on days 1, 15 and 22; epidoxorubicin 30 mg/sqm on day 1; cisplatin 70 mg/sqm on day 1. This cycle was repeated on day 29. After 2 cycles of rescue-M-VEC, patients underwent pelvic cobalt teletherapy 40 Gy combined with low dose cisplatin 25 mg/sqm/week. After restaging, responding patients underwent further radiation therapy (24 Gy) as booster consolidation. RESULTS: After 2 cycles of chemotherapy and pelvic radiotherapy 14/31 evaluable patients (45.2%) achieved CR and 11/31 (35.4%) partial remission, with an overall response rate of 80.6% (25/31). With a median follow up of 21 months the actuarial survival rate at 24 months was equal to 79.8%. Eleven radical cystectomies were performed, 6 of which at restaging in non responding patients and 5 during the follow up due to relapse. Of the 25 patients selected for bladder conservation, 12 (48%) have not yet shown relapses. Three out of 31 (9.7%) patients died of distant metastases. No severe toxicity has been observed: moreover no patient developed stomatitis after chemotherapy. CONCLUSIONS: Our results seem encouraging but longer follow-up and further phase III studies need to be carried out to demonstrate the feasibility of conservative treatment in muscle infiltrating bladder cancer.

"In situ" echo-guided extracorporeal shock wave lithotripsy of ureteral stones. Methods and results with Dornier MPL 9000.

In 285 patients with prevesical ureteral stone and 247 with upper ureteral stone, extracorporeal shock wave lithotripsy (ESWL) was performed with the Dornier MPL 9000 ultrasonographic targeting device. All these stones were treated "in situ" and without regional or general anaesthesia. At 3-month follow-up 96.8% of the patients treated for prevesical stone and 95.5% of those with upper ureteral stone were stone-free. ESWL was repeated once or twice in 99 cases; the average number of sessions was 1.2 for all patients (similar for prevesical and upper ureteral stones). Sparse use of ureteral stenting (6.2% of cases) did not seem to reduce the efficacy of ESWL or increase complications or need for retreatment. Intravenous fentanyl analgesia was given to 40.9% of the patients and intravenous infusion of a furosemide solution was employed in many cases to give adequate dilation of the urinary tract. In situ echo-guided ureteral ESWL is simple, safe and efficacious and can be the technique of choice for sonographically detectable ureteral stone.

Irrepressible renal colic from spontaneous subcapsular hematoma as a sign of presentation of renal neoplasia. Case report and review of the literature.

Renal adenocarcinoma can present with a wide range of symptoms and clinical signs and among them pain is the more frequent. As a matter of fact, it can also assume the features of a reno-ureteral colic. This kind of symptom, however, is more frequently combined with macro-hematuria and seldom presents alone, even in the initial phases of the clinical course. In this case, and if it assumes the features of strong and irrepressible pain, it can probably be related to sudden and remarkable hematic harvest in subcapsular space or, owing to its breach, in perirenal space. Besides the benign neoplastic pathology (angiomyolipoma) or the malignant one, the spontaneous subcapsular or perirenal hematoma may be due to several other etiopathogenetic factors, the most significant being arteriopathy (poliarteritis, aneurysms), phlogosis and hemocoagulopathy. The present case has prompted the authors to underscore the importance and the meaning of isolated algetic lumbar symptomatology in the diagnosis of complicated renal neoplasia. After a critical review of the literature on the modes of presentation of algetic symptomatology in renal adenocarcinoma, particularly spontaneous subcapsular hematoma, the authors report on a 53 year-old male patient who consulted because of a sudden irrepressible pain in his left flank, which could be only partially mitigated by stronger analgetics. Examinations urgently carried out (abdominal ultrasound, urography, pelviabdominal computed tomography) made it possible to diagnose a widespread secondary spontaneous subcapsular hematoma with left-sided solid renal neoplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Functional stenosis of the urethra in girls]. / Le stenosi funzionali dell'uretra nella bambina.

The authors studied 24 girls with distal urethral narrowing at voiding cystourethrography. Their observation seem to confirm that the distal urethral stenosis is generally functional, because often an anatomical obstruction can not be detected with the bougie a boule calibration. The urodynamic and urovideocystographic methods of study allow to differentiate three types of functional urethral stenosis that are not detectable with the radiologic examination alone. The physiopathologic mechanism of the obstruction is the condition for a successful pharmacologic treatment of these small girls.

Phase I-II pilot study on the efficacy and tolerability of neoadjuvant chemotherapy (Rescue M-VEC) and preoperative radiation therapy for infiltrating bladder cancer: results of an 18-month follow-up.

In spite of the improvement of surgical techniques used alone or in combination with preoperative radiation therapy, more than 50% of the patients with infiltrating transitional cell carcinoma (TCC) of the bladder die of distant metastases. Systemic antiblastic polychemotherapy has been reported to achieve a complete remission rate of approximately 30% in patients with infiltrating bladder TCC, although there are still doubts relative to the duration of such complete remissions. This study investigated the efficacy and tolerability of a preoperative chemo- and radiotherapeutic treatment modality and the possibility of performing preservative surgery. Thirty-seven patients with bladder TCC stage T2-T4, N0, M0, have been subjected to neoadjuvant chemotherapy according to the "Rescue M-VEC" scheme of methotrexate 30 mg/m2 +folinic acid 15 mg. after 24 hours on days 1, 15, 22; vinblastine 3 mg/m2 on days 1, 15, 22; epidoxorubicin 30 mg/m2 on day 1 and cisplatin 70 mg/m2 on day 1. The course was repeated from day 29. After 2 "Rescue M-VEC" courses, the patients received pelvic cobalt tele-therapy (CTT) combined with cisplatin 24 mg/m2/week. The patients were then restaged. Those with complete remission (CR) received consolidation radiotherapeutic boost combined with cisplatin 24 mg/m2/week, avoiding radical cystectomy. Such treatment was also given to patients with significant partial remission (PR) who had undergone TUR or partial cystectomy. In all the remaining cases we carried out radical cystectomy. We obtained 45.7% CR, 31.4% PR and 22.8% were non-responders (NR), of 35 patients who were evaluable at restaging. Only 9 radical cystectomies were performed in this series. The overall survival rate was 80.6% at a mean follow-up of 18.1 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytofluorimetric evaluation of DNA ploidy in the diagnosis of bladder cancer.

OBJECTIVE: The aim of the study is to investigate the relationship between urinary cytology, traditional indexes of malignancy of bladder carcinoma and DNA-ploidy (diploid, near-diploid, aneuploid). METHODS: 52 specimens of bladder cancers (transitional cell carcinoma) were obtained from 46 patients at TURB and from 6 patients at radical cystectomy. In every specimen the nuclear content of DNA was investigated using the cytofluorimetric method. Cells were processed in standard fashion for flow cytometry with propidium iodide staining; cellular suspension was obtained mechanically. Peripheral blood lymphocytes were used as diploid standard. Bladder cytology was performed in every patient. RESULTS: A relationship between DNA-ploidy and histological malignancy was observed. The largest portion of near-diploid neoplasm was observed in stage T1, grade G2 malignancies. In some cases negative bladder cytology occurred together with aneuploid DNA content, whilst in other cases positive bladder cytology occurred together with diploid DNA content. In consequence there is not always a relationship between bladder cytology and DNA-ploidy. CONCLUSIONS: Since observed correlations may point out some neoplasms with particular biological behaviour, follow-up of near-diploid malignancies is of great interest.