Conservative management of primary malignant melanoma of the bladder: a case report.

BACKGROUND: Primary malignant melanoma (PMM) of the bladder represents a very rare clinic-pathologic entity. Given the rarity of the disease, the best treatment option is not well recognized. CASE PRESENTATION: We describe a case of neoplasm of the bladder in a 74 years-old Caucasian man presenting with massive hematuria. Based on clinical, instrumental and histological findings a diagnosis of PMM was made. The patient underwent trans urethral resection of bladder tumor plus intravesical Bacillus Calmette-Guérin. CONCLUSIONS: To make a correct diagnosis, clinical history, endoscopic evaluation, histopathological examination and immunohistochemistry, are necessary. Multidisciplinary evaluation is required to discriminate primary from metastatic malignant melanoma.

The Potential Role of MicroRNAs as Biomarkers in Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis.

CONTEXT: Benign prostate hyperplasia (BPH) is one of the most common urologic diseases. However, the molecular and cellular mechanisms involving the stromal and epithelial components of the prostate that lead to BPH remain unclear. OBJECTIVE: To review and evaluate the evidence implicating microRNAs (miRNAs) in the pathogenesis of BPH. EVIDENCE ACQUISITION: A systematic search of the PubMed and Embase databases was performed using the terms "benign prostate hypertrophy and miRNA" or ("benign prostate hypertrophy and microRNAs" or "miRNA" or "miR") on July 31, 2017. EVIDENCE SYNTHESIS: Sixty-four miRNAs from 37 selected articles were ranked according to p values (p≤0.05). To avoid false positive results, Benjamini-Hochberg correction of p values was performed. Application of the robust rank aggregation method identified miR-221 as significantly associated with BPH (p=0.013). The effect size (ES) was calculated for studies with miR-221 data to generate an estimate of the overall ES and its confidence interval. The ES for miR-221 was measured by the standardized mean difference obtained by dividing the difference in the average gene expression between the PCa and BPH groups by a pooled estimate of standard deviation. The random effects model was used to calculate the pooled ES due to the presence of heterogeneity among studies. Publication bias of the seven included studies was assessed by the Funnel plot and Egger's test and it was detected in the overall analysis of the seven studies (p<0.01). After the trim and fill procedure, Egger's test revealed no evidence of publication bias (p=0.76) CONCLUSIONS: miR-221 has the potential to be used both as a biomarker and novel target in the early diagnosis and therapy of BPH. Technological advances should enable the synthesis of pre-RNA or anti-RNA molecules within carrier vehicles that can be safely delivered into patients. The development of such new pharmacologic therapies should be lastly investigated as possible therapy of one of the most common urologic diseases among elderly men. PATIENT SUMMARY: miR-221 has the potential to be used both as a biomarker and novel target in the early diagnosis and therapy of benign prostate hyperplasia. The development of new pharmacologic therapies enabling the synthesis of anti-miR-221 should be lastly investigated as a possible therapy of one of the most common urologic diseases among elderly men.

Ureteral endometriosis: clinical and radiological follow-up after laparoscopic ureterocystoneostomy.

BACKGROUND: Ureteral endometriosis is a rare entity that may lead to progressive hydroureteronephrosis and renal loss. When the localization of ureteral stenosis is close to the ureterovesical junction, ureterocystoneostomy may be required. The aim of the present study was to evaluate post-operative complication rates and clinical outcomes at 1- and 6-month follow-up after laparoscopic ureterocystoneostomy. METHOD: Twenty patients who underwent ureterocystoneostomy for pelvic endometriosis in our tertiary referral centre for endoscopic surgery during 1 year were studied. A cystography was performed on Day 7 after surgery to verify the integrity of anastomosis and a satisfactory bladder capacity. Follow-up consisted of gynaecological examination and transvaginal ultrasound at 1 and 6 months after surgery. At 6 months, urography and cystography were also performed. Measurements included results of a pre-operative clinical and instrumental assessment, intra- and post-operative complications, post-operative bladder capacity at cystography and improvement of pain, using a visual analogue scale for the main symptoms related to endometriosis and uro-specific pain. RESULTS: Neither a case of ureteral fistula nor other complications requiring re-intervention were reported. Post-operative transient deficit of bladder voiding occurred in five cases (25%), urinary infection in one and post-operative pyrexia in four (20%) patients. The median time to resuming voiding function was 3 days (range 1-20 days). In six cases, a mild vesico-ureteral reflux at the operated side was observed at 7-day cystography. Post-operative symptomatology was improved significantly (P<0.05) for all symptoms. Urography and cystography performed at 6 months confirmed good post-operative reconstructions in all cases. CONCLUSIONS: The objective of surgical treatment of ureteral endometriosis is to remove the stenotic tract and to preserve renal function. In cases of intrinsic ureteral endometriosis, the procedure of laparoscopic ureterocystoneostomy is feasible and has good outcomes at short- and medium-term follow-up.

Laparoscopic management of ureteral endometriosis.

PURPOSE OF REVIEW: Severe endometriosis is a leading cause of infertility and pelvic pain and represents one of the most challenging cases in gynecology. Ureteral endometriosis is a rare entity that can lead to ureteral obstruction with subsequent hydroureter, dilatation of the renal pelvis till kidney failure. Laparoscopic management of these lesions is considered the treatment of choice. RECENT FINDINGS: A few studies offer new insights into the laparoscopic management of ureteral endometriosis and the most common surgical procedures are described. SUMMARY: In cases of moderate-severe hydronephrosis due to ureteral endometriosis, laparoscopic ureteral transection (ureterostomy or ureterocystoneostomy) provides good results with low recurrence rates.

Subepithelial pelvic hematoma (Antopol--Goldman lesion) simulating renal neoplasm: report of a case and review of the literature.

The Antopol-Goldman lesion is a subepithelial pelvic hematoma simulating a renal neoplasm. We report the clinico-pathological features of a single case and a review of the literature. A 76-year-old man presented with flank pain and hematuria. Computed tomography showed a hypodense lesion of 6 cm at the left kidney with filling defect at pyelogram. The patient underwent nephroureterectomy for suspected neoplasm. Macroscopically, a mass of 6 cm was present impinging on the pelvi-caliceal system. Microscopically, the lesion was composed by hemorragic material with feature of an hematoma. A diffuse eosinophilic amorphous material suspicious for amyloid was observed among intra- and extraparenchymal vessels. The Congo-Red staining verified the presence of amyloid. The diagnosis was subepithelial pelvic hematoma with severe amyloidosis. Antopol-Goldman lesion should be kept in mind as a possible differential diagnosis of upper urinary tract lesion to avoid unnecessary nephrectomies. The anamnestic knowledge of amiloydosis may increase this diagnostic hypothesis.

Is laparoscopic radical prostatectomy better than traditional retropubic radical prostatectomy? An analysis of peri-operative morbidity in two contemporary series in Italy.

OBJECTIVE: To compare morbidity in two groups of patients who underwent retropubic or laparoscopic radical prostatectomy in the same period. PATIENTS AND METHODS: The clinical and pathological data obtained in 50 consecutive patients who underwent retropubic radical prostatectomy (RRP) from January 2001 to December 2001 were compared to those obtained in 71 consecutive patients who were treated in the same year by extraperitoneal laparoscopic radical prostatectomy (LRP). The two groups were comparable in terms of mean pre-operative PSA and biopsy Gleason score. The peri-operative data included operative time, intra-operative and post-operative transfusion rates, complication rates, hospitalization length, and duration of catheterization. The following pathological parameters were considered: Gleason score, pathological stage, and positive surgical margin rate. A comparative evaluation of continence recovery (no pads and any leakage) was made only in patients with follow-up longer than 12 months. RESULTS: The two groups were comparable in terms of pathological stage and definitive Gleason score. Operating times were significantly shorter in RRP (p<0.0001). LRP patients showed higher autologous (p<0.001) and eterologous transfusion (p=0.03). No significant difference was observed in terms of complication rates (p=0.07). The rectal injury rate was 2.8% in the laparoscopic group. The mean post-operative hospital stay was 10.2+/-2 days in the surgery group and 7.2+/-3.4 days in the laparoscopy group (p<0.001). Catheterization time was 8.4+/-0.9 days in the surgery group and 8+/-2.8 days in the laparoscopy group (p=0.27). After 12 months, complete continence was achieved in 64% of RRP and 40% of LRP patients, respectively (p=0.29). CONCLUSION: The results of our non-randomized study show that up to now laparoscopic radical prostatectomy does not provide significant advantages in terms of peri-operative morbidity compared with the traditional retropubic approach.