Cancer in kidney transplantation.

Cancer in the transplanted kidney is rare, and its clinical and surgical management can be controversial. We report 3 cases of cancer in renal transplantation (1 case of renal cell carcinoma and 2 cases of transitional cell carcinoma) and their treatment. Our data and those reported in the literature suggest that these cancers can be treated like a neoplasm in the general population. However, a higher number of cases and longer follow-up periods are necessary to confirm our findings.

[Fluorescence endoscopy in the diagnosis and treatment of superficial bladder neoplasms]. / L'indagine fotodinamica nella diagnosi e nel trattamento della neoplasia vseicale superficiale.

AIM: The results of a clinical investigation on neoplasm and bladder dysplasia detection by 5-aminolaevulinic acid (5-ALA)-induced fluorescence are reported. In this paper the authors report their experience with 5-ALA in the diagnosis, treatment and follow-up of bladder neoplasms after chemotherapy and endocavitary immunotherapy. METHODS: The 5-ALA was instilled in the bladder 2 h before bladder transurethral resection. This method has been used since December 2000 on 163 patients and a total of 266 biopsies were histologically examined. RESULTS: One-hundred and four benign and 92 malignant/dysplastic areas were biopsied; 46 malignant/dysplastic lesions were not detected during routine white-light cystoscopy but were identified with fluorescence cystoscopy. Sensitivity was 99% but specificity was low (20%). CONCLUSIONS: ALA-based fluorescence cystoscopy is a safe and simple technique that enhances the detection of flat and papillary urothelial neoplasms.

Effects of complete androgen blockade for 12 and 24 weeks on the pathological stage and resection margin status of prostate cancer.

AIMS: To compare the pathological stage and surgical margin status in patients undergoing either immediate radical prostatectomy or 12 and 24 weeks of neoadjuvant hormonal treatment (NHT) in a prospective, randomised study. METHODS: Whole mount sections of 393 radical prostatectomy specimens were evaluated: 128 patients had immediate surgery, 143 were treated for 12 weeks and 122 for 24 weeks with complete androgen blockade. RESULTS: Histopathology revealed organ confined tumours in 40.4% of patients with clinical stage B disease in the immediate surgery group, whereas 12 and 24 weeks of NHT increased the number of organ confined tumours to 54.6% and 64.8%, respectively. Among patients with clinical stage C tumours, pathological staging found organ confined disease in 10.4%, 31.4%, and 61.2% in the immediate surgery, 12 weeks of NHT, and 24 weeks of NHT groups, respectively. Preoperative NHT caused a significant decrease in positive margins both in patients with clinical stage B and C disease. The extent of margin involvement was not influenced by preoperative treatment. CONCLUSIONS: Neoadjuvant androgenic suppression is effective in reducing both the pathological stage and the positive margin rate in patients with stage B and C prostatic cancer undergoing radical surgery. Some beneficial effects are evident in those patients treated for 24 weeks, and it is reasonable to assume that the optimal duration of NHT is longer than three months.

Recombinant alpha interferon in metastatic renal cell carcinoma. A cooperative phase II study.

A total of 61 evaluable patients with advanced renal cell carcinoma have been treated with 3 x 10(6) IU per square meter of body surface with recombinant alpha 2b interferon three times a week within a Cooperative Phase II Study. Toxic death for terminal renal failure occurred in 1 patient (1.63%), and toxicities greater than WHO grade 2 were present in 10 cases (16%). The overall response rate after six months of treatment was 13.1% (partial response 4, minor response 4). Two complete responses were obtained at nine and fifteen months (3.3%). Long-lasting stabilization of disease was 13.1 percent.

[Extra-aponeurotic traditional radical prostatectomy]. / La prostatectomia radicale tradizionale extra-aponeurotica.

Radical extra-aponeurotic prostatectomy is the surgical procedure which guarantees the best chances of total cancer ablation when the lesion is localized. Our incidence of positive specimen margins is low (4.6%). In our experience total incontinence occurs in 3 patients (3.5%). A low rate of post-operative complications makes this operation relatively safe and well accepted by patients. From our data "Nerve Sparing" prostatectomy must be reserved to selected cases in well motivated patients, because with this procedure the risk of oncological failure remains high.

[Vascular and lymphatic anatomy of the penis]. / Cenni di anatomia emo-linfatica del pene.

Anatomic considerations of the penis and its lymphatic drainage are analyzed in this issue. The precise anatomic location of the inguinal and iliac lymph nodes and the fascial planes of the femoral canal is very important to the surgeon to reduce the high morbility of lymphadenectomy.

[Carcinoma of the penis. Staging]. / Il carcinoma del pene. La stadiazione.

The two main classifications for staging carcinoma of the penis are the Jackson, which is probably the most commonly employed, and the UICC, TNM. A consistent method of staging penile cancer as been difficult, as there is no standard use of classifications. The ideal system would directly or indirectly predict the natural life expectancy of the host, the malignant potential of the tumor, the extent of the tumor and dictate the response of the tumor to treatment. Currently, using a grading system in addiction to the staging system has not improved correlation with prognosis. Prognosis appears to correlate only with stage at presentation, and the most reliable prognostic indicator of survival is the presence or absence of lymph nodes involvement at presentation.

[T1G3 bladder neoplasms: treatment and results]. / Neoplasie vescicali T1G3: trattamento e risultati.

The high risk of progression found in T1G3 bladder cancer influence the treatment and follow-up of this kind of patients. From January 1983 to December 1992, 803 patients with superficial bladder cancer (first presentation) had observed in the Urology Department at the Spedali Civili in Brescia. In this group, 96 patients were classified as T1G3 and our retrospective study is a critical analysis about their treatment: 13 patients underwent cystectomy as primary treatment and 83 had been cured with a transurethral resection. Of this last group, 26 patients are still without of disease (mean follow-up: 4.2 years), 30 had a recurrence which, in stage and grade, was identical or lower to the initial disease and 27 patients had a progression. Alltogether 36 patients underwent cystectomy: 15 are tumor-free and 21 died. The results of this retrospective study, led us to believe that T1G3 bladder cancer therapy is endoscopic at the beginning. Adjuvant topic chemotherapy treatments improve the recurrence rate tangibily; an early-operated cystectomy permits a good rate of recovery.

[Urodynamic evaluation of replacement bladders (Mainz)]. / Valutazione urodinamica delle vesciche di sostituzione (M.A.I.N.Z.).

42 ileo-colonic orthotopic reservoirs (M.A.I.N.Z.) following radical cystectomy were evaluated with urodynamic studies. Long term results in 19 patients with a follow up longer than 36 months were compared to the findings of 23 patients with a shorter follow-up. Urodynamic evaluation showed a reservoir with large capacity and low pressure in both groups. Nocturnal incontinence occasionally occurred. Many factors may account for this problem. Instillation of hyperosmotic solution during cystometry resulted in increased amplitudes and frequency of intracavitary pressure waves: the nocturnal increase in urine osmolality could be in correlation with nocturnal incontinence.

[Multicenter study of penile cancer]. / Studio multicentrico sul cancro del pene.

The authors report the experience about diagnosis, treatment, results and follow-up on penile cancer of 15 department of urology of Lombardia region. The aim of the study is to find, through the historical experience, the better way to menage this rare cancer.

[Morbidity of transperineal echo-guided prostatic biopsy, our experience]. / Morbilità da biopsia prostatica ecoguidata transperineale, nostra esperienza.

We present a review of 1245 patients undergone to ultrasound guided transperineal prostatic biopsy. We examined the complications' incidence of this technique to confirm or exclude presence of prostate cancer. Indications to a prostatic biopsy include an abnormal digital rectal examination, TRUS or PSA values increased. Single biopsy or systematic mapping of prostate were performed. For prostate biopsy a "Biopsy Gun" with 18 G. needle was used. Of 1245 patients, only 31 (2.48%) showed complications. Our experience demonstrates that ultrasound guided transperineal prostatic biopsy is a safe and easy technique and it is well accepted by the patient.

[Sex-dynamic characterization of patients subjected to radical pelvic cavity surgery]. / La caratterizzazione sessodinamica nei pazienti sottoposti a chirurgia radicale dello scavo pelvico.

A retrospective study was carried out using sexual case histories, hormonal profiles, vasoactive drugs test, dynamic cavernosometry and cavernosography on 46 patients who underwent radical cystectomy (26 patients: 57%) and radical prostatectomy (20 patients: 43%) for neoplasia, conducted by means of traditional surgical non-nerve sparing methods, in order to characterize the type of damage affecting the erectile function as a result of surgery. The study was carried out at a minimum of 2 months, a maximum of 9 years and 5 months, an average of 2 years and 6 months, after surgery. One patient (2%) reported intact erectile function and withdrew from the study. 37 patients (80%) showed neurological damage, while the remaining 8 (18%) had prevalently vascular damage.

[Retropubic adenectomy (Millin's technique). Our experience]. / Adenomectomia retropubica secondo Millin. Nostra esperienza.

From January 1983 to December 1993, on 1917 ptz who underwent to operations for BPH, 1532 pts (80%) had transurethral adenomectomy, and 385 pts (20%) had retropubic adenomectomy. The prostatic weight, obtained by ultrasound, is the factor which determines the kind of operations: transurethral adenomectomy if the prostate weight is lower than 50 gr, open surgery if it is more than 50 gr. In our experience about retropubic adenomectomy (Millin) we never had patient's death during operation or in the immediate post-operatively period. The early complications were 13.7%, and the late complications were 3.8%. The retropubic adenomectomy, when performed with right indications, is still valid.

[Role of intraprostatic stents in benign prostatic hypertrophy]. / Il ruolo degli stents endoprostatici nell'ipertrofia prostatica benigna.

We report our indications and experience in the use of intraprostatic endoprosthesis. We report also our preliminary experience in the use of a new intraprostatic endoprosthesis which has been developed at our institute. This prosthesis can be easily positioned, shows little invasiveness and does not require ultrasonic, radiological or endoscopical guidance.

[Conservative therapy of renal parenchymal neoplasia]. / Terapia conservativa della neoplasia renale parenchimale.

We review our overall experience in 1375 patients, who underwent surgery for renal cell carcinoma in the Departments of Urology of Brescia and Bergamo from 1983 to 1996. 185 (13.4%) patients had nephron-sparing surgery: imperative procedure was performed in 74 cases, while an elective surgery was done in 111 patients. Three years minimal follow up was considered in order to evaluate the outcome of surgical treatment in 48 patients who underwent imperative nephron-sparing surgery and in 73 with an elective procedure. Disease specific survival was 80.8% in the first group and it was 97% in the latter.

[Immunity and cancer: the role of PSA IgM Immune complexes for prostate cancer]. / Immunità e cancro: ruolo degli immunocomplessi PSA-IGM nel cancro della prostata.

Immunoediting is a new concept in cancer surveillance. Immunity is involved in detecting cellular waste, and taking off transformed cells. In particular, natural IgM antibodies play an important role in immunosurveillance mechanisms against transformed cells in humans.? Scientific evidence indicates that biomarkers for different types of cancer, such as liver and colorectal cancer, circulate in blood associated with immunoglobulin M (IgM) to form complexes that improve diagnosis in comparison to circulating free biomarkers. In prostate cancer it has been demonstrated that testing for serum levels of the PSA-IgM immune complex improves the diagnostic performance of total PSA. Preliminary reports indicate that the combination of PSA-IgM with total PSA is the best approach to reduce the number of negative prostatic mapping thus improving the diagnosis of prostate cancer.

Occurrence rates and predictors of lower urinary tract symptoms and incontinence in female athletes.

INTRODUCTION AND HYPOTHESIS: To assess the prevalence of lower urinary tract symptoms (LUTS) and incontinence in female athletes and to determine the etiological factors. METHODS: An anonymous self-questionnaire was collected from 623 casual female athletes aged 18 to 56 years, who were involved in 12 different sports. The surveys were distributed by hand to the athletes, during their sports fitness tests, in a sports center. We investigated the relationship between urinary disorders and factors such as age, body mass index (BMI), parity, duration of physical exercise, and type of sport. RESULTS: The prevalence of LUTS was 54.7%, and 30% for urinary incontinence. Changes in urinary frequency were detected in 91 (14.6%) women. Prevalence of dysuria was 13.3%, urinary straining was present in 173 (27.8%) athletes, whereas urinary urgency had an estimated prevalence of 37.2% with 232 athletes suffering from this disorder. Urgency was very common in volleyball players, as was dysuria among hockey and basketball players, whereas straining mainly affected aerobic participants and cyclists. Long training hours and competitive practices were correlated with the onset of LUTS. High-impact sports were more frequently associated with incontinence, while low-impact sports with LUTS. The sport with the main number of incontinent people was football. Urge incontinence affected a lot of athletes, mainly cyclists and football players. Stress incontinence was more frequent in hockey and volleyball players. CONCLUSIONS: LUTS and incontinence are prevalent in female athletes. In many cases, the disorders were present only during sports activities. In this sample, the presence of urinary disorders did not seem to be a barrier during sports or exercise.