Which men with non-malignant pathology at magnetic resonance imaging-targeted prostate biopsy and persistent PI-RADS 3-5 lesions should repeat biopsy?

PURPOSE: To assess predictors of clinically significant (cs) prostate cancer (PCa) in men who had a non-malignant Multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy and persistent Prostate Imaging-Reporting Data System (PI-RADS) 3 to 5 lesions in subsequent mpMRI. MATERIALS AND METHODS: We retrospectively analyzed MRI-targeted biopsy database in three centers. INCLUSION CRITERIA: persistence of at least one PI-RADS ≥3 lesion found negative for cancer in a previous MRI-targeted plus systemic biopsy (baseline biopsy). EXCLUSION CRITERIA: downgrading to PI-RADS 1-2. A logistic regression analysis was performed to estimate the predictors of csPCa. RESULTS: Fifty-seven patients were included. Median interval between biopsies was 12.9(2.43) months. Median age was 68.0(12) years. Median PSA was 7.0(5.45) ng/ml. At follow-up, 24.6%, 54.4%, and 21% of patients had a PI-RADS score 3, 4, and 5 index lesion (IL), respectively. At re-biopsy, 28/57(49.1%) men were found to harbor PCa. Among these, 22(78.6%) had csPCa. csPCa was found outside the IL in only 2 patients. Eleven, 13, and 5 patients with PI-RADS 3, 4, and 5, respectively, had no cancer. Three patients with a PI-RADS 3 lesion had cancer (2 with Gleason score 3+3, 1 with Gleason score 3+4). 14/43 men with a PI-RADS 4/5 lesion harbored Gleason score ≥3+4 PCa. Logistic regression analysis found that PSA (HR 1.281, 95% CI: 1.013-1.619, P = 0.039) and IL size (HR 1.146, 95% CI: 1.018-1.268, P = 0.041) were the predictors of csPCa at re-biopsy. CONCLUSIONS: Patients with non-malignant pathology from PI-RADS ≥3 lesions targeted biopsy should be follow-up with mpMRI, and those with persistent PI-RADS 4 to 5 lesions should repeat MRI-targeted and systematic biopsy.

Comparison between thulium laser vapoenucleation and plasmakinetic resection of the prostate in men aged 75 years and older in a real-life setting: a propensity score analysis.

BACKGROUND: Urologists may hesitate to offer transurethral resection of the prostate (TURP) because of increased morbidity in elderly patients. AIMS: We aimed to compare data on postoperative outcomes of elderly men undergoing bipolar transurethral resection of the prostate (B-TURP) as compared to thulium laser vapoenucleation of the prostate (ThuVEP). METHODS: We retrospectively reviewed data of all patients aged ≥ 75 years who underwent benign prostatic hyperplasia surgery. Differences between interventions were estimated using propensity scores (PS) to adjust for different patients characteristics. RESULTS: Between 2017 and 2020, 275 men were included in the analysis. Propensity score retrieved 65 patients in each group. Median age was 78 (4) years in B-TURP group and 78 (6) in ThuVEP group. Median prostate volume was 63 (35) ml and 54 (24) ml in B-TURP group and ThuVEP group, respectively. Only American Society of Anesthesiologists score was significantly higher in ThuVEP group (p = 0.006). Median operation time, catheterization time, and hospital stay were similar in both groups (55 min, 2 and 3 days). Overall, 84.6% of men had no complications, with no significant differences between the groups (p = 0.234). Only one patient in B-TURP group experienced a Clavien grade IIIb complication. By 1 year, there were a statistically significant differences in International Prostate Symptom Score (p = 0.000) in favor of B-TURP group and in maximal urine flow rate (p = 0.000) in favor of ThuVEP group. DISCUSSION AND CONCLUSIONS: Both procedures showed excellent functional improvements one year after surgery with a low rate of major complications in men aged ≥ 75 years with small-to-medium sized prostates.

Serum 25(OH)D seasonality in urologic patients from central Italy.

Hypovitaminosis D is increasingly recognized as a cofactor in several diseases. In addition to bone homeostasis, vitamin D status influences immune system, muscle activity and cell differentiation in different tissues. Vitamin D is produced in the skin upon exposure to UVB rays, and sufficient levels of serum 25(OH)D are dependent mostly on adequate sun exposure, and then on specific physiologic variables, including skin type, age and Body Mass Index (BMI). In contrast with common belief, epidemiologic data are demonstrating that hypovitaminosis D must be a clinical concern not only in northern Countries. In our study, we investigated vitamin D status in a male population enrolled in a urology clinic of central Italy. In addition, we evaluated the correlation between vitamin D status and UVB irradiance measured in our region. The two principal pathologies in the 95 enrolled patients (mean age 66years) were benign prostate hypertrophy and prostate carcinoma. >50% of patients had serum 25(OH)D values in the deficient range (<20ng/mL), and only 16% of cases had serum vitamin D concentration higher than 30ng/mL (optimal range). The seasonal stratification of vitamin D concentrations revealed an evident trend with the minimum mean value recorded in April and a maximum mean value obtained in September. UVB irradiance measured by pyranometer in our region (Abruzzo, central Italy) revealed a large difference during the year, with winter months characterized by an UV irradiance about tenfold lower than summer months. Then we applied a mathematical model in order to evaluate the expected vitamin D production according to the standard erythemal dose measured in the different seasons. In winter months, the low available UVB radiation and the small exposed skin area resulted not sufficient to obtain the recommended serum doses of vitamin D. Although in summer months UVB irradiance was largely in excess to produce vitamin D in the skin, serum vitamin D resulted sufficient in September only in those patients who declared an outdoor time of at least 3h per day in the previous summer. In conclusion, hypovitaminosis D is largely represented in elderly persons in our region. Seasonal fluctuation in serum 25(OH)D was explained by a reduced availability of UVB in winter and by insufficient solar exposure in summer. The relatively high outdoor time that emerged to be correlated with sufficient serum 25(OH)D in autumn warrants further studies to individuate potential risk co-variables for hypovitaminosis D in elderly men.

Low-Dose Intravaginal Estriol and Pelvic Floor Rehabilitation in Post-Menopausal Stress Urinary Incontinence.

INTRODUCTION: Pelvic floor muscle training (PFMT) and electrical stimulation (ES) are conservative models of therapy for treating female stress urinary incontinence (SUI). The presence of estradiol receptors in the lower urinary tract advances the case for estradiol therapy in SUI. The aim of our study was to investigate the effects of the combination of pelvic floor rehabilitation and intravaginal estriol (IE) on SUI treatment in postmenopausal women. MATERIAL AND METHODS: Sixty-two women with SUI were randomized to PFMT, ES and biofeedback (Group 1) or the same treatment plus 1 mg IE (Group 2) for 6 months. Patients were evaluated with medical history, pelvic examination, urodynamics, 24-hour pad test. Urinary incontinence was evaluated using the International Consultation on Incontinence questionnaire on urinary incontinence short form and quality of life using the Incontinence Impact Questionnaire-Short Form. RESULTS: Two patients were lost at follow-up and one discontinued the study. Mean urine leakage at the 24-hour pad test dropped from 42.3 ± 20.2 g/die to 31.5 ± 14.2 g/die in Group 1 and from 48.3 ± 19.8 g/die to 22.3 ± 10.1 g/die in Group 2. Symptoms scores and incontinence status were statistically significant better in Group 2 when compared to Group 1. CONCLUSION: IE added to PFMT, ES and BF is a safe and efficacious first-line therapy in postmenopausal women with SUI.

BPH/LUTS and ED: common pharmacological pathways for a common treatment.

INTRODUCTION AND AIM: This article reviews the current literature on common physiopathogenetic factors and pharmacological pathways of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in men and their implications for diagnosis and treatment. MAIN OUTCOME MEASURES AND METHODS: A literature search was conducted to identify original articles, reviews, editorials, and international scientific congress abstracts by combining the following terms: lower urinary tract symptoms, erectile dysfunction and phosphodiesterase type 5 inhibitors (and their abbreviations LUTS, ED and PDE5-Is). RESULTS: We identified manuscripts presenting: (i) The existence of several newly discovered common pathophysiological mechanisms of LUTS and ED indicating that PDE5-Is might represent an alternative to current treatments of men with LUTS (e.g., α1-adrenergic blockers and 5α-reductase inhibitors); (ii) Randomized controlled clinical trials have shown that treatment with PDE5-Is is associated with improvements in both LUTS and ED in men with significant problems in both areas. CONCLUSION: The presence of common pathophysiological mechanisms between LUTS and ED seems well recognized and needs further exploration. Further comparisons between different PDE5-Is would be useful to determine the most appropriate regimen and their efficacy to safety ratio.

[Nephron sparing surgery in renal cell carcinoma: our experience of a 20-year clinical practice]. / Nephron sparing surgery nei tumori del rene: nostra esperienza relativa a 20 anni di pratica clinica.

OBJECTIVES: Nephron sparing surgery (NSS) is now considered the standard of care in the treatment of renal cell carcinoma (RCC) in stage T1. We retrospectively evaluated our results related to the use of NSS in over twenty years of clinical practice. METHODS: We reviewed our database relating to the use of NSS in the last twenty years of clinical practice, from 1988 to July 2012, in 549 patients. The pre- and post-operative parameters recorded are the evaluation of the site and size of the renal lesion obtained from radiological investigations, the need for clamping the renal pedicle, open or laparoscopic surgical approach, blood loss, histology and intra- and postoperative complications. We also evaluated the parameters related to renal function before and after surgery. RESULTS: The mean follow-up was 95 months (7.6 years). The average diameter of the lesion at CT abdomen was 4.8 cm (1-8 cm). The warm ischemia was required in 317 patients, cold in 18 patients, no need for ischemia in 214 patients. The total duration of surgery was 122.56 ± 52.76 min. 15 procedures were performed laparoscopically. Ischemia time: 3'-25'; bleeding: 50-1000 cc. The lesion was benign in 115 of the 549 patients enrolled; it was a RCC in the remaining cases except for three, which were papillary carcinomas. At 5 years, the cancer free survival rate was 97.5%. CONCLUSIONS: Our data show that the implementation of NSS offers long-term benefits in terms of functional results and a good cancer control.

Inverted papilloma of the bladder: a review and an analysis of the recent literature of 365 patients.

OBJECTIVES: Until the 1970s, inverted urothelial papilloma (IUP) of the bladder was generally regarded as a benign neoplasm. However, in the 1980s, several reported cases suggested the malignant potential of these papillomas, including cases with features indicative of malignancy, recurrent cases, and cases of IUP synchronous or metachronous with transitional cell carcinoma. The aim of this systematic review and analysis of the literature since 1990 to date is to contribute to unresolved issues regarding the biological behavior and prognosis of these neoplasms to establish some key points in the clinical and surgical management of IUP. MATERIALS AND METHODS: Database searches yielded 109 references. Exclusion of irrelevant references left 10 references describing studies that fulfilled the predefined inclusion criteria. RESULTS: One problem regarding these neoplasms is the difficulty of obtaining a correct histopathologic diagnosis. The main differential diagnosis is endophytic urothelial neoplasia, including papillary urothelial neoplasia of low malignant potential or urothelial carcinoma of low or high grade, while other considerably rare differential diagnoses include nephrogenic adenoma, paraganglioma, carcinoid tumor, cystitis cystica, cystitis glandularis, and Brunn's cell nests. The size of the lesions ranged from 1 to 50 mm (mean 12.8 mm). Most cases occurred in the fifth and sixth decade of life. The mean age of affected patients was 59.3 years (range 20-88 years). Analysis of the literature revealed a strong male predominance with a male/female ratio of 5.8:1. The most commonly reported sites of IUP were the bladder neck region and trigone. Of 285 cases included in 8 studies, 12 cases (4.2%) were multiple. Out of the total of 348 patients, 6 patients (1.72%) had a previous history of transitional cell carcinoma of the urinary bladder, 5 patients (1.43%) had synchronous transitional cell carcinoma of the urinary bladder, and 4 patients (1.15%) had subsequent transitional cell carcinoma of the urinary tract. The time before recurrence was <45 months (range 5-45 months, mean 27.7 months) after surgery. CONCLUSIONS: Inverted papilloma could be considered a risk factor for transitional cell carcinoma, and it is clinically prudent to exclude transitional cell cancer when it is diagnosed. Follow-up is needed if the histologic diagnosis is definitive or doubtful. We recommend 4-monthly flexible cystoscopy for the first year and then every 6 months for the subsequent 3 years. Routine surveillance of the upper urinary tract in cases of inverted papilloma of the lower part of the urinary tract is not deemed necessary.

Plasmakinetic bipolar versus monopolar transurethral resection of non-muscle invasive bladder cancer: a single center randomized controlled trial.

OBJECTIVES: To compare the safety and the efficacy of plasmakinetic bipolar resectoscope versus conventional monopolar in the transurethral resection of primary non-muscle invasive bladder cancer. METHODS: From January 2007 to December 2009, 132 patients underwent endoscopic resection for primary non-muscle invasive bladder cancer. They were randomly assigned to two groups: 67 patients underwent a transurethral resection of the bladder with bipolar plasmakinetic energy transurethral resection of the bladder and 65 were treated with conventional monopolar transurethral resection. RESULTS: The mean operative time was 27 min for bipolar plasmakinetic energy transurethral resection of the bladder and 31 min for monopolar transurethral resection of the bladder. No significant differences in the mean change of hemoglobin and serum sodium level were observed. Mean catheterization time was 1.3 days and 2.3 days for bipolar plasmakinetic energy transurethral resection of the bladder and monopolar transurethral resection of the bladder, respectively. The mean hospital stay was shorter in the bipolar plasmakinetic energy transurethral resection of the bladder. Bladder perforation was reported in two cases for the monopolar transurethral resection of the bladder group and obturator nerve reflex occurred in a single case for both procedures. None of the patients experienced transurethral resection syndrome. The median time of bladder tumor recurrence after initial transurethral resection of the bladder was 12.4 months and 11.9 months for bipolar plasmakinetic energy transurethral resection of the bladder and monopolar transurethral resection of the bladder, respectively. No significant differences in the overall recurrence-free survival rate were observed comparing the two procedures. CONCLUSIONS: Plasmakinetic bipolar transurethral resection represents a safe and effective procedure in the management of non-muscle invasive bladder cancer.

Cephalosporins periprostatic injection: are really effective on infections following prostate biopsy?

PURPOSE: To compare the antibiotic prophylaxis based on quinolone administered orally with a combination of cephalosporin administered periprostatically and a fluoroquinolone orally, in terms of post-prostate bioptic infectious complication rates in those men undergoing transrectal ultrasound-guided prostate biopsy (TRUS gpb). METHODS: In a prospective, randomized, double-blind study, 150 consecutive patients were randomized to receive 10 ml lidocaine 1 % in Group A and ceftriaxone 1 g diluted in a solution of 10 ml of lidocaine 1 % in Group B, before TRUS gpb. All signed the informed consent. The men were asked to grade the pain using a ten points visual analogue scale close after TRUS gpb. In a telephone interview at 3 and 6 days, they were asked about early and late complications, assessing rectal bleeding, urinary retection, fewer, haematuria, urethral bleeding and hematospermia. RESULTS: Of the 150 men enrolled, 135, 70 in Groups A and 65 in Group B, completed the study. Four men (5.7 %) in Group A developed sepsis after TRUS gpb requiring hospital admission and intravenous antibiotic treatment, while none in Group B. Escherichia coli was the only organism isolated. The mean pain score was 2.76 ± 1.69 and 1.73 ± 1.26 for Group A and B, respectively (p = 0.08). Complications, evaluated at 3 and 6 days after the procedure through a telephone interview, were similar in both Groups. CONCLUSIONS: The antibiotic prophylaxis based on the combination of ceftriaxone administered periprostatically and ciprofloxacin orally is able to offer a best control on infections caused by fluoroquinolone-resistant E. coli.

Urgent ureteroscopy as first-line treatment for ureteral stones: a meta-analysis of 681 patients.

There are various recent studies on the use of ureteroscopy and debate on whether this should be the first-line treatment for patients with ureteral stones. The aim of this meta-analysis was to understand the role of this surgical procedure in the emergency setting as first-line treatment and to compare the immediate procedure with a delayed one in terms of stone-free rate and complications. A bibliographic search covering the period from January 1980 to March 2010 was conducted in PubMed, MEDLINE and EMBASE. This analysis is based on the six studies found that fulfilled the predefined inclusion criteria. A total of 681 participants were included. The number of participants in each of the studies considered ranged from 27 to 244 (mean 113). Stone-free rates were 81.9% (72.0-91.8) for the proximal ureter, 87.3% (82.6-92.0) for the mid-ureter, 94.9% (92.1-97.6) for the distal ureter and 89.5% (86.5-92.5) overall according to the logistic regression applied. These values are not statistically significantly different from those reported in the AUA and EAU guidelines. The stone diameter seems to affect the stone-free rate. An increase of the stone diameter of 1 mm beyond 8 mm corresponded to a reduction of stone-free rate of 5% (2.4-8.0) and 8.1% (3.8-12.1) for the distal and proximal ureters, respectively. There is a complete lack of information in international guidelines on the ureteroscopic management of ureteral stones in an emergency setting and the currently available results are dispersed in a few studies in the literature. The rationale for using emergency ureteroscopy is more rapid stone clearance and relief from colic pain. According to our meta-analysis, immediate ureteroscopy for ureteral stone colic seems to be a safe treatment with a high success rate. This evidence will be validated by further randomized studies, with larger series of patients.

Inflammation and endothelial activation in benign prostatic hyperplasia and prostate cancer.

PURPOSE: Emerging insights underline a link among chronic inflammation and endothelial activation with benign prostatic hyperplasia (BPH) and prostate cancer (PCa). We aim to investigate whether specific plasma markers of inflammation and endothelial activation allow to discriminate BPH and PCa. MATERIALS AND METHODS: Fifteen patients affected by BPH, 15 by PCa and 15 controls, were enrolled. Interleukin-6 (IL-6), CD40 ligand (CD40L), endothelial-selectin (E-selectin), platelet-selectin (P-selectin), vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) were measured. RESULTS: In systemic blood samples, IL-6 has been found increased in patients affected by BPH (4.25 ± 0. pg/mL) and PCa (5.08 ± 0.24) respect to controls (2.62 ± 0.34; p < 0.05). CD40L was higher in BPH (4.25 ± 0.65 ng/mL; p < 0.05) than in control (2.31 ± 0.20) and PCa group (2.60 ± 0.56). E-selectin, P-selectin and VCAM-1 did not show any significant difference. Higher levels of ICAM-1 were detected in patients with PCa (573.04 ± 52.23) and BPH (564.40 ± 74.67) than in the controls (215.30 ± 11.53 ng/mL; p < 0.05). In local blood samples, IL-6 has been found significantly increased in PCa in comparison with patients with BPH; there was no difference in CD40L, E-selectin, P-selectin, VCAM-1 ed ICAM-1. CONCLUSIONS: Changes in inflammation and endothelial activation markers may be not considered to be of value in discriminating BPH and PCa.

Inflammation and endothelial activation in benign prostatic hyperplasia and prostate cancer

PURPOSE: Emerging insights underline a link among chronic inflammation and endothelial activation with benign prostatic hyperplasia (BPH) and prostate cancer (PCa). We aim to investigate whether specific plasma markers of inflammation and endothelial activation allow to discriminate BPH and PCa. MATERIALS AND METHODS: Fifteen patients affected by BPH, 15 by PCa and 15 controls, were enrolled. Interleukin-6 (IL-6), CD40 ligand (CD40L), endothelial-selectin (E-selectin), platelet-selectin (P-selectin), vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) were measured. RESULTS: In systemic blood samples, IL-6 has been found increased in patients affected by BPH (4.25 ± 0. pg/mL) and PCa (5.08 ± 0.24) respect to controls (2.62 ± 0.34; p < 0.05). CD40L was higher in BPH (4.25 ± 0.65 ng/mL; p < 0.05) than in control (2.31 ± 0.20) and PCa group (2.60 ± 0.56). E-selectin, P-selectin and VCAM-1 did not show any significant difference. Higher levels of ICAM-1 were detected in patients with PCa (573.04 ± 52.23) and BPH (564.40 ± 74.67) than in the controls (215.30 ± 11.53 ng/mL; p < 0.05). In local blood samples, IL-6 has been found significantly increased in PCa in comparison with patients with BPH; there was no difference in CD40L, E-selectin, P-selectin, VCAM-1 ed ICAM-1. CONCLUSIONS: Changes in inflammation and endothelial activation markers may be not considered to be of value in discriminating BPH and PCa.

Tadalafil versus solifenacin for persistent storage symptoms after prostate surgery in patients with erectile dysfunction: a prospective randomized study.

OBJECTIVES: The occurrence of residual storage symptoms after surgical relief of bladder outlet obstruction as a result of benign prostatic enlargement (BPE) underlines the intricate mechanism involved in lower urinary tract symptoms (LUTS). The aim of the present study was to compare tadalafil with solifenacin in modifying symptoms and uroflowmetric parameters in patients with erectile dysfunction (ED) and residual storage symptoms after prostate surgery. METHODS: From May 2007 to April 2009, we evaluated 68 patients who had undergone prostate surgery at least 6months earlier, and presented with ED and persistence of storage symptoms. A total of 56 patients were randomized to receive tadalafil 5mg (group 1) or solifenacin 5mg (group 2), both given daily for 12weeks. International Prostate Symptoms Score (IPSS), IPSS Quality of Life, International Index of Erectile Function-5 (IIEF-5) and uroflowmetry parameters were collected at baseline and after 12weeks of treatment. RESULTS: A total of 26 patients in group 1 and 25 patients in group 2 completed the study. Each group showed a significant and comparable improvement of urinary symptoms with a decrease of IPSS value. Only in group 1 did the treatment with tadalafil result in a significant increase of IIEF-5. No statistically significant variations were noted in uroflowmetric parameters in both groups. CONCLUSIONS: In patients suffering from ED and storage symptoms after surgical treatment for LUTS-BPE, tadalafil 5mg given once daily for 12weeks provided a comparable improvement in IPSS to solifenacin 5mg given for the same period of time.

Tissue print of prostate biopsy: a novel tool in the diagnostic procedure of prostate cancer.

BACKGROUND: Nowadays, the histological examination of prostate core needle biopsies is still regarded as the gold standard in the diagnosis of prostate cancer (PCa). We investigated if the tissue print of core needle biopsy (biopsy print) could be used as adjunctive molecular investigative procedures in conjunction with routine histological examination of biopsy to improve PCa diagnosis. METHODS: The direct contact of PCa core biopsy to nitrocellulose membrane resulted in the release of a cellular micropeel that was used for downstream analytical procedures. RESULTS: By zymogram print-phoresis we demonstrated that matrix metalloproteases MMP-2 and MMP-9 could be visualized in biopsy prints and that the gelatinolytic activity was positively correlated with immunohistochemistry analysis of the same markers in matched bioptic specimens. Moreover, we compared the ability to detect the PCa-associated hypermethylation of GSTP1 promoter in DNA extracted from biopsy prints with those of the corresponding core needle biopsies. Biopsy prints demonstrated the same specificity of biopsies in detecting PCa (50%) while the sensitivity and the positive predictive value were lower than biopsies (56% vs 78% and 63% vs 70%, respectively). CONCLUSIONS: Biopsy print, combining a molecular point of view to the routinely hystopathological analysis of prostate biopsies, should be a useful tool to improve the diagnosis of PCa.

PDE-5 and NOS II mRNA expression in menopausal women: a molecular biology study.

OBJECTIVE: Phosphodiesterase (PDE) and nitric oxide synthase (NOS), evaluated in male erectile dysfunction, are currently under study for their role in the female counterpart. We aim to assess PDE-5 and NOS II presence, at messenger Ribonucleic Acid (mRNA) level, in vaginal environment of menopausal women, by using molecular biology techniques. METHODS: Specimens of vaginal tissue were obtained from 16 menopausal women undergoing surgery for pelvic organ prolapse. The two samples obtained for each patient, one under the urethra (called U) and one on the rest of the vaginal wall (called V), were tested for PDE-5 and NOS II by RT-PCR and by a densitometric semiquantitative analysis. RESULTS: Of the V samples, 81.3% expressed PDE-5 and 100% NOS II. PDE-5 and NOS II expression were revealed in 87.5% of U specimens. A significant difference (P < 0.05) between V and U samples was found in the expression of NOS II (V vs. U: 24.14 vs. 7.25) and PDE-5 (V vs. U: 44.32 vs. 68.57). CONCLUSIONS: Our results demonstrated the presence of PDE-5 and NOS II mRNA in periurethral and vaginal tissue of menopausal women. The distribution of PDE-5 and NOD II may indicate a physiologic role in the regulatory function of human vagina.

Sarcoma of prostate: case report and review of the literature.

OBJECTIVES: Prostate sarcomas are rare entity, the most common is leiomyosarcoma which account for 0.1% of all prostate malignancies. The presenting symptoms are mainly obstructive urinary symptoms. Surgery with chemo- or radiotherapy are the mainstay treatment options. The overall survival rate remains poor regardless of initial tumour size, grade or histological subtype. Immunohistochemistry reveals tumour cells diffusely positive for vimentin, smooth muscle actin, focally positive for progesterone receptor, whilst keratins are usually negative. MATERIALS AND METHODS: We describe a case of a patient affected by sarcoma of prostate. Furthermore, we reviewed the cases of prostate sarcomas available in literature to clarify the best therapeutic options to be applied. RESULTS: In the case described leiomyosarcoma diagnosed by an ultrasound guided biopsy was characterized by fascicles of spindle-shaped cells with a variable degree of nuclear atypia. The immunohistochemistry showed positive staining for smooth muscle actin, vimentin and focally for the S-100 protein. The patient was treated with radical retropubic prostatectomy and radiotherapy of the local recurrence, and chemotherapy at metastases onset. CONCLUSIONS: Prostate sarcomas are highly aggressive, with limited therapeutic options. An early diagnosis and complete surgical excision with negative margins offer patients the long-term disease free survival.

Oxidative stress in benign prostatic hyperplasia and prostate cancer.

OBJECTIVE: The aim was to verify whether oxidative stress could represent a common key factor of benign prostatic hyperplasia (BPH) and prostate cancer (PCa). SUBJECTS AND METHODS: 15 patients affected by BPH, 15 with PCa and 15 controls were enrolled. Blood samples were withdrawn systemically and locally during radical retropubic prostatectomy in patients with PCa and during transvesical retropubic adenomectomy in patients diagnosed with BPH. Plasma oxidized low-density lipoprotein, peroxides, and total equivalent antioxidant capacity (TEAC) including plasma superoxide dismutase (SOD) determination were analyzed as oxidative markers. RESULTS: With respect to the control group, high plasma peroxides and decreased TEAC levels were measured in patients affected by both PCa and BPH. Plasma peroxides were significantly higher in patients with PCa with respect to BPH. A positive correlation was found between peroxides and TEAC values in samples withdrawn locally in patients affected by PCa. An inverse correlation between peroxides and TEAC was observed in patients with BPH. No statistically significant modifications were observed as concerns SOD activity and LDL oxidability. CONCLUSIONS: Our findings confirm a significant unbalance of redox status in patients affected by BPH and PCa, and suggest a potential involvement of oxidative stress as a determinant in the pathogenesis of these diseases.

Haemostatics in surgery and our experience in the enucleoresection of renal cell carcinoma.

BACKGROUND: 30 patients, with T1 renal cell carcinomas (RCC) who underwent open enucleoresection of the tumour, were randomized to the use of a topical haemostatic agent (Floseal) or to an infrared-sapphire coagulator (ISC), to compare their efficacy in achieving haemostasis. METHODS: Successful intra-operative haemostasis, intra- and post-operative bleeding, operative time, hospital discharge were evaluated. RESULTS: Statistically higher rates of successful haemostasis and shorter time-to-haemostasis (8,1 vs 12,9 min) were observed in the FloSeal group (p < 0.001 both). Patients operative time was not different between Group 1 vs 2 (58.7 +/- 12 vs 62.4 +/- 15; p > 0.05). The average blood loss during surgery was less (60 +/- 25.5 mL) for the FloSeal group than for the ISC group (85 +/- 40.5 mL) (p < 0.05). Postoperative blood loss was 25 +/- 5 mL and 40 +/- 45 mL for Floseal and ISC respectively, (p < 0.05). Length of the postoperative hospital discharge was 2.5 +/- 1.2 days for FloSeal group and 3.5 +/- 1.3 for the Group 2 (p < 0.05). No major immediate or delayed complications were observed in either Groups. CONCLUSIONS: The use of Floseal and ISC offer a safe and efficacy haemostasis in the enucleoresection of RCC. Moreover, our results show a less intra-operative and post-operative blood loss as well as a shorter time to haemostasis of Floseal in respect to ISC.

Penile rehabilitation therapy following radical prostatectomy.

PURPOSE: To compare erectile function (EF) recovery of patients treated by early penile rehabilitation therapy (PRT) with sildenafil and with control group. METHOD: Forty men treated by bilateral nerve sparing radical prostatectomy (NSRP) and with a normal pre-operative EF were enrolled. Fourteen days after surgery, they were randomised to a flexible-dose sildenafil group and to a control group. The International Index of Erectile Function (IIEF) questionnaire was completed before surgery and at 3, 6, 12 and 24 weeks after NSRP. RESULTS: In the group treated, the mean IIEF score before surgery was 26.2 and 14.1, 16.2, 22.5 and 25.2 at 3, 6, 12 and 24 weeks after NSRP, respectively. In the control group, the respective scores were 26.5 and 12.4, 15.8, 15.3 and 17.4. There was a significant difference in IIEF mean score (25+/-6 vs. 17+/-9, p<0.05) and in the potency rate (87% vs. 56%) between the groups at 24 weeks after NSRP. The percentage of patients who were capable of having medication-unassisted intercourse was 54% vs. 21%; 34% vs. 18% of patients had a normal EF with 72% vs. 32% of responders to sildenafil. CONCLUSIONS: PRT with PDE-5 inhibitors should be offered early after RP to allow the recovery of EF.