Efficacy and safety of Elevate® system on apical and anterior compartment prolapse repair with personal technique modification

ABSTRACT Aim: To evaluate the effectiveness and safety of Anterior Elevate® mesh kit system (AES) in woman with symptomatic stage 3 or 4 anterior and/or apical pelvic organ prolapse (POP). Materials and Methods: This retrospective, monocentric, single surgeon study enrolled between May 2010 and January 2013 fifty-six woman experiencing symptomatic anterior vaginal prolapse with or without apical descent (POP-Q stage 3 or 4). All women received a AES and 7 (12.5%) received a concomitant transvaginal hysterectomy. Primary endpoint was anatomic correction of prolapse; success was defined as POP-Q stage ≤ 1 or asymptomatic stage 2. Secondary endpoints were quality-of-life (QOL) results and patients' safety outcomes, which were assessed by 3 validated self-reporting questionnaires at baseline and annually: ICIQ-UI short form, ICIQ-VS and P-QOL. All patients completed 2-years and 28 women 3-years of follow-up. Surgical approach was modified in women with uterus, moving the two-propylene strips anteriorly around the cervix itself crossing one another, so the left will take place in the right side and the right on the opposite. This modification was made in order to better support the uterus. Results: Vaginal mesh exposure was present in 3 (5,3%) patients. Very good anatomical outcomes were seen, with one (1,8%) failure at 6-months, 4 (7,1%) at 1-year, 6 at 2-years (10,7%). Statistically significant improvements were seen in the ICIQ-VS and P-QOL questionnaires throughout follow-up. Conclusion: Our data suggest that AES is a minimally-invasive transvaginal procedure to repair anterior and apical POP, with good evidence related to mid-term safety and efficacy.

Efficacy and safety of Elevate® system on apical and anterior compartment prolapse repair with personal technique modification.

AIM: To evaluate the effectiveness and safety of Anterior Elevate® mesh kit system (AES) in woman with symptomatic stage 3 or 4 anterior and/or apical pelvic organ prolapse (POP). MATERIALS AND METHODS: This retrospective, monocentric, single surgeon study enrolled between May 2010 and January 2013 fifty-six woman experiencing symptomatic anterior vaginal prolapse with or without apical descent (POP-Q stage 3 or 4). All women received a AES and 7 (12.5%) received a concomitant transvaginal hysterectomy. Primary endpoint was anatomic correction of prolapse; success was defined as POP-Q stage ≤ 1 or asymptomatic stage 2. Secondary endpoints were quality-of-life (QOL) results and patients' safety outcomes, which were assessed by 3 validated self-reporting questionnaires at baseline and annually: ICIQ-UI short form, ICIQ-VS and P-QOL. All patients completed 2-years and 28 women 3-years of follow-up. Surgical approach was modified in women with uterus, moving the two-propylene strips anteriorly around the cervix itself crossing one another, so the left will take place in the right side and the right on the opposite. This modification was made in order to better support the uterus. RESULTS: Vaginal mesh exposure was present in 3 (5,3%) patients. Very good anatomical outcomes were seen, with one (1,8%) failure at 6-months, 4 (7,1%) at 1-year, 6 at 2-years (10,7%). Statistically significant improvements were seen in the ICIQ-VS and P-QOL questionnaires throughout follow-up. CONCLUSION: Our data suggest that AES is a minimally-invasive transvaginal procedure to repair anterior and apical POP, with good evidence related to mid-term safety and efficacy.

Transobturator surgery in presence of corona mortis: a study in 13 women.

PURPOSE: Severe and life-threatening bleeding has been reported in the literature after retropubic mid-urethral slings procedure, due to corona mortis damage. The aim of this study is to evaluate safety of transobturator passage of the tape in stress-urinary incontinence (SUI) correction and anchoring the mesh in pelvic-organ prolapse (POP) repair in the presence of corona mortis. MATERIALS AND METHODS: Thirteen women with a pre-operatory contrast-enhanced abdominal multidetector computed tomography were prospectively enrolled in the study between January 2009 and December 2014. Eight women underwent a Monarc® and one a Spark® Sling System procedures for SUI correction, and three an Elevate® Anterior and Apical prolapse system and one a Perigee procedure to repair anterior/apical POP. All procedures were performed by a single experienced pelvic surgeon. RESULTS: Surgery was uneventful in all cases. No major bleeding was seen during surgery. No pelvic hematoma was identified 24 hours after the procedure. All women were discharged 1 day after surgery. CONCLUSIONS: Transobturator surgery seems to be a safe way in the presence of the corona mortis. However, further studies are needed to confirm these preliminary findings.

Use of transvaginal ultrasound in females with primary bladder neck obstruction. A preliminary study.

INTRODUCTION AND AIM: The video-urodynamics study is the principal exam to establish a possible primary bladder neck obstruction (PBNO) condition. While trans-rectal ultrasonography plays an important role in the evaluation of the low urinary tract symptoms (LUTS) and the severity of bladder outlet obstruction (BOO) in men, the use of the transvaginal ultrasound (TVUS) in women with symptoms suggesting BOO remains unclear. We tried to check the utility of the TVUS in women with PBNO condition. MATERIAL AND METHODS: We selected female patients which presented BOO without pelvic organ prolapse (POP). According to the data of the video-urodynamic exam we selected the patients with the suspicion of PBNO. A TVUS in basal and during micturition was performed before and after surgery. RESULTS: TVUS showed a closed bladder neck bladder in basal condition and during micturition similarly to the fluoroscopic image during video-urodynamics. The mean distance from bladder neck to the vaginal mucosa resulted 1.3 cm in this patients. CONCLUSIONS: TVUS results worthy in the evaluation of patients with PBNO before and after surgery.

Modulating the inflammatory response to provide the best environment for healing in the pelvic organ prolapse (POP) repair. A preliminary study using coated medical devices.

AIM: We studied the inflammatory response in Phosphorylcholine (PC)-coated and uncoated meshes after 4 weeks of implantation in the subcutaneous tissue of the hypogastric region in six patients. MATERIAL AND METHODS: Six patients underwent POP surgery using two different types of mesh. In three of them a PC-coated mesh was implanted and an uncoated one was implanted in the last three. A small part of the mesh has previously been cut with a standard size decided by the authors and was subsequently implanted in the same time of the pop repair in the subcutaneous fascia of the hypogastric region. After 4 weeks the small part of the mesh was explanted and tissue growth in the fishnet-like mesh was analyzed. RESULTS: A typical foreign body response formed around the uncoated meshes. On the other hand there was a lack in the inflammatory response around the PC-coated mesh identifying less histiocytes, less giant cells and a thinner fibrous capsule formation. DISCUSSION: PC polymers have demonstrated excellent biocompatibility and hemocompatibility. The adsorption of protein onto materials' surface and the trauma involved in surgery necessary for device implantation determines an inflammatory response. The ability of the PC coating to reduce the extent of nonspecific proteins, modulates the specific environment around the implant. CONCLUSION: This preliminary study showed that modulating the inflammatory response we attempt to provide the best environment for healing.

Tumor-stroma metabolic relationship based on lactate shuttle can sustain prostate cancer progression.

BACKGROUND: Cancer cell adopts peculiar metabolic strategies aimed to sustain the continuous proliferation in an environment characterized by relevant fluctuations in oxygen and nutrient levels. Monocarboxylate transporters MCT1 and MCT4 can drive such adaptation permitting the transport across plasma membrane of different monocarboxylic acids involved in energy metabolism. METHODS: Role of MCTs in tumor-stroma metabolic relationship was investigated in vitro and in vivo using transformed prostate epithelial cells, carcinoma cell lines and normal fibroblasts. Moreover prostate tissues from carcinoma and benign hypertrophy cases were analyzed for individuating clinical-pathological implications of MCT1 and MCT4 expression. RESULTS: Transformed prostate epithelial (TPE) and prostate cancer (PCa) cells express both MCT1 and MCT4 and demonstrated variable dependence on aerobic glycolysis for maintaining their proliferative rate. In glucose-restriction the presence of L-lactate determined, after 24 h of treatment, in PCa cells the up-regulation of MCT1 and of cytochrome c oxidase subunit I (COX1), and reduced the activation of AMP-activated protein kinase respect to untreated cells. The blockade of MCT1 function, performed by si RNA silencing, determined an appreciable antiproliferative effect when L-lactate was utilized as energetic fuel. Accordingly L-lactate released by high glycolytic human diploid fibroblasts WI-38 sustained survival and growth of TPE and PCa cells in low glucose culture medium. In parallel, the treatment with conditioned medium from PCa cells was sufficient to induce glycolytic metabolism in WI-38 cells, with upregulation of HIF-1a and MCT4. Co-injection of PCa cells with high glycolytic WI-38 fibroblasts determined an impressive increase in tumor growth rate in a xenograft model that was abrogated by MCT1 silencing in PCa cells. The possible interplay based on L-lactate shuttle between tumor and stroma was confirmed also in human PCa tissue where we observed a positive correlation between stromal MCT4 and tumor MCT1 expression. CONCLUSIONS: Our data demonstrated that PCa progression may benefit of MCT1 expression in tumor cells and of MCT4 in tumor-associated stromal cells. Therefore, MCTs may result promising therapeutic targets in different phases of neoplastic transformation according to a strategy aimed to contrast the energy metabolic adaptation of PCa cells to stressful environments.

[An unusual case of massive funicular lipoma]. / Un inusuale caso di voluminoso lipoma funicolare.

Intrascrotal lipomas are benign diseases that originate from adipose tissue inside the scrotal sac or constituting the scrotal wall itself. Paratesticular spermatic cord lipomas are a rare type of intrascrotal lipomas. A 78 years old patient in good health comes to our attention for massive tense-elastic swelling of left hemiscrotum appeared about 3 years ago and slowly increasing. Ultrasound evaluation of the intrascrotal mass showed inhomogeneous images mainly hyperechoic, not infiltrating the ipsilateral testis and scrotal wall. The ultrasonography found a lipomatous lesion with benign characteristics and a surgical excision has been performed. The lipomatous mass removed presented a size equal to 25 cm x 14 cm x 11 cm and a weight of about 490 gr. The microscopic examination of the tissue showed only the presence of mature adipocytes in the absence of cellular atypia, of other cellular types and of vascular abnormalities.

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.

Does transrectal color Doppler ultrasound improve the diagnosis of prostate cancer?

OBJECTIVE: To prospectively evaluate whether TRUS guided biopsy associated with Color Doppler (CD) imaging improves the detection of PCa. MATERIAL AND METHODS: From January 2008 to December 2010, 144 subjects, with an increased PSA value or with a suspect digital rectal examination, were enrolled. Transrectal grey-scale Ultrasound (US) and CD examination were performed in all patients. CD US was considered positive or negative on the basis of the presence or absence of vascular abnormality. Prostate biopsy was performed immediately after grey-scale and Doppler evaluation, with a mean of 10 core-biopsy for each patient as well as a selective biopsy of all US abnormal areas (hypoechoic lesion or CD abnormality areas). RESULTS: PCa has been detected in 71 (49.3%) patients. 58 of the 71 patients had a hypoechoic area at US scan and 27 had a CD abnormality. The PSA value was < 4 ng/ml in 11 patients (Group 1), in 63 patients PSA ranged between 4 and 10 ng/ml (Group 2) and in 70 patients PSA was greater than 10 ng/ml (Group 3). The detection rate was 36.7, 36.5 and 62.8% respectively. In Group 1 we detected 5 hypoechoic areas and 4 CD abnormal areas. Moreover 6 of 11 patients had a positive DRE. In the Group 2, 20 patients were positive to DRE; we visualized 21 hypoechoic areas and 7 CD abnormality. In the Group 3, 38 patients had a positive DRE, with 32 hypoechoic areas and 16 CD abnormalities found. We obtained 1537 total bioptic cores, 1440 randomly from peripheral gland, 70 from hypoechoic areas and 27 from abnormal CD flow areas. The detection rate was 17.1, 65.7 and 22.2% respectively. CONCLUSION: CD US showed to be a complement to grey-scale imaging of prostate unless insufficiently sensitive to replace the standard systematic 8-12 core random peripherally biopsy. Furthermore it should be associated routinely to TRUS to easily focus suspect areas.

An innovative combined antero-retrograde approach for the resolution of the complete iatrogenic obliteration of ureteral ostium: a case report.

In selected cases of endoscopic surgery of bladder cancer, in order to reach an oncologic radicality, the resection of the ureteral ostium affected by the disease is required. Although infrequent, a possible complication of this manoeuvre is represented by the complete obliteration of theresected ostium. Literature suggests that the traditional "open" surgery and the latest "laparoscopic" surgery are effective in the resolution of this complication, in contrast with the techniques of endourological and uro-interventional radiology which, although minimally invasive, do not appear to be completely appropriate in the treatment of this condition. We believe that an innovative, minimally invasive anterograde trans-nephrostomic and retrograde endoscopic combined approach can be decisive in restoring complete patency of the neo-ostium.

[Impacts of antibiotic and anti-inflammatory therapy on serum prostate specific antigen in asymptomatic men: our experience]. / Riduzione dei livelli sierici di PSA dopo terapia medica: la nostra esperienza.

INTRODUCTION: The management of "grey zone" elevated Prostate Specific Antigen (PSA) is uncertain. After prostate cancer, benign prostatic hyperplasia and prostatitis may induce PSA increase. PSA reduction, after medical therapy, might identify those patients in whom biopsy can be avoided. The aim of this study was to determine if antibiotic and anti-inflammatory allow avoiding prostate biopsies in patients showing PSA decrease or normalization after medical therapy. MATERIALS AND METHODS: Between January 2009 and May 2011, a total of 31 men with total PSA between 4 and 10 ng/ml were enrolled in this study. Patients with pathological digital rectal examination and clinical symptoms of prostatitis or lower urinary tract infection were excluded from the study. Total PSA, free PSA and free/total PSA were evaluated for all of them. Patients received 1000 mg ciprofloxacin daily for 15 days in combination with 100 mg ketoprofen administered rectally. PSA determinations were repeated two weeks after treatment. SPSS for Windows (version 10.0.7) computer package was used for statistical analysis of the data; a p value <0.05 was considered as level of statistical significance. RESULTS: 19 patients (61%) showed a reduction of PSA level after therapy. Initial total PSA and free-PSA levels were 7.41 and 1.24 ng/ml, respectively. After medical therapy total and free PSA decreased to 5.72 and 1.19 ng/ml. Free/total PSA changed from 15.2% to 14.3%. PSA reached a normal range value in 5 patients (16%), while in 26 patients it was persistently >4 ng/ml, it decreased in 14 patients (45%), and increased in 12 (39%). Patients with PSA up to 4 ng/ml reported a prostatic cancer in 28.5% and 41.6% of cases if PSA was respectively decreased or increased from the initial value. CONCLUSIONS: A combination of antibiotic and anti-inflammatory therapy seems to be a useful way to avoid unnecessary biopsies in patients with PSA range from 4 to 10 ng/ml.

Integrated staging systems for conventional renal cell carcinoma: a comparison of two prognostic models.

OBJECTIVE: The objective of the current study was to compare, in a single center experience, the discriminating accuracy of two prognostic models to predict the outcome of patients surgically treated for conventional renal cell carcinoma (RCC). PATIENTS AND METHODS: We retrospectively evaluated the clinical and pathological data of 100 patients surgically treated for RCC between 1998-2008 at our institution. For each patient, prognostic scores were calculated according to two models: the University of California Los Angeles integrated staging system (UISS) and the Stage, Size, Grade, and Necrosis (SSIGN) developed at the Mayo Clinic. The prognostic predictive ability of models was evaluated using receiver operating characteristic (ROC) curves. RESULTS: The median follow-up was 62 months (range 12-120). All clinical and pathological features that compound the algorithms were significantly associated with death from RCC in univariate and multivariate setting. The 5-year cancer-specific survival (CSS) according to the SSIGN score were 95% in the '0-2' category, 88% in '3-4', 60% in '5-6', 37% in '7-9' and 0% in the '> or = 10' group (long-rank p value < 0.001); according to the UISS the 5 yr CSS probabilities in non-metastatic patients were 100% in low, 80% in intermediate and 54% in high-risk groups; in metastatic patients, the respectively CSS were 40% in low and 25% in high-risk groups (long-rank p value < 0.001). The area under the ROC curve was 0.815 for the SSIGN score and 0.843 for the UISS (p = 0.632). CONCLUSION: In our series the SSIGN and UISS discriminated well, without relevant differences. Currently both algorithms represent usefuls clinical tools that allow risk assessment after surgical treatment of RCC. We encourage the uro-oncologist to begin to routinely rely on them in real-life practice.

PSA supernormalisation: a surrogate of complete adenoma removal in men with benign prostatic hyperplasia.

It is known that serum prostate-specific antigen levels (PSA) decrease gradually following surgery for benign prostatic hyperplasia (BPH), but there is not an established cut-off value for normal PSA after relief of obstruction. We evaluated the impact of prostatic adenoma enucleation on PSA levels in 110 patients who underwent transvesical suprapubic adenomectomy for symptomatic BPH. We examined PSA levels before and after open surgery and weight of the prostatic adenoma as measured by the pathologist. Forty-eight percent of the patients had a preoperative PSA level between 0 and 4, 29% between 4 and 7, and 23% between 7 and 10 ng/ml. In patients with suspected abnormality on digital rectal examination or PSA > 4.0 ng/mL systematic multisite biopsies were performed preoperatively to rule out prostate cancer. The mean weight of enucleated adenoma was 87 gr (range 50-201). The mean serum PSA decreased from 4.8 ng/ml preoperatively to 0.5 ng/ml postoperatively. The mean decrease in PSA was 90% (range 70-99%). PSA was resetted at lower level in all patients irrespectively of baseline PSA levels or BPH weight. The transvesical suprapubic adenomectomy supernormalises serum PSA lower than 1 ng/ml in 96% of patients. 100% of patients have a postoperative PSA value < 1.5 ng/ml. PSA supernormalisation represents an objective measure of complete adenoma removal. The urologists should be aware of this resetted level and they should take account of it when different ablative therapies for BPH are confronted.

Urodynamic parameters after solifenacin treatment in men with overactive bladder symptoms and detrusor underactivity.

AIMS: To describe the changes in urodynamic parameters and to assess patients' perceptions of voiding difficulties and improvements in symptom bother after solifenacin treatment in men with overactive bladder (OAB) and detrusor underactivity (DUA). METHODS: In this prospective study, 49 neurologically intact men were enrolled. DUA was defined as a bladder contractility index (BCI) <100. All subjects received 5 mg of solifenacin once a day for 120 days. A complete urodynamic study was carried out on the day before to the first dose of solifenacin and at day 120. RESULTS: Solifenacin treatment resulted in a decrease in Q(max) during UDS (-0.6 ml/sec; P = 0.007), P(det)Q(max) (-6.4 cmH(2)O; P < 0.001), BOOI (-7.5; P < 0.001), BCI (-3.8; P = 0.001), BVE (-4.4%; P = 0.006), and voided volume (-7.5 ml; P = 0.09). On the contrary, PVR (+6 ml; P = 0.152), and maximum cystometric capacity (+22.9 ml; P = 0.001) increased. The regression analysis suggested that changes in urodynamic parameters after solifenacin treatment were limited for BOOI (9.4%), P(det)Q(max) (8.4%), and BCI (6.5%), with no significant impact on Q(max) during UDS, BVE, volume voided and PVR. No significant change in subjective perception of voiding difficulties was found. The incidence of AUR was 2.2% and improvement in patient's experience of OAB symptoms bother after solifenacin treatment was observed. CONCLUSIONS: Solifenacin treatment results in changes of urodynamic parameters. These changes, however, seem not to be of clinical significance as suggested by the lack of subjective deterioration in voiding difficulties and by the low incidence of AUR.

Periprostatic nerve block before ultrasound-guided prostate biopsy: a comparison of two local anesthetics.

The objective of the present study was to evaluate the efficacy of the periprostatic nerve block (PNB) of the prostate-vesicular junction with low volume and high concentration of anesthetics in relieving pain during prostate biopsy. Two hundred and twenty patients were enrolled and randomized to receive PNB with 5 ml 2% lidocaine (group 1110 pts) and PNB with 5 ml 2% mepivacaine (group 2, 110 pts). The anesthetic was administered through a single puncture on each side at the prostate-vesicular junction using a 22-gauge needle. All patients filled in a ten visual analogue pain score scale (VAS) from 0 = no discomfort to 10 = severe pain, for the assessment of pain experienced during biopsy. The two groups were homogeneous concerning the anthropometrical data. The mean pain score with lidocaine was 1.4 +/- 1.02 (CI 95% = 1.53 to 3.57) and with mepivacaine was 1.3 +/- 1.06 (CI 95% = 2.66 +/- 4.84) with no statistical significant difference between groups (p = 0.43). No general or local adverse effects were observed between the anaesthetics. The use of a low volume (2.5 ml on each side) and high concentration (2%) of local anesthetics (lidocaine/mepivacaine) almost completely suppresses pain and discomfort associated with prostate biopsy. The anatomy of neurovascular bundle regions appears favourable to the administration of small amounts of anesthetic.

Ejaculatory duct obstruction caused by a right giant seminal vesicle with an ipsilateral upper urinary tract agenesia: an embryologic malformation.

OBJECTIVE: To report our experience with TURED in infertile men with EDO associated with abnormal development of the mesonephric or Wolffian duct, causing a contemporary malformation of the ipsilateral upper urinary tract. DESIGN: Retrospective clinical study. SETTING: Infertile men in an hospital environment. PATIENT(S): Seven patients affected by Zinner syndrome, from March to September 2005, were selected. INTERVENTION(S): Underwent TURED. MAIN OUTCOME MEASURE(S): Semen analysis, endocrine profile, transrectal ultrasonography and seminal vesicles aspiration, excretory urography, computerized tomography (CT), or magnetic resonance imaging (MRI). RESULT(S): Before surgery, the patients experienced a decreased intensity and force of ejaculation and a low motile sperm count. The detection of the ipsilateral upper urinary tract malformation by the patients was incidental. After surgery, all patients reported having a projectile ejaculation, an increase in the average postoperative volume, and of the total motile sperm count. CONCLUSION(S): A seminal vesicle cyst combined with ipsilateral renal agenesis, described as Zinner syndrome, is a rare urological anomaly. It is frequently asymptomatic or else characterized by infertility, symptoms of bladder irritation, or pain in the scrotum and perineum. In selected patients, TURED can improve semen quality with subsequent ability to impregnate. The upper urinary tract malformation should be treated in symptomatic cases only.

Surgical and biologic outcomes after neoadjuvant bicalutamide treatment in prostate cancer.

OBJECTIVES: To perform a randomized, prospective, controlled, intention-to-treat study to determine the usefulness of bicalutamide as a neoadjuvant hormonal therapy regimen to surgery in reducing positive surgical margins and modulating epidermal growth factor receptor (EGFR) member's in men with prostate cancer. METHODS: From April 2002 to December 2003, 430 men were diagnosed with prostate cancer. Of these men, 119 with clinical Stage T2-T3a were enrolled. Of the 119 men, 61 were assigned to receive 150 mg/day bicalutamide for 120 days before radical prostatectomy (bicalutamide plus surgery group) and 58 to radical prostatectomy alone (surgery group). Logistic regression analysis was performed to determine the relationship between bicalutamide and EGFR/Her2/neu levels. P <0.05 was considered to indicate significance. RESULTS: Patients treated with bicalutamide had a 3.5-fold increase in negative surgical margins (odds ratio [OR] 3.5; 95% confidence interval [CI] 1.4 to 8.74; P = 0.011). In particular, in Stage pT3a tumors, bicalutamide treatment was associated with a fivefold increase in negative surgical margins (OR 5.4; 95% CI 1.9 to 15.5; P = 0.002). In those with Stage pT2, no difference for this surgical outcome was noted. Immunohistochemical analysis revealed that bicalutamide increased EGFR levels 2.8-fold (OR 2.8; 95% CI 1.3 to 6.2; P = 0.014) and of 2.7-fold Her2/neu (OR 2.7; 95% CI 1.2 to 5.8; P = 0.022). When EGFR and Her2/neu were overexpressed, they were also active. In this regard, bicalutamide increased p-EGFR levels 3.3-fold (OR 3.3; 95% CI 1.3 to 8.2; P = 0.0016) and increased p-Her2/neu 2.8-fold (OR 2.8; 95% CI 1.2 to 6.3; P = 0.025). CONCLUSIONS: Bicalutamide appears to reduce the prevalence of positive surgical margins. The upregulation of Her2/neu and EGFR and their phosphorylated forms was an early event after bicalutamide treatment. We hypothesized that the benefits of neoadjuvant hormonal therapy might be overwhelmed by the capacity of the residual tumor to acquire compensatory survival pathways and to grow and progress.

[Percutaneous treatment of varicocele: considerations and our experience]. / Trattamento percutaneo del varicocele: considerazioni e nostra esperienza.

UNLABELLED: Due to its high incidence and its affecting male infertility, varicocele is an important disease. Consequently, it is essential to choose the best treatment. MATERIALS AND METHODS: Since 1999 to 2000, 75 patients affected by varicocele (mean age 25 years) underwent percutaneous retrograde sclerotherapy through a right transfemoral approach. Pre-operative tests included physical examination, sperm analysis and colour Doppler sonography. According to Dubin and Amelar classification, 59% of patients were affected by Grade 3 varicocele. According to Hirsh classification, grade III-IV varicocele was diagnosed with colour Doppler sonography in 77.3% of patients. Mean operative time was 30 minutes with only 5 minutes of exposure to radiation. All patients were followed-up with colour Doppler ultrasound and sperm analysis 1, 4 and 12 months after the treatment. RESULTS: In 6 of 75 patients (8%) sclerotherapy was unsuccessful because it was not possible to catheterize the spermatic vein. No significant complications were observed pre and post-operatively. 3 patients complained of mild testicular pain and 1 case had a transient hydrocele. The patients were dismissed during the next 24 hours after the procedure. During follow-up, physical examination was unremarkable in all patients, while occlusion of spermatic veins showed by Doppler ultrasound at 4 and 12 months was achieved in 94% of patients. CONCLUSIONS: Retrograde sclerotherapy through trans-femoral approach is a safe and effective treatment. In our opinion it should be considered as the treatment of choice, especially if we consider the costs, hospitalization and complications of conventional surgery and laparoscopy.