The impact of 5-ARI on perioperative and functional outcomes of GreenLight PVP: an analysis of the Global GreenLight Group database.

INTRODUCTION: In this study, we sought to investigate the impact of 5-alpha reductase inhibitors (5-ARI) on the perioperative and functional outcomes of 180-Watt XPS GreenLight photovaporization of the prostate (PVP) using a large international database. MATERIALS AND METHODS: Data were obtained from the Global GreenLight Group (GGG) database, which includes eight high-volume, experienced surgeons from seven international centers.  All men with established benign prostatic hyperplasia (BPH) with known 5-ARI status who underwent GreenLight PVP using the XPS-180W system between 2011 and 2019 were eligible for the study.  Patients were assigned to two groups based on the preoperative use of 5-ARI.  Analyses were adjusted for patient age, prostate volume, and American Society of Anesthesia (ASA) score. RESULTS: We included 3,500 men, of which 1,246 (36%) had preoperative 5-ARI use.  Patients in both groups were similar with regards to age and prostate size.  On multivariable analysis, total operative time was slightly shorter (-3.26 min 95% CI: 1.20 - 5.32, p < 0.01) and required 35.6kJ less laser energy (95% CI: -48.0kJ - -23.3kJ, p < 0.01) for patients on 5ARI compared to those without 5-ARI.  However, no clinically significant difference was appreciated regarding postoperative transfusion rates [OR 0.048 (95% CI -0.82-0.91; p = 0.91)], hematuria rates [OR 0.96 (95% CI 0.72-1.3; p = 0.81)], 30-day readmission rates [OR 0.98 (95% CI 0.71-1.4; p = 0.90)], or overall functional outcomes. CONCLUSION: Our findings suggest that preoperative 5-ARI is not associated with any clinically significant different perioperative or functional outcomes for GreenLight PVP using the XPS-180W system.  There is no role for the initiation or discontinuation of 5-ARI prior to GreenLight PVP.

Safety and efficacy of GreenLight PVP in octogenarians: evaluation of the Global GreenLight Group database.

INTRODUCTION: The present study analyzes the largest international GreenLight database, the Global GreenLight Group (GGG), to evaluate the functional and safety profile of GreenLight photoselective vaporization of the prostate (PVP) in octogenarians. METHODS: The GGG is a database comprised of patients that underwent GreenLight PVP from 2011 to 2019 performed by 8 experienced urologists at 7 international hospitals. Patients 80 years or older at the time of surgery were categorized as octogenarians. They were compared to a similar group of PVP patients below the age of 80. RESULTS: Among 3,648 patients, 586 men were above the age of 80. Compared to patients under the age of 80, octogenarians had larger prostates (76.0 vs 71.9 ml, p = 0.02) and a lower BMI (25.6 vs 26.7, p = 0.045). Operative time was not significantly longer in octogenarians. The improvement in functional outcomes between 80-year-old patients and control patients was not significantly different at one-year follow-up, with the exception of maximum urinary flow (Qmax) that favoured younger patients (10.3 vs 12.6 ml/s, p = 0.02). The odds of transfusion were greater for older patients [OR 8.2 (95% CI 3.6-18.9, p < 0.01)], but they were not at increased risk of hematuria. Octogenarians had higher readmission rates (23.0 vs 11.9%, p < 0.01). CONCLUSIONS: GreenLight PVP is a safe option in well-selected octogenarians in a cohort of patients treated by surgeons experienced with the technology. The odds of transfusion were higher in patients over 80, but the absolute risk remains low. The 30-day hospital readmission rate was higher in octogenarians.

Functional outcomes of GreenLight 180-W photoselective vaporization in patients with large (≥ 80 cc) prostates: an analysis of over 3000 men in the Global Greenlight Group (GGG) database.

INTRODUCTION: GreenLight photoselective vaporization of the prostate (PVP) has gained widespread adoption as an option to traditional transurethral resection of the prostate. Prior reports expressed concern with the use of PVP in large prostates. The aim of this study was to investigate the adjusted outcomes of GreenLight PVP in men with large (≥ 80 cc) vs. small prostates (< 80 cc). METHODS: Data were obtained from the Global Greenlight Group which pools data from 7 high volume centers. Men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible and assigned into two groups based on their prostate size (≥ 80 and < 80 cc). 11 functional and perioperative covariates were collected. Analyses were adjusted for patient age and presence of median lobe. RESULTS: 3426 men met the inclusion criteria. 34.6% (n = 1187) of patients had a large prostate size. Baseline age and prostate volume were significantly different between the groups. The magnitude of absolute improvement in unadjusted international prostate symptom score was significantly greater in the large (≥ 80 cc) prostate group at 12 months, with an absolute change of 19.17 points (95% CI 18.46-19.88; p < 0.01). There was also a significant drop in PVR at both 6- (p = 0.007) and 12 months (p = 0.005). There were no significant differences in transfusion (p = 0.42), hematuria (p = 0.80), or 30-day readmission rates (p = 0.28). CONCLUSIONS: Greenlight PVP is a safe and effective alternative for patients with prostate sizes ≥ 80 cc, with durable outcomes relatively independent from prostate size.

Global experience and progress in GreenLight-XPS 180-Watt photoselective vaporization of the prostate.

PURPOSE: To evaluate changes in global perioperative data of GreenLight-XPS 180-Watt photo-selective vaporization of the prostate (GL-XPS) of the Global Greenlight Group (GGG) database. METHODS: 3441 men, who underwent GL-XPS for symptomatic BPH between 2011 and 2019 at seven high volume international centers, were included. Primary outcome measurements were operative time (OT; min), effective laser time (LT; min of OT), as well as intraoperative and postoperative adverse events (AEs), all analyzed by year of surgery (2011-2019) and prostate volume (PV) group (< 80 ml vs. 80-150 ml vs. > 150 ml). RESULTS: The median age was 70 years (interquartile range 64-77), the median PV was 64 ml (IQR 47-90). The OT and LT slightly increased but stayed highly efficient all in all. Median OT was 60 min (IQR 45-83) and LT was 33 min (IQR 23-46). Median energy use was 253 kJ (IQR 170-375) with an energy density of 3.94 kJ/ml (IQR 2.94-5.02). The relative probability of perioperative AEs decreased by 17% each year (p < 0.001). The relative probability of perioperative transfusion dropped significantly from 2% in 2011 to 0% in 2019 (p = 0.007). The early postoperative complications (within 30 days after surgery) decreased significantly from 48.8% (n = 106) in 2011 to 24.7% (n = 20) in 2019 (p > 0.001). CONCLUSION: These findings from the GGG demonstrate significant improvement secondary to growing experience with GL-XPS between 2011 and 2019 in intraoperative AEs, including transfusions, and postoperative AEs. While staying highly efficient in OT and LT of GL-XPS within a 9-year period of experience.

GreenLight photovaporization of the prostate in high-medical-risk patients: an analysis of the Global GreenLight Group (GGG) database.

PURPOSE: We sought to characterize the adjusted outcomes of GreenLight photoselective vaporization of the prostate (PVP) in high-medical-risk (HMR) patients using data from the largest international database. METHODS: Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. Eligible study participants underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019. HMR patients were defined as patients with ASA III or greater and were compared to non-HMR patients. Analyses were adjusted for patient age and prostate volume. RESULTS: In the HMR group, patients on average were older and had smaller prostates than the non-HMR control group. Compared to non-HMR patients, transfusions occurred more frequently (2.6% vs. 0.14%, p < 0.01) and the odds of readmission were elevated [OR 2.0, (95% CI 1.4-2.8, p < 0.01)] among HMR patients. Twelve months postoperatively, HMR patients experience greater improvement in QoL than the control group [+ 0.54 (95% CI 0.07-1.0, p = 0.02)]. PVR also decreased 93.1 ml more in HMR than in non-HMR patients after 12 months (95% CI 33.6-152.6, p < 0.01). CONCLUSION: We found that GreenLight PVP is safe and effective in improving functional outcomes in higher-risk patients with severe systemic disease compared to their lower-risk counterparts. Though absolute risks remain low, GreenLight PVP is associated with higher odds of transfusion and readmission in the high-risk cohort. The findings of our study reaffirm current guidelines that propose PVP as a viable treatment option for HMR patients.

Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety.

INTRODUCTION: Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of benign prostatic hyperplasia (BPH), especially in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling data from international centers. METHODS: Data from 3627 patients who underwent GL-PVP with the XPS-180 W system in seven international centers performed by eight expert surgeons between 2011 and 2019 were retrospectively analyzed. Demographic, perioperative, and postoperative data were collected, including IPSS, QoL, Qmax, PVR, and PSA, and complications. RESULTS: At baseline, median age, prostate volume, PSA, and IPSS were 70 years (interquartile range 64-77), 64 (47-90), 3.1 ng/mL (1.8-6), and 22 (19-27), respectively. Median lasing and operative time were 34 (23-48) and 62 min (46-85), respectively. Median energy use was 250.0 kJ (168.4-367.9), with 92.6% of procedures being completed with one laser fiber. In 60.1% of cases, catheter was removed on postoperative day 1 with median length of 2 days. All-cause mortality within 30 days was 0.3%. Median PSA reduction at 3 months and 60 months compared to baseline was 43.9 and 46.4%, respectively (p < 0.001). All functional outcomes (IPSS, QoL, Qmax, and PVR) were significantly improved across study period when compared to baseline (p < 0.001). For those men with longer follow-up available, the observed surgical BPH retreatment rate was 1.5% CONCLUSION: Using the largest multi-user, international database of GL-PVP, Greenlight XPS laser treatment in experienced hands is a safe, effective, and durable BPH treatment option.

Impact of the presence of a median lobe on functional outcomes of greenlight photovaporization of the prostate (PVP): an analysis of the Global Greenlight Group (GGG) Database.

OBJECTIVES: Previous analyses of the impact of median lobe presence on Greenlight photoselective vaporization of the prostate (PVP) outcomes were limited by their small sample size and the ability to adjust for important confounders. As such, we sought to investigate the impact of prostate median lobe presence on the operative outcomes of 180 W XPS GreenLight PVP using a large international database. METHODS: Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. All men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible for the study. Patients were assigned to two groups based on presence or absence of median lobes. Analyses were adjusted for patient age, prostate volume, body mass index, and American Society of Anesthesia (ASA) score. RESULTS: A total of 1650 men met the inclusion criteria. A median lobe was identified in 621 (37.6%) patients. Baseline prostate volume, patient age, and ASA score varied considerably between the two groups. In adjusted analyses, the operative and lasing time of patients with median lobes was 6.72 (95% CI 3.22-10.23; p < 0.01) minutes and 2.90 (95% CI 1.02-4.78; p < 0.01) minutes longer than the control group. Men with median lobes had similar postoperative functional outcomes to those without a median lobe except for a 1.59-point greater drop in the 12-month IPSS score compared to baseline (95% CI 0.11-3.08; p = 0.04) in the median lobe group, and a decrease in PVR after 6 months which was 46.51 ml (95% CI 4.65-88.36; p = 0.03) greater in patients with median lobes compared to men without median lobes. CONCLUSIONS: Our findings suggest that the presence of a median lobe has no clinically significant impact on procedural or postoperative outcomes for patients undergoing Greenlight PVP using the XPS-180 W system.

Calcium channel blocker and renal mitochondrial function in warm renal ischemia.

OBJECTIVE: Ions, particularly calcium ions, play an important role in ischemia-reperfusion cell injury. In this study, we investigated the action of verapamil on the mitochondrial function of kidneys submitted to ischemia without blood reperfusion in order to study isolated early and late ischemic effects. MATERIALS AND METHODS: 44 rats were submitted to bilateral warm renal ischemia for 30 minutes. The kidneys were then immediately reperfused with saline or Euro-Collins (EC) solution, with and without previous administration of 0.35 mg/kg of verapamil. Mitochondrial function was assessed at the end of renal perfusion and after 24 hours of cold preservation. RESULTS: In kidneys perfused with saline, verapamil allowed a significant early preservation of state III mitochondrial respiration, a result that was no longer evident after 24 hours. In kidneys perfused with EC solution, verapamil did not change state III for either early or late evaluations. Comparison of the groups showed that the results obtained for kidneys perfused with EC were always superior to those obtained for the saline group, except for the initial analysis of kidneys treated with saline and verapamil, which showed results similar to those obtained with EC perfusion alone. CONCLUSION: Administration of verapamil before warm ischemia provides partial and short-lasting functional protection of the mitochondrial function in kidneys perfused with sodium rich saline. With Euro-Collins solution, verapamil did not show any additional beneficial effect. This fact permits us to conclude that protective action is effective only under conditions that facilitate increased sodium uptake and/or potassium loss.

Calcium channel blocker and renal mitochondrial function in warm renal ischemia

OBJECTIVE: Ions, particularly calcium ions, play an important role in ischemia-reperfusion cell injury. In this study, we investigated the action of verapamil on the mitochondrial function of kidneys submitted to ischemia without blood reperfusion in order to study isolated early and late ischemic effects. MATERIALS AND METHODS: 44 rats were submitted to bilateral warm renal ischemia for 30 minutes. The kidneys were then immediately reperfused with saline or Euro-Collins (EC) solution, with and without previous administration of 0.35 mg/kg of verapamil. Mitochondrial function was assessed at the end of renal perfusion and after 24 hours of cold preservation. RESULTS: In kidneys perfused with saline, verapamil allowed a significant early preservation of state III mitochondrial respiration, a result that was no longer evident after 24 hours. In kidneys perfused with EC solution, verapamil did not change state III for either early or late evaluations. Comparison of the groups showed that the results obtained for kidneys perfused with EC were always superior to those obtained for the saline group, except for the initial analysis of kidneys treated with saline and verapamil, which showed results similar to those obtained with EC perfusion alone. CONCLUSION: Administration of verapamil before warm ischemia provides partial and short-lasting functional protection of the mitochondrial function in kidneys perfused with sodium rich saline. With Euro-Collins solution, verapamil did not show any additional beneficial effect. This fact permits us to conclude that protective action is effective only under conditions that facilitate increased sodium uptake and/or potassium loss.

Free PSA and prostate volume on the diagnosis of prostate carcinoma

OBJECTIVE: To analyse the influence of prostate volume on the performance of total prostate specific antigen (tPSA) and free PSA (fPSA) on the diagnosis of prostate adenocarcinoma. METHODS: A total of 188 patients underwent transrectal ultrasound guided biopsies (10-12 cores) due to prostate nodes detected by digital rectal examination and/or tPSA range of 2.5-10ng/ml. Mean age was 65.7±8.7 years. 19/100 (19%)(GI) patients with prostate volume >40ml had prostate cancer while the corresponding figure for patients with prostate 40ml was 26/88 (29.5%)(GII). We analyzed the sensitivity and specificity of tPSA at cut-off points of 2.5 and 4ng/ml as well as the influence of the ratio f/tPSA in both groups of patients. RESULTS: In the group GI tPSA sensitivity and specificity were 94.4% and 19.5% at the cut-off level of 4ng/ml and 100% and 6% at 2.5ng/ml. The corresponding values for GII were 76.5% and 62.9%, and 100% and 19.3%. In group GI a cut-off of 19% for the ratio f/tPSA kept tPSA sensitivity over 90% while the specificity increased to 46.2% at cut-off level of 4ng/ml and to 32.9% at 2.5ng/ml. In the group GII the ratio f/tPSA was not able to increase the specificity of tPSA at a cut-off level of 4ng/ml without an expressive reduction of sensitivity. On the other side, for this group a cut-off of 16% for the f/tPSA ratio rose the specificity to 46.7% for a sensitivity over 90%. CONCLUSION: We recommend stratification of patients according to prostate volume to define tPSA cut-off point. The cut-off level of 2.5ng/ml for tPSA combined with f/tPSA ratio of 19% in prostates >40ml and 16% in prostates 40ml was a better option for prostate biopsy indication than tPSA at a cut-off of 4ng/ml associated or not with f/tPSA ratio.

OBJETIVO: Investigar a influencia do volume prostático no desempenho do PSA total (tPSA) e livre (fPSA) no diagnóstico do adenocarcinoma prostático. MÉTODOS: 188 patients foram submetidos à biópsias prostáticas guiadas por ultra-som trans-retal (10-12 fragmentos) por apresentarem toque retal alterado e/ou tPSA entre 2,5 e 10ng/ml. A idade média foi 65,7±8,7 anos. A prevalência do câncer foi de 19% (19/100) em pacientes com próstatas >40ml (GI) e 29,5% (26/88) naqueles com próstatas 40ml (GII). Analisamos a sensibilidade e a especificidade do tPSA em corte de 2,5ng/ml e 4ng/ml bem como a influência do fPSA nos dois grupos de pacientes. RESULTADOS: No grupo GI a sensibilidade e a especificidade do tPSA foram de 94,4% e 19,5% no corte de 4ng/ml e 100% e 6% no corte de 2,5ng/ml. Para o grupo GII os valores correspondentes foram 76,5% e 62,9%, e 100% e 19,3%. No GI a aplicação da fração f/tPSA, corte de 19%, manteve a sensibilidade do teste acima de 90% e elevou a especificidade para 46,2% no corte de 4ng/ml e 32,9% no corte de 2,5ng/ml. No GII a fração f/tPSA não foi capaz de elevar a especificidade do tPSA sem afetar significativamente a sensibilidade. Porém, neste grupo o uso do quociente f/tPSA de 16% elevou a especificidade do tPSA, corte de 2,5ng/ml, para 46,7% para sensibilidade acima de 90%. CONCLUSÃO:Recomenda-se estratificar os pacientes segundo o volume prostático para definir o corte do tPSA. O tPSA no corte de 2,5ng/ml, associado ao f/TPSA de 19% em próstatas >40ml e de 16% para próstatas 40ml representou melhor opção para indicação de biópsia que o tPSA no corte de 4ng/ml associado ou não à fração f/tPSA.

Adrenalectomia laparoscópica: análise de 11 pacientes

OBJECTIVE: To analyze the initial experience of the Division of Urology from HCFMRP-USP on the transperitoneal laparoscopic adrenalectomy. METHODS: We analyze retrospectively 11 cases of laparoscopic adrenalectomy carried out from February of 1,999 to March of 2,003. The sample included all patients operated on through this method in such period and was composed of 3 (27%) men and 8 (73%) women with a mean age of 40,2 ± 13,1 years. The patients had the following diagnosis: adenoma - 5, Cushing's syndrome - 3, feocromocytoma - 1, Conn's syndrome - 1 and Carey's syndrome - 1. RESULTS: The adrenalectomy was bilateral in 5 (45.4%) patients and unilateral in 6 (54.6%) being 4 (36.4%) on the right side and 2 (18.2%) on the left side. The mean hospital stay was 3,6 ± 1,1 days and the mean operating time was 220,5 ± 103,7 minutes. Conversion to open surgery was required in 2 patients (18.2%). CONCLUSION: The results of laparoscopic adrenalectomy were similar to those reported elsewhere and corroborate the safety and efficacy of the method resulting in an acceptable surgical time, faster postoperative recovery and shorter hospital stay.

OBJETIVO: Analisar a experiência inicial da Divisão de Urologia do HCFMRP-USP na adrenalectomia transperitoneal videolaparoscópica. MÉTODOS: Análise retrospectiva de 11 casos de adrenalectomia transperitoneal laparoscópica realizados de fevereiro de 1999 a março de 2003 sendo 3 em homens( 27%) e 8 em mulheres (73%), idade média de 40,2 ± 13,1 anos. Os pacientes apresentavam os diagnósticos seguintes: adenoma - 5, síndrome de Cushing - 3, feocromocitoma - 1, hiperaldestorismo - 1 e síndrome de Carney - 1. RESULTADOS: A cirurgia foi bilateral em 05 pacientes (45,4%) e unilateral em 06 pacientes (54,6 %), destes 04 à direita (36,4%) e 02 à esquerda (18,2%). O tempo médio de internação foi de 3,6 ± 1,1 dias, o tempo médio de cirurgia foi de 220,5 ± 103,7 minutos e a taxa de conversão foi de 18,2%. CONCLUSÃO: Os resultados apresentados são similares aos relatados pela literatura, demonstrando que a adrenalectomia videolaparoscópia pode ser realizada de maneira segura e eficiente com benefícios: tempo cirúrgico aceitável, rápida recuperação pós-operatória e alta precoce.

Performance of PSA and of PSA density in the diagnosis of prostate carcinoma

OBJECTIVE: The aim of the study was to investigate the influence of the prostate volume and PSA density on the performance of total PSA to diagnosis of prostate carcinoma. METHODS: We analyzed 217 patients (PSA 0-10ng/ml) submitted to transrectal sextant prostate biopsy. Criteria for biopsy indication was PSA >2ng/ml and/or digital rectal exam suspicious of prostate cancer. RESULTS: Fifty five patients had prostate neoplasia (25.3%) and in 8/55 (25.3%) the serum PSA was under 4ng/ml. The sensitivity and specificity of the test were respectively 98.2% / 16.6% at a cut-off point of 2.5ng/ml and 85.4% / 38.8% at cut-off of 4ng/ml. The corresponding values for prostates >40ml or 40ml were: 96.2% / 8.1% and 100% / 27.2% at the cut-off point of 2.5ng/ml, and 92.5% / 20% and 78.5% / 62.3% at a cut-off level of 4ng/ml. For prostates 40ml a PSA cut-off point of 4ng/ml leads to a misdiagnosis in 21.4% of the malignant tumors. The median PSAD of benign prostates are different according to prostate volume (.40ml or 40ml). PSAD at cut-off of 0.08 increases the PSA specificity at both PSA cut-off points. CONCLUSIONS: Prostate volume affects the sensitivity and specificity of PSA and the median values of PSAD. PSAD of 0.08 increases the PSA specificity specially at a cut-off point of 2.5ng/ml in prostates smaller than 40ml.

CD34 immunoexpression in penile carcinoma

OBJECTIVE: To investigate microvessel density as a risk factor in squamous cell carcinoma of the penis. METHODS: Fifty patients with penile carcinoma were evaluated retrospectively. The mean age and standard deviation were 60.8±11.8 years. All of them were treated by penectomy and with positive nodes underwent groin lymphadenectomy. Tumor grading was 36 G1 and 24 G2/3. Primary lesion stage was 22 pT1 and 28 pT2-4. Positive inguinal nodes were observed in 18 patients. Selected paraffin embedded sections were submitted to CD34 immunohistochemical analysis by the avidin-biotin-immunoperoxidase method with antigen retrieval. All slides were examined using an automatic analyzer system and the number of micro-vessels in 10 high magnification power fields (400X) were counted in a blind analysis. RESULTS: Median number of microvessels was 631 in G1 versus 695 in G2/3 tumors (p=0.78), and 696 in pT1 versus 566 pT2-4 tumors (p=0.23). The respective data for pN0 patients was 525 and for pN+ was 696 (p=0.01), which is an unexpected result. CONCLUSION: CD34 immunoexpression or microvessel density determined by this method bear no association with tumor grade, stage or prognosis.

Alça intestinal invertida como substituto do ureter: estudo experimental em cães

OBJECTIVE: To investigate the outcome of ureter replacement with inverted seromuscular tube in dogs. METHODS: 40 adult mongrel dogs were divided in 5 groups of 8 animals. Each group was divided in 2 subgroups: 1 - sacrifice on 12-15 postoperative days, and 2 - sacrifice on the 60th postoperative day). In group A ureter longitudinal incision 2cm long was sewed with an inverted ileal seromuscular patch 2cm long. In group B ureter incision and patch size were 4cm long. In the remaining groups a ureter segment was replaced by an inverted ileal seromuscular tube 2cm long (group C) or 6cm long (groups D and E). In all groups, except E, ileal mucosa was removed by a grasping maneuver with a scalpel. In group E the ileal mucosa was trimmed away by blunt dissection with a scissors. The ureter permeability was tested by an intravenous urogram, and after sacrifice by anatomic exploration with a catheter. All ureter segment removed through the necropsy were analyzed by histology after hematoxilin-eosin coloration. RESULTS: The number of animals with normal urogram after the followup was: A - 2, B - 2, C - 3, D - 2 and E - 2. Histology revealed that ileal serosa was covered by ureteral mucosa grown from the ureter buds. CONCLUSION: The inverted ileal seromuscular tube or patch does not work well for ureter replacement.

OBJETIVO: Pesquisar a viabilidade da alça ileal invertida como substituto ureteral. MÉTODOS: Quarenta cães foram divididos em 5 grandes grupos de 8 animais, cada um subdividido em 2 subgrupos de acordo com a data do sacrifício (I - sacrifício em 12-15 dias de pós-operatório, e II - 60 dias de pós-operatório). Nos grupos A e B fez-se a substituição ureteral parcial com selo de íleo invertido, após abertura lateral do ureter direito com 2 (Grupo A) ou 4 cm (Grupo B) de extensão. Nos demais grupos fez-se a substituição do segmento completo do ureter usando-se um tubo de íleo invertido de comprimento equivalente ao segmento do ureter ressecado com 2cm (Grupo C) e 6cm (Grupos D e E) de extensão. A mucosa ileal foi removida por raspagem ou diérese. A permeabilidade ureteral foi testada por urografia excretora e por exploração anatômica com cateter após o sacrifício. As peças foram estudas histologicamente após preparação e coloração com hematoxilina-eosina. RESULTADOS: O número de animais com urografia normal após o seguimento foi: A-2, B-2, C-3, D-2 e E- 2. A histologia revelou que a serosa ileal se reveste com urotélio, não como decorrência de metaplasia, mas do crescimento a partir da borda da mucosa ureteral. CONCLUSÃO: Conclui-se que o íleo invertido não é um bom substituto ureteral.

Performance of PSA and of PSA density in the diagnosis of prostate carcinoma

Objective: The aim of the study was to investigate the influence of the prostate volume and PSA density on the performance of total PSA to diagnosis of prostate carcinoma. Methods: We analyzed 217 patients(PSA 0-10ng/ml) submitted to transrectal sextant prostate biopsy. Criteria for biopsy indication was PSA >2ng/ml and/or digital rectal exam suspicious of prostate cancer. Results: Fifty five patients had prostate neoplasia (25.3 percent) and 8/55 (25.3 percent) the serum PSA was under 4ng/ml. The sensitivity and specificity of the test were respectively 98.2 percent /16.6 percent at a cut-off point of 2.5ng/ml and 85,4 percent /38.8 percent at cutt-off of 4ng/ml. The corresponding values for prostates >40ml or <40ml were: 96.2 percent /8.1 percent and 100 percent /27.7 percent at the cut-off point of 2.5ng/ml, and 92.5 percent /20 percent and 78.5 percent /62.3 percent at a cut-off level of 4ng/ml. For prostates <40ml a PSA cut-off point of 4ng/ml leads to a misdiagnosis in 21.4 percent of the malignant tumors. The median PSAD of benign prostates are different according to prostate volume (.40ml or <40ml). PSAD at cut-off of 0.08 increases the PSAspecificity at both PSA cut-off points. Conclusions: Prostate volume affects the sensitivity and specificity of PSA and the median values of PSAD. PSAD of 0.08 increases the PSA specificity specially at a cut-point of 2.5ng/ml in prostates smaller than 40ml.

CD34 immunoexpression in penile carcinoma

Objective: To investigate microvessel density as a risk factor in squamous cell carcinoma of the penis. Methods: Fifty patients with penile carcinoma were evaluated retrospectively. The mean age and standard deviation were 60.8 +/- 11.8 years. All of them were treated by penectomyand with positive nodes underwent groin lymphadenectomy. Tumor grading was 36 G1 and 24 G2/3. Primary lesion stage was 22pT1 and 28pT2-4. Positive inguinal nodes were observed in 18 patients. Selected paraffin embedded sections were submitted to CD34 immunohistochemical analysis by the avidinbiotin-immunoperoxidase method with antigen retrieval. All slides were examined using an automatic analyser system and the number of micro-vessels in 10 high magnification power fields (400X) were counted in a blind analysis. Results: Median number of microvessels was 631 in G1 versus 695 in G2/3 tumors (p=0.78), and 696 in pT1 versus 566 pT2-4 tumors (p=0.23). The respective data for pN0 patients was 525 and for pN+ was 696 (p=0.01), which is an unexpected result. Conclusion: CD34 immunoexpression or microvessel density determined by this method bear no association with tumor grade, stage or prognosis.

Alça intestinal invertida como substituto do ureter: estudo experimental em cães / Inverted intestinal handle as substitute of the ureter: experimental study in dogs

Objetivo: Pesquisar a viabilidade da alça ileal invertida como substituto ureteral. Métodos: Quarenta cães foram divididos em 5 grandes grupos de 8 animais, cada um subdividido em 2 subgrupos de acordo com a data do sacrifício (I - sacrifício em 12-15 dias de pósoperatório, e II - 60 dias de pós operatório). Nos grupos A e B fez-se a substituição ureteral parcial com selo de íleo invertido, após abertura lateral do ureter direto com 2 (Grupo A) ou 4 cm (Grupo B) de extensão. Nos demais grupos fez-se a substituição do segmento completo do ureter usando-se um tubo de íleo invertido de comprimento equivalente ao segmento do ureter ressecado com 2cm (Grupo C) e 6cm (Grupo D e E) de extensão. A mucosa ileal foi removida por raspagem ou diérese. A permeabilidade ureteral foi testada por urografia excretora e por exploração anatômica com cateter após o sacrifício. As peças foram estudadas histologicamente após preparação e coloração com hematoxilina-eosina. Resultados: O número de animais com urografia normal após o seguimento foi: A-2, B-2, C-3, D-2 e E-2. A histologia revelou que a serosa ileal se reveste com urotélio, não como decorrência de metaplasia, mas do crescimento a partir da borda da mucosa ureteral. Conclusão: Concluí-se que o íleo invertido não é um bom substituto ureteral.