Collagenase clostridium histolyticum for the treatment of Peyronie's disease: a prospective Italian multicentric study.

Peyronie's disease (PD) is a common condition which results in penile curvature making sexual intercourse difficult or impossible. Collagenase clostridium histolyticum (CCH) is the first licensed drug for the treatment of PD and is indicated in patients with palpable plaque and curvature deformity of at least 30° of curvature. However, only few monocentric studies are available in the current literature and this is the first national multicentric study focusing on this new treatment. In five Italian centres, 135 patients have completed the treatment with three injections of CCH using Ralph's shortened modified protocol. The protocol consisted of three intralesional injections of CCH (0.9 mg) given at 4-weekly intervals in addiction to a combination of home modelling, stretching and a vacuum device on a daily basis. An improvement in the angle of curvature was recorded in 128/135 patients (94.8%) by a mean (range) of 19.1 (0-40)° or 42.9 (0-67)% from baseline (p < 0.001). There was also a statistically significant improvement in all IIEF and PDQ questionnaires subdomains (p < 0.001 in all subdomains). This prospective multicentric study confirms that the three-injection protocol is effective enough to achieve a good result and to minimize the cost of the treatment.

Multiple ipsilateral renal tumors: retrospective analysis of surgical and oncological results of tumor enucleation vs radical nephrectomy.

AIMS: To evaluate the role of nephron-sparing surgery (NSS) compared to radical nephrectomy (RN) for treating multiple ipsilateral renal tumors. METHODS: We retrospectively reviewed the clinical and pathological data of 960 patients who had surgery for pathologically confirmed RCC between 1986 and 2006. Thirty-four patients were diagnosed as having at least one ipsilateral smaller solid lesion associated with the primary RCC: 22 had RN while 12 had NSS for tumor enucleation. RESULTS: All patients who had NSS had tumors confined within the kidney, as did 82% of patients treated with RN. The sole presence of concomitant accompanying benign histology to the primary RCC was diagnosed in 20% of patients. The mean (median, range) follow-up for patients treated with RN and NSS was 69 (58, 12-214) and 58 (44, 12-151) months. Tumor stage was significantly associated with tumor-specific survival (TSS) in the RN group (p<0.001). None of the patients who had tumor enucleation had positive surgical margins. Two patients recurred locally after NSS, elsewhere in the kidney, resulting in a crude ipsilateral recurrence rate of 17%. The analysis of TSS for patients with multiple ipsilateral tumors with a pT1 primary lesion showed no statistically significant differences between patients who had RN or NSS. Two patients had contralateral recurrence, resulting in a crude rate of 6%. CONCLUSIONS: For patients with multiple ipsilateral renal tumors, 20% of the satellite lesions are benign and 6% develop a contralateral metachronous recurrence. We also observed similar TSS for patients treated with NSS and RN.

Quality of life after radical treatment of prostate cancer: validation of the Italian version of the University of California-Los Angeles Prostate Cancer Index.

OBJECTIVES: To validate an Italian version of the University of California-Los Angeles Prostate Cancer Index (UCLA-PCI). METHODS: Men with prostate cancer treated with radical retropubic prostatectomy (RRP) or external beam radiation (EBR) were retrospectively selected. Each subject was asked to complete the UCLA-PCI short form and the 36-item short-form health survey (SF-36) questionnaires (principal sample); a subgroup completed both questionnaires twice (retest sample). A linguistic translation and validation was performed. Psychometric properties were analyzed. RESULTS: A total of 595 men were included in the study: 394 from the Department of Urology (treated with RRP) and 201 from the Department of Radiotherapy (treated with EBR). Of these, 75 patients (50 from the RRP group and 25 from the EBR group) were selected as the retest cohort. Internal consistency reliability of the SF-36 and UCLA-PCI for the primary sample of the surgery and radiotherapy populations ranged from 0.82 to 0.94; the mean values of sexual function were superior in the principal urology group, whereas the principal radiotherapy group demonstrated superior mean values of urinary function and urinary bother. A strong correlation between urinary function and sexual and bowel function, and between urinary function and all bother scales, was reported only for patients treated with RRP. The expected correlation between sexual function and sexual bother was reported for the EBR group but not for the RRP group. CONCLUSIONS: Our study demonstrated the excellent psychometric properties of the Italian version of the UCLA-PCI; the Italian version of the UCLA-PCI questionnaire will allow cross-cultural comparative studies in men with prostate cancer.

Clinical characteristics and overall survival in genitourinary sarcomas treated with curative intent: a multicenter study.

OBJECTIVES: Adult soft tissue sarcomas in general, and those arising from the urological organs in particular, are a group of rare tumours with a generally poor prognosis, only a few studies are available. We report our experience with this type of tumours in a multicenter study carried out in a single region of Central Italy (Tuscany). METHODS: Pre-treatment and follow-up data were obtained from 22 adult patients, all residing in Tuscany, treated consecutively between 1984 and 2002 for primary or locally recurrent genito-urinary sarcomas in 8 urology departments in the area. All cases were classified according to the French Federation of Cancer Center System Grading Scheme for Adult Sarcomas (FFCC) and Broders System. The crude survival probability was estimated by using the Kaplan-Meier method and differences between patient sub-groups were assessed by the log rank test. RESULTS: The study series included 18 males and 4 females. The mean age at diagnosis was 61+/-21.5 years (range: 15.3-89.1). The most common site was paratesticular (n=9, 40.9%), followed by kidney (n=8, 36.4%), prostate (n=3, 13.6%) and penis and bladder (1 case each, 4.6%). 15 cases (68.2%) were classified as FFCC III, and 16 (72.7%) as Broders IV. The most common histological type was leiomyosarcoma (8 cases, 36.7%), followed by liposarcoma (6, 27.3%), rhabdomyosarcoma (3, 13.6%) and other histological types (5, 22.7%). At the last follow-up (mean: 3.66+/-3.25 years; range 0.15-10.0), 11 of the 22 patients (50%) were still alive. The overall survival rate at 1, 3 and 5 years was 85.9%, 62.0% and 48.8%, respectively. There were no significant differences in survival according to sex, age or histological type. When we compared paratesticular vs. kidney and prostate cancer cases, a significant difference in survival emerged (p=0.02). According to size and grade of the tumour we also found a significant difference in survival (p=0.0006 and p=0.01, respectively). CONCLUSIONS: In our representative series, 3 tumor parameters (site, size and grade) appeared to represent the most important prognostic factors in adult genitourinary sarcomas.

Priapism due to sacrococcygeal chordoma metastasis treated with radiation therapy.

We are reporting the first case of priapism due to a sacrococcygeal chordoma metastasis treated with radiation therapy as palliative treatment.

[The kidney in shock. A new experimental method for the induction of controlled shock. I]. / Il rene da shock. Nuova tecnica sperimentale per l'induzione dello shock controllato. Nota I.

In this research we identify a new experimental model to study the shock-kidney, since this complication occurs with discreet frequency during high surgery operation. The model that better reproduce the surgical shock-kidney is the controlled hypovolemic shock. We used for this experiment five pigs of weight between 40 and 50 kg and were studied the following data: Ecg, arterial pressure, central venous pressure, diuresis (by incannulation of both ureters), renal arterial flow, levels of the renin in the renal vein. The measurements were made before, during and after the shock. The hypovolemic shock was induced by removing from carotid artery a sufficient quantity of blood to bring the pressure to 45-50 mmHg. This pressure level was kept constant for 120 min and then was reported to normal level by introducing the blood previously removed. During the experiment no kind of drugs were used.