Malakoplakia of the urinary bladder: A review of the literature.

OBJECTIVE: The aim of the study is to make a review of the literature about bladder malakoplakia. MATERIAL AND METHODS: We searched articles on the PUBMED web-literature database with the following keywords: "vesical malakoplakia" and "bladder malakoplakia". In the literature we found 254 articles. At final we have excluded 219 articles, including in our study only 35 articles. RESULTS: The overall average age found was 50.85 years. The average age of men was 43.22 years, while that of women was 53.37 years. 75% of the patient cases were women and 25% were men. Regarding comorbidities, in 5.55% of the cases were missing whereas 47.22% of the patients suffered from recurrent urinary tract infection (UTI) and 19.44% from immune system disorders. Urine culture was positive in 69.44% with E.coli being isolated in 92% of cases. Hydroureteronephrosis was present in 44.44% of the cases: left in 6.25% of cases, right in 18.75% and bilateral in 75%. The mean serum creatinine of patients with hydroureteronephrosis was 5.11 (1-21) mg/dl. The most frequent site of the lesion was the vesicoureteral junction (VUJ) (42.31%), followed by the trigone (38.46%). 30.56% of patients were treated with antibiotic and surgery (transurethral resection of bladder, partial or radical cystectomy), less frequent options were antibiotics alone and surgery alone. The recurrence rate was 15%. CONCLUSIONS: Malakoplakia is a disorder usually related to other affections, like UTI and immunodepression, and it seem to be caused by an abnormal macrophage function. In almost half of the described cases of isolated bladder malakoplakia, hydroureteronephrosis and renal failure were present.Treatment is not standardized, but both medical and surgical therapies are effective to avoid recurrence.

Feasibility study for interspecialistic collaboration in active research of urothelial neoplasms of professional origin.

INTRODUCTION: In Italy only a small fraction of cancer is reported to the supervisory body and recognised as professional by the insurance institution. Among the causes of this sub-notification, especially for lowgrade etiologic fractional cancers such as bladder cancers are the lack of knowledge of carcinogenicity in the occupational field and the consequent incomplete medical history collections. OBJECTIVES: Diagnosis of occupational bladder neoplasms and activation of systematic surveillance of tumors of professional origin through an "active research" program. METHODS: From July 2010 to July 2017, all patients diagnosed with Bladder Cancer in the departments of Urology of Area Vasta 3 ASUR Marche underwent a first interview and a further anamnestic study in selected cases.When an occupational exposure was recognised, more information for preventive, social security and criminal justice has been acquired. RESULTS: The study highlighted 18 cases of bladder tumors due to occupational exposure to aromatic amines and polycyclic aromatic hydrocarbons, which are the most important risk factor for BC after tobacco smoking. CONCLUSIONS: Our study confirmed that active research is an useful tool both for the activation of epidemiological surveillance and for the regional registration of professional tumors. In addition active research of occupational exposure allow obtaining information that can be used for preventive purposes, for criminal justice and for the initiation of medico-legal actions and improvement of working conditions aimed at guaranteeing workers' rights.

Use of a Non-cross-linked Xenograft (Xenform) in Surgical Treatment of Peyronie's Disease.

OBJECTIVE: To evaluate the effectiveness in Peyronie's disease surgical treatment using Xenform, a non-cross-linked graft derived from dermal bovine tissue, to close the defect obtained after plaque incision, without penile prosthesis implant. A further objective is to evaluate the satisfaction of patients. MATERIALS AND METHODS: We treated with plaque incision 28 patients with a stable penile curvature ≥60° hindering penetration and with erectile function conserved. International Index of Erectile Function-15 and a not-validated questionnaire constituted of 7 questions about their satisfaction were administered after 1 year of follow-up. Furthermore, specific questions were relative about penile straightening, penile postoperative length, glandular sensitivity, and feeling palpability. RESULTS: Graft is resulted compatible with albugineal features, like thickness, consistency, and elasticity; it is waterproof, allowing the visualization of complete correction of the curvature after the suture. No severe complications were observed except 1 hematoma requiring surgical revision. Sixteen patients were seen after at least 1 year of follow-up. Curvature improvement was obtained in all cases, with the complete straightening in 75%; we did not observe any retraction of the graft and any recurrence on the curvature. Significant reduced glans sensibility and erectile dysfunction were the more frequent postoperative complications, resulting in 43.8% and 25%, respectively. All patients are satisfied with the straightening. Only 2 patients are dissatisfied about the overall result. CONCLUSION: Plaque incision corporoplasty with Xenform graft is an effective and safe surgical treatment. Xenform is a secure and a reliable albugineal substitute, comparable to other heterologous graft. We have not observed any retraction. Patient's satisfaction is linked to the treatment result and to sexual life.

Salvage Procedure in Case of Urethrocavernous Fistula after Revision Surgery for Malfunctioning Three-Piece Penile Prosthesis.

Urethrocavernous fistula is a rare complication of penile prosthesis. Literature lacks any materials regarding this complication's treatment. We report our experience with a 66-year-old man who developed urethrocavernous fistula after penile prosthesis implant. Our technique involves the careful closure of urethral and corpus cavernosum defects with application of TachoSil (®) above the sutures. After the salvage procedure, no recurrence of fistula occurred and patient was able to have sexual intercourse. We believe that our technique may be successfully used in case of urethrocavernous fistula after penile prosthesis implant.

Testicular sparing surgery in small testis masses: A multinstitutional experience.

INTRODUCTION: The incidence of benign testicular tumors is increasing in particular in small lesion incidentally found at scrotal ultrasonography. Primary aim of this study was to perform radical surgery in malignant tumor. Secondary aim was to verify the efficacy of the diagnostic-therapeutic pathway recently adopted in management of small masses with testis sparing surgery in benign lesions. MATERIALS AND METHODS: In this multicenter study, we reviewed all patients with single testis lesion less than 15 mm at ultrasound as main diameter. We applied the diagnostic-therapeutic pathway described by Sbrollini et al. (Arch Ital Urol Androl 2014; 86:397) which comprises: 1) testicular tumor markers, 2) repeated scrotal ultrasound at the tertiary center, 3) surgical exploration with inguinal approach, intraoperative ultrasound, and intraoperative pathological examination. Definitive histology was reviewed by a dedicated uro-pathologist. RESULTS: Twenty-eight patients completed this clinical flowchart. The mean lesion size was 9.3 mm (range 2.5-15). Testicular tumor markers were normal except in a case. Intraoperative ultrasound was necessary in 8/28 cases. We treated 11/28 (39.3%) with immediate radical orchiectomy and 17/28 (60.7%) with testis-sparing surgery. Definitive pathological results were: malignant tumor in 6 cases (seminoma), benign tumor in 10 cases (5 Leydig tumors, 2 Sertoli tumors, 1 epidermoid cyst, 1 adenomatoid tumor, 1 angiofibroma), benign disease in 11 (8 inflammation with haemorragic infiltration, 2 tubular atrophy, 1 fibrosis), and normal parenchyma in 1 case. We observed a good concordance between frozen section examination and definitive histology. Any malignant tumor was treated conservatively. Any delayed orchiectomy was necessary based on definitive histology. CONCLUSIONS: The incidence of benign lesions in 60% of small testis lesions with normal tumor markers makes orchiectomy an overtreatment. Testicular sparing surgery of single testicular nodules below 15 mm is a safe option, but requires a standardized pathway in diagnosis. Our pathway has shown good reliability and security profile to be applied in a multicenter management for small scrotal masses. Our study has shown the reliability of the diagnostic-therapeutic pathway in the management of single testicular masses. The higher incidence of benign lesions in 60% of patients makes often orchiectomy an overtreatment.

Rare presentation of a testicular angiofibroma treated with testis sparing surgery.

INTRODUCTION: Testicular benign tumors are very rare (< 5%). Testicular Angiofibroma (AF) is one of those, however the gold standard of treatment and follow-up is still unclear. CASE REPORT: A 47 years-old man with only one functioning testis was referred to our clinic for a palpable right testicular mass and atrophic contralateral testis. Patient underwent testis-sparing surgery with inguinal approach and intraoperative frozen sections examination with diagnosis of AF. Final histology confirmed AF. Post-operative follow-up was uneventful. Clinical and ultrasonographic follow-up was negative after 8 months. CONCLUSION: We report a conservative surgery in a patient with AF of the solitary testis. AF is a benign para-testicular fibrous neoplasm that could be misinterpreted as malignant tumor and treated with orchiectomy. Testis-sparing surgery is recommended in this case with intraoperative pathological examination. The excision of the mass is enough but in front of a possible recurrence a long follow-up is advisable.

Serum prostate-specific antigen to predict the presence of bladder outlet obstruction in men with urinary symptoms.

OBJECTIVE: To determine whether prostate specific antigen (PSA) level can usefully predict or exclude bladder outlet obstruction (BOO), in men with lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: A cohort of men from 1996 to 1999 who had LUTS caused by BPH was evaluated by serum PSA and pressure-flow urodynamic studies, and a blinded comparison made. The settings were teaching hospitals in London, UK and L'Aquila, Italy. Men (302) were referred by primary-care practitioners with LUTS and a PSA of < 10 ng/mL. Regression analysis was used to predict the extent of BOO, and create likelihood ratios and predictive values for BOO according to the PSA value. RESULTS: PSA was significantly associated with BOO (P < 0.001; r2 0.07), with significant likelihood ratios altering the probability of BOO. If the PSA was > 4 ng/mL, mild or definite BOO was likely (89%), whereas if the PSA was <2 ng/mL, there was about a one-third chance each of no, mild and definite BOO. CONCLUSION: High PSA levels in patients with LUTS are significantly associated with BOO; low PSA levels mean that definite BOO is unlikely.

Prostate cancer cell proliferation is strongly reduced by the epidermal growth factor receptor tyrosine kinase inhibitor ZD1839 in vitro on human cell lines and primary cultures.

PURPOSE: To investigate the effects of the epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) ZD1839 ('Iressa') on the cellular proliferation of androgen-sensitive and androgen-independent human prostatic cancer cell lines and primary cultures in vitro. EXPERIMENTAL DESIGN: In this study, we investigated the effects of the quinazoline ZD1839, a potent, selective EGFR-TKI, on the EGFR autophosphorylation and cellular proliferation of androgen-sensitive (ND1, LNCaP, and ALVA-31) and androgen-independent (PC3, DU145, and TSU-Pr1) human prostatic cancer cell lines and 20 primary cultures derived from human prostatic cancer tissue. RESULTS: EGFR was present and phosphorylated in all cell lines tested. ZD1839 reduced EGFR autophosphorylation in intact cell lines with IC(50)s of 0.46-0.97 microM, and inhibited cellular proliferation with IC(50)s of 0.37-1.03 microM. Constitutive EGFR autophosphorylation was low in primary cell cultures, but addition of EGF (50 ng/ml) caused marked EGFR autophosphorylation; cellular proliferation in the presence of EGF was inhibited by ZD1839 with a mean IC(50) of 0.45 microM. At doses >1 microM, ZD1839 induced apoptosis in both androgen-dependent and androgen-independent PCa cell lines. CONCLUSION. Our experiments suggest that EGFR-TKIs such as ZD1839 may have potential in blocking the growth and progression of human prostatic cancers even in early phases of the disease.

Bicalutamide dose-dependently inhibits proliferation in human prostatic carcinoma cell lines and primary cultures.

OBJECTIVE: Androgen antagonists inhibit prostatic cell proliferation in normal and pathological conditions and are useful antitumor agents in prostatic carcinoma (PCa). Bicalutamide (BCLT) is a well-known non-steroidal antiandrogenic agent able to interfere with androgen receptor (AR). We tested the efficacy of BCLT in inhibiting proliferation of human PCa cell lines and of primary cultures from biopsies of PCa patients. MATERIALS AND METHODS: Human prostatic carcinoma cell lines (PC3, DU145, LNCaP ALVA 31 and ND1) and short-term primary tissue cultures from PCa patients were treated with BCLT. Cell proliferation and orange acridine and ethidium bromide fluorescence staining studies were performed. RESULTS: BCLT was able to inhibit, significantly and dose-dependently, cell proliferation in AR-positive human PCa cell lines and in 10 cases of primary cultures with Gleason grades 4 to 8. Its action appears to be mainly apoptotic in AR-positive cells and cytotoxic in AR-negative cells. CONCLUSION: BCLT, which inhibits growth in both human PCa cell lines and PCa primary cultures from patients with medium and low-grade tumors, deserves attention as a potential widely effective antiandrogenic monotherapy in prostatic carcinoma. However, its efficacy in AR-negative cells requires further research.

[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.

[Ultrasonographic assessment of bladder volume]. / Valutazione ecografica del volume vescicale.

INTRODUCTION: The aim of this study is to evaluate intra and inter-observatory variability in the sonography measurement of bladder volume. MATERIALS AND METHODS: We have evaluated 138 patients (128 men and 10 women) affected by lower urinary tract symptoms with a mean age of 64 years (range 36-75) between December 2000 and June 2001. Sonography measurement of bladder volume was obtained at the end of a pressure/flow study with the double lumen catheter in situ. Measurement of bladder volume was performed by the same operator in 113 patients by calculating the transverse, longitudinal and anterior-posterior diameter; each measurement was repeated three times. In the remaining 25 patients examination was performed by three different operators for every patients, with a single evaluation for each operator. The real volume was measured by emptying the bladder using the urethral catheter. RESULTS: The real bladder volume in the intra and inter-observatory group was 240 +/- 130 and 145 +/- 97, respectively. First, second and third measurement in the intra-observatory group were 229 +/- 113, 231 +/- 112, 234 +/- 127, respectively. On the other hand, first, second and third measurement in the inter-observatory group were 131 +/- 73, 129 +/- 66, 143 +/- 94, respectively. CONCLUSIONS: Looking at our results, it is clear that there is no significant difference between every single measurement in the intra and inter-observatory group. In addition, the estimation of bladder volume by ultrasound was quite similar to the real volume. We conclude that ultrasound is a precise, non invasive and highly reproducible technique to calculate the bladder volume.

[Transrectal prostatic biopsy with "end-fire" endovaginal probe]. / Biopsia prostatica transrettale con sonda endovaginale "end-fire".

OBJECTIVE: Sextant ultrasound-guided biopsy is still the standard way for the diagnosis of prostate cancer, although there have been several modifications. We report our experience using a 7.5 MHz endovaginal "end-fire" probe in patients undergoing prostate biopsy because of clinical findings suggestive of prostate cancer (abnormal digital rectal examination and/or elevated prostate specific antigen). MATERIALS AND METHODS: Since June 1999 to December 2001, we performed 262 ultrasound-guided transrectal 18G core biopsies with a 7.5 MHz endovaginal "end-fire" probe, using different schemes according to the presence or not of suspicious areas on ultrasound (a modified sextant biopsies plus two cores from the transitional zone with multiple cores from and around suspected lesions in case of abnormal findings on ultrasound). RESULTS: We obtained a detection rate of about 44%. Complications were mild: 5 cases (1.9%) of urosepsis and 4 cases (1.5%) of urinary retention. Both haematuria and rectal bleeding were not significant. CONCLUSIONS: The endovaginal "end-fire" probe allows us to obtain core biopsies in both longitudinal and transverse view. This means an optimal sampling of the prostate gland, in particular a better and safer sampling of transitional zone avoiding the prostatic urethra and the choice of the best plane in order to sample more peripheral zone and its lateral aspects. Furthermore, with the "end-fire" probe it is quite simple to obtain cores biopsies from every portion of the prostate gland and, consequently, it is possible to make an accurate staging of the disease prior to surgery.