Oncological cases and complications in Urology.

This collection of cases describes some unusual urological tumors and complications related to urological tumors and their treatment. Case 1: A case of left hydronephrosis referred four years after a right radical mastectomy for lobular breast carcinoma was described. Computed tomography scan revealed a left hydronephrosis with dilated ureter up to the proximal third. An exploratory laparoscopy was performed and the definitive histopathology examination showed a recurrence of the carcinoma with a right tubal metastasis and peritoneal carcinosis. Case 2: A rare case of an extensive penile squamous cell carcinoma in a young man. The patient was treated with radical surgery and modified inguinal lymphadenectomy. No recurrence was noticed so far. Case 3: A rare case of left sided Inferior Vena Cava (IVC) in a patient diagnosed with renal cell cancer who underwent open left partial nephrectomy. Case 4: A case of urethrorrhagia, caused by a recent trauma from an urinary catheter placed in a patient submitted to gastric resection due to a neoplastic pathology. Urethrorrhagia only temporarily responded to conservative treatment and ultimately resolved by coagulation with an endoscopic approach.

[Conservative treatment of persistent calyceal fistula after tumor excision. Case report and clinical remarks]. / Trattamento conservativo di fistola caliceale persistente secondaria ad enucleoresezione renale. Descrizione di un caso e considerazioni cliniche.

BACKGROUND: Nowadays, ultrasounds allow to discover accidentally a large number of renal small tumors. So, radical nephrectomy, which years ago was considered as the gold standard, is rarely required. Today, nephron sparing surgery is often prescribed for renal masses smaller than 4 cm. Its most frequent complication is calyceal fistula. It can be prevented exploring carefully the surgical surface, and suturing any opening. It can heal over within a few days or some weeks, so it can be a trouble for both the patient and the surgeon. A complete urinary drainage, obtained with an ureteral stent and an open bladder catheter, helps heal. Recently, it has become common practice to spread synthetic or biological tissue sealants over the surgical surface, to improve hemostasis. These surgical glues have also been used to repair calyceal openings, with conflicting results. METHODS: We performed left renal tumor excision (3.5 x 3 cm) in a 72-years-old man, during temporary renal artery occlusion with surface hypothermia. We placed intraoperatively an ureteral stent. The visual examination of the surgical cavity did not reveal any calyceal opening. We electrocauterized it and stuffed it with FloSeal. Surgical edges were free from illness. After 5 days urinary leakage from the drainage tube increased. Pyelography showed a calyceal fistula. A further stent was placed, with no results. Bladder catheter was kept open for about 2 months. Urinary leakage stopped 34 days after surgery. RESULTS: Urinary leakage increased when the catheter was removed, and stopped only after many days of complete urinary drainage. CONCLUSIONS: The conservative treatment of a calyceal fistula must be considered a still effective therapy, also in difficult cases, provided that a complete and long-lasting urinary drainage is carried out.

The role of granulocytes following intravesical BCG prophylaxis.

OBJECTIVES: The antitumour effect of bacillus Calmette-Guérin (BCG) still remains relatively undefined. Most investigations on its mechanism of action have focused on mononuclear cells; little consideration has been given to granulocytes. We analysed urine of patients with bladder cancer during 8 wk of intravesical BCG prophylaxis. The number of polymorphonuclear neutrophils (PMNs) and urothelial cells (UCs) was evaluated. We examined the in vitro response of the T24 UC line to human PMNs after BCG treatment. METHODS: Seventeen patients were enrolled in the study. Cytologic analyses were performed on urine samples collected before each BCG instillation and after 2 h from the first voided urine after BCG instillation. Elastase activity was determined on these samples to evaluate PMN activation. PMN-induced damage was measured on the T24 cell line treated with BCG. RESULTS: After BCG treatment, a large number of PMNs transmigrated through the urothelium and PMNs adherent to detached UCs were found. One patient, who did not respond with significant PMN transmigration, experienced recurrent disease. The number of eosinophils that transmigrated was low, with the exception of three patients with recurrent disease. In vitro, PMNs adhered to BCG-primed T24 cells and damaged the monolayer. CONCLUSIONS: The results agree with recent evidence that PMNs may play an important role in the antitumour action of BCG during the BCG induction period. This role is probably nonspecific because both normal UCs in vivo and tumour cells in vitro appeared to be injured. As suggested by results obtained from a limited number of patients, a high number of eosinophils in the urine may indicate therapy failure.