Adaptation and validation of an Italian version of the Prostate Cancer Specific Quality of Life Instrument (PROSQOLI).

OBJECTIVE: The Prostate Cancer Specific Quality of Life Instrument (PROSQOLI) is a measure of health-related quality of life (HRQoL) in advanced hormone-resistant prostate cancer. In this study, we aimed at performing a cross-cultural adaptation and validation of the Italian version of the PROSQOLI. PATIENTS AND METHODS: The original version of the PROSQOLI underwent several turnarounds of translations. A total of 472 patients treated with radical prostatectomy, radiotherapy or medical therapy were enrolled for the validation of the questionnaire. The PROSQOLI was administered together with the SF-12. Reliability indexes were calculated by using Cronbach alpha. To evaluate the validity of the construct, relationships between PROSQOLI and SF12 were assessed. The ANOVA test was used to evaluate the differences between groups of patients who had received different treatments. RESULTS: The reliability coefficient was 0.91. Item-to-total correlation indices were in most cases >0.70. The correlation between the scores of the PROSQOLI and those of the SF-12 questionnaire was high (r=0.8139, p<0.0001). The ANOVA test showed significant differences between groups (p<0.01) based on age, recurrence risk and treatment. CONCLUSIONS: The adaptation process showed that the PROSQOLI Italian version has high reliability and presents both convergent and discriminant validity. This version of the tool can be used to assess HRQoL in Italian men who underwent radical treatment for advanced prostate cancer.

Elective segmental ureterectomy for transitional cell carcinoma of the ureter: long-term follow-up in a series of 73 patients.

UNLABELLED: What's known on the subject? and What does the study add? Upper Urinary Tract (UUT) Transitional Cell Carcinoma (TCC) is an uncommon disease and represents approximately 5% of all urothelial carcinomas. We report our series on 73 patients treated with Kidney Sparing Surgery for UUT TCC. Good results have been achieved in terms of oncological outcome comparing this conservative approach to the radical nephrourectomy. OBJECTIVES: • To report the long-term oncological outcome in patients with transitional cell carcinoma of the ureter electively treated with kidney-sparing surgery. • To compare our data with the few series reported in the literature. PATIENTS AND METHODS: • We considered 73 patients with transitional cell carcinoma of the distal ureter treated in five Italian Departments of Urology. • The following surgeries were carried out: 38 reimplantations on psoas hitch bladder (52%), 21 end-to-end anastomoses (28.8%), 11 direct ureterocystoneostomies (15.1%) and three reimplantations on Boari flap bladder (4.1%). • The median follow-up was 87 months. RESULTS: • Tumours were pTa in 42.5% of patients, pT1 in 31.5%, pT2 in 17.8% and pT3 in 8.2%. • Recurrence of bladder urothelial carcinoma was found in 10 patients (13.7%) after a median time of 28 months. • The bladder recurrence-free survival at 5 years was 82.2%. • The overall survival at 5 years was 85.3% and the cancer-specific survival rate at 5 years was 94.1%. CONCLUSION: • Our data show that segmental ureterectomy procedures do not result in worse cancer control compared with data in the literature regarding nephroureterectomy.

[Radical cystectomy - pro laparoscopic]. / Radikale Zystektomie - pro laparoskopisch.

Although the technical feasibility of laparoscopic radical cystectomy (LRC) has been proven and the procedure has been accepted in the EAU guidelines 2011 as a valid alternative, its actual position has to be determined. On the one hand the advantages of LRC (less blood loss, lower transfusion rates, shorter analgesia time) have been proven in retrospective studies; however, the technical difficulties of purely laparoscopic urinary diversion result in very long operating times and in cases of a laparoscopic-assisted creation of a neobladder, the question of the advantage of this approach remains doubtful. Despite case reports of port metastases and peritoneal carcinosis following laparoscopic and robot-assisted radical cystectomy, there is no difference in terms of oncological long-term data (up to 10 years) between laparoscopy and open surgery performed at centres of excellence. Evidently, the curative options for the patients do not depend on the type of surgery (open versus minimally invasive) but on the efficacy of adjuvant treatment strategies (polychemotherapy). Currently it is believed that LRC should be considered for patients with low risk of progression (pT1-2). The final position of laparoscopic radical cystectomy can only be evaluated in a multicentric randomized controlled trial.

Minimally invasive laparoscopic neobladder.

PURPOSE: To our knowledge orthotopic reconstruction after laparoscopic radical cystectomy has not been described in the human. After anatomical and surgical studies on cadavers we developed an original technique and performed the first laparoscopic radical cystectomy with pelvic lymphadenectomy and ileal orthotopic neobladder reconstruction in a patient. MATERIALS AND METHODS: Our technique has 3 steps, namely laparoscopic pelvic clearance, external reconstruction and laparoscopic reconstruction. After cystoprostatectomy and lymphadenectomy were completed via laparoscopy we removed the surgical specimens through a 5 cm. supraumbilical incision. Through the same incision an ileal loop was extracted from the abdominal cavity, isolated, detubularized and partially reconfigured. Intestinal continuity was restored extracorporeally. All intestinal loops were inserted back into the abdomen and pneumoperitoneum was started again. The ureteroileal (nipple valve) and urethroileal anastomoses were formed via laparoscopy and the neobladder was then completed with an intracorporeal running suture. RESULTS: Operative time was 450 minutes and blood loss was 350 ml. Postoperatively pain was minimal. The patient was ambulatory, regained bowel activity on postoperative day 2 and began food intake 2 days later. He was discharged home on postoperative day 7 with an indwelling catheter, which was removed after 7 days. Histopathological examination showed organ confined bladder cancer without margin invasion. CONCLUSIONS: To our knowledge we report the first case of laparoscopic radical cystectomy with ileal orthotopic reconstruction. This original technique combines the advantages of minimally invasive laparoscopy with the speed and safety of open surgery.

[Transrectal echography in laser treatment of incidental prostatic carcinoma]. / L'ecografia transrettale nel trattamento-laser del carcinoma prostatico incidentale.

This report is concerning on our experience in the management of the incidental prostatic cancer treated by laser irradiation and transrectal ultrasounds (TRUS). 22 patients, with stage A incidental prostatic cancer, underwent preliminary TRUS to evaluate suspected areas of residual tumor and/or the capsule thickness. 5 patients, before the laser irradiation, have been treated with 2nd look TURP because residual tumor or much residual prostatic tissue was present. Following TRUS evaluation all the patients underwent a laser irradiation with TRUS guidance. During the laser irradiation TRUS evaluation allows to recognize the anatomy of the prostatic capsule, the thickness of the capsule and to perform a safety and complete laser irradiation of the prostatic capsule with a depth laser irradiation. In the postoperative follow-up the TRUS demonstrated, in 18 patients, a complete laser induced fibrosis of the capsule. In conclusion the TRUS represents a good technique for pre and postoperative evaluation in the patients of stage A prostatic cancer treated with laser irradiation.

[Echo-guided percutaneous treatment of intraprostatic cysts]. / Trattamento percutaneo ecoguidato di cisti intraprostatiche.

Diagnostic and therapeutic values regarding echoguided percutaneous treatment of intraprostatic cysts are reviewed and discussed. Since 1987 we have detected by ultrasonography 48 intraprostatic cysts, 22 asymptomatic patients were evaluated periodically. A ultrasound guided percutaneous puncture was performed in 26 symptomatic patients. 10 patients affected by dysuria were treated by aspiration and injection of antibiotics. 14 oligospermic patients underwent cyst aspiration followed by introduction of sclerosing agents (aethoxysclerol or alcohol). In one communicating cyst simple aspiration has been performed. A giant cystoadenoma has been resolved by surgical procedure. In the follow-up (2 months - 6 years) we observed: 5 recurrences (50%) in the cysts treated with antibiotics and 6 (43%) recurrences in the cysts treated with sclerosing agents. However, 8 patients out of 10 obtained a resolution of the urinary symptoms and 8 patients out of 14 improved their seminal parameters. On our experience, percutaneous echoguided treatment of prostatic cysts is a suitable and safe technique because of the possibility to resolve some clinic problems, although an high recurrence rate.

Conservative treatment of upper urinary tract tumors with Nd:YAG laser.

Diagnosis of upper tract filling defects sometimes presents a difficult dilemma. In many patients, a direct endoscopic approach may permit both diagnosis and treatment. Patients (n = 28) suspected of having malignancies or with known upper tract filling defects underwent ureteropyeloscopy. Malignancy was confirmed in 18 patients, who underwent treatment of the urothelial tumors and the tumor bases with Nd:YAG laser irradiation (25-30 W; 3 seconds). The follow-up included endoscopic surveillance every 3 months. Ten patients remain tumor free after 6 to 30 months (mean 15 months). Eight patients who had recurrences underwent a new laser irradiation followed by intracavitary therapy with mitomycin C. Only one nephrectomy has been necessary, and no cases of disseminated disease have been found. A ureteropyeloscopic approach coupled with Nd:YAG laser irradiation is a useful treatment for selected patients with upper tract urothelial tumors. In the future, the indications may expand.

The neodymium:YAG laser recanalization in a patient with azoospermia due to ejaculatory duct agenesis.

A 32-year-old man with azoospermia is presented. Transperineal echographically guided vesiculography of the vas deferens showed absence of the ejaculatory duct and presence of a cystic müllerian duct in which both enlarged seminal vesicles joined. Transurethrally, by means of a contact tip over the verumontanum a new channel was created by neodymium:YAG laser irradiation at 25 watts every 2 seconds. The patient had 32.10(6) spermatozoa per ml. with good quality on semen analysis 10 months later.

Congenital urethral diverticulum in the male: a twenty-one year old man with a congenital urethral diverticulum at the bulbous urethra.

Diverticula of the urethral wall are not common. Generally, in the male, congenital urethral diverticulum is located in the anterior urethra. We report a twenty-one year old man who referred to our department for dysuria, micturition in two times, small stream urination. Sometimes he also presented a dry ejaculation. The exams showed, at the bulbous portion of the urethra, an urethral diverticulum. The diverticulum was probably congenital because the patient had no history of urinary infection, catheterization or trauma. A surgery procedure was performed. 9 months later, the result is good.

Sodium dodecyl sulphate electrophoresis of urinary proteins.

The analysis of urinary proteins and their identification are discussed, particularly in regard to the technique of sodium dodecyl sulphate electrophoresis in polyacrylamide gradient gels. Urine collection, storage and preparation are evaluated, especially in regard to problems connected with concentration and dialysis of such samples. The instrumental approach to sodium dodecyl sulphate polyacrylamide gel electrophoresis represented by the Phast System appears to be particularly valuable in routine clinical analysis of urine specimens, since no sample pretreatment is required. The following types of proteinurias are evaluated: (a) orthostatic proteinurias; (b) post-renal proteinurias; (c) Bence-Jones proteinuria; (d) lower and upper urinary tract infection (cystitis and pyelonephritis) and (e) diabetes mellitus proteinurias.

[Intraprostatic prosthesis: echographic monitoring]. / Protesi intraprostatica: monitoraggio ecografico.

22 patients affected by BPH have been treated with a spiral urethral prosthesis under local anesthesia with ultrasonic guidance and endoscopic technique. All the patients either refused the surgical procedure or had high operative risk. Insertion guided by ultrasound and endoscopic technique was successful in 19 patients (86%) with a follow-up of 12 months. In our experience the insertion of this prosthesis is a favorable alternative to an indwelling catheter in selected patients.

[Transrectal echography in the diagnosis of non-palpable prostatic carcinoma]. / L'ecografia transrettale nella diagnosi del carcinoma prostatico non palpabile.

285 affected by BPH have been evaluated by transrectal ultrasound. All the patients had a palpably normal prostate without abnormality suggestive of cancer. 56 patients (19.6%) presented ultrasonic abnormality areas. Under ultrasound guidance, biopsy was done by the transperineal route and biopsy material showed the presence of prostatic carcinoma in 24 patients (8.3%). 6 of these had neoplasm in the non peripheral zone. The study suggests the validity of ultrasound, in particularly transrectal ultrasound, in the identification of non palpable prostatic cancer. In conclusion ultrasound appears very useful in the preoperative evaluation of the patients affected by BPH in order to identify neoplasms non detectable with other methods.

Adrenal incidentalomas: what is the role of fine needle biopsy?

A series of 13 patients with incidental adrenal mass discovered by computed tomography or/and ultrasound is reported. In 5 cases endocrine evaluation and radiological criteria suggested the diagnosis of the mass. In 8 cases we carried out fine needle biopsy (FNB) under ultrasound guidance. FNB confirmed in two cases the presence of metastatic diseases, in one case adrenal adenoma, in other two cases myelolipoma and in one case lymphoma. Surgical exploration was avoided in all cases. In two cases the presence of an asymptomatic adrenal carcinoma and of a giant adenoma, potentially malignant, was demonstrated by FNB. None of the patients underwent surgical exploration as a final diagnostic measure. In conclusion, FNB may represent a useful tool to select the best modalities of treatment.

[Congenital hip dysplasia. The controversial results of a screening program]. / Displasia congenita dell'anca. Risultati controversi di un programma di screening.

The authors report their experience in a screening program for congenital hip dislocation. Goal of this study is to recognize the best technique for early diagnosis in this disease. The result show that we need further study and complete cooperation between pediatrician, radiologist and orthopedist to realize the best cost/benefit ratio.

Rhabdomyosarcoma of the kidney.

Rhabdomyosarcoma of the kidney is a rare tumor. The ninth case of the literature is reported. The treatment was surgery alone and after three years of follow up the patient is tumor-free.

[Gianotti-Crosti acrodermatitis. Description of a case of rare etiology]. / Acrodermatite di Gianotti-Crosti. Descrizione di un caso ad eziologia rara.

Originally described in 1955, papular acrodermatitis is considered a rare disease whose manifestations are mainly cutaneous. The disease is characteristically associated to a non icteric hepatitis with B serologic tests positive. We recently observed a case whose etiology is unusual and, therefore, in our opinion worth of a brief description.

Nd: YAG laser treatment of vesical leiomyosarcoma.

The first in the literature of bladder leiomyosarcoma, treated by transurethral resection followed by laser irradiation, in a 75-year-old woman is reported. At 22 months follow-up the patient is well and has no evidence of metastasis.

The Nd:YAG laser and methylene blue staining in the diagnosis and treatment of premalignant vesical lesions and carcinoma in situ (CIS).

The aim of this report is to emphasize the use of methylene staining test and the Nd:YAG laser in the diagnosis and treatment of premalignant lesions and CIS of the bladder. The use of an appropriate solution of methylene blue (0.2% in 0.9 M NaCl for 15 min) permits the staining of premalignant areas and CIS, and their early diagnosis. Laser irradiation of the stained areas facilitates the treatment of lesions. The technique was utilized in 8 patients without noteworthy side effects. It allowed an adequate treatment of the lesions and provided good results.