[Urologic surgical procedures in patients with uterus neoplasm and colon-rectal cancer].

INTRODUCTION. During the last 30 years, the multidisciplinary treatments of colon and uterus neoplasm have yielded an increase in total survival rates, fostering therefore the increase of cases with regional relapse involving the urinary tract. In these cases the iterative surgery can be performed, if no disease secondary to pelvic pain, haemostatic or debulking procedure is present, and must be considered and discussed with the patient, according to his/her general status. MATERIALS AND METHODS. From 1997 to August 2007 we performed altogether 43 pelvic iterative surgeries, with simultaneous urologic surgical procedure because of pelvic tumor relapse in patients with uterus neoplasm and colon and rectal cancer. In 4 cases of anal cancer, the urological procedure were: one radical prostatectomy with continent vesicostomy in the first case, while in the other 3 cases radical pelvectomy with double-barrelled uretero-cutaneostomy. In 23 cases of colon cancer, the urologic procedures were: 9 cases of radical cystectomy with double-barrelled uretero-cutaneostomy, 4 cases of radical cystectomy with uretero-ileo-cutaneostomy according to Bricker- Wallace II procedure, and 9 cases of partial cystectomy with pelvic ureterectomy and ureterocystoneostomy according to Lich-Gregoire technique (7 cases) and Lembo-Boari (2 cases) procedure. In 16 cases of uterus cancer, the urological procedure were: 7 cases of partial cystectomy with pelvic ureterectomy and uretero-cystoneostomy according to Lich-Gregoire procedure; in 3 cases, a radical cystectomy with urinary continent cutaneous diversion according to the Ileal T-pouch procedure; 2 cases of total pelvectomy and double uretero-cutaneostomy, and 4 cases of bilateral uretero-cutaneostomy. RESULTS. No patients died in the perioperative time; early systemic complications were: 2 esophageal candidiasis, 1 case of venous thrombosis. CONCLUSIONS. The iterative pelvic surgery in the case of oncological relapse involving the urinary tract aims to achieve the best quality of life with the utmost oncological radicality. The equation: eradication of pelvic neoplasm and urinary tract reconstruction, with acceptable quality of life, will be the future target; nevertheless, it is not possible to establish guidelines beforehand, and the therapy must be adapted to each single case.

Ileal T-pouch as a urinary continent cutaneous diversion: clinical and urodynamic evaluation.

OBJECTIVE: To report the functional results of continent cutaneous urinary diversion with ileum, using the serous-lined extramural valve and Mitrofanoff procedure for the continence mechanism. PATIENTS AND METHODS: From April 1999 to October 2001, 18 patients (mean age 68 years) underwent radical cystectomy for invasive bladder cancer involving the bladder neck, urethra or prostate; they then had an ileal continent cutaneous T pouch constructed. The mean (range) follow-up was 12 (4-20) months. The first five patients had reconstructions using the original orthotopic T-pouch configuration, but in subsequent patients the technique was simplified, reducing the ileal segments. The ureteric-intestinal anastomosis was made using a split-cuff nipple technique. RESULTS: All patients were continent day and night, and there were no late complications. All cutaneous continent T pouches had a good capacity and low pressure, with no urinary reflux. No catheterization difficulties were reported and the evacuation intervals were approximately 4 h. CONCLUSIONS: This ileal cutaneous continent diversion is a versatile technique; the T-valve can be used successfully as a continent mechanism, ensuring continence day and night. The simplified technique maintains a reservoir of good capacity and compliance, thus preserving approximately 13 cm of ileal tract. The ureteric intestinal anastomosis by the split-cuff nipple technique is suitable in undilated and peristaltic ureters.

[Uretero-intestinal anastomosis using the ureteral nipple technique with personal modification in continent urinary diversion]. / Anastomosi uretero intestinale secondo la tecnica del nipple ureterale con modifica personale nelle derivazioni urinarie continenti.

BACKGROUND: This report presents the follow-up data for the incidence of stenosis and reflux in 143 split cuff nipple ureteral intestinal anastomoses in continent urinary diversions. METHODS: 74 ureteral implants (1990-1995) were performed using the original technique, whereas a technical modification was adopted after 1996. This was used in 69 implants and consisted of the removal of a button of bowel tract in order to obtain a linear implant to the reservoir, instead of using a simple enterotomy at the level of the anastomosis. RESULTS: The rate of clinically significant refluxes was 2.2%, whereas the incidence of stenosis fell from 6.8% in the group using the original technique to 2.9% in those using the modified technique. CONCLUSIONS: Anastomosis using the split cuff ureteral nipple technique is simple to perform and is indicated in peristaltic and non-dilatated ureters. Moreover, this technical modification improves the overall results.

Treatment of urinary infections: clinical perspectives.

The present study was carried out with the aim of comparing the microbiological and clinical efficacy of norfloxacin, cinoxacin and aztreonam in urinary tract infections. Patients were tested who had infections of the higher and/or lower urinary tracts associated with complicating factors. The microorganism most frequently isolated in these individuals was Escherichia coli. The assays carried out with the aim of testing the in vitro antibacterial activity (agar diffusion method and minimum inhibitory concentration) on the microorganisms responsible for the infections, as well as the evaluation of clinical efficacy, showed that norfloxacin has a wider antibacterial spectrum of action and inhibitory activity greater than the other two drugs tested.

Palliative cryotherapy in inoperable prostate carcinoma.

Cryotherapy was applied by us as a palliative in 91 cases of carcinoma of the prostate. 1. Disobstruction was achieved in 87% of patients. 2. Results proved stable over time. 3. Operating mortality, survival curve, number of deaths, etc. was not statistically different in patients treated with cryotherapy compared with patients undergoing other treatments. 4. Precutions are required to combat infection of cryotherapy patients in the first few weeks. We feel authorized to pursue cryotherapy in the future exploiting all its immunologic possibilities.