Open versus laparoscopic partial nephrectomy for clinical T1a renal masses: a matched-pair comparison of 280 patients with TRIFECTA outcomes (RECORd Project).

AIM OF THE STUDY: To report a matched-pair comparative analysis between open (OPN) and laparoscopic partial nephrectomy (LPN) for clinical (c) T1a renal masses from a large prospective multicenter dataset. MATERIALS AND METHODS: The RECORd Project includes all patients who underwent OPN and LPN for kidney cancer between January 2009 and January 2011 at 19 Italian centers. Open and laparoscopic groups were compared regarding clinical, surgical, pathologic, functional results and TRIFECTA outcome. Multivariable logistic regression models were used to analyze predictors of WIT >25 min, surgical complications (SC) and the achievement of the TRIFECTA outcome. RESULTS: Overall, 301 patients had OPN and 149 LPN. Groups were matched 1:1 (140 matched pairs) for clinical diameter, tumor location and type of indication. Laparoscopic partial nephrectomy was associated with a significantly mean longer WIT (19.9 vs. 15.1 min; p < 0.001), and it was an independent predictor of a WIT >25 min (RR 6.29, p < 0.0001). The TRIFECTA was achieved in 78.6 and 74.3% after OPN and LPN (p = ns), respectively, and the surgical approach was not a predictor of a negative TRIFECTA and SC at multivariable analysis. At 6-month follow-up, no significant differences were observed between the OPN and LPN group both in estimated glomerular filtration rate (eGFR) (∆GFR 1.1 vs. 4.1 mL/min) and in new-onset stage III-V chronic kidney disease (CKD) rate (0 vs. 0.7%). CONCLUSION: No significant difference in achieving the TRIFECTA outcome was reported after OPN and LPN. LPN was associated with a significantly longer WIT. However, eGFR at 6-month follow-up did not differ significantly between the two surgical approaches.

Outpatient periurethral injections of polyacrylamide hydrogel for the treatment of female stress urinary incontinence: effectiveness and safety.

PURPOSE: To investigate the effectiveness and safety of periurethral injections (PIs) of polyacrylamide hydrogel (PAHG, Bulkamid(®)) for the treatment of female stress urinary incontinence (SUI). METHODS: This double-centre prospective study included 82 female patients with SUI who were treated with PIs of PAHG between January 2008 and December 2010 in outpatient setting. The International Consultation on Incontinence Questionnaire short form (ICIQ-SF) and the Patient Global Improvement Impression (PGI-I) were used to assess incontinence and patient satisfaction after treatment. The impact of incontinence on quality of life (QoL) was investigated using the Incontinence Impact Questionnaire (IIQ-7). RESULTS: All patients were discharged on the same day of treatment and there was no intraoperative complication. At 1-year follow-up, the efficacy of PIs of PAHG (subjective success rate) was 74.4 %. The subjective responder rate was 86.6 %, 8.5 % of patients had no change and no patient reported worsening of symptoms. The mean number of episodes of urine leakage/24 h and the mean leakage/24 h significantly decreased after treatment. At 1-year follow-up, the IIQ-7 results were significantly improved compared with baseline. 25.6 % of patients had adverse events (mainly urinary tract infections and injection site pain). CONCLUSION: This study demonstrates that PIs of PAHG are effective and safe and cause significant improvement of the QoL at 1-year follow-up. PIs of PAHG can be safely performed in an ambulatory setting and patients may be discharged on the day of the procedure.

Periurethral injection of polyacrylamide hydrogel for the treatment of stress urinary incontinence: the impact on female sexual function.

INTRODUCTION: Urinary incontinence can negatively affect sexual function. AIM: To investigate sexual function in female patients treated for urodynamic stress incontinence (USI) by periurethral injections. METHODS: This double-center prospective study included 29 female patients who were treated for USI by periurethral injections of polyacrylamide hydrogel (Bulkamid(®); Ethicon Women's Health and Urology, Contura, Denmark). MAIN OUTCOME MEASURES: Patients answered the International Consultation on Incontinence Questionnaire short form, the Incontinence Impact Questionnaire, and the Patient Global Improvement Impression. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) was used to evaluate sexual function at baseline and at 1-year follow-up. Patients were also asked to rate their sexual activity by using a 10-mm visual analog scale at baseline and at 12-month follow-up. Subjective and objective success was examined. RESULTS: All patients were discharged on the same day of treatment and there was no intraoperative complication. At 1-year follow-up, the subjective success rate was 89.7% and the objective success rate was 79.3%. At 1 year from the first treatment, all the 23 sexually active patients continued to have regular sexual life. Six women reestablished sexual activity after the treatment. The total PISQ-12 scores showed a significant improvement in quality of sexual life of patients who were sexually active before surgery. CONCLUSIONS: Periurethral injections of polyacrylamide hydrogel to treat USI are clinically effective and safe. These surgical procedures cause significant improvements in sexual function and sexual satisfaction of patients.

Testicular sertoli cell tumours and relative sub-types. Analysis of clinical and prognostic features.

INTRODUCTION: Sertoli cell tumours have a rare (0.4-1.5% of all testicular neoplasms) and heterogeneous pathology. The aim of this paper is to analyse the histological classification of Sertoli cell tumours, in order to assess if the three different histotypes--classic type, large cell calcifying Sertoli cell tumour (LCCSCT) and sclerosing Sertoli cell tumour (SSCT)--really present distinctive clinical and prognostic features. MATERIALS AND METHODS: The current literature was reviewed; Sertoli cell tumour clinical series and single case reports were searched and analysed. Hence, more than 200 classic Sertoli cell tumours, 48 LCCSCTs and only 12 SSCTs were found. The thirteenth SSCT has been found by us in a 34-year-old man. RESULTS: Every single sub-type presents clinical specific characteristics regarding age of onset, bilaterality, focality, abnormal hormone production, correlated systemic symptoms. Ultrasonographic findings, size and--above all--malignant potential. CONCLUSIONS: The precise classification of these tumours is not important only histologically: the currently recognised variants really differ in clinical presentation and course. Moreover, LCCSCTs can be further divided in two subgroups with very different clinical behaviour, those in older patients and those associated with well-known syndromes. These clinical and prognostic variables are of great importance when deciding on the therapeutical approach.

Preperitoneal inguinal hernia repair during pelvic surgery.

OBJECTIVES: We report our experience with posterior preperitoneal prosthetic herniorrhaphy for inguinal hernia in patients undergoing concomitant pelvic surgery for both benign and malignant urological pathologies. METHODS: 116 patients with either unilateral or bilateral inguinal hernia underwent posterior preperitoneal prosthetic herniorrhaphy during a pelvic operation for various urological pathologies. The technique described by Mahorner and Goss was used for unilateral hernia, while the modified Stoppa technique was used for bilateral hernia. RESULTS: All patients had a complication-free peri- and post-operative course, except for one patient who developed a spontaneously resolving small peri-prosthetic hematoma. In the follow-up of all patients (mean 35.7 months, range 4-72) we did not observe any hernia recurrence. CONCLUSIONS: Posterior preperitoneal prosthetic inguinal herniorrhaphy during pelvic surgery for urological pathologies is a relatively simple and safe procedure to perform and a recurrence rate of zero, or very close to zero, is to be expected.

Renal dysplasia associated with ureteral ectopia and ipsilateral seminal vesicle cyst.

The simultaneous presence of renal aplasia/dysplasia, ureteral ectopia and seminal vesicle cyst represents an exceptionally rare malformation. The literature is reviewed here and a new case of such malformation, concerning a 45-year-old man affected by recurrent epididymitis, is reported.

Cirugía de corrección de hernia preperitoneal inguinal concomitante con cirugía pelviana / Preperitoneal inguinal hernia repair during pelvic surgery

OBJETIVOS: Comunicamos nuestra experiencia con este tipo de corrección herniaria con material protésico concomitante con cirugía pelviana tanto en patologías malignas o benignas urológicas. MÉTODOS: Hemos tratado 116 pacientes con hernia uni o bilaterales, durante una cirugía pélvica por variada patología urológica. La técnica descrita por Mahorner y Goss se usó para las hernias unilaterales y la de Stoppa para las bilaterales. RESULTADOS: Todos los pacientes tuvieron un postoperatorio libre de complicaciones, excepto uno que desarrolló un pequeño hematoma periprotésico, que se resolvió espontáneamente. En el seguimiento (media 35,7 meses, rango 4-72 meses) no objetivamos ninguna recidiva herniana. CONCLUSIONES: Este tipo de corrección herniaria aplicada por nosotros, durante la cirugía pélvica urológica nos parece un procedimiento seguro y fácil de realizar con tasa de recurrencia igual o muy cercana a cero (AU)