The role of multiparametric resonance and biopsy in prostate cancer detection: comparison with definitive histological report after laparoscopic/robotic radical prostatectomy.

PURPOSE: Magnetic Resonance Imaging (MRI) targeted biopsy increases overall detection rates and decreases the risk of clinically insignificant PCa detection. The aim of this retrospective study is to compare concordance rates regarding side of lesion and Gleason Score at fusion targeted/systematic biopsy and MRI with the definitive histologic report of prostatectomy specimen. METHODS: 115 patients underwent multiparametric (mp) MRI and successively fusion targeted/systematic biopsy. 107 patients, with a positive biopsy for PCa, further underwent laparoscopic/robotic radical prostatectomy. We compared surgical histologic report with biopsy histologic report for side of lesion and Gleason Score. We further compared PIRADS score at mpMRI with Gleason Score of both histologic reports. RESULTS: Concordance rate for mpMRI lesion side was 74% compared to biopsy and 52.3% compared to surgical histologic report (p < 0.0001). Fusion targeted/systematic biopsy reported a concordance rate with surgical histologic report of 67.3% for side of the lesion, while Gleason Score was concordant for 73.6% for clinically significant cancer (Gleason Score ≥ 7) (p < 0.0001). PIRADS score ≥ 3 was further associated with clinically significant cancer at surgical histologic report in 92.4% of cases (p = 0.359). CONCLUSION: Multiparametric MRI of the prostate reaches a good and improvable accuracy in the detection of suspicious PCa before biopsy. A combined approach of fusion targeted and systematic biopsy could further increase the overall accuracy in PCa diagnosis, especially in biopsy-naïve patients, reaching concordance rates with definitive histologic report up to 52.3% and 85.5%.

Laparoscopic partial nephrectomy for endophytic hilar tumors: feasibility and outcomes.

OBJECTIVE: To analyze feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for endophytic hilar tumors in low-intermediate (ASA I-II) risk patients. METHODS: This is a single centre retrospective study. From May 2009 to September 2011, 208 LPNs were performed at our institution. Overall 11 (5.2%) elective LPNs were for hilar tumors not visible on kidney surface. Hilar tumor was defined as a mass located in the renal hilum and in contact with a major renal vessel on preoperative imaging. Procedures were carried out by a single experienced surgeon (G.G.) via retroperitoneal approach by clamping the only main renal artery. RESULTS: Mean (range) age of patients was 45.3 years (38.2-64.1), tumor size 1.6 cm (1.2-2.0), warm ischemia time 24 min (19-32), operative time 140 min (110-200) and estimated blood loss 270 ml (100-750). Two collecting system injuries were observed and repaired intraoperatively. No conversion to open surgery was required. Final pathological examination revealed 10 renal cell carcinomas and 1 oncocytoma. A negative surgical margin was obtained in 10/11 (91%) patients. Renal function and serum hemoglobin were nearly unaltered pre and post-surgery. No tumor recurrence was observed at mean (range) follow-up of 34 months (15-43). CONCLUSIONS: In experienced hands, LPN represents a feasible, safe and effective treatment for selected patients diagnosed with endophytic hilar masses. A larger number of patients and longer follow-up are required to draw definitive conclusions.

Transurethral resection of prostate: technical progress by bipolar Gyrus plasma-kinetic tissue management system.

AIM: We report our experience about bipolar plasma-kinetic resection of the prostate for the treatment of bladder outlet obstruction due to benign prostatic hyperplasia (BPH), considering intraoperative variables and short-term METHODS: Three hundred and eighty-nine patients affected by symptomatic BPH, underwent transurethral resection of prostate using the bipolar plasma-kinetic technique from Decem-ber 2001 to July 2004 in a prospective fashion. Bipolar resections of the prostate were performed using Plasma-Kinetic Tissue Management System (Gyrus Medical Ltd., UK). Preoperative, digital rectal examination, haemoglobin level, total PSA, transrectal ultrasound, International-Prostate Symptom Score (I-PSS) and uroflowmetry parameters were recorded. Patients were assessed for safety and efficacy, evaluating intraoperative and postoperative complications and measuring both the IPSS and the maximum flow rates (Qmax) after 12 months. RESULTS: The mean operative time was 89 min (range 48-121 min); the mean prostatic resected weight (measured by an electronic scales) was 49.6 g (3267 g). The mean decrease of haemoglobin level was 1.1 g/dL (range 0.5-1.9), with a mean catheterization time of 1.3 days (range 1-5). Qmax increase ranged from 120 to 230% (mean 190%) 12 months after surgery. Correspondingly, IPSS decrease ranged from 48% to 86% (mean 79%). Postoperative acute urinary retention, urethral strictures, bladder neck sclerosis and urinary incontinence were recorded in 1.57%, 2.57%, 1.28% and 0.77%, respective. CONCLUSION: The transurethral resection of prostate using a bipolar plasma-kinetic device represent a safe and effective option for the treatment of symptomatic BPH.

Highly diastereoselective lithium enolate aldol reactions of butane-2,3-diacetal desymmetrized glycolic acid and deprotection to enantiopure anti-2,3-dihydroxy esters.

[reaction--see text] The butane-2,3-diacetal (BDA) desymmetrized glycolic acid building block 1 undergoes efficient and highly diastereoselective lithium enolate aldol reactions with both aromatic and aliphatic aldehydes to afford, after an acidic methanolysis deprotection step, the enantiopure anti-2,3-dihydroxy esters in good yield.