Post-chemotherapy residual mass in non-seminomatous testicular cancer. The role of retroperitoneal lymph node dissection.

PURPOSE: To determine the role of RPLND for residual masses following chemotherapy in patients with non-seminomatous germ cell tumors (NSGCT) stage T1N2 and T1N3 (IIB and IIC). MATERIALS AND METHODS: We have preformed retrospective analysis of 11 patients who underwent RPLND for residual masses following chemotherapy in an oncologic reference center between January 1997 and December 2002. All patients harbored either pure nonseminomatous or mixed tumors in the testis tissue and had undergone 4 cycles of primary chemotherapy with bleomycin, etoposide and cisplatin. The residual masses were assessed by abdominal computed tomography preoperatively. RESULTS: There were perioperative complications in 3 cases owing to vascular iatrogenic lesion. One of who died in the early postoperative period due to extensive iliac thrombosis. The other 2 patients had an inferior vena cava injury owing to the difficulty in removing the attached lymph nodes. The injuries were repaired by continuous suture with Prolene 5-0. All patients had tumors in the final pathological report and were referred to other 2 cycles of chemotherapy with the same drugs. Seven patients (63.3%) had complete response and remained free of the disease in a mean follow up of 38.3 months (ranging from 12 to 72). The remaining 3 patients had disease progression, 2 of which died 6 and 12 months after surgery, respectively, and one patient missed the follow-up after salvage chemotherapy. CONCLUSION: Retroperitoneal lymph node dissection for residual masses after chemotherapy is a high-morbidity procedure, even by experienced surgeons, although it remains an efficient modality of treatment in advanced germ cell carcinoma. The high frequency of tumor found in the RPLFN following chemotherapy might have been caused by the small number of patients in this study.

Post-cheotherapy residual mass in non-siinomatous testicular cancer: the role of retroperitoneal lymph node dissection

PURPOSE: to determine the role of RPLND for residual masses following chiotherapy in patients with non-siinomatous germ cell tumors (NSGCT) stage T1N2 and T1N3 (IIB and IIC). MATERIALS AND METHODS: We have preformed retrospective analysis of 11 patients who underwent RPLND for residual masses following chiotherapy in an oncologic reference center between January 1997 and Deciber 2002. All patients harbored either pure nonsiinomatous or mixed tumors in the testis tissue and had undergone 4 cycles of primary chiotherapy with bleomycin, etoposide and cisplatin. The residual masses were assessed by abdominal computed tomography preoperatively. RESULTS: There were perioperative complications in 3 cases owing to vascular iatrogenic lesion. One of who died in the early postoperative period due to extensive iliac thrombosis. The other 2 patients had an inferior vena cava injury owing to the difficulty in rioving the attached lymph nodes. The injuries were repaired by continuous suture with Prolene 5-0. All patients had tumors in the final pathological report and were referred to other 2 cycles of chiotherapy with the same drugs. Seven patients (63.3 percent) had complete response and riained free of the disease in a mean follow up of 38.3 months (ranging from 12 to 72). The riaining 3 patients had disease progression, 2 of which died 6 and 12 months after surgery, respectively, and one patient missed the follow-up after salvage chiotherapy. CONCLUSION: Retroperitoneal lymph node dissection for residual masses after chiotherapy is a high-morbidity procedure, even by experienced surgeons, although it riains an efficient modality of treatment in advanced germ cell carcinoma. The high frequency of tumor found in the RPLFN following chiotherapy might have been caused by the small number of patients in this study.

Variables predictive of voiding disfunction following aponeurotic sling surgery: multivariate analysis

INTRODUCTION: Aponeurotic sling surgeries can evolve with obstruction or voiding dysfunction in 5 to 20 percent of patients. There are few studies on factors that could possibly predispose to voiding difficulties or urinary retention. The objective of this work is to identify these potential clinical or urodynamic factors. MATERIALS AND METHODS: Records from 130 patients who underwent aponeurotic sling surgeries were reviewed. All patients underwent a throughout urodynamic study during pre-operative investigation. The variables studied were age above 65 years, previous pelvic surgeries, concomitant surgeries, post-voiding residue higher than 100 mL, vesical obstruction (according to Blaivas-Groutz nomogram) and urinary flow under 12 mL/s. Post-voiding residue was assessed on the seventh post-operative day through vesical catheterization. Recovering of spontaneous voiding after 7 post-operative days or with a residue higher than 100 mL, was regarded as voiding dysfunction. Univariate analysis was performed with qui-square test and Fisher's exact test, and multivariate analysis was performed by logistic regression with alpha = 5 percent. RESULTS: Age in the studied group ranged from 41 to 83 years (mean 56.7 years), with 69 (53 percent) patients having urethral hypermobility and 61 (47 percent) having intrinsic urethral lesion. Normal voiding occurred in 97 (75.6 percent) women with 7 post-operative days. The only significant variable in the univariate (p = 0.014) and multivariate (p = 0.017) analysis was post-voiding residue higher than 100 mL. CONCLUSION: Pre-operative presence of a post-voiding residual urine higher than 100 mL was the only variable predictive of voiding dysfunction.

Variables predictive of voiding disfunction following aponeurotic sling surgery: multivariate analysis.

INTRODUCTION: Aponeurotic sling surgeries can evolve with obstruction or voiding dysfunction in 5 to 20% of patients. There are few studies on factors that could possibly predispose to voiding difficulties or urinary retention. The objective of this work is to identify these potential clinical or urodynamic factors. MATERIALS AND METHODS: Records from 130 patients who underwent aponeurotic sling surgeries were reviewed. All patients underwent a throughout urodynamic study during pre-operative investigation. The variables studied were age above 65 years, previous pelvic surgeries, concomitant surgeries, post-voiding residue higher than 100 mL, vesical obstruction (according to Blaivas-Groutz nomogram) and urinary flow under 12 mL/s. Post-voiding residue was assessed on the seventh post-operative day through vesical catheterization. Recovering of spontaneous voiding after 7 post-operative days or with a residue higher than 100 mL, was regarded as voiding dysfunction. Univariate analysis was performed with qui-square test and Fisher's exact test, and multivariate analysis was performed by logistic regression with alpha = 5%. RESULTS: Age in the studied group ranged from 41 to 83 years (mean 56.7 years), with 69 (53%) patients having urethral hypermobility and 61 (47%) having intrinsic urethral lesion. Normal voiding occurred in 97 (75.6%) women with 7 post-operative days. The only significant variable in the univariate (p = 0.014) and multivariate (p = 0.017) analysis was post-voiding residue higher than 100 mL. CONCLUSION: Pre-operative presence of a post-voiding residual urine higher than 100 mL was the only variable predictive of voiding dysfunction.

Use of cadaveric fascia lata to correct grade IV cystocele

We describe a modification of the cadaveric prolapse repair and sling - CaPS technique that uses the sling surgery principles to correct grade IV cystocele. In this modification, the central and paravaginal defects reconstitution are performed using cadaveric fascia lata fixed over rectus abdominis muscle, eliminating the need of pubic fixation by screws, as proposed by the original technique. The modification described, besides presenting the benefits of CaPS, i.e., not using impaired tissues to reconstruct vesical support, and lower risks of perineal hypercorrection, also reduces the probability of complications of bone fixation

Use of cadaveric fascia lata to correct grade IV cystocele.

We describe a modification of the cadaveric prolapse repair and sling - CaPS technique that uses the sling surgery principles to correct grade IV cystocele. In this modification, the central and paravaginal defects reconstitution are performed using cadaveric fascia lata fixed over rectus abdominis muscle, eliminating the need of pubic fixation by screws, as proposed by the original technique. The modification described, besides presenting the benefits of CaPS, i.e., not using impaired tissues to reconstruct vesical support, and lower risks of perineal hypercorrection, also reduces the probability of complications of bone fixation.

Relato de caso: angiossarcoma de glândula adrenal / Case report: angiosarcoma of adrenal gland

Angiossarcoma de glândula supra-renal é um tumor extremamente raro, näo tendo nenhum caso publicado na literatura brasileira. Nós relatamos o primeiro caso desta neoplasia no Brasil