Polyacrylamide hydrogel (bulkamid®) in female patients of 80 or more years with urinary incontinence.

INTRODUCTION: To assess the effectiveness of polyacrylamide hydrogel (Bulkamid®) in injection therapy for urinary incontinence in women of 80 or more years. MATERIALS AND METHODS: Twenty consecutive women mean age 84.5 (range 80-87) with stress or mixed urinary incontinence were enrolled in this prospective study. All subjects were evaluated at baseline and re-evaluated 7 days, 6,12,18 and 24 months after treatment. A detailed clinical evaluation, physical examination, daily pad count, urodynamic investigation and evaluation of urethral mobility by trans-labial ultrasound were performed. RESULTS: A statistically significant decrease in the number of pads was observed in the follow-up (p = 0.0002 after 24 months). Physical examination showed a statistically significant lack or reduced lost of urine with stress test (p = 0.0163 after 24 months). Urodynamic findings showed an increase of Valsalva leak point pressure, maximum urethral closure pressure and functional length. Maximum flow and post void residual were respectively observed to be significantly reduced and increased only after 7 days from injection therapy. Quality of life (QoL) assessed with the Incontinence Impact questionnaire short form (IIQ-7) showed a statistically significant improvement (p = 0.0001 after 24 months). Patient satisfaction assessed with the Visual Analogue Scale and Patient Global Impression of Improvement questionnaire respectively produced evaluation of ″satisfied″ and "much improved" even after 24 months. CONCLUSIONS: Polyacrylamide hydrogel (Bulkamid®) is an effective treatment with low morbility in patients of 80 or more years.

The efficacy of hemostatic radiotherapy for bladder cancer-related hematuria in patients unfit for surgery

Objective The aim of our study was to assess short and mid-term clinical efficacy of external beam radiation therapy to achieve hemostasis in patients with bladder-cancer related gross hematuria who were unfit for surgery. We also assessed hypofractionation as a possible alternative option for more severe patients. Patients and Methods Thirty-two patients were included for hemostatic radiation therapy, with two schedules based on Eastern Cooperative Oncology Group performance status. The standard treatment was 30 Gy in 10 fractions over 2 weeks. More severe patients underwent a hypofractionated regimen, with 20 Gy in 5 fractions over a one week period. Clinical evaluation was performed at 2 weeks and 6 months. Results At 2 weeks, 69% of patients were hematuria-free. Subgroup analysis showed that 79% of patients undergoing hypofractionated regimen were hematuria-free. A total of 54% were hematuria-free with the standard regimen. Based on tumor stage, hematuria was controlled at 2 weeks for 57% of non-muscle invasive tumors and 72% of muscle-invasive tumors. After 6 months, 69% of patients had relapsed, regardless of tumor stage or therapy schedules. Conclusions Hemostatic radiotherapy is an effective option for palliative-care hematuria related to bladder cancer in patients unfit for surgery. Although it appears to be rapidly effective, its effect is of limited duration. Hypofractionation also seems to be an effective option; however larger cohorts and prospective trials are needed to evaluate its efficacy compared to standard schedules. .

The efficacy of hemostatic radiotherapy for bladder cancer-related hematuria in patients unfit for surgery.

OBJECTIVE: The aim of our study was to assess short and mid-term clinical efficacy of external beam radiation therapy to achieve hemostasis in patients with bladder-cancer related gross hematuria who were unfit for surgery. We also assessed hypofractionation as a possible alternative option for more severe patients. PATIENTS AND METHODS: Thirty-two patients were included for hemostatic radiation therapy, with two schedules based on Eastern Cooperative Oncology Group performance status. The standard treatment was 30 Gy in 10 fractions over 2 weeks. More severe patients underwent a hypofractionated regimen, with 20 Gy in 5 fractions over a one week period. Clinical evaluation was performed at 2 weeks and 6 months. RESULTS: At 2 weeks, 69% of patients were hematuria-free. Subgroup analysis showed that 79% of patients undergoing hypofractionated regimen were hematuria-free. A total of 54% were hematuria-free with the standard regimen. Based on tumor stage, hematuria was controlled at 2 weeks for 57% of non-muscle invasive tumors and 72% of muscle-invasive tumors. After 6 months, 69% of patients had relapsed, regardless of tumor stage or therapy schedules. CONCLUSIONS: Hemostatic radiotherapy is an effective option for palliative-care hematuria related to bladder cancer in patients unfit for surgery. Although it appears to be rapidly effective, its effect is of limited duration. Hypofractionation also seems to be an effective option; however larger cohorts and prospective trials are needed to evaluate its efficacy compared to standard schedules.

Surgery for testicular cancer: indication, results and technical aspects.

The standard therapeutique approach to patients with advanced germ cell tumors of the testis is a combination of systemic chemotherapy with surgical removal of the residual disease. The indication of surgery, residual tumor resection (RTR) or retroperitoneal lymph node dissection (RPLND), has changed during the last 10 years. Sugery is not longer recommended after chemotherapy of pure seminoma and surveillance of the residual tumor is the favored option. RPLND is a critical component of the treatment armentarium in low-stage nonseminomatous germ cell. RPLND is an accurate staging tool prviding important information to dtermine the need for chemotherapy. When performed properly, RPLND eliminates the retroperitoneum as a site for relapse, wich in turn provides emotional and psychological relief to the patient, and simplifies the follow-up protocol. In advanced nonseminomatous tumours, surgery after chemotherapy is recommended in most of the cases since large studies have shown that a considerable proportion of patients with complete radiological remission after chemotherapy harbor vital carcinoma or teratoma. Prediction models of necrosis after chemotherapy in order to avoid RTR are generally accepted since the accuracy of most models is too low. RTR is indicated in patients with elevated markers after two different chemotherapy regimens (including salvage chemotherapy) either to resect teratoma or cystic residual disease or to remove chemorefractory disease. Laparoscopic approache is a viable staging tool; however, oncologic control of the retroperitoneum has not been reliably determined.