Detection of prostate cancer by Raman spectroscopy: A multivariate study on patients with normal and altered PSA values.

Digital rectal examination (DRE) was the primary means to detect prostate diseases. The DRE has a high variability as it is based manly in the tactile sensitivity and expertise of the examiner. The prostate-specific antigen (PSA) test was initially developed for surveillance of prostate cancer and later it was also used as a diagnosis test. Raman spectroscopy is a powerful analytical technique that can measure the chemical composition of complex biological samples, such as body fluids. Biochemical changes caused by diseases can lead to significant changes in the Raman spectra. This study aimed to identify the differences in the Raman spectra of serum samples with normal and altered PSA values and correlate these differences by using multivariate techniques (principal component analysis - PCA and partial least squares regression - PLS). A total of 321 spectra were collected from 108 subjects. Two hundred and seventy were obtained from 91 non-altered PSA samples and 51 spectra from 17 samples with altered PSA. Each spectrum acquired was standardized to the area under the curve (1-norm). Discriminating and quantitative models employing PCA and PLS were developed. The PCA analyses showed 85.7% predictive power (87.41% sensitivity and 76.47% specificity). The PLS test showed a near-perfect sensitivity (98.51%) and an intermediate specificity (62.75%). The quantitative model through PLS regression showed a good correlation between PSA values and the spectral features (r = 0.605). This preliminary study suggests that Raman spectroscopy could be efficiently used for screening patients with altered PSA as well as for follow-up of the treatment of the prostate cancer by using initially the PLS to identify the possible presence of the prostate cancer and later on use de PCA to confirm the diagnosis.

Robotic-assisted laparoscopic management of a caliceal diverticular calculus.

PURPOSE: To report the first case of robotic-assisted laparoscopic management of a symptomatic caliceal diverticular calculus and review the literature on laparoscopic treatment for this condition. CASE REPORT: A 33-year-old obese woman with a 2×1 cm calculus within an anterior caliceal diverticulum located in the middle pole of the left kidney was referred to our service. She had already undergone two flexible ureterorenoscopies without success. We considered that a percutaneous approach would be very challenging due to stone location, thus we elected to perform a robotic-assisted laparoscopic procedure for stone removal and diverticulum fulguration. The procedure was uneventfully performed with no intraoperative or postoperative complications. The patient was discharged from the hospital on the second postoperative day and after 1.5 years of follow-up she is asymptomatic with no recurrence. CONCLUSIONS: The robotic-assisted laparoscopic approach to caliceal diverticular calculi is feasible and safe, providing one more option for treatment of stones in challenging locations.

Laparoscopic nephrectomy in inflammatory renal disease: proposal for a staged approach.

INTRODUCTION: The present study shows and discusses the preliminary experience of customized and staged approach in the minimally invasive treatment of inflammatory renal diseases, using either pure laparoscopic surgery or the hand-assisted technique. MATERIALS AND METHODS: We prospectively assessed 17 patients with inflammatory renal diseases operated by laparoscopic approach. Mean age was 41 years and the surgical indication was repeated pyelonephritis in 8 cases, pyonephrosis in 4 cases and renal exclusion due to staghorn stone in 5 cases. The staged laparoscopic approach was chosen based on kidney size and on the presence or not of tomographic findings showing significant perirenal infiltration. Thus, retroperitoneal access was chosen in cases where the kidney was smaller than 12 cm or in the absence of signs of significant perirenal infiltration on the computerized tomography. For the remainder, transperitoneal access was employed. RESULTS: Of the 17 patients, 11 underwent laparoscopic nephrectomy by retroperitoneal access, and all cases were successful. Mean surgical time was 160 minutes. In 6 cases where the nephrectomy was performed by laparoscopic transperitoneal access, the use of hand assistance was required. Four surgeries were successfully completed with mean time of 190 minutes and 2 were converted to open surgery with mean time of 220 minutes. CONCLUSION: The laparoscopic nephrectomy for inflammatory renal disease is feasible, but presents a high degree of complexity, requiring a customized approach. The use of hand assistance is an attractive option when the inflammatory process is intense, and can avoid conversions, maintaining the advantages of minimally invasive treatments.

Laparoscopic nephrectomy in inflammatory renal disease: proposal for a staged approach

INTRODUCTION: The present study shows and discusses the preliminary experience of customized and staged approach in the minimally invasive treatment of inflammatory renal diseases, using either pure laparoscopic surgery or the hand-assisted technique. MATERIALS AND METHODS: We prospectively assessed 17 patients with inflammatory renal diseases operated by laparoscopic approach. Mean age was 41 years and the surgical indication was repeated pyelonephritis in 8 cases, pyonephrosis in 4 cases and renal exclusion due to staghorn stone in 5 cases. The staged laparoscopic approach was chosen based on kidney size and on the presence or not of tomographic findings showing significant perirenal infiltration. Thus, retroperitoneal access was chosen in cases where the kidney was smaller than 12 cm or in the absence of signs of significant perirenal infiltration on the computerized tomography. For the remainder, transperitoneal access was employed. RESULTS: Of the 17 patients, 11 underwent laparoscopic nephrectomy by retroperitoneal access, and all cases were successful. Mean surgical time was 160 minutes. In 6 cases where the nephrectomy was performed by laparoscopic transperitoneal access, the use of hand assistance was required. Four surgeries were successfully completed with mean time of 190 minutes and 2 were converted to open surgery with mean time of 220 minutes. CONCLUSION: The laparoscopic nephrectomy for inflammatory renal disease is feasible, but presents a high degree of complexity, requiring a customized approach. The use of hand assistance is an attractive option when the inflammatory process is intense, and can avoid conversions, maintaining the advantages of minimally invasive treatments.