ILEOVAGINOPLASTICA IN PAZIENTE SOTTOPOSTO AD INTERVENTO DI CONVERSIONE ANDROGINOIDE MEDIANTE APPROCCIO COMBINATO LAPAROSCOPICO PERINEALE

ILEOVAGINOPLASTICA IN PAZIENTE SOTTOPOSTO AD INTERVENTO DI CONVERSIONE ANDROGINOIDE MEDIANTE APPROCCIO COMBINATO LAPAROSCOPICO PERINEAL

Laparoscopic radical prostatectomy: 10 years of experience at a single institution.

BACKGROUND/AIM: The Urological Clinic of the S. Orsola-Malpighi University Hospital, Bologna has been carrying out laparoscopic radical prostatectomy since 2002. In this study, we report the results after 10 years of LRP, analyzing in particular the oncological and functional aspects. PATIENTS AND METHODS: Between March 2002 and August 2011, 400 patients underwent laparoscopic radical prostatectomy. Cancer control, recovery of continence and potency were evaluated at 1, 3, 6 and 12 months. All data were retrospectively collected on the basis of thorough clinical and pathological examination. RESULTS: Follow-up ranged from 10 to 122 months. Pathological examination revealed pT2 and pT3 cancers in 63.5% and 36.5% of patients, respectively. The incidence of positive surgical margins and biochemical relapse rate was 33.8% and 12.0%, respectively. CONCLUSION: 10 Years after the first laparoscopic radical prostatectomy was performed at our Center, we can state that it is a reliable alternative to traditional surgery, with satisfactory oncological and functional results

Accuracy of endorectal Magnetic Resonance Imaging (MRI) and Dynamic Contrast-Enhanced-MRI (DCE-MRI) in the preoperative local staging of prostate cancer.

Background. The proper management of newly diagnosed prostate cancer (PCa) requires the choice of the appropriate treatment plan. A crucial factor is the accurate evaluation of the tumor local extension. The Magnetic Resonance Imaging (MRI) plays an important role in the local staging of prostate cancer, although its use in clinical practice is widely debated. Therefore, the purpose of our study was to evaluate the diagnostic accuracy of T2-weighted MR imaging in association with DCE-MRI, performed using an endorectal coil, in preoperative local staging of patients with prostate cancer, by using the histopathologic findings as the reference standard. Methods. From April 2010 to May 2011, 65 patients (mean age, 65 years; range, 51-77 years) with clinical localized PCa, underwent radical prostatectomy at our institution, performed by 2 experienced surgeons. All patients were prospectively evaluated with eMRI in association with DCE-MRI prior to radical prostatectomy. In all patients MRI was performed at least 6 weeks after biopsy and within 2 weeks before Radical Prostatectomy (RP). Histologic analysis was our diagnostic "gold standard". To ensure that the histopathological findings matched with MR images, the assessment of radiological images and the RP specimens were performed dividing the prostate in 14 regions. Results. First, we performed a "per-patient" analysis, considering the entire prostate as a single region. Then, we performed a "per-emigland" analysis, finally a "per-region" analysis. The sensitivity, specificity, PPV, NPV and AUC in predicting ECE in the analysis "per-emigland" were respectively 66.7, 95.7, 66.7, 95.7, 0.824. The evaluation of SVI reported similar results: 62.5, 97.5, 62.5, 97.5, 0.797. DCE-MRI did not improve the diagnostic accuracy of T1-T2-weighted MR images in the evaluation of ECE or SVI. Conclusions. T1-, T2-weighted MRI adds important information regarding the preoperative local staging of PCa. DCE-MRI does not improve the diagnostic accuracy of MRI in the local staging of PCa

Differing Risk of Cancer Death Among Patients With Pathologic T3a Renal Cell Carcinoma: Identification of Risk Categories According to Fat Infiltration and Renal Vein Thrombosis.

OBJECTIVES: The study objectives were to evaluate the prognostic impact of fat infiltration and renal vein thrombosis in patients with pT3a renal cell carcinoma (RCC) and to identify new prognostic groups. MATERIAL AND METHODS: We analyzed 122 consecutive patients with pT3a who underwent radical nephrectomy for RCC between 2000 and 2011 at the University of Bologna. Cancer-specific survival (CSS) rates were estimated using Kaplan-Meier survival curves; univariable and multivariable analyses were performed with Cox analysis. RESULTS: The mean follow-up was 41.7 ± 35.4 months. Patients with peritumoral/hilar fat infiltration (n = 63) and patients with renal vein thrombosis (n = 18) experienced comparable CSS rates, whereas patients with both fat infiltration plus renal vein thrombosis (n = 41) showed worse survival outcomes than the first group (P = .026). Patients were divided in 2 groups: group A, with fat invasion or renal vein thrombosis, and group B, with concomitant fat invasion and renal vein invasion. Group B showed worse cancer-specific survival than group A (P = .024). At multivariate analysis, this new risk-group stratification was found to be an independent prognostic predictor of CSS (P < .05). CONCLUSIONS: Patients with T3a RCC with both fat invasion and renal vein thrombosis experience worse survival rates when compared with those patients with only 1 prognostic factor. The TNM classification should consider the concomitant presence of those parameters as a different prognostic predictor

A novel spectral ultrasonic differentiation method for marking regions of interest in biological tissues. In vivo preliminary results.

BACKGROUND: "in vivo" application of a new echographic method able to better identify neoplastic tissue. The aim of this study was to evaluate its accuracy in the diagnosis of prostate cancer. MATERIALS AND METHODS: Double-blind prospective study on 60 patients (pts) submitted to both transrectal ultrasound (TRUS) of prostate with a traditional echograph connected to a new hardware/software platform named FEMMINA (Fast Echographic Multiparameter Multi Image Novel Apparatus) that processes the echo signal by RULES (Radiofrequency Ultrasonic Local EStimators) algorithm and to a prostatic biopsy (8 to 12 cores). Histological findings of biopsies were compared to B-mode and the new ultrasound method. RESULTS: Cancer was detected in 18/60 pts. 14 patients had positive images with RULES, 11 with B-mode modality. The positive predictive value (PPV) and negative predictive value (NPV) of B-mode were 42% and 79% while 77% and 90% of RULES. Sensitivity and specificity of B-mode were 61% and 79% while those of RULES were 77% and 90%. B-mode diagnostic accuracy was 63% and RULES accuracy was 86%. CONCLUSIONS: Results obtained with RULES are encouraging but they need further studies for its application in clinical practice

The extent of pelvic lymph node dissection correlates with the biochemical recurrence rate in patients with intermediate- and high- risk prostate cancer

To assess the impact of the pelvic lymph-node dissection (PLND) and of the number of lymph-nodes (LN) retrieved during radical prostatectomy (RP) on biochemical relapse (BCR) in pNX/0/1 patients according to the clinical risk of lymph-node invasion (LNI