Open Partial Nephrectomy in the Management of Small Renal Masses

Introduction. Most of the kidney masses are being detected incidentally with smaller size due to widespread use of imaging modalities leading to increased RCC incidence worldwide with an earlier stage. This article reviews the role of open partial nephrectomy (PN) in the management of small renal masses. Material and Methods. Review of the English literature using MEDLINE has been performed between 1963–2008 on small renal masses, partial nephrectomy, kidney cancer, nephron sparing surgery (NSS), radical nephrectomy, laparoscopy, and surgical management. Special emphasis was given on the indications of NSS, oncological outcomes and comparison with open and laparoscopic PN. Results. Overall 68 articles including 31 review papers, 35 human clinical papers, 1 book chapter, and 1 animal research study were selected for the purpose of this article and were reviewed by the authors. Conclusions. Currently, open NSS still remains as the gold standard surgical treatment modality in patients with small renal masses

Современные подходы к лечению почечно-клеточного рака

Surgery is the only effective method for the treatment of localized renal cell carcinoma (RCC). Today nephron sparing surgery (NSS) cures the majority of patients with early stage disease. Open radical nephrectomy (RN) is performed mainly in patients with large tumors and in cases complicated by the tumor thrombus extension into the vena cava. Laparoscopy is now more and more often used for RCC treatment. Laparoscopic RN (LRN) is now recommended for the treatment of early stage RCC, when NSS cannot be used. LRN seems to provide longterm cancer control comparable to open RN. RCC is now often diagnosed when the tumors are still small and can be often cured by NSS providing excellent local cancer control. Tumor size, location, multiple foci, surgical margin, and pathological variants are significant for cancer outcome in selective NSS. Laparoscopic partial nephrectomy (LPN) is now gaining popularity as an effective minimally invasive treatment in patients with relatively small and peripheral renal tumors. Recently minimally invasive ablative techniques were introduced for the treatment of RCC. These methods involve little complications if used for the treatment of small renal tumors. The currently used best therapy for metastatic RCC is inadequate and surgery is an important component of combined treatment including immunochemotherapy. Combinations of interferon-alpha, interleukin-2, and 5-fluorouracyl are now used for the treatment of metastatic RCC. Nephrectomy can be recommended for patients with good performance status before immunotherapy. Modern research is focused on identification of novel agents and treatment modalities with better antitumor activity.

Superficial Urothelial Cancer in the Prostatic Urethra

Transitional cell carcinoma (TCC) is a multifocal disease of the urinary tract that can also involve the prostatic urethra (PU). The exact incidence of superficial involvement of the PU in patients with bladder TCC is not well known. Bladder TCC may involve the prostate in 12—40% of the patients and the degree of involvement can include urethral mucosa, ducts, acini, and stroma of the gland, which has been shown to affect the outcome. Risk factors for superficial urothelial cancer in the PU are high-grade, multifocal bladder TCC and presence of carcinoma in situ (CIS) in the bladder. While visible tumors are easy to detect and resect, controversy still exists regarding the optimal technique to identify prostatic involvement by TCC. Prostatic urethral sampling by a transurethral resection biopsy or a cold-cup biopsy, particularly in the high-risk group of bladder cancer patients, has been recommended for detecting prostatic urethral involvement. Management of superficial prostatic involvement by TCC is also unclear. Currently, there is increasing recognition of the value of conservative treatment options with intravesical agents when there is superficial involvement of the PU. Particularly, intravesical bacillus Calmette-Guèrin (BCG) seems to be an effective treatment alternative in the management of superficial involvement of the PU by TCC. Close follow-up by cystoscopy and PU biopsy at 3-month intervals, particularly in intermediate and high-risk patients who respond to intravesical therapy and in whom cystectomy is appropriate, is recommended in order to detect persistent tumor, recurrences, or progression

Modern Approaches to the Treatment of Renal Cell Carcinoma

Surgery is the only effective method for the treatment of localized renal cell carcinoma (RCC). Today nephron sparing surgery (NSS) cures the majority of patients with early stage disease. Open radical nephrectomy (RN) is performed mainly in patients with large tumors and in cases complicated by the tumor thrombus extension into the vena cava. Laparoscopy is now more and more often used for RCC treatment. Laparoscopic RN (LRN) is now recommended for the treatment of early stage RCC, when NSS cannot be used. LRN seems to provide longterm cancer control comparable to open RN. RCC is now often diagnosed when the tumors are still small and can be often cured by NSS providing excellent local cancer control. Tumor size, location, multiple foci, surgical margin, and pathological variants are significant for cancer outcome in selective NSS. Laparoscopic partial nephrectomy (LPN) is now gaining popularity as an effective minimally invasive treatment in patients with relatively small and peripheral renal tumors. Recently minimally invasive ablative techniques were introduced for the treatment of RCC. These methods involve little complications if used for the treatment of small renal tumors. The currently used best therapy for metastatic RCC is inadequate and surgery is an important component of combined treatment including immunochemotherapy. Combinations of interferon-alpha, interleukin-2, and 5-fluorouracyl are now used for the treatment of metastatic RCC. Nephrectomy can be recommended for patients with good performance status before immunotherapy. Modern research is focused on identification of novel agents and treatment modalities with better antitumor activity

Pharmacologic targets on the female urethra

WOS: 000257459400001PubMed ID: 18587243Introduction: This article reviews the mechanisms affecting contraction and relaxation of the urethra in order to establish a basis for current and future treatments for urinary incontinence in women. Material and Methods: A review of the English literature using MEDLINE was performed between 1970 and 2008 on female urethra pharmacology, urinary incontinence, and mechanisms involved in contraction and relaxation of the female human urethra. Results: alpha - Adrenoceptors (ARs) cause contraction and beta-ARs cause relaxation. Use of selective alpha - agonist and beta-AR blocker agents might have potential for the treatment of stress urinary incontinence. Tolerable doses of cholinergic agonists did not have significant effects on intraurethral pressure. Nitric oxide seems to be the major nonadrenergic- noncholinergic inhibitory transmitter causing relaxation. c-kit-positive interstitial cells seem to regulate urethral tone. The roles of adenosine triphosphate and carbon monoxide have not been fully investigated in humans. Neuropeptides function similarly to the urinary bladder. Prostanoids cause urethral contraction and relaxation depending on their subtypes. Serotonin enhances the strength of urethral sphincteric contractions. The Rho- kinase pathway also appears to be modulating smooth muscle contraction in the urethra. Conclusions: Understanding of the urethral function and pharmacology may lead to the development of promising new agents which might be useful in the management of urinary incontinence in women. Copyright (c) 2008 S. Karger AG, Base

INTRAOPERATIVE ORGAN INJURIES SEEN DURING THE SURGICAL MANAGEMENT OF KIDNEY TUMORS

Introduction: Renal cell carcinoma (RCC) is the most common malignancy of the kidney and radical nephrectomy (RN) or nephron sparing surgery (NSS) has been the standard treatment. Due to the technological developments and the increasing use of the imaging modalities like abdominal ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI), increasing numbers of RCCs have been diagnosed in recent years. Therefore, the number of surgical treatments has also increased. Intraoperative organ injuries during RN and NSS could occur during surgery. The aim of this retrospective study was to evaluate the intraoperative organ injuries occurred during the surgical management of kidney tumors