Oncological cases and complications in Urology.

This collection of cases describes some unusual urological tumors and complications related to urological tumors and their treatment. Case 1: A case of left hydronephrosis referred four years after a right radical mastectomy for lobular breast carcinoma was described. Computed tomography scan revealed a left hydronephrosis with dilated ureter up to the proximal third. An exploratory laparoscopy was performed and the definitive histopathology examination showed a recurrence of the carcinoma with a right tubal metastasis and peritoneal carcinosis. Case 2: A rare case of an extensive penile squamous cell carcinoma in a young man. The patient was treated with radical surgery and modified inguinal lymphadenectomy. No recurrence was noticed so far. Case 3: A rare case of left sided Inferior Vena Cava (IVC) in a patient diagnosed with renal cell cancer who underwent open left partial nephrectomy. Case 4: A case of urethrorrhagia, caused by a recent trauma from an urinary catheter placed in a patient submitted to gastric resection due to a neoplastic pathology. Urethrorrhagia only temporarily responded to conservative treatment and ultimately resolved by coagulation with an endoscopic approach

Protocol of the Italian Radical Cystectomy Registry (RIC): a non-randomized, 24-month, multicenter study comparing robotic-assisted, laparoscopic, and open surgery for radical cystectomy in bladder cancer

Bladder cancer is the ninth most common type of cancer worldwide. In the past, radical cystectomy via open surgery has been considered the gold-standard treatment for muscle invasive bladder cancer. However, in recent years there has been a progressive increase in the use of robot-assisted laparoscopic radical cystectomy. The aim of the current project is to investigate the surgical, oncological, and functional outcomes of patients with bladder cancer who undergo radical cystectomy comparing three different surgical techniques (robotic-assisted, laparoscopic, and open surgery). Pre-, peri- and post-operative factors will be examined, and participants will be followed for a period of up to 24\u2009months to identify risks of mortality, oncological outcomes, hospital readmission, sexual performance, and continence

Protocol of the Italian Radical Cystectomy Registry (RIC): a non-randomized, 24-month, multicenter study comparing robotic-assisted, laparoscopic, and open surgery for radical cystectomy in bladder cancer

Background: Bladder cancer is the ninth most common type of cancer worldwide. In the past, radical cystectomy via open surgery has been considered the gold-standard treatment for muscle invasive bladder cancer. However, in recent years there has been a progressive increase in the use of robot-assisted laparoscopic radical cystectomy. The aim of the current project is to investigate the surgical, oncological, and functional outcomes of patients with bladder cancer who undergo radical cystectomy comparing three different surgical techniques (robotic-assisted, laparoscopic, and open surgery). Pre-, peri- and post-operative factors will be examined, and participants will be followed for a period of up to 24 months to identify risks of mortality, oncological outcomes, hospital readmission, sexual performance, and continence. Methods: We describe a protocol for an observational, prospective, multicenter, cohort study to assess patients affected by bladder neoplasms undergoing radical cystectomy and urinary diversion. The Italian Radical Cystectomy Registry is an electronic registry to prospectively collect the data of patients undergoing radical cystectomy conducted with any technique (open, laparoscopic, robotic-assisted). Twenty-eight urology departments across Italy will provide data for the study, with the recruitment phase between 1st January 2017-31st October 2020. Information is collected from the patients at the moment of surgical intervention and during follow-up (3, 6, 12, and 24 months after radical cystectomy). Peri-operative variables include surgery time, type of urinary diversion, conversion to open surgery, bleeding, nerve sparing and lymphadenectomy. Follow-up data collection includes histological information (e.g., post-op staging, grading, and tumor histology), short- and long-term outcomes (e.g., mortality, post-op complications, hospital readmission, sexual potency, continence etc). Discussion: The current protocol aims to contribute additional data to the field concerning the short- and long-term outcomes of three different radical cystectomy surgical techniques for patients with bladder cancer, including open, laparoscopic, and robot-assisted. This is a comparative-effectiveness trial that takes into account a complex range of factors and decision making by both physicians and patients that affect their choice of surgical technique. Trial registration: ClinicalTrials.gov , NCT04228198 . Registered 14th January 2020- Retrospectively registered

Narrow band imaging for detecting residual/recurrent cancerous tissue during second transurethral resection of newly diagnosed non‐muscle‐invasive high‐grade bladder cancer

Study Type – Diagnostic (case series) Level of Evidence 4OBJECTIVETo determine if narrow‐band imaging (NBI) can be used to detect high‐grade cancerous lesions missed with the white light at the time of a second transurethral resection (TUR) of high‐grade non‐muscle‐invasive bladder cancer (NMIBC).PATIENTS AND METHODSConsecutive patients with newly diagnosed high‐grade NMIBC were enrolled in a prospective observational study. Patients with incomplete resection or absence of muscle tissue in the specimen were excluded. About 1 month after the first TUR, NBI cold‐cup biopsies were taken from areas suspicious for urothelial cancer at the end of an extensive white‐light second TUR protocol including: (i) resection of the scar of the primary tumour; (ii) resection of any overt or suspected urothelial lesions; and (iii) six random cold‐cup biopsies of healthy mucosa.RESULTSIn 2008, 47 consecutive patients were recruited after giving written consent (median age 62 years, range 49–83, 39 men and eight women). Nine patients (19%) had macroscopic or microscopic high‐grade NMI urothelial cancer, whereas one was reassessed as having muscle‐invasive disease at the white‐light second TUR plus the six random biopsies. NBI biopsies were taken in 40 of the 47 patients and detected six more patients with high‐grade cancerous tissue (13%). In all 16 of the 47 patients (34%) were found to have residual/recurrent cancer using our extensive protocol of second TUR followed by NBI biopsies.CONCLUSIONSAdding NBI biopsies at the end of an extensive second TUR protocol in patients with newly diagnosed high‐grade NMIBC can lead to the identification of patients with otherwise missed high‐grade residual/recurrent urothelial carcinoma

Clitoroplastica e ricostruzione chirurgica delle grandi labbra in mosaicismo X0/XY: Case report

The goal of genital correction surgery is to create a cosmetic and functional outcome preserving the sensitivity. A case of correction for hypertrophy of the clitoris and labia majora is described. A 46 years old women, diagnosed at infancy with X0/XY mosaicism, presented in early childhood, hypertrophy of clitoris and labia majora. She underwent surgery to remove gonads in infancy, but she asked for reduction clitoroplasty and labia majora only after a long psicotherapic support. A small area of the clitoris to be preserved was marked. Neurovascular bundle was carefully separated from the corporal tissue that was cut off. Later the estimated amount of skin and fat to be removed from labia majora was marked. At 12 months after surgery, the patient's external genitalia had reached a normal appearance. The sensitivity of the surgically reduced clitoris had preserved and labia majora aspect had a good cosmetic result. \ua9 Capsula Eburnea, 2010

An Innovative Reactivity Control Strategy for Small Modular Reactors

Currently, the main reactivity control methods for small modular reactors (SMR) use control rods as the primary control system, with chemical SHIM or burnable absorbers as secondary systems to control the reactivity excess. However, this kind of control system presents some risks, such as control rod undesired drop or positive moderator coefficient due to the high concentration of boric acid in the moderator. This paper evaluates the possibility of using a displaceable heavy neutron reflector with a neutron absorber (boron) as a secondary reactivity control method. The reference NuScale core geometry has been simulated using the DRAGON5 and DONJON5 deterministic codes, computing the neutron flux and power distribution at each reflector withdrawal step. Two different strategies have been considered: 1) withdrawing the entire movable reflector block towards the upper part of the vessel and 2) separating the reflector block into two equal parts, removing each in different directions from the core equator region. Results indicate that the most suitable reflector withdrawal mechanism is the latter: this solution is promising to replace secondary reactivity control methods in small reactor cores

Narrow band imaging for detecting residual/ recurrent cancerous tissue during second transurethral resection of newly diagnosed non-muscle-invasive high-grade bladder cancer

About 1 month after the first TUR, NBI cold-cup biopsies were taken from areas suspicious for urothelial cancer at the end of an extensive white-light second TUR protocol including: (i) resection of the scar of the primary tumour; (ii) resection of any overt or suspected urothelial lesions; and (iii) six random cold-cup biopsies of healthy mucosa. RESULTS In 2008, 47 consecutive patients were recruited after giving written consent (median age 62 years, range 49-83, 39 men and eight women). Nine patients (19%) had macroscopic or microscopic high-grade NMI urothelial cancer, whereas one was reassessed as having muscle-invasive disease at the white-light second TUR plus the six random biopsies. NBI biopsies were taken in 40 of the 47 patients and detected six more patients with high-grade cancerous tissue (13%). In all 16 of the 47 patients (34%) were found to have residual/recurrent cancer using our extensive protocol of second TUR followed by NBI biopsies. CONCLUSIONS Adding NBI biopsies at the end of an extensive second TUR protocol in patients with newly diagnosed high-grade NMIBC can lead to the identification of patients with otherwise missed high-grade residual/ recurrent urothelial carcinoma. KEYWORDS urinary bladder, neoplasm, cystoscopy, recurrence, diagnostic imaging Study Type -Diagnostic (case series) Level of Evidence 4 OBJECTIVE To determine if narrow-band imaging (NBI) can be used to detect high-grade cancerous lesions missed with the white light at the time of a second transurethral resection (TUR) of high-grade non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS Consecutive patients with newly diagnosed high-grade NMIBC were enrolled in a prospective observational study. Patients with incomplete resection or absence of muscle tissue in the specimen were excluded