Pseudosarcomatous myofibroblastic lesion of the urinary bladder: A rare entity posing a diagnostic challenge and therapeutic dilemma

<p>Abstract</p> <p>Background</p> <p>Pseudosarcomatous myofibroblastic lesions of the urinary bladder are relatively rare entities of an uncertain pathogenesis and benign indolent nature.</p> <p>Case presentation</p> <p>We present an extremely rare case of an ALK-1-positive pseudosarcomatous myofibroblastic lesion of the urinary bladder, which was initially misinterpreted as a low-grade leiomyosarcoma of myxoid subtype on histologic examination owing to prominent atypia, high mitotic activity, abnormal mitotic figures and infiltration of the bladder wall. Although the histologic features were suggestive of a sarcoma, the correct diagnosis was finally established and radical surgical treatment was subsequently avoided. The patient is currently free of disease without any evidence of tumor recurrence or metastasis at 3 years post-operatively.</p> <p>Conclusion</p> <p>The key differentiating point rests in distinguishing the aforementioned mass forming lesion from the myxoid subtype of low-grade leiomyosarcoma in order to avoid unnecessary radical therapy.</p

Glutathione-S-transferase-pi (GST-pi) expression in renal cell carcinoma

Multidrug resistance correlates with unfavourable treatment outcomes in numerous cancers including renal cell carcinoma. The expression and clinical relevance of Glutathione-S-transferase-pi (GST-pi), a multidrug resistance factor, in kidney tumors remain controversial. We analyzed the expression of GST-pi in 60 formalin-fixed, paraffin-embedded renal cell carcinoma samples by immunohistochemistry and compared them with matched normal regions of the kidney. A significantly higher expression of GST-pi was observed in 87% of clear cell carcinoma and 50% of papillary subtypes. GST-pi expression did not correlate with tumor grade or patient survival. GST-pi is unlikely to be a prognostic factor for renal cell carcinoma. However, further studies with large number of samples are warranted to establish the role of GST-pi, if any, in intrinsic or acquired resistance of renal cell carcinoma to conventional treatments. Supplementary files: The supplementary files of this article are found under 'Article Tools' at the left side bar

High-Risk Laparoscopic Urologic Surgery

Currently, the majority of operations in the urologic field can be performed laparoscopically. Even in experienced hands, some operations are considered of increased risk either because of increased surgical difficulty of the specific case or because the patient per se is at risk due to associated comorbidities. Scope of this review is to present the existent experience regarding difficult laparoscopic urologic cases, along with points of technique, the product of the experience collected by performing such difficult laparoscopic cases. Knowledge of anticipated difficulties allows both patients and their surgeons to be better prepared. Patients have their expectations from laparoscopy realistically set, whereas urologists, especially those new to laparoscopy, realize their abilities and properly set their indications to achieve the best for their patients

Molecular pathogenetics of renal cancer

Recent developments in genetics and molecular biology have led to an increased understanding of the pathobiology of renal cancer. Thorough knowledge of the molecular pathways associated with renal cancer is a prerequisite for novel potential therapeutic interventions. Studies are ongoing to evaluate novel anticancer agents that target specific molecular entities. This article reviews current knowledge on the genetics and molecular pathogenesis of sporadic and inherited forms of renal cancer. Copyright (c) 2006 S. Karger AG, Basel

Is there a role for hyberbaric oxygen as primary treatment for grade IV radiation-induced haemorrhagic cystitis? a prospective pilot-feasibility study and review of literature

Purpose To examine the safety and efficacy of hyperbaric oxygen as the primary treatment for Grade IV radiation-induced haemorrhagic cystitis. Materials and Methods Hyperbaric oxygen was prospectively applied as a primary treatment option in 11 patients with Grade IV radiation cystitis. Primary endpoint was the incidence of complete and partial response to treatment. Secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. Results All patients completed therapy without complications for a mean follow-up of 17.82 months (range 3 to 34). Mean number of sessions needed was 32.8 (range 27 to 44). Complete and partial response rate was 81.8% and 18.2%, respectively. However, in three patients the first treatment session was not either sufficient or durable giving a 72.7% rate of durable effect. Interestingly, all 9 patients with complete response received therapy within 6 months of the haematuria onset compared to the two patients with partial response who received therapy at 8 and 10 months from the haematuria onset, respectively (p = 0.018). The need for blood transfusion (p = 0.491) and the total radiation dose (p = 0.259) were not correlated to success-rate. One patient needed cystectomy, while all patients were alive at the end of follow-up. Conclusions Early primary use of hyperbaric oxygen to treat radiation-induced grade IV cystitis is an effective and safe treatment option

Hyberbaric oxygen as sole treatment for severe radiation - induced haemorrhagic cystitis

ABSTRACT Purpose To examine the safety and efficacy of hyperbaric oxygen as the primary and sole treatment for severe radiation-induced haemorrhagic cystitis. Materials and methods Hyperbaric oxygen was prospectively applied as primary treatment in 38 patients with severe radiation cystitis. Our primary endpoint was the incidence of complete and partial response to treatment, while the secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. Results All patients completed therapy without complications with a mean follow-up of 29.33 months. Median number of sessions needed was 33. Complete and partial response rate was 86.8% and 13.2%, respectively. All 33 patients with complete response received therapy within 6 months of the haematuria onset. One patient needed cystectomy, while 33 patients were alive at the end of follow-up. Conclusions Our study suggests the early primary use of hyperbaric oxygen for radiation-induced severe cystitis as an effective and safe treatment option

Diagnostic efficacy of transrectal ultrasound-guided biopsy of the prostatic fossa in patients with rising PSA following radical prostatectomy

To evaluate the diagnostic efficacy of transrectal ultrasound (TRUS)-guided biopsy of the prostatic fossa in men with biochemical relapse following radical retropubic prostatectomy (RP). Thirty patients, with detectable prostate specific antigen (PSA) and negative imaging for metastases after RP, were evaluated for local recurrence. All patients underwent TRUS-guided biopsies of the prostatic fossa, with at least six cores obtained. PSA and digital rectal examination (DRE) were correlated with biopsy results. Twelve patients (40%) were found with local recurrence. Sensitivities of TRUS and DRE were 75 and 50%, while specificities were 83 and 100%, respectively. Local recurrence was detected in 25% of the patients with PSA &lt;= 1 ng/ml, and higher PSA levels were correlated with an increased positive biopsy rate. All patients with positive DRE had positive biopsy and positive TRUS as well. When both TRUS and DRE were positive it was more likely for the patient to have positive biopsy than when both TRUS and DRE were negative. TRUS-guided biopsy is an efficient tool in detecting local recurrence after RP and should be offered to all patients with biochemical relapse and absence of metastatic disease irrespective of the level of PSA

Ultrasound-guided percutaneous nephrostomy performed by urologists: 10-year experience

Objectives. To assess the safety, feasibility, and effectiveness of percutaneous nephrostomy tube (PNT) insertion performed solely by a urologist on an outpatient basis. We present our relevant 10-year experience. Methods. From 1996 to 2005, 650 PNT insertions were performed in 530 patients (356 men and 174 women), aged 39 to 94 years (mean 67.4). All patients were referred to our outpatient department. PNT placement was performed under local anesthesia by a consultant urologist or registrar during regular work hours or during on-call duty. Early complications within 30 days of PNT insertion were recorded. Results. Primary successful PNT insertion was recorded in 615 (94.6%) of the 650 procedures. Follow-up data up to 30 days were available for 545 PNT placements (83.8%). Of the 650 PNT insertions, 22 (3.3%) major immediate complications were encountered. In 4 patients, laparotomy was performed for surgical exploration of hemorrhage (3 patients) or choleperitoneum, resulting in nephrectomy (I patient). In 5 (0.8%) of 615 successful PNT procedures, we recorded septicemia, which resulted in 2 deaths. In I more case (0.1%), the nephrostomy tube was misplaced into the inferior vena cava. Minor complications within the follow-up period were recorded in 24 (4.5%) of 545 cases. The complication rate did not differ significantly between the consultants and registrars or whether PNT insertion was performed during regular work hours or during on-call duty. Conclusions. Ultrasound-guided PNT insertion performed solely by a urologist is a safe, feasible, and efficient procedure, regardless of the operator’s experience. (c) 2006 Elsevier Inc

Eighteen-Month Results of a Randomized Prospective Study Comparing Transurethral Photoselective Vaporization with Transvesical Open Enucleation for Prostatic Adenomas Greater Than 80 cc

Conflict of Interest: None Take Home Message: This is a prospective randomized study showing that for large prostatic adenomas, photoselective vaporization of the prostate requires less blood transfusions, shorter catheterization time and shorter hospital stay compared to open prostatectomy, while achieving similar functional results at the same time. Aim: The effectiveness and the safety of photoselective vaporization of the prostate (PVP) was compared to that of open prostatectomy (OP) for the surgical treatment of large prostatic adenomas. Methods: 125 patients with prostate glands &gt;80 ml, were randomly allocated to PVP (n = 65) or OP (n = 60) and prospectively evaluated at 1, 3, 6, 12, and 18 months postoperatively. International prostate symptom score (IPSS) and peak urinary flow rate (Q(max)) were chosen as primary treatment-related endpoints. Results: Longer length of operation time, shorter length of catheterization and hospital stay were experienced by patients who underwent PVP. Although patients who underwent OP showed a higher transfusion rate, adverse events in general were minor and of similar profile in both groups. All functional parameters improved significantly compared to baseline values in both groups. There was no difference in IPSS between the two groups at 3, 6, 12, and 18 months postoperatively. Patients who underwent OP scored better in the IPSS-Quality of life score at 18 months postoperatively. At 18 months there were no significant differences between the two groups in the Qmax, post void residual urine volume and in the International Index for Erectile function-5 questionnaire. At three months prostate volume was significantly lower in the OP group and remained as such throughout follow-up. Conclusions: Our results indicate that for an 18 month period photoselective vaporization of the prostate is a highly acceptable treatment alternative to open prostatectomy