Inflammatory Myofibroblastic Bladder Tumor in a Patient with Von Recklinghausen's Syndrome

Myofibroblastic tumor, also known as inflammatory pseudotumor or pseudosarcoma, is a benign tumor with mesenchymal origin. Bladder location is very uncommon. We report the case of a 58-year-old man with a history of von Recklinghausen's disease who complained for painless macroscopic hematuria 5 months after suprapubic prostatectomy. The radiograph evaluation revealed a bladder tumor, and the pathologic examination following a transurethral resection showed inflammatory myofibroblastic tumor of the bladder. The patient finally underwent a radical cystectomy due to the uncertain pathogenesis of inflammatory myofibroblastic tumor as well as the rarity of cases published on bladder tumors in Von Recklinghausen's patients

Ethical issues in live donor kidney transplantation

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The use of non-steroidal anti-inflammatory drugs in the treatment of postoperative pain after radical prostatectomy

Purpose: The systematic use of non-steroidal anti-inflammatory drugs (NSAIDs) immediately after open radical retropubic prostatectomy (RRP) is often avoided because of their anticoagulant effect and potential hemorrhagic complications. Our aim was to assess the efficacy and safety of NSAIDs administered after RRP. Materials and Methods: One hundred patients undergoing open RRP by one surgeon were divided randomly and prospectively into two groups of 50 patients each receiving systematically either an NSAID (lornoxicam) or paracetamol for postoperative analgesia. Opiates were administered if needed for breakthrough pain. Parameters potentially correlated with postoperative bleeding such as pre- and post-op hemoglobin (Hb) differences, estimated blood loss (EBL), number of transfusions and drain output were recorded. Furthermore the degree of pain was assessed daily by the visual analog scale (VAS) score until discharge from hospital. Results: After procedures with similar EBLs, postoperative bleeding was not more in the NSAIDs group, as evidenced by similar transfusion rates (p£1), similar postoperative haemoglobin (Hb) values (p>0.05) and Hb drop after the procedure. No patient required re-exploration for bleeding while drain output when elevated was never attributed to postoperative bleeding. Pain control as evaluated by the visual analog pain score was adequate with the use of NSAIDs and not statistically different from the non-NSAIDs group during the 1st, 4th and onwards postoperative days. Pain control with lornoxicam was even better on the 2nd and 3rd postoperative days (p?0.05). Conclusions: NSAIDs administered after open RRP are safe and effective. They do not increase the risk for bleeding and offer adequate analgesia.Σκοπός: Η συστηματική χορήγηση μη στερινοειδών αντιφλεγμονοδών φαρμάκων (ΜΣΑΦ) μετά από οπισθοηβική ριζική προστατεκτομή (RRP) συνήθως αποφεύγεται λόγω της αντιαιμοπεταλιακής τους δράσης και της πιθανότητας αιμορραγικών επιπλοκών. Ο σκοπός μας ήταν να αξιολογηθεί η αποτελεσματικότητα και η ασφάλεια χορήγησης ΜΣΑΦ μετά από RRP. Υλικό και Μέθοδος: Εκατό ασθενείς υποβλήθηκαν σε ανοικτή RRP από ένα χειρουργό και κατανεμήθηκαν τυχαία και προοπτικά σε 2 ομάδες των 50 ασθενών. Στη μια ομάδα χορηγήθηκε συστηματικά ΜΣΑΦ (λορνοξικάμη) ενώ στην άλλη παρακεταμόλη ως μετεγχειρητική αναλγησία. Επί εντόνου άλγους χορηγήθηκαν επιπλέον οπιοειδή. Έγινε καταγραφή των παραμέτρων που σχετίζονταν με πιθανή μετεγχειρητική αιμορραγία όπως η προεγχειρητική και μετεγχειρητική διαφορά στην αιμοσφαιρίνη (Hb) αίματος, η εκτιμώμενη διεγχειρητική απώλεια αίματος (EBL), ο αριθμός των φιαλών αίματος που μεταγγίστηκαν και η ποσότητα του υγρού των παροχετεύσεων. Ο βαθμός του πόνου καταγράφηκε καθημερινά με τη βαθμίδα οπτικού αναλόγου μέχρι την έξοδο από το νοσοκομείο. Αποτελέσματα: Οι επεμβάσεις είχαν παρόμοια EBL και η μετεγχειρητική αιμορραγία δεν διέφερε στην ομάδα του ΜΣΑΦ όπως αποδεικνύεται και από τον παρόμοιο αριθμό μεταγγίσεων (p£1) τις παρόμοιες τιμές αιμοσφαιρίνης καθώς και τον παρόμοιο ρυθμό ελάττωσής της μετεγχειρητικά. Κανένας ασθενής δεν χρειάστηκε επανεπέμβαση εξαιτίας αιμορραγίας ενώ σε καμία περίπτωση που η ποσότητα του υγρού των παροχετεύσεων ήταν αυξημένη δεν οφειλόταν σε αιμορραγία. Ο βαθμός του πόνου δεν διέφερε μεταξύ των 2 ομάδων κατά την 1η, 4η και τις επόμενες μετεγχειρητικές ημέρες αλλά ήταν μικρότερος κατά την 2η και 3η μετεγχειρητική ημέρα για την ομάδα της λορνοξικάμης (p?0.05). Συμπέρασμα: Η χορήγηση των ΜΣΑΦ μετά από ανοικτή RRP είναι ασφαλής και αποτελεσματική. Φαίνεται ότι δεν αυξάνουν τον κίνδυνο αιμορραγίας και προσφέρουν αποτελεσματική αναλγησία

Is TURBT able to cure high risk recurrent superficial or muscle invasive bladder cancer: Factors resulting in pT0 radical cystectomy specimens

Purpose In 76% of radical cystectomy patients there is discrepancy between the initial stage at transurethral resection and the final pathological stage of the cystectomy specimen. More specifically in contemporary series the absence of tumor at radical cystectomy specimens (stage pT0) is estimated at 5-25%. Our aim was to determine which factors contributed to the absence of tumor in our series of radical cystectomy patients. Materials and Methods Fifty one patients were submitted to radical cystectomy in our department over the last 10 years (January 2002-January 2012). A thorough analysis of the patients' files with no residual tumor on the cystectomy specimen (pT0) was performed. Possible factors contributing to such a result were described and a systematic analysis of the relevant literature was performed. Results Five patients had a pT0 stage after radical cystectomy. Four of them had transitional cell carcinoma and one of them had squamous cell carcinoma of the bladder on the initial transurethral resection. None of the tumors presented lymphovascular invasion. Four patients are still alive and one died 45 months postoperatively from a cardiac cause. Conclusions Four factors were identified in our study to contribute towards a pT0 cystectomy result. Those included the absence of lymphovascular invasion, the completeness of transurethral resection, the experience of the surgeon and the use of a standardized technique for the transurethral resection. The time to cystectomy in our series did not have a negative effect on pT0 final pathology result

Difference between actual vs. pathology prostate weight in TURP and radical robotic-assisted prostatectomy specimen

Introduction To investigate and highlight the effect of formaldehyde induced weight reduction in transurethral resection of prostate (TURP) and radical robotically-assisted prostatectomy (RALP) specimen as a result of standard chemical fixation. Materials and Methods 51 patients were recruited from January 2013 to June 2013 who either underwent a TURP (n=26) or RALP (n=25). Data was collected prospectively by the operating surgeon who measured the native, unfixed histology specimen directly after operation. The specimens were fixed in 10% Formaldehyde Solution BP and sent to the pathology laboratory where after sufficient fixation period was re-weighed. Results Overall mean age 64.78 years, TURP mean age 68.31 years RALP mean age 61.12years. We found that the overall prostatic specimen (n=51) weight loss after fixation was a mean of 11.20% (3.78 grams) (p≤0.0001). Subgroup analysis of the native TURP chips mean weight was 16.15 grams and formalin treated mean weight was 14.00 grams (p≤0.0001). Therefore, TURP chips had a mean of 13.32 % (2.15 grams) weight loss during chemical fixation. RALP subgroup unfixed specimen mean weight was 52.08 grams and formalin treated mean weight was 42.60 grams (p≤0.0001), a 19.32 % (9.48grams) mean weight reduction. Conclusion It has not been known that prostatic chips and whole human radical prostatectomy specimen undergo a significant weight reduction. The practical significance of the accurate prostate weight in patient management may be limited, however, it is agreed that this should be recorded correctly, as data is potential interest for research purposes and vital for precise documentation