Rigid and flexible ureteroscopy (URS/RIRS) management of paediatric urolithiasis in a not endemic country.

Introduction: In the last years due to miniaturization of endoscopic instruments and percutaneous surgery, endourology has become very popular in paediatric urinary stone managment. We reported our single-centre experience in retrograde endoscopic procedures in children. Results and complications of URS/RIRS are discussed. Materials and methods: We retrospectively reviewed our experience in patients ≤ 16 years old affected by urinary stones who underwent URS/RIRS procedures performed by two surgeons with expertise in endourology. A total of 30 renal Units (RUs) underwent endoscopic procedures (URS, RIRS or both). Surgical complications according to the ClavienDindo's classification and stone-free rate were evaluated at 3 months follow-up. Success of URS was defined as stone-free status after single procedure while RIRS success rate was considered as presence of residual stone fragments smaller than 4 mm at first procedure. Results: The mean age of our patients was 8 years, range 2- 16 years. A total of 30 renal units (RUs) underwent 40 endourological procedures (23 URS and 17 RIRS; 10 children underwent both procedures at the same time). 17/30 (56.6%) RUs were pre-stented before surgery. The stone-free status was achieved in 23/30 renal units treated, with a 76.6% success rate. The remaining 7 patients had residual stones greater than 4 mm and underwent further treatments. After a second surgery the stone-free rate turned out to be 93.3% (28/30 renal units). Conclusions: Rigid and flexible ureteroscopy (URS/RIRS) is a reliable technique for treatment of < 2 cm urinary stones in paediatric age group. It shows low rate of major complications and promising results in terms of stone-free rate

Retrospective immunophenotypical evaluation of MET, PD-1/PD-L1, and mTOR pathways in primary tumors and pulmonary metastases of renal cell carcinoma: the RIVELATOR study addresses the issue of biomarkers heterogeneity

Aim: In renal cell carcinoma (RCC), tumor heterogeneity generated challenges to biomarker development and therapeutic management, often becoming responsible for primary and acquired drug resistance. This study aimed to assess the inter-tumoral, intra-tumoral, and intra-lesional heterogeneity of known druggable targets in metastatic RCC (mRCC). Methods: The RIVELATOR study was a monocenter retrospective analysis of biological samples from 25 cases of primary RCC and their paired pulmonary metastases. The biomarkers analyzed included MET, mTOR, PD-1/PD-L1 pathways and the immune context. Results: High multi-level heterogeneity was demonstrated. MET was the most reliable biomarker, with the lowest intratumor heterogeneity: the positive mutual correlation between MET expression in primary tumors and their metastases had a significantly proportional intensity (P = 0.038). The intratumor heterogeneity grade was significantly higher for the mTOR pathway proteins. Combined immunophenotypical expression patterns and their correlations with the immune context were uncovered [i.e., mTOR expression in the metastases positively correlated with PD-L1 expression in tumor-infiltrating lymphocytes (TILs), P = 0.019; MET expression was related to PD-1 expression on TILs (P = 0.041, ρ = 0.41) and peritumoral lymphocytes (RILs; P = 0.013, ρ = 0.49)], suggesting the possibility of predicting drug response or resistance to tyrosine kinase, mTOR, or immune checkpoint inhibitors. Conclusions: In mRCC, multiple and multi-level assays of potentially predictive biomarkers are needed for their reliable translation into clinical practice. The easy-to-use immunohistochemical method of the present study allowed the identification of different combined expression patterns, providing cues for planning the management of systemic treatment combinations and sequences in an mRCC patient population. The quantitative heterogeneity of the investigated biomarkers suggests that multiple intralesional assays are needed to consider the assessment reliable for clinical considerations

Carcinoma in situ (CIS) of the testis

: Abstract. Testicular cancer is the most common malignancy in 20- to 34-years-old males. It has been stated that testicular cancer derives from a precocious lesion, the carcinoma in situ of the testis, also known as Intratubular Germ Cell Neoplasia (IGCN) or Testicular Intraepithelial Neoplasia (TIN). This lesion deserves great attention, because the diagnosis of CIS may lead to a precocious diagnosis of testicular cancer. Generally, the diagnosis of CIS is incidental. Every physician should know the management of this precocious lesion, as the correct management of CIS can lead to a decrease of the incidence of overt testicular cancer (the most frequent malignancy in young men). Moreover, the correct diagnosis and management of CIS can shorten the hospital stay, reduce the cost, and improve the social impact of the testicular cancer

Ureterectomy and ureteral reimplatation for low-grade transitional cell carcinoma: is the laparoscopic approach feasible and effective?

: As it is well known, the gold-standard to treat ureteric and pelvi-caliceal transitional cell carcinoma (TCC) is nephroureterectomy. Nevertheless, in particular circumstances, such as solitary kidney, a more conservative treatment is needed. Conservative treatment has been reported for low-grade TCC, also. In this paper we discuss the laparoscopic approach to low-grade ureteric TCC in patients with otherwise normal urinary tract. After reporting a case of a patient treated with this approach, we deal with some technical aspect of the surgical procedure and with the pre-operative and post-operative management of the patient

High-Intensity Focused Ultrasound for Prostate Cancer: Long-Term Followup and Complications Rate

Introduction. As it is well known, High Intensity Focused Ultrasound (HIFU) is a minimally invasive procedure for prostate cancer. Many investigators reported their series of patients, demonstrating the effectiveness of the treatment. The most majority of Authors, however, do not report the side effects and the complications of the procedure, which is the aim of our study. The diagnosis and management of complications is discussed, and the oncologic outcome is reported in terms of quality of life. Materials and Methods. We report our experience in 89 patients, low-, intermediate-, and high-risk patients according with D’Amico classification. All data collected along the study were analyzed, including side effects and complications of the procedure. Results. Our series demonstrates the effectiveness of the procedure, in line with larger series reported in literature by other investigators. The most important side effects are sexual function impairment and transient incontinence in a minority of cases. Minor complications are reported as well as rare cases of major complications, which can require surgical treatment

Pazopanib as a possible option for the treatment of metastatic non-clear cell renal carcinoma patients: a systematic review

Effective systemic treatment of non-clear cell renal carcinoma (nccRCC) is still an unmet clinical need, with few studies to support an evidence-based approach. To date, the only recommended standard first-line treatment is sunitinib. Pazopanib may also be used in nccRCC but its place in therapy is not clearly established. It has comparable efficacy and better tolerability than sunitinib in clear cell renal carcinoma. Our objective was to review the use of pazopanib in metastatic nccRCC

Metastatic Clear Cell Renal Cell Carcinoma: The Great Pretender and the Great Dilemma

Metastatic renal cell carcinoma (mRCC) may present with a wide range of clinical pictures. Reportedly, paraneoplastic syndromes are the first sign in 20% of cases and only 15% of cases show the classic triad (flank pain, gross hematuria, and palpable abdominal mass) at presentation. The remaining cases present with signs and symptoms related to the site of distant metastases. These data may explain the reason why about 20-30% of patients are metastatic at presentation. We report the case of a 63-year-old woman who came to our attention for lower back pain. After imaging studies, we detected a left kidney mass of 86 x 61 x 79 mm, multiple right pulmonary nodules and six bone lesions. She underwent left radical nephrectomy. After 1 month, she developed signs of spinal cord compression with neurological deficits and she underwent emergency spinal decompression. In order to allow complete motor recovery, the subsequent stereotactic body radiation therapy was not performed, and she is currently taking combination immunotherapy regimens. Management of mRCC is in a continuous evolution due to availability of new target therapies and the possibility of a multimodal approach with surgical, focal and radiotherapy treatments. However, the ideal treatment algorithm is yet to come. This is why mRCC diagnosis and management are still challenging for the clinicians