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Introduction and Objectives. Although discovered in the late 19th century by the American physician Robert F Weir, lichen sclerosus is still a condition not fully understood. Initially considered a simple skin disorder, it mainly affects the genital regions of both men and women, producing white hypomelanotic lesions, that if left untreated tend to evolve into more serious health related problems. In this paper we conducted a thorough review of the literature in order to assess the current level of knowledge of lichen sclerosus of the male genitalia, to identify its etiology, clinical presentation and diagnostic methods, and establish the main treatment options. Materials and Methods. So far a total of five etiologic factors have been considered for lichen sclerosus: autoimmunity, genetics, hormonal infiuence, repeated microtrauma and infections. As only empirical observations sustain each of them, and none alone can explain or predict lichen sclerosus, it is assumed that this condition has a multifactorial origin, and the precise appearance mechanism has yet to be determined. Regarding the lichen sclerosus of the male genitalia, four distinct clinical stages of presentation have been described, based on the extent of the disease and the complications it produces. During the first stage the white hypomelanotic lesions can be observed at the level of the prepuce, that gets scarred and brittle, and can lead to phimosis. For the second stage the lichen lesions also affect the glans of the penis, that can fuse with the phimotic prepuce. The third stage marks the involvement of the urethra, patients exhibiting stenoses and strictures, of various degrees of severity. And the fourth and most dangerous stage represents the malignant transformation of the involved tissues, resulting in squamous cell carcinoma of the penis or urethra, verrucous carcinoma of the penis, and erythroplasia of Queyrat. While definitive diagnosis is obtained after a histopathological examination of a removed specimen, the clinical presentation can often be enough to identify lichen sclerosus. Imaging like ultrasound, computed tomography or magnetic resonance is also required to correctly assess the extent of the complications. Results. Various treatment options have been employed for lichen sclerosus thus far, ranging from local ointments and creams to surgical excision and correction in the complicated cases. Some, like the revulsives and X-rays, retain only historic value, having been already abandoned. Out of the topical treatments used nowadays, meant to alleviate the symptoms and reduce the lichen affected areas, the most common are corticosteroids, calcineurin inhibitors, hormonal creams and retinoids. The same effects have been obtained with some forms of phototherapy. But when lichen sclerosus evolves beyond simple skin lesions, surgery is required in order to correct the acquired complications. If phimosis is associated, a complete circumcision of the involved tissue is needed. For the second stage, if the prepuce is fused to the glans, a restoration of lost obscured coronal sulcus procedure achieves the best results. In the third stage, when urethral strictures develop, various forms of urethroplasties are necessary to restore normal micturition, and even perineal urethrostomies are considered in cases of panurethral strictures. The fourth and most severe stage of lichen sclerosus, marked by the malignant transformation, imposes an oncologic treatment catered to the extent of the disease, from a simple excision of a prepuce or penile tumor, to complete emasculation and ilio-inguinal lymph node dissection, or even palliative chemotherapy in metastatic cases. Conclusions. Although known for almost 150 years, lichen sclerosus is still not a fully understood disease. Being considered a simple skin disorder for a long time, it's been overlooked by both patients and physicians, and its true incidence is underestimated. Only recently, after all the evolutive complications of lichen sclerosus have been identified, more effort has been invested in the diagnosis and treatment of this condition. While uncomplicated lichen sclerosus can be managed by topic therapies, advanced forms require complex surgical interventions and experienced physicians in order to achieve the best results. But further research is still needed to clarify the etiology and evolution risks. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Incidence of bladder stones is rising among women secondary to the increased number of genitourinary procedures. Materials and Methods. We report the case of a 34 years old female with history of emergency hysterectomy and cystorraphy for placenta percreta; at admission the patient had haematuria. dysuria, frequency, urgency and urinary incontinence. Spontaneously eliminated calculi containing suture material was reported. Cystoscopy revealed the large stone that was immobile, attached to the posterior bladder wall. Results. Transurethral cystolitholapaxy with ultrasonic lithotripsy was performed, and a black suture material passing through the calculus and the bladder wall was observed, incised and removed. Conclusions. With the urogenital procedures in female patients rising, it is important to bear in mind some simple principles: use of absorbable suture material, good surgical technique and cystoscopic evaluation before discharging the patient. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Renal cell carcinoma (RCC) represents about 3% of all cancers. The classic triad of flank pain, palpable abdominal mass and hematuria, is present in less than 10% of patients and as many as 60% of renal masses are detected incidentally. The treatment methods for renal tumors include radical nephrectomy and partial nephrectomy. Partial nephrectomy or nephron-sparing surgery (NSS) is considered the treatment of choice for localized small renal masses with oncological outcome in cases of renal cell carcinoma (RCC) similar to that of radical nephrectomy (RN). The aim of this paper is to present partial nephrectomy as a treatment method in a patient with multiple renal cell carcinoma on a solitary kidney. Materials and Methods. A 59 years old male patient who referred to our clinic with three renal masses on the left kidney. The patient had a history of right radical nephrectomy, performed 7 years prior, for a pT3aNxMx RCC. We opted for an open partial nephrectomy in order to preserve as much of the renal parenchyma as possible and avoid dialysis. After performing a left subcostal incision, we dissected the kidney and were able to identify the renal masses on the lower extremity of the kidney. After clamping the renal vessels we performed a wedge resection for all three tumors, while also being careful to keep a maximum amount of healthy renal tissue intact. We sutured the kidney and after adequate hemostasis, two drainage tubes were inserted using a small incision and the surgery was completed. Results. The operative time was 90 minutes with a warm ischemia time of 20 minutes. No major complications were encountered in the postoperative setting. The patient was discharged on the 8th postoperative day, with a subsiding creatinine level (from 3.49 mg/dL at the 48 hour mark to 1.79 mg/dL) and subsequent follow-ups have been nominal. The histopatological examination revealed clear cell renal carcinoma pT(m)3a pNx pMx. Conclusions. Nephron sparing surgery should always be considered when managing patients with renal tumors, especially in cases of solitary kidneys, in order to maintain normal renal function and avoid dialysis. While laparoscopic partial nephrectomies are feasible for patients with multiple RCCs, they should be avoided in solitary kidney cases, due to a longer warm ischemia time and higher blood loss when compared to the open approach. Open partial nephrectomy is the preferred approach for these types of patients at high risk for chronic kidney disease. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. A seminal vesicle cyst is a very rare diagnosis, with a reported prevalence as low as 0.005% The cysts are usually congenital, a coexistence with Zinner syndrome being described (renal agenesis, ectopic ureteral orifice in the prostatic urethra or seminal vesicle and vas deferens stenosis). The aim of this paper is to present the management of a rare case of an acquired seminal vesicle cyst with normal upper urinary tract anatomy. Materials and Methods. A 33-yrs old male patient presented with chronic pelvic pain associated with dysuria and frequency. The ultrasound identified a right regular hypoechoic mass without Doppler signal. The imagistic diagnosis was sustained by computed tomography, revealing a high-volume (84/65/74 mm) inseparable mass from the right seminal vesicle, without contrast enhancement. The surgical approach was minimally invasive, represented by laparoscopic excision of the right seminal vesicle cyst. The patient was placed in Trendelenburg position and 4 trocars were inserted (a 12 mm optic trocar inserted 1 cm above the umbilical fold, 2 other trocars, one of 5 mm and one of 10 mm bilaterally between the umbilicus and the anterior iliac crest, and one of 5 mm on the midline below the umbilicus). A transperitoneal technique was used in order to identify the vas deferens, which guided the dissection to the cystic mass. Further, the right seminal vesicle and the cystic mass were detached from adjacent pelvic structures. The contents of the cyst were evacuated and the cystic wall was resected, the specimen removed through the 10 mm trocar. Results. The operation time was 100 minutes, with minimal blood loss. The postoperative period was uneventful and the patient was discharged on the third postoperative day, with no complications during follow-up. The pathological analysis of the specimen emphasized hyalinized fibrous tissue, ducto-acinar and seminal epithelial structures, with no evidence of malignancy. Conclusions. The proper management of seminal vesicle cyst is represented by laparoscopic excision. Whenever possible, the minimal invasive approach should be used, due to better postoperative outcomes regarding morbidity and convalescence, in comparison with open techniques. [ABSTRACT FROM AUTHOR]

Introduction. Upper urinary tract urothelial carcinomas (UTUC) are quite rare and account for only 5-10% of all urothelial carcinomas. Approximately two-thirds of patients who present with UTUCs have invasive disease at diagnosis. Studies made in the past century reported renal tumors as the most common ethiology of massive retroperitoneal bleeding, accounting for roughly 60% of cases (benign and malignant tumors being almost equally represented). Vascular disease was the next most common, with polyarteritis nodosa being most frequent, followed by other vascular conditions including aneurysm, arteriovenous malformation, portal hypertension, Wegener's granulomatosis and infarction. More rare causes are represented by severe pyelonephritis, cyst rupture, nephrosclerosis, preeclampsia, adrenal tumors. In his article about massive bleeding in the renal fossa, Lenk observed a clinical triad of sudden strong pain in the renal fossa, signs of massive hemorrhage (pallor, tachycardia, hypotension) and developing retroperitoneal mass. However, present day technology allows for complex imaging investigations which help to establish the diagnosis and course of action long before the full clinical triad of Lenk appears. We present the case of a female patient whose only symptom was an acute onset of left lumbar pain and by means of advanced imaging was found to have a large retroperitoneal hematoma and a suspected (and later proven) spontaneous renal rupture, with the underlying cause being an upper tract urothelial carcinoma obstructing and bleeding into the upper calix shaft, with subsequent dilation of the upper calices and rupture of the parenchyma. [ABSTRACT FROM AUTHOR]

obstruction and therapeutic management is a challenge for urologists. Materials and Methods. We report the case of a 46-year-old male patient investigated for left lumbar colicative pain and diagnosed on IV contrast CT scan with partially obstructive extended thrombosis in the left renal vein, reflux of contrast from the middle calyx into the left renal vein detected and grade II ureterohydronephrosis secondary to a 4 mm obstructive left ureteral stone. At admission, the patient was in good general condition, being afebrile, with blood pressure of 160/80 mmHg, white blood cells count and markers of inflammation / sepsis within normal limits. A total left nephrectomy was performed. Laboratory tests revealed the presence of an antiphospholipid syndrome. Results. The postoperative evolution was favourable, the patient being discharged from hospital 7 days after nephrectomy. The histopathological report of the nephrectomy specimen showed the presence of a renomedullary interstitial tumor with a diameter of 4 mm, nonspecific chronic focal nephritis and non-obstructive thrombosis of the left renal vein. Conclusions. We consider that the treatment of choice for calico-venous fistula secondary to ureteral obstruction with the presence of thrombus in the renal and adrenal vein is total nephrectomy. [ABSTRACT FROM AUTHOR]

Congenital urinary obstruction is one of the most frequent conditions affecting the urinary tract in children. It may lead to significant long-term health consequences and the management of these pathologies represents a major challenge for urologists.[1] In cases where the patient presents with a complex pathology and an intricate medical and surgical history, retracing and understanding this history require a thorough anamnesis. Access to a state-of-theart Imaging department is vital in order to have the highest degree of accuracy in determining the diagnosis. The doctor-patient relationship plays a very important role and all available treatment options must be discussed. The cases should be resolved through as few surgeries as possible. When the full reconstruction of the urinary tract is not feasible, as a last resort remains total nephrectomy or partial nephrectomy - when possible. The urologist's approach should always also bear in mind the patient's quality of life and it is preferable to avoid long-term indwelling catheters. Postoperative follow-up after reconstructive surgeries must be done through high-performance imaging studies of the urinary tract. In this article we will present the case of a female patient with multiple congenital anomalies of the urinary tract and iatrogenic stenoses of the ureteropelvic junction and of the ipsilateral ureterovesical reimplantation site, following the reconstructive procedures she underwent during childhood. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Bladder cancer is one of the most common malignancies in Europe. Many risk factors for bladder cancer have been identify, with tobacco smoking and exposure to environmental and occupational carcinogens being the most important ones. The objective of this study was to identify the risk factors associated with the development of bladder cancer among patients that underwent radical cystectomy. Materials and Methods. The study included 391 patients that underwent radical cystectomy from January 2017 to December 2018 in our center. According to their smoking status, patients were grouped into non-smokers (patients that didn't smoke any cigarette in the last 10 years), smokers (patients that did smoke in the last 6 months) and ex-smokers (patients that have more than 6 months and less than 10 years since they have quit smoking). Other risk factors analyzed were hereditary factors, history of external beam radiation therapy and exposure to occupational carcinogens. Results. The median age of the patients was 69 years old with 308 men (78.77%) and 83 women (21.23%) included. 170 patients were classified as smokers (43.48%), while 131 patients were ex-smokers (33.50%) and 90 patients were non-smokers (23.02%). The prevalence of occupational carcinogens exposure was 10.74%. Hereditary risk factors associated with the development of bladder cancer were identified in 17 patients (4.35%). External beam radiation therapy was identified as a risk factor in 27 patients (6.90%). Current smokers were more frequently diagnosed with T3b and T4a, while N1 and N2 lymph node stages were more often diagnosed among smokers and ex-smokers. Conclusions. Bladder cancer is a common malignancy that has a big impact on health systems and will continue to be so, due to the high prevalence of its most important risk factor, tobacco smoking. In our study, smoking was the most important risk factor, with a prevalence of 77% among patients that were classified as current smokers and ex-smokers. Prevention of smoking needs to be highlighted and cessation programs must be developed in order to lower the incidence of bladder cancer. More measures for increasing safety at work must be taken in order to decrease the exposure to occupational carcinogens. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Bilateral renal tumors have a rare occurrence, accounting for 1% to 4% of patients with renal cell carcinoma (RCC). Partial nephrectomy (PN) is the first option for treating patients with RCC especially in elective settings. While open PN is still indicated in difficult centrally located or large renal tumors, the laparoscopic approach can be as effective in standard cases. Prostate cancer (PCa) is the second most common cancer in men, accounting for 15% of all the diagnosed cancers. Laparoscopic radical prostatectomy (LRP) is a viable alternative to open prostatectomy. The aim of this paper is to present our management of a patient with bilateral renal tumors and prostate cancer. Materials and Methods. We present the case of a 65 years old patient, who was referred to our clinic for elevated PSA levels. On ultrasonography and CT examination the patient was diagnosed with a 22 mm right and 21 mm left renal tumors. Prostate biopsy at a PSA of 5 ng/ml showed acinar adenocarcinoma, Gleason score 7 (4+3), stage cT2b, classified as localized intermediary risk. The treatment strategy was to perform staged bilateral 3D LPN and then 3D LRP. Firstly we approached right kidney, then one month later the left. After another month we performed LRP, using an extraperitoneal technique. Results. We performed LPN on both sides. The operative time was 130 minutes, respectively 140 minutes, and warm ischemia time was 22 minutes, respectively 24 minutes. No major complications and no urinary fistula were encountered in the postoperative setting. Blood loss was approximately 150 ml. All surgical specimens had a minimum 1 mm safety margin of healthy renal tissue. The patient was discharged on the 4th postoperative day. The histopathological examination revealed: RCC on the right side and oncocytoma on the left. For the LRP operative time was 3.5 hours. Blood loss was 250 ml, without intraoperative complications or incidents. The Foley catheter was removed on the day 11th postoperative day. No urinary fistula was encountered in the postoperative course. The patient was discharged on the 4th day after surgery. Conclusions. In selected cases 3D LPN represents a safe and efficient alternative to open surgery in the management of renal tumors and offers earlier recovery for the patients with less pain and shorter convalescence. LRP offers similar oncologic and functional results as ORP in localized selected cases. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The most common fusion anomaly of the kidney with an incidence of approximately 1 in every 500 births is represented by the horseshoe kidney (HSK). The most common complication of HSK is kidney lithiasis. Uretero-pelvic junction obstruction (UPJO) occurs in 1 in every 1500 births, and the three conditions can be associated. The purpose of this case report is to present the 3D laparoscopic pyeloplasty as treatment for uretero-pelvic junction obstruction in horseshoe kidney and multiple renal calculi. Materials and Methods. We present the case of a 33 years old male patient, with surgical history of percutaneous nephrolithotomy 7 years prior and two ESWL procedures 1 year before, admitted for recurrent right lumbar pain. The CT scan revealed HSK with dilated right pelvi-calyceal system suggesting right UPJO and multiple secondary renal calculi. We opted for a 3D laparoscopic transperitoneal pyeloplasty and calculi extraction. The surgery was performed in a standard flank position using three ports (a 12 mm for the camera and two working trocars of 10 mm and 5 mm). After a difficult dissection due to postoperative fibrosis and vascular anomalies, the renal pelvis was suspended with a suture wire from the abdominal wall to avoid the need of an additional trocar. Then the pelvis was incised and 11 stones were removed under direct vision. We proceeded to perform a standard dismembered Anderson-Hynes pyeloplasty. A 6 Fr ureteric double-J stent was inserted in an antegrade fashion over a guidewire. The pelvi-ureteric anastomosis was performed with continuous 4-0 Vicryl suture. Results. The operative time was 90 minutes. There were no intraoperative complications or incidents encountered. The patient was discharged on the 4th postoperative day. The JJ stent was removed after 21 days. Conclusions. Although it is a high-complexity surgery due to the aberrant vessels, renal isthmus, modified anatomy of the kidney and secondary lithiasis, the 3D laparoscopic pyeloplasty could be an effective and safe procedure for treating UPJO in horseshoe kidney and secondary multiple renal calculi, even in patients with previous renal surgeries. The 3D vision system reduces the operative time as it ensures better depth perception and faster and more precise surgical gestures. In the cases of recurrent renal lithiasis UPJO should be considered and immediately managed in order to achieve long term healing. [ABSTRACT FROM AUTHOR]

Introduction. The relationship between autosomal dominant polycystic kidney disease (ADPKD) and the development of Renal cell carcinoma (RCC) is not fully understood, but according to some recent studies, ADPKD is an independent risk factor for RCC. Renal transplantation is the treatment of choice for the patients with end stage renal disease (ESRD). There are no solid indications for RCC screening in these patients, but according to some recent studies, prevalence of RCC is high, especially when ESRD is associated. It is very important to know the oncological status before the transplant procedure in order to obtain the best outcome. Case report. We report the case of a 52 years old female, with ESRD and ADPKD, who was referred to our department by the nephrologist for incidentally diagnosed left kidney tumor being evaluated for admission on the kidney transplant wait list. Left radical nephrectomy was performed and the histopathological study revealed papillary RCC pT2a pN0. At the six month follow-up, CT scan revealed no local recurrence or distant metastases. The estimated time before kidney transplant in case of cancer remission is at least 2 years. Conclusions. For clinicians it is important to be aware of the higher incidence of RCC in patients with ADPKD, especially for patients receiving long term dialysis, in order to diagnose them in an early stage. For the patients with ADPKD undergoing evaluation for kidney transplant, screening should be considered, in order to choose the right time for transplant after cancer remission, bearing in mind that tumor recurrence or de novo kidney cancer is more frequent after kidney transplant; this could provide the best oncological outcome and graft function. Because there are no clear indications for kidney cancer screening of these patients, it is important to report every case of ADPKD harbouring RCC. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. In the era of increased need for kidney allografts, it is essential to identify predictors of graft dysfunction after kidney transplantation. Delayed graft function (DGF) is the most common form of acute kidney injury diagnosed in the first week following kidney transplantation that is frequently associated with a negative impact on short-term and long-term allograft function. This study aimed to determine the risk factors influencing DGF after deceased donor kidney transplantation in our center. Materials and Methods. In this prospective study we enrolled 116 recipients of kidney grafts transplanted from deceased donors between January and December 2014 in the Center of Uronephrology and Renal Transplantation, Fundeni Clinical Institute. Our kidney transplant center team consisted of experts in transplant surgery, nephrology and anesthesiology was involved in all steps of transplantation. The endpoint of our study was DGF which was defined as the need for dialysis within the first 7 days after kidney transplantation. Results. Incidence of DGF was 12.9%. Recipient cardiac heart failure (CHF) was the only independent risk factor for DGF. Moreover, by multivariate analysis, CHF significantly increased the risk of DGF by 7.4 times (OR=7.39; 95% CI 1.57- 34.63, p=0.01). Recipient weight and cold ischemia time > 12 h presented a statistical trend of association with DGF. Conclusions. In our study, recipient weight and recipient CHF were the most important risk factor associated with DGF, highlighting the importance of recipient characteristics for a successful kidney transplant. Moreover, prolonged CIT presented a trend association with DGF, underlining the importance of logistic period until reimplantation. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Tuberous sclerosis complex (TSC) is a rare autosomal dominant disease with multisystemic involvement. Renal angiomyolipomas (AMLs) affect up to 80% of TSC patients and AML hemorrhage risk increases with size. Everolimus (EVE) is a mTOR inhibitor and is the only approved drug for managing renal AMLs in the adult population. We studied a series of TSC patients who received EVE therapy to evaluate its renal efficiency and safety. Materials and Methods. 18 patients with TSC and renal AML were enrolled, and they received 10 mg Everolimus daily. AML measurements were performed yearly, by using either computed tomography (CT) or magnetic resonance imaging (MRI). The largest baseline diameter of the biggest renal tumor was compared with the subsequent measurements. Clinical examination was performed, and biological parameters were systematically evaluated. Results. Of the total of 17 patients who underwent efficiency assessment, 16 (94.1%) responded to EVE by renal tumor shrinkage. A significant AML reduction was observed after 12 months of treatment, from a mean of 74.5 mm to 57.3 mm (23% reduction). The primary endpoint (AML’s diameter shrinkage ≥ 25% from baseline) was attained by 8 (47%) patients. In the aspect of adverse events (AE), no treatment interruptions were necessary due to intolerance. The most frequent AE was dyslipidemia, affecting 14 patients (82.3%), followed by anemia in 10 patients (58.8%). Proteinuria was the most common renal AE, which was managed by temporarily lowering the EVE dose. There were no AML-related hemorrhage and no local interventions were necessary. Conclusions. In our experience, EVE is an efficient and well tolerated treatment for adult TSC patients and associated AML. The most important positive result observed was no new bleeding episodes, which improves both renal and general outcomes. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Cystatin C is a reliable, alternative marker to creatinine in estimating glomerular filtration rate in patients with chronic kidney disease (CKD), even in those with kidney transplant. Also, cystatin C tends to be superior to serum creatinine in evaluating early stages of CKD in kidney recipients, which is critical to early detection of acute rejection. The aim of our study was to evaluate the correlation of serum cystatin C measured after transplantation with demographical, biological parameters and organ preservation time. Materials and methods. We performed a prospective observational study on 44 consecutive kidney transplant recipients, followed for 3 months after transplantation. Graft kidney function was evaluated with both serum creatinine and cystatin C and was estimated with CKD-EPI and Cystatin C formula. Cystatin C was analyzed on a latex enhanced immunoturbidimetric assay. Results. We found that cystatin C levels measured first time post-transplant was correlated with recipient age (r=0.39, p=0.008), cold ischemia time (r=0.56, p< 0.001) and warm ischemia time (r=0.35, p= 0.01). Results evaluated at 3 months after transplantation showed that serum cystatin C was also correlated with recipient age (r=0.36, p=0.001) and cold ischemia time (r=0.32, p=0.003) and more than that, with pretransplant recipient weight (r=0.34, p=0.002), tryglicerides and haemoglobin levels (r=0.40, p= 0.008 and r= -0.36, p=0.01). Conclusions. We showed that serum cystatin C measured early after kidney transplantation is correlated with demographic, biological parameters and ischemia times, in kidney transplant recipients. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Hypospadias, one of the most prevalent birth malformation of the male genitalia, consists of the insertion of the urethral meatus on the ventral side of the penis instead of the tip of the glans common associated with other penile defects and ventral chordee. It can vary in location from the glandular region (distal hypospadias) towards the perineum (proximal hypospadias). The later, although far less common, it is a lot more difficult to treat as it requires the reconstruction of the whole circumference and the full length of the urethra. The aim of this paper is to present the surgical management of a difficult case of perineal hypospadias cripple. Materials and Methods. A 21 years old patient presented in our clinic with a perineal hypospadias, inadequately treated during his infancy and early childhood at a pediatric department, when the perineal segment of the urethra was created using a scrotal skin graft, while the penile segment was reconstructed from a prepuce and penile skin flap and left "a plat". The physical examination revealed a perineal urethral meatus, with urethral calculi formed on hair grown inside the perienal segment. No ventral chordee was observed in this case. We decided on a two stage repair technique, spaced over a six months period. During the first stage the defective perineal urethra was completely removed, and two long buccal mucosa segments were harvested from both inner cheeks and grafted to the corpora cavernosa to replace the old scrotal skin graft. After the wait period of six months the matured buccal mucosa graft was tubularized in continuity with the prepuce flap and the neourethra was created. A 16 Fr Foley catheter was left in place for about three weeks. Results. No immediate or late complications were observed after any of the two stages of the intervention. The patient was discharged 5 days after the grafting and 6 days after the tubularization. The Foley catheter was removed after 21 days and normal micturitions using the neomeatus were possible, voiding at 18 ml/sec. Conclusions. Although hypospadias remains one of the most challenging problems of the urologist, even the more severe perineal cases can be successfully treated. A two stage repair is a versatile technique as it allows the use of buccal mucosa grafts in combination with prepuce and penile skin flaps to reconstruct of the whole circumference and full length of the urethra. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Despite refinements in the initial evaluation and management of patients with newly diagnosed localized high-risk prostate cancer, urologist have difficulties to counsel their patients based upon currently used pretreatment parameters. In this study, we investigate preoperative characteristics that can predict unfavorable pathological outcome in patients undergoing radical prostatectomy for clinically localized high-risk prostate cancer. Materials and Methods. We analyzed a database of 279 patients diagnosed with prostate cancer and treated with radical prostatectomy in our institute between 2014 and 2017 and identified 83 patients with high-risk characteristics because of PSA > 20 ng/ml or biopsy Gleason score ³ 8. The following postsurgical parameters were considered unfavorable pathological outcome: seminal vesicle invasion, surgical margins, perineural invasion and lymph node invasion. To identify the determinants associated with unfavorable pathologic outcomes, we performed univariate and multivariate logistic regression in two models. Results. 77.1% of patients (n=64) had unfavorable pathological outcome. In multivariate analysis, we pointed out that PSA > 20 ng/ml was an independent determinant associated with lymph node invasion ( OR: 3.7, 95 % CI: 1.02- 14.36, p=0.04), biopsy Gleason score ≥ 8 was independently associated with increased risk of perineural invasion ( OR: 6.04, 95% CI: 1.09-33.31, p=0.03) and PSA > 20 ng/ml and biopsy Gleason score ≥ 8 were independent high risk factors for seminal vesicle invasion (OR: 11.10, 95% CI: 1.30-98.44, p=0.02; OR: 11.45, 95% CI: 1.28-102, p=0.02, respectively). Moreover, in the second model, we showed that Gleason score pattern 5 increased the risk of lymph node invasion by 3.21 (OR: 3.21, 95% CI: 1.03-9.99, p=0.04). Conclusions. Newly diagnosed patients with PSA > 20 ng/ml or biopsy Gleason score≥ 8 are at increased risk of more extensive disease. Our data is important for urologist in the selection of patients with high risk characteristics proposed for radical prostatectomy and for patients to better understand their disease. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Cystatin C could be used as a reliable alternative marker to creatinine in estimating glomerular filtration rate (GFR), even in kidney transplant recipients. The aim of our study was to evaluate the clinical and biological determinants of glomerular filtration rate estimated with cystatin C (CysC) in kidney transplant recipients, at 3 months after kidney transplantation. Materials and Methods. We performed a prospective observational study on 44 consecutive kidney transplant patients, followed for 3 months after kidney transplantation. Cystatin C was measured by latex enhanced immunoturbidimetric assay (EuroLyser). Results. Thirty patients (68.2%) out of 44 had an estimated GFRCysC less than 60 ml/min/1.73m2. Patients with estimated GFRCysC < 60 ml/min/1.73m2 tended to be older (33.4 ± 11 vs 40.6 ± 12 years, p = 0.06), were more frequently males (35.7% vs 80%, p = 0.004) and presented significantly decreased levels of pretransplant total cholesterol (208± 32.7mg/dl vs 175.8 ± 54.6 mg/dl, p= 0.04). By multivariate binary logistic regression, recipient male gender (OR: 5.59; 95% CI: 1.06-29.53; p= 0.04) and pretransplant total cholesterol levels (OR: 0.97; 95% CI: 0.95-0.99; p= 0.02) were independently associated with estimated GFRCysC < 60 ml/min/1.73m2 at 3 months after transplantation and recipient age had a near-significant trend (OR: 1.08; 95% CI: 0.98-1.18; p= 0.07). Conclusions. In conclusion, we found that recipient male gender and pretransplant total cholesterol levels were independent determinants of glomerular filtration rate estimated with cystatin C in kidney transplant recipients, at 3 months after kidney transplantation [ABSTRACT FROM AUTHOR]

Introduction and Objectives. In 1983, prostate cancer patients were treated for the first time by Holm et al with permanent placement of 125I seeds inserted transperineally directly into the prostate. The objective of this study was to assess the efficacy of brachytherapy with permanent 125I seed implantation for the treatment of localized prostate cancer -- long-term results. Materials and Methods. Between October 2006 and December 2011, a total of 177 patients with prostate cancer were treated with permanent 125I implantation brachytherapy. This technique was applied as monotherapy for 168 patients, who had favorable prognosis according with ABS recommendations (stage T1c-T2a, Gleason < 7, PSA < 10 ng/ml). Results. Procedure time of 1.5 hours to 3 hours. Indwelling urinary catheter was withdrawn in the second day. Hospitalization period was no longer than 24 hours. PSA values at 6 weeks post-implant decreased with 40% in all patients. At 6 weeks and then at 3 months showed urinary morbidity grade I and II in 30% patients without any rectal toxicity. At the 36-months follow-up, 5 patients reported late rectal toxicity. In 85% of cases the erectile function was acceptable. Conclusions. Prostate brachytherapy using permanent I-125 seed implantation is a viable alternative to radical prostatectomy or external beam radiation therapy for the treatment of localized prostate cancer. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. estimating the quality of life in relation to the health status is a helpful tool in assessing the results and determining the efficacy of any form of treatment. The main purpose of this study is to rate the patients' quality of life after renal transplantation. The objectives of this paper are: to describe the demographic characteristics of the included patients, to compare their auto perceived quality of life before and after kidney transplant surgery, and to find and analyze correlations between the demographic characteristics and the quality of life after renal transplantation. Materials and Methods. This observational descriptive study was performed in a longitudinal and prospective manner. 106 patients that had been treated for chronic kidney disease through renal transplantation were included, and they were assessed before surgery, and 1, 3, 6 and 12 months after surgery. In order to evaluate them we used the Quality of Life Index - Kidney Transplant. Results. Most of the patients are males. The quality of life scores for the four individual sub-domains follow the overall score model, slightly dropping one month after transplantation compared to the pre surgery level, then constantly rising going through all the other three assessment moments (3, 6 and 12 months after surgery). Conclusions. This study analyzes the impact of renal transplantation on the quality of life of the chronic kidney disease patients. Our results clearly show a positive trend on the auto perceived quality of life. [ABSTRACT FROM AUTHOR]

Introduction Idiopathic retroperitoneal fibrosis (IRF) is a rare benign pathology, consisting of fibrous inflammatory tissue formation in the retroperitoneal space, surrounding main vessels and often involving nearby anatomic structures, such as the ureters, leading to obstruction and renal function impairment. Diagnosis is challenging, based upon high clinical suspicion, correct differential diagnosis and imagistic evaluation. Biopsy is required to confirm the non-malignant nature of the retroperitoneal mass. Medical immunosuppressive treatment is reasonable for moderate disease, whereas surgical treatment is indicated in advanced stage. Follow-up is mandatory but there is no consensus upon a surveillance schedule. Material and Methods We present a case of a male patient treated for a left retroperitoneal tumour destructive for the left renal unit, which was partially removed alongside the kidney, and turned up to be IRF and consequently immunosuppressive therapy was administered with 5 years normal follow-up. 8 years after the first event, IRF recurred on the right side of the retroperitoneum, obstructing the solitary kidney. Ureterolysis with omental wrapping was performed with optimal results and immunosuppressive therapy was reinitiated, with good response and normal check-ups to present day. Results and Conclusions IRF can prove to be a real challenge, as knowledge on its origin, optimal diagnostic, treatment and follow-up protocols is still building up. It is a potentially curable disease if managed correctly. Bilateral ureterolysis in unilateral disease could be taken into consideration from the start as late recurrence can occur. Follow-up should be conducted for a long period of time, maybe for the rest of the patient's life. [ABSTRACT FROM AUTHOR]

Introduction. Renal transplantation represents the best treatment choice for patients with chronic kidney disease, as it provides a better quality of life in comparison with chronic dialysis. Materials and Methods. This longitudinal prospective study comprises of a number of 106 patients with chronic kidney disease, assessed before and after the renal transplant surgery. The main tool used to accomplish this task was the SF-36 Quality of Life Questionnaire, that rated the autoperceived physical and mental health. Results. Renal transplanted patients have significantly higher scores at the six months postoperative follow-up concerning Physical Functioning (PF) (p=0.003), General Health (GH) (p<0.001), Vitality (VT) (p<0.001), Social Functioning (SF) (p=0.005) and Mental Health (MH) (p=0.014) as opposed to before surgery. Other aspects of the autoperceived health have only improved somewhat, like Bodily Pain (BP) (p=0.102), Physical Role (RP) (p=0.102) and Emotional Role (RE) (p=0.666). The average physical health score at the six months postoperative follow-up is significantly higher as opposed to the average physical health score before transplantation (p<0.001). Also, the average mental health score at the six months postoperative follow-up is significantly higher as opposed to the average mental health score before transplantation (p<0.001), and it has a negative correlation with the age of the patients (p=0.032), meaning that this score improves greater for younger patients, and less for the older ones. Conclusions. After the renal transplant surgery we observed a significant increase of the autoperceived health status, both for physical and mental functions. Mental health is more important and better perceived in cases of younger patients. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to review current imaging techniques used for diagnostic, disease monitoring and follow-up of idiopathic retroperitoneal fibrosis (IRF), as to provide the reader with up to date information that can be useful in clinical practice. We conducted a PubMed search for original articles, literature reviews and series reports published in English in the past 16 years regarding IRF, mainly focusing on imagistic study of the disease and selected 52 articles which we found most relevant. Today, CT and MRI seem to be the wise choice and the right combination of imaging techniques, with reasonable accessibility of the method and widespread use in clinical practice, but we reviewed all imagistic methods that might be of use, in order to provide the reader with an overview of current information regarding this topic. [ABSTRACT FROM AUTHOR]

Introduction. Delayed graft function (DGF) is one of the most commonadverse event affecting kidney allografts immediately after transplant surgerywith detrimental effect upon short and long graft survivaland several risk factors were associated with its presence. However, data concerning the impact of warm ischemia time on DGF are contradictory. The aim of this study was to analyse the influence of warm ischemia time for DGF and to determine whether simultaneously prolonged cold ischemia time and warm ischemia time were associated with DGFin recipients of kidneys from deceased donors at our center. Materials and Methods. This prospective observational study included a series of 143 consecutive deceased donor renal transplants performed in our center beetwen 1st of January 2014 and 30th of September 2015. The study endpoint was DGF, defined as the requirement of dialysis in the first week after transplantation. Results. DGF occured in 21 kidney recipients from deceased donors (14.7%). Univariate analysis showed that recipient dialysis time before transplantation and recipient comorbidities were associated with DGF, whereas recipient age at transplantation, donor age and donor serum creatinine were not. As for the post renal transplant factors, prolonged cold ischemia time and the intensive care support time prior to aortic cross-clamping were associated with an increased risk of DGF, while prolonged warm ischemia time was not. The simultaneously prolonged cold ischemia time and warm ischemia time were associated with DGF (p <0.001), suggesting some cumulative effects on postoperative renal graft function. Conclusions. In our study, warm ischemia time was not associated with increased risk of DGF. However, simultaneously prolonged cold ischemia time and warm ischemia time were associated with DGF. Despite improvements in kidney transplantation, DGF remains an important medical problem and more risk factors should be investigated to help clinicians to decrease its incidenceand minimize clinical outcomes. [ABSTRACT FROM AUTHOR]

Knowledge of lymph node metastases in patients with urologic tumors is important for clinical management and may help the urologic surgeon in choosing the best treatment for these patients. Accurate nodal staging helps to predict prognosis. Conventional magnetic resonance imaging (MRI) often fails to differentiate between benign and malignant changes in lymph nodes because this technique is reliant on nonspecific features such as size and morphologic criteria. Therefore, there is a need for more accurate non-invasive diagnostic technique to improve nodal assessment. Diffusion-weightedmagnetic resonance imaging (DW-MRI) is a non-invasive functional imaging technique that provides unique information related to tumor cellularity and the integrity of the cellular membrane. DW imaging has the potential to differentiate malignant from benign lymph nodes based on the mean ADC value. Metastatic nodes show, as most primary malignant tumors, lower ADC values due to their impeded diffusion caused by high cellularity. Improved diagnostic of lymph node metastases might guide the surgeon to remove positive nodes only. Although initial results are promising, larger-scale studies will be needed to improve detection and localization of lymph node metastases. Standardizing the technical parameters and improving the image analysis represent major challenges to the widespread adoption of DW imaging. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Papillary renal cell carcinoma is the second most common histological subtype of renal cell carcinoma, after the clear cell carcinoma. Materials and Methods. This is a case of a 48-year-old male with history of transperitoneal radical nephrectomy for a left renal mass, with a histopathological diagnosis of pT3a pN1 type 2 papillary renal cell carcinoma, Fuhrman grade 3, who developed large adenopathies three years after the excision of the primary tumor. Results. The histopathological analysis of the excised intraabdominal adenopathies confirmed the suspicion of lymph node metastasis from type 2 papillary renal cell carcinoma, Fuhrman grade 3. Nine months postoperatively the intraabdominal masses reappeared, at which point Sunitinib therapy was initiated, with favorable response: the significant reduction in size of the adenopathies after six months of treatment. Conclusions. The presence of positive lymph nodes on the surgical specimen should warrant the initiation of adjuvant chemotherapy with curative objective, as the sole removal of the affected lymph node is most likely not enough to cure the disease. [ABSTRACT FROM AUTHOR]

There are approximately 30 case reports in the literature of synchronous bilateral upper tract urothelial carcinoma (UTUC) without bladder involvement[1-11]. Surgical treatment, eitheropen, laparoscopic or robotic approach, remains the standard therapy, but choosing the appropriate technique is crucial in this situation. Some patients with low-risk disease may benefit from a more conservative approach (e.g., endoscopic ablation, segmental resection), in order to preserve the renal function. No specific guidelines for management have so far been formulated, given the rarity of disease. We present the case of a patient with synchronous bilateral UTUC, involving renal pelvis, in which we decided radical nephrectomy on one side and a conservative intervention on the contralateral side, with very good clinical and functional results. The challenges in diagnosis and surgical management of such a case are highlighted and various available treatment options are presented. [ABSTRACT FROM AUTHOR]

Introduction and objectives. Fast-track protocols (FTP) have been used in colorectal surgery for more that two decades, resulting in better rehabilitation after surgery, shorter hospital stay, less morbidity and mortality, lower overall costs. Recent studies emphasize the importance and benefits of applying FTP also in urologic surgery. This study represents the initial experience and results of implementing FTP in radical cystectomy (RC) patients in our center. Materials and methods. The study comprises 20 randomized patients divided into two groups: group A which includes 10 patients with RC and ileal urinary diversion (IUD) benefiting of classical perioperative approach and group B which also includes 10 patients with RC and IUD in whom we used the FTP. The FTP used is adapted from the guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS) Society recommendations and consist of pre-, intra- and postoperative measures. The parameters analyzed during this study were major complications (Clavien grade ≥III) and minor complications (Clavien 1 or 2), type of urinary diversions, age, gender, ASA Score, pathologic stage, operative time, time to first flatus, time to first stool, time to normal diet, intolerance to oral feeding, postoperative ileus, length of hospital stay, smoker/non-smoker, and also in the FTP group we recorded the implementation of each FTP element per patient in order to test the feasibility of applying all items of the protocol. Results. We noticed a decrease in median time to first stool in the FTG of 2.5 days compared with the CSG and a lower median time to first stool - 6 days in the FTG compared with 7 days in the CSG. Moreover, the median time to a normal diet was lower for the FTP patients, resuming to a normal diet after 4.5 days compared to CSG patients who began oral feeding in 6 days. Intolerance to oral feeding was encountered in 2 patients in the FTG and in 4 patients in the CSG. In our opinion, the NGT plays a key-point issue. When analyzing complications we encountered complications in 4 patients from the FTG and in 6 patients from the CSG. Seven minor complications were found in the FTG and 17 in the CSG respectively and we encountered two cases of major complications in the CSG - bowel evisceration, while there was none in the FTG. Conclusions. As a conclusion to our study, we can state that from these initial data, FTP applied in RC patients have promising results with a good overall implementation of protocol items, nearly 84%. [ABSTRACT FROM AUTHOR]

Introduction and objectives. The aim of this paper is to systematize and illustrate distinct imaging patterns and lesions distribution seen in renal lymphomas and to discuss the differential diagnosis with other renal tumors. Materials and methods. We realized a retrospective study over a period of 12 years from the cases investigated by CT or MRI in our hospital and diagnosed with a lymphoproliferative disease. Of the 3290 patients found, a total of 48 showed renal lymphoma. There was pathological confirmation for all patients, either node biopsy or after nephrectomy. All patients had at least two CT / MRI examinations. Indications for CT examination were: disease staging, follow-up at 6 or 12 months, clinical suspicion of recurrence and evaluation of renal or other organs lesions. Follow-up interval varied from four months to four years. MRI examination was performed only in two patients with iodinated contrast material allergy. Results. The most common imaging appearance of renal lymphomas is that of homogeneous, isodense (non-enhanced CT) and hypoattenuated (contrast-enhanced CT) masses compared with normal parenchyma. We found a wide variety of manifestation: multiple bilateral (52%) or unilateral masses (13%), a solitary nodular lesion (8%) or infiltrative lesions (13%), contiguous retroperitoneal extension (6%) or masses in the perirenal space (8%). Conclusions. Contrast enhanced CT is useful in: detection and characterization of renal involvements in patients with lymphoma, disease staging, follow-up and response after therapy and differential diagnosis with other renal masses. Histological confirmation of disease and the presence of bilateral renal nodular lesions associated with other extra-nodal involvements can establish the diagnosis of renal lymphoma. Otherwise renal biopsy is necessary. [ABSTRACT FROM AUTHOR]

Introduction and objectives. Kidney transplantation improves survival and quality of life for the recipients and although not a direct concern of the patient it is the most cost-effective treatment for end-stage renal disease compared to chronic dialysis. Lymphocele is one of the most common complications in kidney transplant recipients and may affect as many as 26% of them. Materials and methods. We evaluated retrospectively the occurrence of lymphocele in a series of 1542 consecutive kidney transplants performed in our center between 1st of July 1997 and 31st of December 2014. Lymphocele were diagnosed by ultrasonography and computed tomography. Results. The incidence of lymphoceles after kidney transplantation in our center was 1.23% (19 cases). The indication for treatment ware local symptoms, graft dysfunction or both. In eight cases percutaneous drainage guided by ultrasonography and sclerotherapy with povidone-iodine was an efficient therapy. In 11 cases open surgery was the therapy of choice and consisted in large fenestration into the peritoneal cavity in six cases or associated with ureterocystoneostomy in five cases. Conclusions. Lymphoceles after kidney transplantation can be treated by ultrasound-guided drainage associated with sclerotherapy with the inconvenience of a longer hospital stay and a recurrence rate up to 40%, or by open or laparoscopic surgical intervention with large fenestration into the peritoneal cavity, associated or not with ureterocystoneostomy. Taking into account that we did not notice any recurrence or complication after open surgery, we consider that open fenestration into the peritoneal cavity is the method of choice for the treatment of lymphoceles after renal transplantation. [ABSTRACT FROM AUTHOR]

Introduction. Papillary renal carcinoma is a heterogenous disease and the second most common histological type of renal malignant tumor after clear cell carcinoma. Of the three types, type 2 papillary renal carcinoma has the worst impact on patient heath status. Materials and method. We present the case of a 63-year-old man, former kidney donor with type two papillary renal carcinoma with rapid growth and fast disease progression to metastatic stage. Although upon been investigated for kidney donation and being declared disease free and fit for the kidney transplantation, this patient developed 12 years later a fast growing renal neoplasia. Conclusions. Because type 2 papillary carcinoma has a worse prognosis than other renal malignancies, with rapid progression from local to metastatic stage, the treatment of these cases should not be postponed and patient should be rapidly assessed by urologist and if necessary by oncologist. Kidney transplantation remains the best solution for people with end-stage renal failure but we must also keep in mind that the donor which is left with solitary kidney must be reevaluated periodically because it has a higher risk that general population of further renal pathology on the urogenital apparatus. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper is to present in a simple concise and clear manner the computer tomography (CT) perfusion technique using a 64-multi-slice CT (MSCT) and to discuss the main clinical applications. Materials and Methods: The CT protocol included: unenhanced CT scan to locate the prostate, intravenous administration of non-ionic iodinated contrast medium using a power injector (volume-100 ml, rate 5ml/s), scanning in CINE mode (cranio-caudal coverage - 40 mm, continuous exposure for 40 seconds) with a 10 seconds delay after beginning of injection, followed by ten additional 1-second scans in axial mode, with a 15-second interval to quantify the amount of contrast medium that filtered into the interstitial compartment. Perfusion CT examination was followed by a standard thoraco-abdomino-pelvic examination; a report was issued according to our daily clinical practice. The patients received doses (DLP - Dose Length Product) ranged between 1000 and 1500 mGy·cm, depending on their age and weight. Analysis of source images was performed on a workstation using a dedicated software. Results: Colored functional maps and quantitative measurements were obtained for the following parameters: Permeability Surface-area product (PS), Blood Volume (BV), Mean Transit Time (MTT), Blood Flow (BF), Contrast Arrival Delay (IRF T0), Time to Peak (TTP), Transit Time to Impulse Residue Function Peak (Tmax). Placing ROI's in femoral artery, normal and abnormal prostate tissue, we obtained graphs with contrast-enhancement curves and tables with specific CT perfusion parameters. Conclusions: Perfusion CT represent an imaging diagnostic tool that may be used in prostate cancer, allowing an easy and quick assessment of the functional changes, providing informations about in vivo tumor vascularity and guidance for histopathological correlation if biopsy is scheduled. Moreover, this technique may be performed in cases where MRI is contraindicated. [ABSTRACT FROM AUTHOR]

Introduction. Prostate cancer may express great variety in clinical behavior, from an indolent evolution to lethal disease. According to preoperative d'Amico criteria it is appreciated that patients with localized prostate cancer, PSA > 20 ng/ml, Gleason score of 8 to 10 are classified at high risk for recurrence of symptomatic or asymptomatic metastatic disease. The Scandinavian Prostate Cancer Group 4 (SPCG-4) and Prostate Intervention Versus Observation Trial (PIVOT) trials generated new coordinates in the means of the right moment and treatment option in prostate cancer. Objective. The aim of this study was to determine the number of patients restaged in the means of risk stratification after pathologic results from the radical prostatectomy specimen. Materials and methods. 218 patients with prostate cancer were enrolled in a prospective study between June 2011 and January 2014, after obtaining the informed consent. All cases underwent open retropubic radical prostatectomy in our Center. Results. Of the 29 pts staged preoperatively as cT1c, 21 were staged as pT2 postoperatively, the rest being staged as pT3. From the preoperative group staged cT2, after surgery and pathology, one case is staged pT1, 40 pts pT3, one case pT4 and only 48 pts staged pT2, the same as before surgery. For cT3 stage, 61 pts were actually pT3, representing 55,5% of the cT3 group, and 28% of the total number of pts in the study, as 36 pts were reassigned to other risk groups. Of the two cT4 cases, one was actually pT4 and one pT3. Of the preoperative 2-6 Gleason group, 34,6% were reassigned to the intermediate risk group, and 4,8% were restaged as high risk. Of the initial intermediate risk group, 43 were actually intermediate risk, 17 pts were reassigned to low risk Gleason 2-6 group, and the remaining 11 were Gleason 8 and 9. Preoperatively high risk pts were restaged as follows: 17,3% reassigned to low risk group, 21,7% intermediate risk,the remaining 61 % maintaining in the high risk group. Conclusions. For cT1c, 27,6% of the cases areoverstaged after pathology report, as for cT2 the proportion being even higher, of 45,5%, which explains the high risk of progression without surgical treatment for this stage. According to statistical data, cT3 stage isthen placed in an inferior risk group in 34% of cases. Regarding the number of initially overstaged patients (based upon cT), 16% of the study group are overstaged preoperatively, of which 33 pts fall in the cT3 stage, this being probably the result of insufficient information from the preoperative panel consisting of transrectal ultrasound, serum PSA, digital rectal examination and Gleason score from the biopsy specimens. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. This study aims to present performance and limitations of computed tomography (CT) in detecting and characterizing the lymph node involvement in patients with renal cell carcinoma (RCC), in an attempt to support the urologic team in choosing the best surgical approach. Material and Methods. This is retrospective study conducted on a total of 94 patients (63 men and 31 women, age range 33-79 years, mean age 55.7) that underwent radical nephrectomy associated with extensive lymph node dissection in Center for Uronefrology and Renal Transplantation, Fundeni Clinical Institute, from January 1st 2014 to December 31st 2014 for renal cell carcinoma confirmed on histopathology, that performed preoperative contrast-enhanced CT. CT results were compared with surgical and pathological findings. Results. Considering the 10 mm size as the normal limit value of the nodal short-axis diameter, we found a suboptimal value of CT specificity (CT specificity = 65.07%) in diagnosing lymph node metastases in patients with renal cell carcinoma Instead, we found a good value of CT sensitivity (CT sensitivity = 80.6%) in the detection of regional lymphatic metastasis of renal cell carcinoma. Conclusions. CT has a limited value in characterizing the nature of lymph node hyperplasia (tumor versus inflammatory) in patients with renal cell carcinoma, especially in the presence of tumor necrosis, most likely due to the pronounced immune reaction caused by the primary cancer and the presence of necrosis. [ABSTRACT FROM AUTHOR]

Introduction. Despite advances in molecular medicine, prostate cancer remains the most important medical problem facing the male population and the second most common cause of cancer-related mortality for men in many countries. Moreover, prostatecancer exhibits tremendous variability in clinical behavior, ranging from indolent to aggressive tumors and patients with PSA ≥ 20ng/ml or Gleason score ≥8 or clinical tumor stage stage≥2c who have undergone a curative treatment such as radical prostatectomy may have to face the high risk of recurrence or metastatic progression. Therefore, it is very important to identify patients with one or more adverse clinicopathologic features reflecting unfavorable prognostic outcomes. A number of variables were extensively studied and could be potentially used to identify agressive tumor behaviour and improve the accuracy of outcome prediction for patients with localized prostate cancer. Furthermore,researchers created predictive toolsthat incorporate several pre- and post-operative clinicopathological parametersto optimeze their prognostic value and improve clinical decision making. Objective. To give a brief overview of data focusing on the predictive toolsfor men with high risk PCa treated by radical prostatectomy for more accurate risk stratification and immediate impact on difficult clinical-making decision. Conclusions. While the performance of currently predictive models is encouraging, further improvement by inclusion of new prognostic biomarkers in the development of maybe more sophisticated predictive models as well as external validation of their clinical utility in larger data set is imperative. [ABSTRACT FROM AUTHOR]

Enhanced recovery after surgery (ERAS) represents a concept first introduced over two decades ago. This concept comprises of a multitude of pre, intra and post operatory measures that have a primordial goal in reducing stress induced by surgery, and starting early mobilization and nutrition for the patient. ERAS protocols were first implemented in colorectal surgery where now studies show level 1 evidence in lowering complication rates and shortening hospital stay. Comparing radical cystectomy with colorectal surgery, several differences that harden the usefulness of ERAS in urologic surgery appear. As in colorectal surgery the ERAS society recommendations for cystectomy patients divide the possible applicable pathways in pre, intra and post operatory items. Even though some elements appear at first glance practically impossible to put into practice for cystectomy patients, as resection site drainage and urinary drainage due to certain morbidity escalation, most of the program's pathways look encouraging and logical due to confirmation studies in colorectal surgery. ERAS protocols represent a new approach in modern urologic surgery. They are based on hard scientific evidence proved in large prospective clinical trials of colorectal surgery and also urologic surgery. Centers and physicians are encouraged to implement this pathway for the better management of patients resulting in a faster recovery, shorter hospital stay, lower costs and improved quality of life, while maintaining an optimal oncologic control. [ABSTRACT FROM AUTHOR]

Introduction: Kidney transplantation is considered the "gold-standard" replacement therapy for patients with end stage renal disease because it offers a better quality of life and longer survival compared to dialysis. The rate of chronic graft loss is still considerable despite significant improvements in short and long term graft survival and patients may be suitable candidates for retransplantation. However, retransplantation is a high-risk procedure because of limited surgical options performed on highly sensitized patients, and higher rate of graft failure. The aim of this study was to evaluate urological complications of renal retransplantation in our center. Materials and Methods: We evaluated retrospectively the outcomes of kidney retransplantation performed in our center between 1st of July 1997 and 31st of December 2014. A total of 1542 consecutive kidney transplantation were performed and 78 patients were candidates for a second transplant. Renal grafts were obtained in 34 cases (43.5%) from cadaveric and in 44 cases (56.5%) from living-related donors. Among these 78 cases of retransplantation, the most common identified causes of end-stage renal disease were chronic glomerulonephritis (30.7%), diabetic nephropathy (16.7%) and systemic lupus erythematosus (6.4%). In 20.5% of retransplanted cases (N=16) recipients were at high immunologic risk compared with 3.89% (N=60) from the first kidney transplantation group (p < .05). Receptor average age was 37.2±9.8 y. o. with a male to female ratio 1.51/1. Donors mean age 48.2±16.4 y. o. with a ratio 1.17/1. Results: The overall incidence of urological complications in kidney retransplanted patients was 6.4% (five cases). Ureteral leakage was the most common complication recorded in three cases (3.8%), all in the first month postoperatively. Other urological complications identified in the retransplanted group were ureteral stenosis (one case - 1.3%) and lymphocele (one case - 1.3%). Conservative treatment (prolonged vesical catheterization) was successful in one case with a small anastomotic fistula. In the other cases of ureteral leakage and stenosis open surgery was needed, consisted in resection of the affected segment and stented ureterocystoneostomy. Lymphocele was successfully treated by US guided percutaneous drainage. Conclusions: Urological complication rate for kidney retransplantation was acceptable and comparable with the first transplant group (p>.05). Although the number of patients retransplanted in our center was low, results from this study encourage us to consider retransplantation as the best choice for patients after previous graft failure. [ABSTRACT FROM AUTHOR]

Intorduction and Objectives. There are multiple protocols for the follow-up time of renal cell carcinoma (RCC) after surgical resection. However, there is no consensus on witch period of time is best for surveillance. Materials and Methods. This is the case of a 32-year-old male who underwent left radical nephrectomy for a pT3a RCC. The patient did not receive any adjuvant treatment and had follow-up computed tomography (CT) scans at 6, 15, 31, 45, 57 and 60 months postoperatively. Results. The computed tomography scan showed at 57 months postoperatively a newly appeared right renal mass. The 3 months follow-up CT scan showed an increase in size of the mass, so the decision was made to perform enucleation of the right renal tumour. The histopathological diagnosis was pT1a clear cell RCC with negative resection margins. The 10 months follow-up CT scan showed no signs of local recurrence. Conclusions. No consensus currently exists on surveillance guidelines after radical or partial nephrectomy for renal cell carcinoma. The follow-up strategies are ment to detect as early as possible local recurrence or metastatic disease and to allow appropriate treatment. The emphasis on follow-up should be during the first 3-5 years after nephrectomy. There are no guidelines based on age, but younger patients might require a longer period of follow-up. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Prostate-specific antigen levels after brachytherapy may fluctuate and increase temporarily without a clear reason in some of the successfully treated men. The phenomenon is called "PSA bounce" and it was first described in 1997 by Wallner et al. The purpose of the study is to evaluate PSA levels at the 60 month follow-up after prostate brachytherapy - permanent prostate implant with 125I, for patients with and without PSA bounce phenomenon. Materials and Methods. Between October 2006 and December 2011, a total of 168 patients with prostate cancer were treated with permanent 125I implantation brachytherapy, in stage T1c-T2a. PSA bounce is defined as a temporary increase in PSA value followed by a consecutive decrease recorded with the same value before the increase or a lower value. Results. The average magnitude of the bounce was 0.8 ng/ml with values between 0.1 and 4.1 ng/ml. Mean time to bounce was 17 months. At the 60-month follow-up, 83% of patients had PSA values lower than 1 ng/mL and 17% higher than 1 ng/mL. Conclusions. A bounce definition of a rise ≥ 0.2 ng/mL is a reliable definition, to use as a threshold. PSA bounce is a common phenomenon after prostate brachytherapy and should be always considered whenever we have a patient with rising PSA after implant. [ABSTRACT FROM AUTHOR]

Introduction and objectives: The true incidence of premalignant lesions or low stage / grade penile tumors is often underestimated, these problems being treated by dermatologists. When topic treatments fail, the cases are referred to the urologist. Surgery with its mutilating consequences can be considered an overtreatment, therefore conservative techniques like glans resurfacing must be taken into account. The aim of this paper is to present the case of a 67 year old male with squamous cell carcinoma who underwent glans resurfacing. Materials and Methods: We present the case of a 67-year-old male with superficial penile lesions and no notable co-morbidities who was diagnosed after a glans biopsy with Queyerat eritroplasia. After diagnosis, the patient underwent topical treatment with 5-fluorouracil (5-FU). Due to bleeding occurring from the lesion after sexual contact, the patient repeated the biopsy 6 months later. The result was "in situ" squamous cell carcinoma. After a full body CT scan (recommended by the dermatologist), that turned out uneventful, the patient was referred to out department. We decided to perform glans skin excision with resurfacing. After we placed the urinary catheter, the glans skin was excised and multiple biopsies were taken from the spongiosal tissue. The circumference and length of the remained defect was measured. Then we harvested a full thickness skin graft from the abdominal left flank wall using a geometric pattern. The donor site defect was closed and the harvested skin was quilted over the spongiosum using 4/0 Vicryl sutures. We used a tie over dressing at the end of the surgery. Results: The pathological report was: "in situ" squamous cell carcinoma. The biopsies from the remaining spongiosal tissue turned out negative for cancer. The urinary catheter was suppressed the second day after surgery and the patient was discharged in the third day. The dressing was removed in the 7th day postoperatory. At the 3-month follow- up, the cosmetic penile aspect was excellent and the patient presented good functional results, having returned to a full sexual activity. Conclusions: Primary premalignant glans lesions and "in situ" SCC can be safely treated using TGR even for patients with failed topical treatments, resulting in an optimal aesthetic, functional and psychological outcome as well as an improved quality of life. A close follow-up in necessary in order to rapidly diagnose possible recurrences. [ABSTRACT FROM AUTHOR]

Objectives. This study aims to present performance and limitations of magnetic resonance imaging (MRI) in detection and characterization of venous tumor extension in patients with renal cell carcinoma (RCC) and in assessing its resectability, in order to select the most appropriate surgical techniques. Material and method. Retrospective study conducted on a total of 39 patients (29 men and 10 women, age range 41-83 years, mean age 58.7) who underwent surgical treatment in Urological Surgery Center, Renal Dialysis and Kidney Transplant in Fundeni Hospital from January 1st 2008 to December 31st 2009 for renal cell carcinoma, to which the pathological examination revealed the presence of venous tumor extension on renal vein and / or inferior vena cava and who performed preoperative MRI with contrast. Images obtained by MRI evaluation were assessed for the presence of tumor thrombus, its level (including any extension into the contralateral renal vein or hepatic veins), vessel wall adherence or invasion, and tumor staging. MRI results were compared with surgical and pathological findings. Results and discussions: 28 patients (71.7%) had RCC on the right side and 11 patients (28.3%) on the left side. According to TNM classification, clinical and histopathological findings, 34 patients (87.1%) with clear cell carcinomas are in T3b stage and five patients (12.9%) are in T3c stage. MRI accurately predicted venous tumor extension in 36 patients (92.3%). In all 3 patients (7.7%) in which MRI did not reveal the presence of tumor thrombus, the pathological exam showed its presence in the segmental branches of renal vein. Conclusions. MRI is a reference imaging method in diagnosing the presence of tumor thrombus, characterizing the nature of the thrombotic process as well as appreciating the higher level of tumor thrombus in renal cell carcinoma, the limits of the method is found in cases showing tumor extension into the segmental branches of renal vein. It is also a sensitive technique for detecting vessel wall invasion and provides important preoperative information for surgical planning. [ABSTRACT FROM AUTHOR]

Background. Prognostic markers for renal cell carcinoma (RCC), such as histologic subtype, tumor stage, grade and tumor necrosis are useful for determining appropriate follow-up. Hence, the objective of the current study was to evaluate these pathological variables and also we attempted to establish possible correlations between them. Patients and Methods. 430 patients operated between 1 january 2007 and 31 december 2009 in Urology Department of Fundeni Clinical Institute, Romania, were included in this retrospective study. Histologic subtype, pT stage, Fuhrman grade and tumor necrosis were determined in all cases. Results. Clear cell, papillary, chromophobe carcinomas and Bellini's duct carcinoma, sarcomatoid variants accounted for 320 (74.41%), 45 ( 10,46 %), 25 (5,81%), 12 (2,71%) , 33 (7,67%) cases, respectively. Fuhrman grade 2 (33,25 %) and pT3 stage (50, 23 %) were predominant features, tumor necrosis was identified in one third of investigated tumors. Almost pT4 tumors (91,66%) have Fuhrman grade 3 and 4 with sarcomatoid features. Conclusions. Most tumors were clear cell type and had a predilection for Fuhrmann grade 2 and pT3 categories, instead papillary form, the second as frequency, had higher values regarding grading and tumor necrosis, but lower stage. Tumor necrosis correlates with higher grade and tumor stage. [ABSTRACT FROM AUTHOR]

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Retroperitoneal liposarcoma is a rare tumor in clinical practice, that is difficult to diagnose and treat. We present the case of a 64 years old female patient diagnosed by computed tomography imaging with a massive left renal tumor, after the emergence of an autopalpable mass within the abdominal left flank. The CT showed a large left renal mass without a clear limit from the adiacent structures (pancreas, spleen, colon). After a correct and complete surgical resection, a retroperitoneal dedifferentiated liposarcoma was histopathologicaly diagnosed, witch encapsulated the left kidney and adrenal gland without microscopic invasion of these structures. [ABSTRACT FROM AUTHOR]

Introduction. The incidence of urological complications after renal transplantation varies from 2.5% to 14.1% of recipients [1]. Ureteral stenosis and leakage are the most common urological complications. The percentage of urological complications has improved over the years as a result of prevention, early diagnosis and management Materials and Methods. A series of 506 consecutive renal transplantations were performed between 1st of October 2004 and 30th of September 2009 in our Department with a male to female ratio of 1.78/1. Renal grafts were obtained in 376 cases (74.3%) from living-related and in 130 cases (25.7%) from cadaveric donors. In 308 cases (60.8%) we performed a transvesical ureteroneocystostomy and in198 cases (39.2%) an extravesical ureteroneocystostomy. Results. Ureteral stenosis and ureteral fistulae were the most common urological complications, with an incidence of 5.73% (29 cases). We recorded 18 ureteral stenosis (3.56%), 11 ureteral fistulas (2.17%). For the patients with ureteral stenosis (18 cases) the most common method of surgical treatment was vesicoureteral re-anastomosis (11 cases - 2.17%). In the other seven cases (1.38%) we performed retrograde or anterograde insertion of a double pigtail stent. Ureteral leakage was the second major urological complication (11 cases). Double pigtail ureteral stent insertion was performed in six cases (1.18%), 4 vesicoureteral re-anastomosis (0.79%) and one ureteropyelostomy (0.2%). Graft survival was similar among patients who presented urological complications compared to all patients without any complication over the follow-up period. Conclusions. Urological complications related to leakage or stenosis can be treated minimally invasive in order to preserve organ function. Early diagnosis and treatment will helpmaintain renal graft function. Graft survival after successful treatment was similar for all the patients in our study. [ABSTRACT FROM AUTHOR]