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BACKGROUND: A hydatid cyst is a parasitic disease caused by the tapeworm Echinococcus granulosus. Kidney involvement represents 4% of all cases, and is rare compared to that in the liver or lung, even more as an isolated site of infection. We present a case report of a woman with septic status, cutaneous fistula and a renal cystic mass revealed to be a solitary hydatid cyst of the kidney. METHODS: A 60-year-old woman was referred acutely by another hospital to our department because of septic fever, cutaneous lumbar fistula and a left kidney cystic mass of 10 x 8 cm. We suspected a renal abscess and the patient underwent immediate left nephrectomy. RESULTS: We performed an extraperitoneal nephrectomy with a lumbar access under the 12th rib with complete resection of the fistula. The histopathological examination revealed it to be a hydatid cyst involving 2/3 of the kidney. After surgery a medical therapy with albendazol was administrated for 6 months, and the patient did not have any other localization 24 months after surgery. CONCLUSIONS: An isolated renal hydatid cyst presenting as cutaneous fistula with a septic status is a very rare condition. A pre-surgical diagnosis is not always possible as in this case. The surgical therapy (nephron-sparing or radical) is the key of the success and a medical therapy after surgery is recommended to prevent other localizations of this parasitic disease. [ABSTRACT FROM AUTHOR]

BACKGROUND: In literature, the majority of data about treatment with botulinum toxin A are based on the results of a single treatment. We evaluate the safety and effectiveness in the medium term of the use of botulinum toxin type A in patients with neurogenic bladder, taking into consideration the clinical and urodynamic parameters, particularly in cases with repeated injections. METHODS: 25 patients were divided into 2 groups: a first group of patients with detrusor overactivity, and a second with overactive sphincter. We performed 20-30 injections (Dysport), at a dose ranging between 500 and 1000 U. The first group was treated with infiltration in the detrusor and in the detrusor and trigone. The second group received injections in the perisphinteric zone, and in the perisphinteric zone and bladder neck. Of the 25 patients, 12 received a retreatment: the first group of patients kept a daily voiding diary to record the number of bladder emptying, incontinence episodes, nycturia and urgency of urination. The urodynamic parameters and symptoms pre-treatment and 4 months after the treatment were compared in both groups. RESULTS: In the first group there were significant changes in the cystometric capacity, maximum detrusor pressure, and in the post-void residual urine 4 months after treatment. These patients were satisfied with the treatment because of the improvement of incontinence and episodes of urgency. In 9 out of 15 retreated patients, the therapeutic results were similar to the first treatment. The second group reported significant improvements in maximum urinary flow rate, post-void residual urine and maximum detrusor pressure. 3 out of 10 patients were retreated even in this group; the new therapeutic results were similar to the first treatment. CONCLUSIONS: Our results in 25 patients with neurogenic bladder showed a concordance with the literature data. The treatment of detrusor and sphincter neurogenic overactivity with botulinum toxin A is effective and safe. Also in the 12 patients with repeated injection treatment, it has been proven safe and effective. [ABSTRACT FROM AUTHOR]

INTRODUCTION. It is not well known how many Small Volume Prostate Cancers (SVPC) may host high grade (Gleason pattern 4/5) or have extraprostatic extension in particular in the national setting. Features of SVPC are very interesting since they raise controversies in diagnosis and have important clinical implications in treatment strategies. The diagnosis may be difficult and the treatment ranges from active surveillance to radical surgery. AIM. We evaluate clinical and pathological features of SVPC in surgical specimens of patients who underwent biopsy and radical prostatectomy. METHODS. We analysed a consecutive series of 849 radical prostatectomies performed between 2005 and 2008. Inclusion criteria were: biopsy specimen available, pathological tumor volume analysis according to standard criteria, whole-mount section 3 mm step analysis according to Stanford protocol, clinical parameters (PSA, DRE, number of core biopsy taken). Exclusion criteria: any hormonal manipulation before surgery and cT1A/B stage. Data were analysed using SPSS for statistical comparison. RESULTS. 238 patients were evaluated. SVPC<0.5 cc was observed in 58 (24.3%). Overall in 17/58 (29.3%) a clinical/pathological relevant disease was observed. In 16/58 (27.5%) pathological Gleason Score (GS) was 7-8, in 5/58 (9%) pathological stage was T3. The number of tumor foci was >1 in 78.3%, tumor-involving in both lobes in 55%. Unifocal disease was observed in 22%. Clinically relevant disease is significantly associated with total cancer volume (0.20 versus 0.31, p 0.007), but not to tumor foci (2.5 versus 2.0). PSA, age, no. of positive cores, DRE were not predictive of clinical relevant disease. Six of 17 (35%) cases with SVPC - who were in the low risk category (PSA <10, biopsy Gleason score <7 and negative DRE), had clinical relevant disease. CONCLUSION. SVPC are clinically relevant in 29.3% since they have a Gleason pattern 4 (27.5%) or have only pathological T3 (9%). Early diagnosis techniques and treatments have to consider that SVPC prostate cancer may contain high risk disease in 1/4 of cases. Clinical parameters are not useful to accurately detect high risk SVPC. [ABSTRACT FROM AUTHOR]