Search

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. Varicocele affects one in ten adult men and one in four men with infertility. The exact mechanism through which it reduces male fertility is not known but surgical correction usually improves semen parameters. We consider the study of varicocele repair in single testis patients to be less biased by the presence of a healthy contralateral testicle and thus providing accurate results regarding the benefits of the procedure. Materials and Methods. This is a retrospective, descriptive, single-center study, where we analyzed data from the clinical records of patients diagnosed with varicocele and a history of contralateral orchiectomy during a period of 4 years. All patients had varicocele surgery done by the same surgeon and the same surgical procedure of microsurgical subinguinal varicocelectomy was used. We follow their pathological history, clinical findings, hormonal work-up and semen analysis from before the surgery until the present day. Results. There were six patients that corresponded to our criteria during the studied period. The patients were between 25 and 39 years old. All of them had right-sided orchiectomy for either benign or malignant disease and a left sided varicocele. Four of these patients presented for infertility of various lengths and two for clinical symptoms associated with the varicocele. Two patients that presented for infertility and were candidates for in-vitro-fertilization before varicocele repair managed to obtain natural pregnancies. All four patients that presented for infertility managed to obtain a pregnancy. The other two patients had their symptoms settled. Conclusions. Microsurgical subinguinal varicocelectomy is a straightforward way to relieve clinical symptoms and upgrade the fertility status of single testis patients. Microsurgical treatment of a varicocele in single testis patients could result in the use of a safer, less invasive and less expensive artificial reproductive technique and a higher natural pregnancy rate. [ABSTRACT FROM AUTHOR]

Background. The survival of patients with cutaneous malignant melanoma (MM) depends on multiple factors whose role is continuously updated, as the molecular mechanisms underlying the disease progression are understood. This study intended to assess whether the patient's gender and tumor location affect the disease outcome. Methods. Between 2008 and 2012, 155 patients with cutaneous MM underwent various types of surgeries in our clinic. Patients were staged according to the 2009 TNM classification. There were 90 women and 65 men. Primary tumors were located as it follows head and neck region - 4.5%, limbs - 50.7% and trunk - 44.8%. The disease free and overall survival rates (DFS, OS) were estimated by using the Kaplan-Meier method. Results. Metastases developed in 52.3% of the males and 31.1% of the females (p=0.008). In univariate analysis, distant metastasis risk was significantly higher in men (p = 0,0472 for stage II patients and p = 0.0288 for stage III). In multivariate analysis, male gender almost doubled the risk of relapse (p = 0.044) and death (p = 0.022). Consequently, DFS and OS were significantly higher among females. Primary tumor location seemed to influence the melanoma spreading ability. Half of the trunk MM developed metastases while only a third of limbs MM did. The association between MM location and the recurrence risk was not random (p = 0.033). Conclusions. The patient gender represents an independent prognostic factor for both relapse and death. Although trunk MM had a significantly higher risk of metastasis than limbs MM, the location per se was not an independent prognostic factor for survival (p = 0.078). [ABSTRACT FROM AUTHOR]

Introduction and Objectives. There is no scientific consensus to date regarding the approach to a clinically significant left varicocele associated with a right varicocele (frequently of a smaller size). We could not find studies concerning the efficacy of bilateral microsurgical subinguinal approach for the treatment of bilateral varicoceles. Materials and Methods. A retrospective study was performed with patients presenting with infertility and diagnosed with bilateral varicocele. 46 patients that have been admitted to the Center for Uronephrology and Renal Transplantation of Fundeni Clinical Institute and underwent microsurgical subinguinal varicocelectomy between June 2009 and November 2014 were selected. Patients were divided into two groups, group I - that underwent unilateral left varicocelectomy, and group II - that underwent bilateral varicocelectomy. Results. There was a significant rise in post-op sperm concentration for both groups (34.4 mil - group I vs 31.18 - group II). There was a higher rise in progressive motility percentage in group II (from 23% to 30%) than in group I (27% to 30%), but overall results were identical. (p=0.932). At the 3-months check-up we noticed a 20% higher rise (p=0.765) in TMSC for the bilateral surgery group (34.89 mil for group I vs 40.04 for group II). Conclusions. There weren't important postoperative differences in classical semen parameters (sperm concentration, motility, morphology, viability) but TMSC value was better in the bilateral surgery group. [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. 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]

Rationale: Malignant melanoma (MM) is the cutaneous neoplasia with the greatest mortality rates and one of the malignancies with the highest potential of dissemination. The prognosis of patients with metastatic MM is grim, with a 5-years survival rate between 5- 19%, and is dictated by the location and the number of metastases. Objective: We aimed to estimate the survival of patients with metastatic MM from our study and find out if the metastasis' location influences survival. Methods and results: Between 2008 and 2013,155 patients with cutaneous MM were diagnosed in our clinic. All the patients were staged according to 2009 AJCC staging system. The median follow-up period was of 24 months. Survival was calculated by using the Kaplan-Meier method with a confidence level of 95%. 40.5% of the patients developed metastases in different organs, especially the brain. 80.6% of those with metastases died during the study. The median overall survival, estimated for the entire group of patients who developed metastases, was of 5.3 months. Discussion: The influence of metastases distribution on the overall survival was examined and it was noticed that there were statistically significant differences between the risks of death of various groups of patients, depending on metastasis topography. Thus, the death probability of a patient with brain metastases is twice that of a patient with digestive metastasis, about 7 times higher than that of a patient with lung metastasis (p = 0.0004) and 12 times higher than the death risk of a patient with extra-regional lymph nodes or subcutaneous metastasis (p = 0.0000). [ABSTRACT FROM AUTHOR]

Rationale The current standard surgical treatment for the cervix and uterine cancer is the radical hysterectomy (lymphadenohysterocolpectomy). This has the risk of intraoperative accidents and postoperative associated morbidity. Objective The purpose of this article is the evaluation and quantification of the associated complications in comparison to the postoperative morbidity which resulted after different types of radical hysterectomy. Methods and results Patients were divided according to the type of surgery performed as follows: for cervical cancer - group A- 37 classic radical hysterectomies Class III Piver - Rutledge -Smith ( PRS), group B -208 modified radical hysterectomies Class II PRS and for uterine cancer- group C -79 extended hysterectomies with pelvic lymphadenectomy from which 17 patients with paraaortic lymphnode biopsy. All patients performed preoperative radiotherapy and 88 of them associated radiosensitization. Discussion Early complications were intra-abdominal bleeding ( 2.7% Class III PRS vs 0.48% Class II PRS), supra-aponeurotic hematoma ( 5.4% III vs 2.4% II) , dynamic ileus (2.7% III vs 0.96% II) and uro - genital fistulas (5.4% III vs 0.96% ll).The late complications were the bladder dysfunction (21.6% III vs 16.35% II) , lower limb lymphedema (13.5% III vs 11.5% II), urethral strictures (10.8% III vs 4.8% li) , incisional hernias ( 8.1% III vs 7.2% II), persistent pelvic pain (18.91% III vs 7.7% II), bowel obstruction (5.4% III vs 1.4% II) and deterioration of sexual function (83.3% III vs 53.8% II). PRS class II radical hysterectomy is associated with fewer complications than PRS class III radical hysterectomy , except for the complications of lymphadenectomy . A new method that might reduce these complications is a selective lymphadenectomy represented by sentinel node biopsy . In conclusion PRS class II radical hysterectomy associated with neoadjuvant radiotherapy is a therapeutic option for the incipient stages of cervical cancer. [ABSTRACT FROM AUTHOR]

Tumour antigens are poorly expressed, heterogeneous and they modulate rapidly. As a result, their recognition and elimination by the immune system is very difficult. There are several mechanisms, by means of which, the host can neutralize oncogenesis and prevent it from occurring. The sentinel lymph node concept has brought about a revolution in the surgical treatment of the regional lymphatic basin while preserving the prognostic value of the regional lymph node status in breast cancer. This prospective study included 93 women with early breast cancer with initial indication for surgery in whom the sentinel lymph node technique was employed. Cell immune response was assessed prior to surgery by means of in vitro mononuclear cells blastic transformation assay (BLT), of immunoglobulin (Ig) and interleukin 2 (IL-2) measurements. The results were correlated with tumour size, presence of positive sentinel lymph node, tumour proliferation and growth markers (Ki- 67, c-erbB2, bcl-2). Even in its less advanced stages, breast cancer is more aggressive and associates with an increased rate of sentinel lymph node metastases in patients below 50 years old, the tumour size exceeds 20 mm, with the presence of peritumoral lymphocytic infiltrate, positive Ki-67 and bcl-2, an alteration of T helper (Th) lymphocytes function, increased immune suppression through IL-2 decrease, signalled by blastic transformation indexes modifications and a drop in IL-2 production (p<0.0l). [ABSTRACT FROM AUTHOR]

Aims: Breast cancer is particularly recognized as highly impredictible, even in early stages. The natural evolution of breast cancer is however determined by both clinical and histopathological characteristics. The aim of the study is to evaluate these characteristics from a lot of 93 patients with early stages of breast cancer and subsequently to determine which are the factors with statistical significance that are more likely linked to more aggressive forms of the disease, in which the invasion of the sentinel lymph node had already occurred. Methods: The study included 93 patients with breast cancer that underwent sentinel node biopsy and oncologic treatment at the Bucharest Insitute of Oncology. We assessed data that included histopathological findings such as tumor size, sentinel lymph node involvement, receptor status, and imunohistochemistry parameters ranging. Also, a comparisson to data obtained from similar published studies was made. Results: Cases with aggressive types of breast cancer, that had already spread to axillary lymph nodes, were characterized by early age, poor Bloom Richardson grading, the presence of peritumoral infiltration, and high levels of Ki67, PCNA and p53. Conclusions: Daily practice has shown the need for personalised treatment in cancer patients. If possible, it is highly useful to establish the aggressiveness profile of a malignant breast tumor, in order for a specific patient with a particular set of tumor characteristics to benefit from a targeted and optimized treatment plan. [ABSTRACT FROM AUTHOR]

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and aim Cryptorchidism or undescendent testis is a very common anomaly of the male genitalia, affecting 2% - 4% of male infants and about 30% in premature infants. The choice between orhiectomy and orhidopexy for uni/bilateral cryptorchidism in adolescents and young adults is still a debate in the urological practice. The aim of the study was to report a case of a young adult with bilateral cryptorchidism. Method and patients A case of 21 years old male with bilateral cryptorchidism is presented. The sperm analysis shown azoospermia and the level of plasma testosterone was at the lower border - 10.96 nmol/L (normal range 9.9 - 27.8 nmol/L). Contrast enhanced abdominopelvin computed tomography located left testicle in the upper third of inguinal canal and right testicle in the abdomen. The testicles were about the same size (3.8/2.2 cm on the left and 3.4/2 on the right). A standard orhidopexy on left side and, after 2 weeks, testicular autotransplantation on the right side was performed. Result 2 weeks postoperative check-up revealed the left and right testicle at the upper and, respectively, at the base of the scrotum. Doppler ultrasound detected peek systolic speed of 7.62 cm/sec and 31.64 cm/sec in the left, respectively, right testicle. Conclusion For a high level undescendet testis (into the abdomen or in the upper part of inguinal canal) the best aproach in order to achieve a good cosmetical aapearance of the genitalia and a good prezervation of testicular function is testicular autotransplantation. [ABSTRACT FROM AUTHOR]

Background: Varicocele represents the most common cause of male infertility. Open surgical approach and minimally invasive procedures have been performed for varicocelectomy with significant difference in the postoperative complications and pregnancy rates. Many reports suggest that microsurgical varicocelectomy has the advantages of no hydrocele formation, lower incidence of varicocele recurrence, and better improvement in sperm quality compared with other treatments modalities. Purpose: To evaluate the effects of microscopic assisted subinguinal varicocelectomy (MSV) on sperm quality and pregnancy rate. Design: Prospective longitudinal study. Materials and Methods: In a 2-year period (2008 - 2010) a standard MSV was performed in 104 patients with palpable varicocele. Inclusion criteria were: unilateral or bilateral clinical palpable varicocele, normal reproductive blood hormones levels (FSH, LH and Testosterone) and at least one abnormal semen parameter. The single exclusion criteria was vasectomy. At least 2 sperm analysis were obtained both preoperatively and at follow up visit. The main outcome measures were sperm count, total motile sperm count, sperm morphology and pregnancy rate. The follow-up visit was scheduled at 3, 6 and 12 months postoperatively. Statistical analysis was performed using the paired t test to compare mean preoperative with postoperative sperm parameters and p value < 0.05 was considered significant. A postoperative increase of sperm count, TMSC and sperm morphology with at least 50% of preoperative value was considered success. The patients were divided into 4 groups according to pre and postoperative sperm count: group 1 (0-1milion/ml) and group 2 (1-5 million/ml) - indication for in vitro fertilization, group 3 (5-20 million/ml) - indication for intrauterine insemination, and group 4 (>20 million/ml) - indication for natural pregnancy. Results: 70 patients completed at least one follow up visit. The mean sperm count, TMSC and sperm morphology increased from 19 to 35.6 million/ml, from 41.7 to 44 million and from 53.1% to 76.7%. The difference was statistically significant for sperm count (p = 0.0001). The success of varicocelectomy to increase each sperm parameter with at least 50% of preoperative sperm count, TMSC and sperm morphology were 57.1%, 27.1% and 32.8%. 70.3% of patients from group 1 and 2 migrated postoperative into groups 3 and 4; 64.2% of patients from group 3 migrated postoperative in group 4. Conclusions: Microscopic assisted subinguinal varicocelectomy (MSV) is very effective in increasing sperm count and offer a good natural pregnancy rate; depending on the sperm count, couples can benefit of less invasive techniques for achieving pregnancy after MCV.A systematic preoperative check of genetic abnormalities of male patients and fertility potential of female partner would improve the overall results. [ABSTRACT FROM AUTHOR]