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The aim of this study was to assess the changes in 2-year conditional survival (CS) rates after first-line chemotherapy for metastatic urothelial cancer (UC) and to determine how well established prognostic factors evolve over time in these patients. Our results showed that patients with hemoglobin (Hb) levels < 12 g/dL had a significantly poorer survival, although this difference tended to disappear over time. In addition, patients with neutrophil to lymphocyte ratio (NLR) < 3 and age < 70 years showed an increase in their conditional overall survival (COS) and conditional progression-free survival (CPFS) over time. In conclusion, the conditional probability of survival at 2 years from the start of first-line chemotherapy for advanced UC changes over time according to clinical characteristics.

Ureterovaginal fistulae are pathological communications between the ureter and the vagina; it commonly occur as a rare but serious sequela of unrecognized distal ureteral injuries during pelvic operations. Patients may present symptoms as leakage of urine from the vagina, flank pain and fever; in some cases it could be possible also the loss of renal function. The purpose of this study is to review the articles from 1991 to 2014 to evaluate the most correct diagnostic procedures and endourological and surgical techniques used in the management of ureterovaginal fistula. Nowadays computered tomography and retrograde pielography are the most commonly diagnostic modalities used to identify fistulous tract and to describe its anatomical position. The major of ureterovaginal fistulae can be successfully managed by conservative methods. Modern endourological treatment will result in resolution of a ureterovaginal fistula if retrograde or anterograde passage of a suitable internal stent is feasible. When stenting failed or in complicated cases, ureteral reimplantation is necessary. Ureteroneocystostomy, psoas hitch and Boari flap are three different possible surgical techniques used to realized an ureteral reimplantation. Both open and mini invasive (laparoscopy and robot assisted) surgical approach have proved successful.

Most -blockers may induce weight gain, dysglycemia, and dyslipidemia. Nebivolol is a third-generation 1-blocker with vasodilating properties mediated by 3 adrenergic receptors (3AR). We investigated whether nebivolol is able to induce 3AR-mediated lipolysis, uncoupling protein 1 (UCP1), and size-reduction in human adipocytes.

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 12thrib 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.

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.

Introduction Cancer of the testis is not always early detected and recognised, both by the physician and by the patient: sometimes physicians do not make an accurate genitals exam while patients often underestimate this problem.Case reports Discussion Current studies showed an association between trauma and cancer of the testis, even if some authors did not find this association because they consider that patients with trauma undergo US and in that occasion cancer is incidentally detected.Conclusions The association between trauma and cancer of the testis is controversial in current studies. Furthermore screening for the cancer of the testis does not seem to be useful, even if the self- and the physician's palpation of the testis seem to be very important because in these two cases they should allow the early detection of the condition, with a resulting better prognosis.

Intra- and post-operative bleedings are frequent complications of all surgical procedures and can represent a severe risk for patients. Beginning from the second half of the 20thcentury, with an important spur from the development of laparoscopy, great efforts were made in the field of surgical research, aiming at improving hemostatic techniques. The development of mechanical and thermic hemostatic devices, in addition to the improvement of new suturing materials, already improved the possibility of bleeding control; yet a very important contribution in this field has been represented by the introduction in the surgical setting of chemical/biological agents capable of empowering locally blood hemostatic capacity. Currently, there are more chemical hemostatic agents surgeons can make use of in order to minimize bleedings: we reviewed the most important classes, considered their advantages, disadvantages and risks, and tried to look forward to those that will offer, in our view, the best options - for surgeons and patients - for an efficient and safe prevention and control of surgical bleedings, either in open or minimally invasive surgery.

Tumor angiogenesis is a complex multistep process, resulting from the imbalance between pro- and antiangiogenic factors in tumor environment. A crucial role in this process is played by vascular endothelial growth factor (VEGF). Its expression in metastatic renal cell carcinoma (mRCC) is mostly regulated by hypoxia and it is associated with the loss of the von Hippel-Lindau (VHL) tumor suppressor gene. The importance of identifying VEGF-independent pathways in tumor angiogenesis is increasingly recognized as result of the emerging drug resistance to anti-VEGF therapies. Advances in knowledge of tumor angiogenesis, growth and progression permit to develop new approaches for the treatment of mRCC, targeting not only VEGF and VEGF tyrosine kinase receptors (VEGFRs) tyrosine kinase pathway, but also serine/threonine kinases, α5β1-integrin, AKT, PI3K and STAT3. Starting from sorafenib and sunitinib, several agents have been approved, with a long list of drugs, as well as axitinib, tivozanib, cediranib and VEGF-Trap, presently in course of evaluation. Here, we illustrate the principal steps of tumor angiogenic process; showing approved anti-angiogenic agents, the emerging molecules currently under evaluation and some relevant patents.

Any article reporting on Interstitial Cystitis (IC) will list numerous investigations. This paper presents a review of the minimum investigations needed and their significance for the initial evaluation and diagnosis of patients with Interstitial Cystitis. To optimize patient's early diagnosis and disease monitoring, a comprehensive algorithm for the diagnosis of IC has been proposed. The paper defines interstitial cystitis (IC) as a disease of the urinary bladder diagnosed by at least one of the following 3 requirements: 1) endoscopic criteria (cystoscopy findings); 2) pathologic criteria of bladder biopsy; and 3) clinical criteria including pain and lower urinary tract symptoms evaluation. Furthermore, the exclusion of confusable diseases is mandatory in all cases. These are recommendations, mostly based on expert opinions and literature review. Where possible, a level of recommendation was developed according to a 3–grade scale: mandatory (grade 1), recommended (grade 2), and optional (grade 3). By using a stepwise approach and an evidence-based thought process, the diagnosis of IC is made easier and reliable.

Background and aim of the study: Scant information on the cellular distribution of the five somatostatin receptor (SSTR) subtypes in the normal prostate and in neoplasms of the prostate has been reported in very few studies in which techniques, such as in situ hybridization histochemistry, autoradiography, and more recently immunohistochemistry, have been applied. The aim of the study was to examine immunohistochemically the distribution and localization of these 5 subtypes in the various tissue components in normal prostate.Materials: The study was conducted in 14 surgical specimens of normal prostate tissue from adenomectomy specimens from patients with bladder outlet obstruction. The distribution and localization of the 5 somatostatin receptor (SSTR) subtypes was investigated with an immunohistochemical technique. Specificity of the antibodies against the 5 receptor subtypes was preliminarily investigated.Results: Close to 90% of secretory cells showed a weak positivity in the cytoplasm, the proportion ranging from 86.3% (SSTR4) to 89.9% (SSTR5). Strong immunoreactivity was seen in a small proportion of cells, ranging from 0.8% (SSTR3) to 3.2% (SSTR1). For the subtypes 1 and 3 the greatest proportion of basal cells showed a moderate intensity (42.5 and 41.4%, respectively), strong immunoreactivity being observed only in 18.1 and 15.8% of cells, respectively. For the subtypes 2, 4 and 5, the majority of cells showed a weak intensity (72.3, 65.7 and 65.1%, respectively). Subtype 1 showed a strong immunoreactivity in the cytoplasm in 60% of the smooth muscle cells. With subtypes 2, 3 and 4 the greatest proportion of cells showed a weak intensity (63.4, 89.8 and 81.7%, respectively). With the subtype 5 the majority of cells (59.8%) were negative. Subtype 1 showed a strong immunoreactivity in the cytoplasm in 98.6% of the endothelial cells. With subtypes 3 and 4 the greatest proportion of cells showed a weak intensity (73.5 and 56.4%, respectively). With the subtype 2 and 5 the majority of cells were negative (59.1 and 50.7%, respectively).

Objective. In the present study we wanted to determine whether sacral neuromodulation benefits patients with bladder and bowel symptoms caused by multiple sclerosis (MS).

Purpose:To evaluate the role of intrarectal EMLA, a new topical anesthetic cream, and lidocaine gel as local anesthesia during transrectal prostate biopsy and to observe whether gel temperature can improve pain control.Patients and Methods:A series of 210 consecutive patients were randomized. Group 1 (N = 60) underwent intrarectal instillation of EMLA cream, group 2 (N = 50) 2.5% lidocaine gel, group 3 (N = 40) placebo, and group 4 (N = 60) no treatment. Patients in groups 2 and 3 were subdivided into subgroups according to instillation of warm or cooled gel. Pain control was assessed by a 10-point visual analog scale.Results:The median pain scores were 2.6 in group 1, 3.8 in group 2, 3.9 in group 3, and 3.6 in group 4. In 16 patients (7.6%), the procedure was suspended because of pain: none group 1, 6.0% in group 2, 10% in group 3, and 15% ing group 4. The temperature of the lidocaine gel did not affect tolerability.Conclusion:Intrarectal instillation of EMLA cream is a simple, safe, and effective method of local anesthesia during transrectal prostate biopsy, superior to lidocaine gel, placebo, and no treatment.

We investigated the safety and efficacy of transurethral resection of the prostate (TURP) for prostate glands between 70 and 150 ml.

Abstract An international consultation on the diagnosis of non-invasive urothelial neoplasms was held in Ancona, Italy in May 2001. Besides histology and problems of classification, one group of experts (Committee no. 3) discussed the molecular pathology and cytometry of non-invasive urothelial carcinomas. In the following first part, special immunohistochemical and molecular markers for stratifications in bladder cancer were discussed including different cytokeratins (clone 34βE12, CK 20), cell proliferation markers (Ki67/MIB-1, PCNA, AgNOR, DNA-cytometry), tumor suppressor genes and oncogenes (p53, p21, erb-B2, bcl-2), different receptor expressions of epidermal growth factor and vascular endothelial growth factor and others. These molecular markers were analyzed in diagnosis of urothelial carcinomas, recurrences, progression and response to treatment.

We evaluated the efficacy of the α1-adrenergic antagonist tamsulosin for conservative expulsive therapy in patients with ureteral colic due to juxtavesical stones.

Tumors clinically confined to the prostate gland (T1-2) are heterogeneous with respect to pathological staging and outcome after definitive radical surgery (radical prostatectomy). The preoperative prognostic factors that could predict pathological stage and outcome of individual patients with clinically localized prostate cancer are reviewed. New preoperative factors have been identified by histological analysis of needle biopsy prostate specimens in addition to Gleason grading score, serum markers (PSA), and clinical staging. These factors are related to tumor volume, zonal origin of the tumor, and spread into the gland and surrounding tissues. Other biological factors are identified by molecular and immunohistochemical analysis (neuroendocrine differentiation, DNA content, microvessel density, and perineural invasion). Biomolecular factors can also be assessed preoperatively on serum samples (freetotal PSA ratio, PSA RT-PCR). Although only a few of these factors have a role in predicting treatment failure andor disease recurrence, the neural network analysis seems to be the most important tool for identifying patients with more aggressive disease. A combination of these new factors, also using neural networks, could be relevant in the preoperative management of patients with prostate cancer to identify those with confined disease and to select those suitable for a "nerve sparing radical prostatectomy" to preserve sexual function and to achieve definitive cancer control.

ABSTRACTUreteral stents coated with the quorum-sensing inhibitor RNAIII-inhibiting peptide (RIP) were implanted in rat bladders and shown to suppress Staphylococcus aureusformation on the stent and in urine and was especially effective when combined with teicoplanin. Coating ureteral stents with RIP thus increases the efficacy of teicoplanin in preventing ureteral stent-associated staphylococcal infections.

Prostate needle biopsy can disclose important clinical information on tumor extension and grading, useful prognostic parameters for therapeutic choices and prognostic definition. To obtain more histopathologic information on specimens and clinical prognostic parameters, we used a new method to handle and embed tissue fragments of prostate biopsy as well as a new trans-rectal probe (TRUS) with an end-fire convex ultrasound transducer to guide ultrasonically precise needle placement in the prostate gland. In our experience these methods combined can be useful in obtaining reliable clinical and prognostic information in the management of patients with prostate cancer.

We present a case of enterovesical fistula caused by an accidental ingestion of a foreign body. A 23-year-old man presented to our hospital with pneumaturia, fecaluria, and abdominal pain but no recent possible causes of enterovesical fistula at anamnesis. Cystoscopy, cystography, and also colonoscopy were not able to detect the fistulous tract. Computer tomography (CT) revealed a fistula between bladder and bowels caused by a toothpick accidentally swallowed 2 years earlier. We tried to remove the foreign body endoscopically by cystoscopy and colonoscopy but with no success. The failure of endoscopic procedures required a surgical treatment. The patient underwent laparoscopic segmental resection of the sigmoid colon to remove the fistulous tract and the foreign body. The cystography revealed no external leakage of contrast from the bladder with complete resolution of the problem.

Background and Aim of the Study: Scant information on the cellular distribution of the five somatostatin receptor (SSTR) subtypes in the normal prostate and in neoplasms of the prostate has been reported in very few studies in which techniques, such as in situ hybridization histochemistry, autoradiography, and more recently immunohistochemistry, have been applied. The aim of the study was to examine immunohistochemically the distribution and localization of these 5 subtypes in the various tissue components in normal prostate.Materials: The study was conducted in 14 surgical specimens of normal prostate tissue from adenomectomy specimens from patients with bladder outlet obstruction. The distribution and localization of the 5 somatostatin receptor (SSTR) subtypes was investigated with an immunohistochemical technique. Specificity of the antibodies against the 5 receptor subtypes was preliminarily investigated.Results: Close to 90% of secretory cells showed a weak positivity in the cytoplasm, the proportion ranging from 86.3% (SSTR4) to 89.9% (SSTR5). Strong immunoreactivity was seen in a small proportion of cells, ranging from 0.8% (SSTR3) to 3.2% (SSTR1). For the subtypes 1 and 3 the greatest proportion of basal cells showed a moderate intensity (42.5 and 41.4%, respectively), strong immunoreactivity being observed only in 18.1 and 15.8% of cells, respectively. For the subtypes 2, 4 and 5, the majority of cells showed a weak intensity (72.3, 65.7 and 65.1%, respectively). Subtype 1 showed a strong immunoreactivity in the cytoplasm in 60% of the smooth muscle cells. With subtypes 2, 3 and 4 the greatest proportion of cells showed a weak intensity (63.4, 89.8 and 81.7%, respectively). With the subtype 5 the majority of cells (59.8%) were negative. Subtype 1 showed a strong immunoreactivity in the cytoplasm in 98.6% of the endothelial cells. With subtypes 3 and 4 the greatest proportion of cells showed a weak intensity (73.5 and 56.4%, respectively). With the subtype 2 and 5 the majority of cells were negative (59.1 and 50.7%, respectively).Conclusions: Our immunohistochemical study on the SSTRs expands our knowledge in the distribution of these subtypes in the various tissue components in the prostate. Such an information may prove useful in developing further non-surgical strategies for the prevention and treatment of benign prostatic hyperplasia and, in particular, of preneoplastic and neoplastic lesions of the prostate.