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Objective: To access the feasibility of palliative cystoprostatectomy/pelvic exenteration in patients with bladder/rectal invasion due to prostate cancer (PC). Patients and methods: Twenty-five men with cT4 PC were retrospectively identified in the institutional databases of six tertiary referral centers in the last decade. Local invasion was documented by CT or MRI scans and was confirmed by urethrocystoscopy. Oncological therapies, local symptoms, previous local treatments, time from diagnosis to intervention and type of surgical procedure were recorded. Patients were divided into groups: ADT group (12 pts) and 13 pts without any history of previous local/systemic treatments for PCa (nonADT groups). Perioperative complications were classified using the Clavien–Dindo system. Overall survival (OS) was defined as the time from surgery to death from any cause. A Cox regression analysis, stratified for ISUP score and previous hormonal treatment (ADT) was also performed for survival analysis. Results: Ileal conduit was the main urinary diversion in both cohorts. For the entire cohort, complication rate was 44%. No significant differences regarding perioperative complications and complication severity between both subgroups were observed (p = 0.2). Median follow-up was 15 months (range 3–41) for the entire cohort with a median survival of 15 months (95% CI 10.1–19.9). In Cox regression analysis stratified for ISUP score, no statistically significant differences in OS in patients with and without previous ADT before cystectomy or exenteration were observed (HR 3.26, 95% CI 0.62–17.23, p = 0.164). Conclusion: Palliative cystoprostatectomy and pelvic exenteration represent viable treatment options associated with acceptable morbidity and good short-term survival outcome. [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]

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 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]

Patient aged 76 years old, with single episode of macroscopic hematuria, recently diagnosed in other department during a CT examination with bilateral renal tumors and a gall bladder stone, presented at our department for evaluation and surgical treatment. Abdominal magnetic rezonance examination confirmed renal masses (9/6 cm on the upper pole of the right kidney and 3.8 cm / 3.8 cm on the left kidney of the same location). The right nephrectomy and retrograde cholecystectomy were performed by anterior approach (first session; right tumor histopathology - clear cell carcinoma conventional pT3apN0pM0 Fuhrman grade 3) and we performed a partial nephrectomy to the left renal tumor by lumbar approach (second session; left tumor histopathology- renal oncocytoma) that was postoperatively complicated with obstructive anuria due to a migration of calculus of 4 mm in the left pelvic junction (undiagnosed by ultrasound, tomography and MR preoperatively examinations) and solved by insertion of an ureteric double "J" stent and ESWL treatment. The clinical and imagistic control at 6 months were normal. [ABSTRACT FROM AUTHOR]

Rationale: The management of renal parenchymal tumors has known many changes over time, a trend that continues today, as a result of technological advances, clinical research and improved diagnostic and therapeutic tools. Unfortunately, conventional cancer treatments - chemotherapy and radiotherapy have proven ineffective and modern approaches such as immunotherapy, angiogenesis inhibitors, though they enjoyed an initial enthusiasm, subsequent studies have shown limited and controversial effects. Thus, surgery remains the gold standard therapy for this type of cancer. The options for the treatment of RCC are numerous, with options that have advantages and disadvantages, with oncological results, in most cases, positive at five years and with different impact on cancer specific survival. It is difficult to compare the results, as these are different techniques with various instruments and intraoperative steps, with more questionable inclusion criteria, selection biases and prosecution, with a tendency for preferential enrollment, different reasons to why randomized prospective studies have not been performed until today. Objective: This article is a review of the diagnosis and methods of treatment of small renal masses 2011. Conclusion: At the beginning of the new millennium, kidney cancer, with all the arsenal of techniques and methods of ablative surgery, remains a potentially fatal disease for a high percentage of patients, and the decision to choose a treatment or another should be taken with responsibility, depending on currently existing medical records, the degree of expertise and not based on subjective or other non-standard parameters. [ABSTRACT FROM AUTHOR]

Von Hippel Lindau is an multisystem autosomal dominant disorder that causes tumors of the central nervous system (brain, retinal, and spinal cord hemangioblastomas), endolymphatic sac tumors, renal cell carcinomas, renal cysts, pheochromocytomas, pancreatic cysts and tumors, and epididymal cystadenomas. In this review we describe the major semiological computed tomography and magnetic resonance imaging findings of this pathological entity. [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.)

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]