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Background: Epithelioid hemangioendothelioma (EH) is a rare vascular neoplasm with an unpredictable malignant potential that has been described mainly in soft tissue, liver, and lung., Case Report: We report a case of a primary renal EH in a 54-year-old woman who presented with a 3-month history of abdominal pain. Abdominal ultrasound and computed tomography scan revealed a solitary mass of 4.0 x 3.2 cm in the outer surface of the right kidney. Nephron-sparing surgery was performed. On the basis of the histological and immunohistochemical findings, the diagnosis of EH was made. The patient was free of disease 6 months after surgery., Conclusions: Although EH may have a histologically benign appearance and can be treated using a nephron-sparing approach, this neoplasm is potentially malignant urging the need for a long-term follow-up in these patients., (Copyright 2009 S. Karger AG, Basel.)

Although minimally invasive treatments for ureteral stones are efficacious, they are not free of complications and are associated with high cost. Medical expulsive therapy (MET) has recently emerged as an alternative strategy for the initial management of small distal ureteral stones. A MEDLINE search was undertaken to evaluate all currently available data on efficacy and safety of MET therapy in such patients. The specific mechanism of action on the ureteral smooth muscle and the emerging evidence of the efficacy (defined as either an increase in expulsion rate or a decrease in time to expulsion) and low-risk profile suggest that alpha-adrenergic receptor antagonists (alpha-blockers) and calcium channel antagonists should be the initial medical treatment in patients amenable to conservative therapy. NSAIDs and anticholinergics have not shown efficacy as single agents or in combination with alpha-blockers or nifedipine. Corticosteroids may provide a small additive effect when combined with either alpha-blockers or nifedipine.

Purpose of Review: Lower urinary tract symptoms (LUTS) include voiding, storage, and postmicturition symptoms whereas in addition LUTS and sexual dysfunction are highly prevalent in aging men. The present article investigates how symptoms can guide our initial therapeutic approach to male LUTS and provides the recent data on the current treatment options., Recent Findings: Recent studies suggest that not all male LUTS are associated with prostate pathology and that bladder plays a role in the development of LUTS and especially in storage symptoms. In addition to the traditional drug classes including alpha-blockers and 5alpha-reductase inhibitors, there is an increasing flow of data on the use of anticholinergics and phosphodiesterase type 5 inhibitors. Available studies provide high-level evidence on the efficacy and safety of these medical treatments. The upcoming data are beginning to shape new strategies for the initial management of male LUTS., Summary: Male LUTS have a complex nature and there is an overlap of storage and voiding symptoms. Weighing of storage versus voiding symptoms is a decisive factor for the selection of medical treatment. In addition, assessment of specific voiding and prostate parameters and the status of patient's sexual function may guide our choice.

During the past decade, increasing numbers of minimally invasive treatments for managing male lower urinary tract symptoms caused by urinary tract obstruction have been positioned. On one hand, transurethral needle ablation and transurethral microwave thermotherapy bridge the gap between medical management and surgery, while on the other hand, outcomes of holmium laser enucleation of the prostate and Greenlight laser equal outcomes following transurethral resection of the prostate (TURP). With the introduction of the bipolar technology, however, TURP has reinforced its position.

Objectives: The aim of the study was to evaluate female sexuality in a selective population of newly diagnosed multiple sclerosis (MS) women., Materials and Methods: In this clinic-based study, 63 newly diagnosed consecutive women affected by definite MS were admitted. Disability and depression were evaluated with the expanded disability status scale (EDSS) and Beck depression inventory, respectively. Sexual function was evaluated with the female sexual function index (FSFI). A group of 61 healthy female volunteers with the same baseline characteristics were used as controls. Postmenopausal women and patients with other major concomitant neurological, endocrinological, vascular, gynecological, psychiatric disorders, use of medicines that can cause female sexual dysfunction (FSD) and disease-modifying drugs were excluded from the study., Results: All the evaluated patients were ambulant with no major neurological impairment (mean EDSS score 2.5, range 0-3.5). None of the patients were considered clinically depressed, but some of them were sad or worried. According to the sexual history and FSFI scores, sexual dysfunction was diagnosed in 22 (34.9%) out of the 63 patients and in 13 (21.31%) out of the 61 healthy females (P > 0.05)., Conclusions: In the newly diagnosed MS patients, FSD represent an important issue even though disability and other concomitant disorders affecting sexual function were excluded.

Background and Purpose: Shockwave-induced pain may become an important issue during extracorporeal shockwave lithotripsy (SWL), although the new generation of lithotriptors generally produces less pain than previous models. The aim of the study was to compare the analgesic effect of a cyclooxygenase-2-specific inhibitor (parecoxib sodium) with that of our standard method of analgesia (fentanyl citrate) in patients who needed pain relief when undergoing SWL., Patients and Methods: Fifty-eight patients who were undergoing SWL for renal calculi were randomized to receive intravenously either fentanyl citrate (group A, n = 30) or parecoxib sodium (group B, n = 28) when they felt that their pain during the session became intolerable. Lithotripsy was recommenced 10 minutes after administration of analgesia. The severity of pain before and after administration of the analgesic regimens was evaluated using a five-level verbal scale. The effectiveness of each drug was evaluated with respect to degree of pain relief and ensuing tolerance of the procedure to completion, as well as the need for supplementary analgesia (half the standard dose of fentanyl citrate)., Results: The patients in the two groups were comparable with regard to age, sex, body mass index, and stone size. There was no statistically significant difference in the maximum energy level achieved as well as in the total number of shock waves given in the two groups. Administration of fentanyl citrate resulted in alleviation of pain and completion of SWL in 27 patients (90%), whereas parecoxib sodium was effective in five patients (17.8%) (P < 0.01). The remaining 23 patients in group B received supplementary analgesia, and 22 completed the lithotripsy session., Conclusions: Parecoxib sodium was not as effective as fentanyl citrate in alleviating pain during SWL. Its use, however, may lower the dose of opioid-based analgesia in this group of patients.

Objectives: To compare effectiveness in terms of blood loss and operative time of stapling devices among surgeons with different levels of surgical volume., Methods: We evaluated a group of 29 male patients with invasive bladder cancer who underwent radical cystectomy by two groups of surgeons. The first group included two high-volume surgeons, and the second group two low-volume surgeons. All cystectomies were performed using the multifire autosuture articulated vascular Endo-GIA. We compared patients with a series of 28 patients who had undergone radical cystectomy during the same period using standard technique by the same surgeons. Blood loss was defined as the difference between the hemoglobin at the beginning and at the end of cystectomy., Results: In the group of high-volume surgeons, the mean operative time was 81.4 +/- 17 minutes and 79.3 +/- 20 minutes for the classical and stapler arm, respectively (P = 0.551). In the low-volume surgeons group, the mean operative time was 114.3 +/- 22 minutes and 92.4 +/- 12 minutes for the two methods (P = 0.003). The mean intraoperative blood loss in the experienced surgeons was 2.3 +/- 0.82 g/dL and 1.49 +/- 0.66 g/dL for the classical and stapler arm, respectively (P = 0.008). In the group of low-volume surgeons, the difference in hemoglobin was 3.02 +/- 0.84 g/dL and 1.91 +/- 0.6 g/dL for the two methods (P = 0.02)., Conclusions: Stapling devices seem to make cystectomy safer and faster in surgeons with different surgical volumes. The group of low-volume surgeons benefited more.

Purpose of Review: The aim of this article is to describe the current position of clinical practice guidelines for benign prostatic hyperplasia in daily management and identify the potential barriers that may hinder the implementation of guidelines into clinical practice., Recent Findings: Recent studies have attempted to compare and grade benign prostatic hyperplasia clinical practice guidelines using appraisal instruments underlining the issues of quality and updates of guidelines. Surveys have evaluated the adoption of guidelines from the urological community and recent studies have made major contributions to our knowledge of the translation of evidence to daily practice., Summary: Numerous clinical practice guidelines (both national and international) for benign prostatic hyperplasia exist. High methodological quality clinical practice guidelines are likely to be the most beneficial to patients and strength of recommendations depends on available evidence. Efforts to implement guidelines are not always successful and a considerable variation especially in diagnostic assessment of benign prostatic hyperplasia has been reported. Difficulties in translation of benign prostatic hyperplasia guidelines into clinical practice are related to lack of knowledge but also to differences in routine practices, beliefs, cost, availability, and reimbursement policy. Bridging the implementation gap represents a challenging task for clinical practice guideline supporters.

We report a case of endobronchial metastasis from prostate adenocarcinoma. A patient with a history of prostate cancer under complete androgen blockade presented to the respiratory department complaining of dyspnea and dry coughing. Flexible bronchoscopy showed multiple polypoid lesions in the tracheobronchial tree and the immunohistochemical studies on the biopsy specimen determined the diagnosis. The patient was treated with paclitaxel, estramustine phosphate and carboplatine, and experienced symptoms suppression. To our knowledge, this is the first case of endobronchial metastasis of a patient with androgen refractory prostate cancer without any evidence of extrathoracic metastasis. The current report also emphasises the need for a multidisciplinary approach for cases of endobronchial metastases, with the collaboration of pneumologists, urologists, pathologists and oncologists.

Objectives: To evaluate the durability of transurethral microwave therapy (TUMT) Prostasoft 3.5 for the treatment of patients with benign prostatic hyperplasia treated with the 30-minute protocol., Methods: A total of 213 patients (45 with urinary retention) were treated with TUMT Prostasoft 3.5. The International Prostate Symptom Score (IPSS), quality of life (QOL) score, and maximal flow rate (Qmax) were assessed at baseline and at 12, 24, 36, 48, and 60 months of follow-up., Results: The overall mean follow-up period was 33.9 months, with a maximum of 65 months. Patients without retention had significant improvement (P <0.0001) in the Qmax for up to 4 years (from 8.5 to 13.2 mL/s). The mean IPSS had decreased significantly from 20.3 to 12.2 at 5 years (P <0.0001). Similarly, the mean QOL score improved significantly during follow-up (P <0.0001). In the retention group, analysis showed that the clinical outcomes in terms of Qmax, IPSS, and QOL score remained stable during the follow-up period. Retreatment was required for 48 patients without urinary retention (28.6%) and 17 patients with retention (37.8%). The corresponding Kaplan-Meier cumulative retreatment risk at 5 years was estimated to be 42.3% and 58.8%., Conclusions: Our long-term data have indicated that the IPSS and QOL score remained improved in responders compared with their pretreatment scores 5 years after the 30-minute TUMT protocol and the Qmax remained significantly increased for up to 4 years. However, a significant number of patients required additional treatment, with those in retention before TUMT at a greater risk.

We present 2 cases of large bladder stones formed on a tension-free vaginal tape (TVT) which was inadvertently passed through the bladder during the continence procedure. The stones together with the intravesical portion of the slings were removed using a suprapubic approach. High clinical suspicion of bladder complications is necessary when evaluating patients with urinary symptoms after a TVT operation., (2007 S. Karger AG, Basel)

We report the first case of a juvenile granulosa cell tumor of the epididymis in a young man. Clinical and histological findings are presented and the clinical significance of the case is discussed., (Copyright 2007 S. Karger AG, Basel.)

Purpose of Review: The aim of this article is to provide new clinical data on transurethral microwave thermotherapy, evaluate it in the perspective of evidence-based guidelines and daily practice and investigate the driving forces that determine the current position of thermotherapy for the management of benign prostatic obstruction., Recent Findings: Recent studies have provided significant evidence regarding the efficacy, safety and durability of thermotherapy. Updated evidence-based clinical guidelines on the management of patients with benign prostatic obstruction have been made available. Surveys have evaluated the acceptance of transurethral microwave thermotherapy from the urological community. In addition, several studies have made major contributions to our knowledge of the translation of evidence to daily practice., Summary: The range of therapeutic options for benign prostatic obstruction continues to widen creating the need for clarity in selection and application of these treatments. High-quality data on transurethral microwave thermotherapy have been published and integrated into clinical guidelines. Considerations on the implementation of guidelines to clinical practice, emergence of new treatments, shift of benign prostatic obstruction therapy, economics and the increasing need to treat patients with different clinical profile during the last decade seem to affect the position of transurethral microwave thermotherapy in the armamentarium of a urological centre. Into this frame, transurethral microwave thermotherapy tailored to selective cases seems to remain an attractive option.

Objective: To evaluate the feasibility of performing percutaneous nephrolithotomy (PCNL) under local anaesthesia in selected patients., Methods: Twenty-four patients with unilateral renal obstruction due to pelvic stones > or =2.0 cm were enrolled in our study. First a percutaneous nephrostomy to decompress the obstructed kidney was performed using local anaesthesia (lignocaine). A 16-Fr nephrostomy tube was left in place for 1 wk, and then the second stage was carried out. After having infiltrated the tract and the renal parenchyma with lignocaine, dilatation of the nephrostomy tract was performed. Subsequently, PCNL was done using a 24-Fr rigid nephroscope and a ballistic lithotripter. All patients were premedicated with pethidine HCl intramuscularly 30 min before the beginning of both stages. Diazepam was given (0.1mg/kg orally) to patients before the second stage. Pain scores were collected using 10-cm linear visual analogue scale (VAS) after the completion of both procedures., Results: The procedure was well tolerated. One patient needed further treatment with midazolam during PCNL. The mean VAS score was 38 mm (range: 17-60 mm) for the first stage and 36 mm (13-69 mm) for the second stage. The mean operative time, including both stages, was 127 min (85-155 min). No anaesthesia-related complications occurred., Conclusion: Our study indicates that PCNL under assisted local anaesthesia is safe and effective in selected patients.

Background and Purpose: Forgotten, encrusted ureteral stents represent a difficult problem for urologists, and a consensus on the best therapeutic approach is lacking. We present our experience with endoscopic management of this challenging problem and discuss the chosen treatment combinations., Patients and Methods: Five women and four men aged 31 to 71 years (mean 50.2 years) with 10 stents indwelling for 6 to 85 months (mean 24.1 months) were treated in our department. Stent encrustation and the associated stone burden were evaluated by plain radiographs and intravenous urography. Treatment decisions were based on the clinical presentation and imaging findings. Three stents in two patients had minimal or slight encrustations., Results: The mean number of procedures per patient was 2.1 (range 1-4). Percutaneous nephrolithotomy was performed in eight patients and retrograde ureteroscopy with or without intracorporeal lithotripsy in seven cases. Cystolitholapaxy or percutaneous cystolithotripsy was used to manage the distal portion of the encrusted stent in two cases. Extracorporeal shockwave lithotripsy was performed in only two patients. All stents and the associated stones were eventually removed without any complications., Conclusions: Combined endourologic techniques can achieve safe removal of forgotten stents if treatment is tailored to the volume of encrustation and associated stone. Imaging evaluation and documentation of negative urine culture are imperative prior to any attempt to remove the stent.

Objective: To evaluate, in a prospective study, the efficiency of helical computed tomography (CT) and endoluminal ultrasonography (ELUS) for detecting significant crossing vessels, a major cause of bleeding complications when treating patients with pelvi-ureteric junction (PUJ) obstruction, and to compare our results using ELUS with those of an earlier multicentre study (not using ELUS), to see whether the complication rate decreased., Patients and Methods: The study included 27 patients with a PUJ who had isotope renography, intravenous urography, helical CT and ELUS before surgery. Depending on the findings of ELUS, patients were treated with a pure lateral Acucise incision (Applied Medical, Irvine, CA, USA) an Acucise with changed cutting direction, or (later) a laparoscopic pyeloplasty., Results: ELUS detected 15% more crossing vessels than helical CT; 16 patients had Acucise (seven lateral, nine other cutting direction), eight were treated with a laparoscopic pyeloplasty and three with other procedures. By contrast with earlier reports and as a consequence of using ELUS, there was no bleeding, vs 16% in the study not using ELUS. The success rate of 73% of the endourological approach is comparable with previous reports., Conclusion: ELUS is more sensitive in detecting relevant crossing vessels than helical CT and therefore the use of ELUS can better prevent bleeding complications. ELUS can also improve the success rate by helping in selecting the correct treatment. Because it is minimally invasive and safe, ELUS combined with Acucise (or other possible endourological techniques, like holmium laser incision) should be the first choice of treatment for PUJ stenosis.

Purpose: We compared ProstaLund Feedback Treatment (PLFT) to transurethral prostate resection (TURP) in terms of efficacy and safety in a pooled analysis of 3 clinical studies with 1-year followup., Materials and Methods: Overall raw data on 183 patients with PLFT and 65 with TURP were pooled. All studies had identical inclusion criteria, and the efficacy and safety of the method were evaluated using the International Prostate Symptom Score, maximum urine flow (Qmax), responder rate, bother score, prostate volume reduction and adverse events., Results: The response rate was 85.3% and 85.9% in the PLFT and TURP groups, respectively. One-sided 95% CI analysis showed the noninferiority of PLFT vs TURP for this variable. Mean International Prostate Symptom Score was significantly decreased in the PLFT and TURP groups after 12 months (from 20.9 to 6.4 and 20.7 to 7.1, respectively). The 1-sided upper 95% CI of PLFT was within the noninferiority definition compared with that of TURP. The bother score decrease in the PLFT and TURP groups was not significant different (70.9% and 64.0%, respectively). An increase in Qmax from 7.7 to 16.1 ml per second 12 months after PLFT was noted, while the improvement in Qmax in the TURP group was higher (from 7.5 to 18.6 ml per second). The 1-sided lower 95% CI was close (0.76) but it did not attain the predetermined level of noninferiority (0.80). Mean transurethral ultrasound determined volume 12 months after PLFT and TURP was reduced by 32.8% and 58.1%, respectively. A significant correlation between the transurethral ultrasound determined prostate volume reduction and estimated cell kill was found (r = 0.456, p <0.000001). Serious adverse events with causality occurred in 15.4% of patients with TURP compared with 6.0% in those with PLFT (p = 0.035)., Conclusions: Combined experience from our pooled analysis indicates that PLFT challenges TURP in terms of efficacy and safety after 1 year of followup.

The excellent clinical results of transurethral microwave thermotherapy (TUMT) for the treatment of symptomatic benign prostatic hyperplasia (BPH) gave to TUMT the leading position among the microwave thermotherapy modalities available for the treatment of different urologic conditions. Research in TUMT has focused on operating software, temperature monitoring, intraprostatic heat distribution, cell-kill calculations, and correlations with clinical variables. Randomized comparisons of TUMT with other established therapies for BPH, including transurethral resection, have facilitated the evaluation of the clinical outcome, durability, morbidity, and costs of the treatment. The applications of microwave thermotherapy in other urologic diseases are also presented in this review.

Background and Purpose: Different devices for transurethral microwave thermotherapy (TUMT) are currently available for the treatment of benign prostatic hyperplasia (BPH). We evaluated the efficacy and safety of the Prostalund Feedback Treatment (PLFT), which continuously records the intraprostatic temperature, and its impact on sexual function of the patients., Patients and Methods: A total of 41 patients with lower urinary tract symptoms attributed to BPH were entered in this prospective open-label, single-center study of PLFT. The initial evaluation was performed according to a standard protocol. At 3, 6, and 12 months, the International Prostate Symptom Score (IPSS), bother score, sexual function, and peak flow rate (Qmax) were recorded. In addition, determination of prostate volume by transrectal ultrasonography (TRUS) and measurement of residual urine volume were repeated at the 6- and 12-month visits. All adverse events were also recorded. Patients with IPSS of < or =7, > or =50% improvement in IPSS from baseline, a Qmax of > or =15 mL/sec, or > or =50% improvement in Qmax from baseline were judged responders to the treatment., Results: Thirty-three of the patients completed the 12-month visit. The response rate was 88% (29 of 33 patients). There was a statistically significant decrease in IPSS at the 12-month visit, the mean IPSS being 7.1 v 21.9 at baseline (P<0.001). The mean IPSS was 10.3 and 7.6 at the 3- and 6-months' follow-up, respectively. The bother score presented a similar improvement, with a decrease from a mean of 4.2 at baseline to a mean of 1.4 after 12 months (P<0.001). The mean Qmax improved from 8.4 mL/sec at baseline to 15.9 mL/sec, 19.2 mL/sec, and 17.8 mL/sec at 3, 6, and 12 months, respectively (P<0.001). The mean change in prostate volume, as determined by TRUS, was 16 mL at 6 months and 19 mL at 12 months (P<0.001). The procedure was well tolerated. The mean post-treatment catheterization time was 17.90 days. Bladder spasms and urinary tract infection were the most common adverse events. Coitus ability remained practically unchanged after treatment (from 71% to 74.3%), but the number of patients with ejaculation decreased (from 78% to 51.4%)., Conclusion: Our results indicate that PLFT is an effective and safe treatment for most patients with BPH.

From all available minimally invasive methods for the treatment of symptomatic benign prostatic hyperplasia (BPH), transurethral microwave thermotherapy (TUMT) has gained a firm position as the most attractive option. Recent research has produced innovations in high-energy TUMT, including new treatment protocols, refined selection criteria, and monitoring of intraprostatic temperature. Furthermore, long-term results from randomized studies comparing TUMT with transurethral resection of the prostate (TURP) or medical treatment are now available. All these data indicate that more durable clinical outcomes and less morbidity can be achieved with TUMT, strengthening its position as a standard treatment for BPH. This paper describes the status of TUMT in the treatment of lower urinary tract symptoms related to BPH, focusing on variations in the outcomes with different devices, the durability of treatment outcomes, morbidity, selection criteria, and cost. The relation of TUMT to medical management and TURP also is addressed.

Purpose of Review: From all the available thermoablative methods for the treatment of symptomatic benign prostatic hyperplasia, transurethral microwave thermotherapy is considered as standard in minimally invasive management. The literature is enriched by several new studies on transurethral microwave thermotherapy, and thus this review presents up-to-date information about thermotherapy., Recent Findings: New studies have provided significant information regarding differences in outcome for devices with different protocols and selection criteria, confirming the superiority of high-energy programmes. Furthermore, monitoring of the intraprostatic temperature promises better clinical results by means of individualization of the treatment. Long-term results have been available and allow the evaluation of the fundamental issue of treatment durability. Improvement after high-energy transurethral microwave thermotherapy remains durable for more than 2.5 years. Randomized studies comparing this treatment with other established therapies for benign prostatic hyperplasia, including medical treatment and transurethral resection of the prostate, have also contributed to an evaluation of the morbidity, and costs of treatment. Clinical outcomes with transurethral microwave thermotherapy are in the range of those obtained with transurethral resection of the prostate and are superior to those of medical management. Retreatment after transurethral resection of the prostate emerges because of complications following the procedure, whereas retreatment after transurethral microwave thermotherapy is as a result of treatment failure. In addition, the rate of failure of medical management is almost seven times higher than that for transurethral microwave thermotherapy. Thus, the latter seems to play a dominant role in the economic models used to assess the cost-efficiency of different treatment modalities for benign prostatic hyperplasia., Summary: The recent innovations in high-energy transurethral microwave thermotherapy provide better and more durable clinical outcomes and lower morbidity, and strengthen its position as an established treatment for benign prostatic hyperplasia. However, there is always room for improvement, so further research on therapeutic protocols, treatment monitoring and selection criteria are to be welcomed.

To date, only I I cases of sclerosing Sertoli cell tumors have been reported in the literature, representing a distinctive subtype of Sertoli cell tumor in humans. We present a 12th case with a review of the current urological and pathological literature.