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Metanephric adenomas are benign tumors frequently found post-mortem (from 7% to 22% of autopsies) which originate from distal tubules; they are generally small in dimensions (smaller than 1 cm) and located in the renal cortex. Etiology is unknown, even though they could be associated with smoke, tubular nephrosclerosis, dialysis. An endocrinal relationship was proposed, because of its more frequent incidence in female (2:1). Metanephric adenoma is an uncommon kind of renal adenoma with no malignant potentiality: from the clinical and diagnostic viewpoint its own greater importance depends on the probability of diagnostic misunderstanding with Wilms' tumor; furthermore its echographic, tomographic and arteriographic characteristics are often similar to small renal adenocarcinoma ones (100). Polycytemia is frequently associated to metanephric adenoma as paraneoplastic syndrome and, more rarely, abdominal mass, abdominal pain, hematuria and hypertension (140). The most important study on metanephric adenoma is the one realized by E.K. Mostofi, including 50 cases from the Department of Genitourinary Pathology, Armed Forces Institute of Pathology, Washington, D.C., published in 1995; in this study half of findings was incidental; mean dimension of tumor about 5,5 cm and in 50% it could be seen a distinct capsule sourrounding the tumor (in the remaining cases the capsule was discontinuos or absent) (210). An important radiological characteristic is that metanephric adenomas are more frequent calcificated than other histotypes and, from the pathological viewpoint, the most important differential element seems to be the smaller dimensions of its cells with hyperchromatic nuclei in the absence or lack in mitotic activity and in the absence of chromosome aberrations. In the case of difficult histological diagnosis, cytogenetic and immunohistochemical analysis can be useful. In conclusion, because it is impossible to distinguish in the preoperatory between the metaneprhic adenomas and the other tumoral types on the bases of the symptoms, dimensions or radiographic appearance, it is mandatory to treat it as malignant eteroformations in a therapeutical strategy, when it is possible.

Objectives: Evaluation of the authors' results achieved using corporoplasty in patients treated for penile curvature from 1/1/1993 to 31/12/2002., Materials and Methods: 26 patients underwent corporoplasty to correct penile curvature: congenital curvature without hypospadias or epispadias in 22 patients (aged 17 to 42) and curvature due to La Peyronie's disease in 4 patients (aged 48 to 65). In the latter 4 cases corporoplasty was chosen, instead of plaque excision or incision, since the plaque was quite small-sized and well stabilized, causing an overall limited curvature in a proportionately long penis with perfectly preserved erectile functions. The Ebbehoj-Metz technique (plication of the tunica albuginea of the corpora cavernosa using introflecting double cross-over stitch of 2/0 Prolene, grasping deep into the tunica in 4 positions) was used in 24 patients and the Yachia procedure (longitudinal incision of the tunica albuginea of the corpora cavernosa followed by transverse suture using 2/0 PDS) in 2 patients, both affected by congenital curvature., Results: Penile straightening was completely satisfactory in 24 patients, while 2 with congenital curvature, who had undergone the Ebbehoj-Metz technique corporoplasty, had recurring penile curvature. One of these last 2 patients, aged 17, required further corporoplasty, using the same procedure again, obtaining penile straightening. The other patient, aged 42, refused further operation. Although the 2 patients treated using the Yachia technique had a satisfactory curvature correction, for some months they reported feeling a bothersome bump on the corpus cavernosum in the cut and sutured area of the tunica albuginea, with moderate pain during erections. For this reason this technique was not used in other patients. The only complication reported by 1 patient was the formation of a redundant balanopreputial scar due to suture dehiscence, later removed under local anaesthesia., Conclusions: Considering their results, the authors consider corporoplasty a reliable and easy to perform procedure in the treatment of both congenital penile curvature and in well selected cases of penile curvature due to induratio penis plastica.

In this article we report on our diagnostic experience of fine-needle aspiration biopsies (FNAB) performed on 17 patients with testicular lesions in the period from 1994-1998. The cytological diagnosis was consistent with seminoma in 7 cases, sex cord-stromal tumors in 3 cases (2 Sertoli cell tumors, 1 Leydig cell tumor), embryonal carcinoma in 3 cases, and yolk-sac tumor in 1 case; the other 3 patients were suffering from flogistic pathology. The cytological diagnosis was confirmed in all cases after surgery. According to our experience, ultrasound FNAB of testicular lesions proved to be a very reliable technique in predicting malignancy with high sensitivity and specificity. None of the patients developed local recurrences or inguinal lymph-node metastasis due to FNAB. Therefore, tumor stage classification (TNM) was not modified in any patient., (Copyright 2000 Wiley-Liss, Inc.)

From January 1992 to September 1997, 29 male patients between the age of 39 and 71 affected by localized bladder cancer underwent radical cystectomy and received detubularized orthotopic ileal neobladder. In most cases we performed the ileal neobladder utilizing the Studer technique, preferring the Wallace 1 method for the uretero-ileal anastomosis, that seems to reduce the risk of stenosis. In some patients we experimented different techniques. One of these was the utilization of staplers but, at present, we are no longer using this procedure due to its high costs without any real advantage in operative time. Another technique is the performance of continuous suture in catgut 000 on the ileal aperture edges for the anastomosis with the urethra, because we believe that this method makes the ileal wall stronger. Usually we apply 6 stitches in vicryl 000 for the urethro-ileal anastomosis. In 14-28 days, after a cystography to exclude the presence of urinary fistula, the catheter was removed. 6 months later an evaluation was made utilizing an auto-evaluation questionnaire, biochemical, radiological and urodynamic examinations. The diurnal continence (96%), the nocturnal continence (71%), the renal function preservation (normal in 86% of patients), the radiological, biochemical and urodynamic (low pressure and high capacity of the neobladder) results were comparable with those published in literature. The discrete percentage of urinary refluxes observed (39%) puts in doubt the real efficacy of the undetubularized ileal tract as an antireflux mechanism, however it does not seem to determine an important reduction of renal function, as confirmed in the check up five years later. In our experience, this operation reduces the risk of stenosis of the uretero-ileal anastomosis.

Renal oncocytoma is a neoplasm which rarely occurs in patients with solitary kidney, the other being absent because of a previous nephrectomy performed for renal cancer. We present two case reports and a literature review. We have studied some important problems such as the histogenesis, the potential for malignancy, the diagnosis, the treatment and the follow up. The high incidence of coexistence of renal oncocytoma and renal cell carcinoma has important clinical implications. We would like to emphasize the importance of preoperatory FNAB, nephron sparing surgery and very careful follow up.

Tumors of the epididymis are very rare. They are benign tumors in 75 per cent of the cases. Papillary cystadenoma represents 4-9 per cent of epididymal benign tumors. Often associated with the syndrome of von Hippel Lindau and infertility, histologically it can be confused with metastatic renal cell carcinoma. We report two cases of papillary cystadenoma located in the head of the right epididymis, with no concomitance with the syndrome of von Hippel Lindau, cured by the removal of the neoplastic nodule. There was no recidivation, in confirmation of the neoplastic benignity.

Ureteroscopy has become a common technique in the diagnosis and treatment of ureteral pathologies, but this procedure is quite invasive and some complications have been reported in literature. In our Institute 49 patients underwent ureteroscopy and ballistic lithotripsy with lithoclast for ureteral stones. The stones were localized both in the middle and distal part of the ureter. We used a small caliber 7-8.5 Wolf ureteroscope. The treatments were performed under antibiotic prophylaxis. Direct access to the ureter without dilation of the meatus was obtained in 97.96% of patients. The stones were easily reached in 93.88% of the cases and satisfactory fragmentation was obtained in 90.7%. In 4 patients (9.3%) one or more large stone fragments escaped into the kidney, requiring the patients to be treated with ESWL. No major complications occurred: no ureteral perforations, no important bleeding and no severe or persistent infections. All patients were discharged in one to four days postoperatively. The authors conclude that ureteroscopy using small caliber instruments with Lithoclast is a safe and satisfactory alternative to ESWL in the treatment of ureteral stones.

We report a case of Leydig cell tumor of the testis in a young man, in whom preoperative diagnosis was achieved by fine-needle aspiration biopsy cytology. Cytology, histology, and ultrastructural examination showed diagnostic Reinke's crystals, both in nuclei and in cytoplasm. Immunohistochemistry displayed strong vimentin and estrogen positivity.

A pure Sertoli cell tumor of the testis in a 26-year-old man is reported, with cytologic, histologic and ultrastructural findings. The preoperative cytological diagnosis allowed a conservative surgical approach.

Of 19 patients with advanced transitional bladder cancer (T2-T4, N0-N+, M0) who received two or three cycles of pre-emptive MVC (Methotrexate, Vinblastine, Cisplatin), pathological partial (PR) and complete (CR) remissions were observed in 67% (50% and 17% respectively). The toxicity of chemotherapy was generally acceptable but 5 patients required hospitalization for neutropenia and thrombopenia . In one of them chemotherapy was stopped for severe sepsis. No death was observed. In 11 patients follow-up is greater than 12 months. In this group, 10 patients are actually alive and disease-free, while the other one was dead owing to brain metastasis, after eight months from surgery.

A study on 81 patients who underwent partial cystectomy for bladder cancer is presented. The low postoperative mortality (2.46%) and the high 5-year survival (72%) show that this type of surgery is effective and without major complications. Thirty-eight patients were treated with endovesical thiotepa (OTT); the remaining 41 patients were untreated after surgery. Results showed that survival and number of relapses were similar in the two groups. This fact seems to prove that chemotherapy with OTT is not essential after segmental cystectomy. To explain this assertion, several hypotheses are presented.

This is a report on a case of 2 concurrent neoplasms of different histology within the same kidney: a renal cell carcinoma and a transitional cell carcinoma of the renal pelvis in a patient affected by chronic renal failure due to abuse of phenacetin. There was also a transitional cell carcinoma of the urinary bladder.