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INTRODUCTION AND OBJECTIVE:During last years, prostate cancer (PCa) detection has been improved by the implementation of software allowing to perform MRI-transrectal ultrasonography fusion-guided p...

INTRODUCTION AND OBJECTIVES:The correlation between PCa and increased levels of the most important androgens is well known. The aim of the present study was to evaluate prostate cancer (PCa)-induce...

Acute pyelonephritis (APN) was first described over 2000 years ago. Despite this long history, many points remain open and will be addressed in this narrative review.

Objective The most commonly used staging system for renal cell carcinoma (RCC) is the tumor-node-metastasis (TNM) system. In the most recent TNM edition, lymph node (LN) involvement is defined as pN0, pN1, or pN2, depending on the number of metastatic LNs (none, 1, or >1). This study evaluated the prognostic value of this classification and tried to improve its clinical impact by considering an additional parameter, that is, LN density (ratio between number of positive LNs and total number of LNs retrieved). Methods All pathologic reports of radical nephrectomies performed for RCC in two urologic centers between November 1983 and December 1999 were reviewed. For each patient, complete clinical and pathologic data, number of LNs removed, location and number of positive LNs, and LN density were recorded. The Kaplan-Meyer method and the log-rank test were used to calculate cause-specific survival rates and to compare survival curves, respectively. Results A total of 735 patients underwent radical nephrectomy. Lymphadenectomy was performed in 618 cases, and the rate of positive LNs was 14.2%. The 5-yr cause-specific survival rate of pN+ patients was 18%, with no statistically significant difference between pN1 and pN2. The average number of LNs removed was 13 (range, 1–35). The median number of LNs involved was 3 (range, 1–18). LN density ranged between 3.7% and 100% (median, 22.9%). The number of LNs removed had no impact on survival in pN+ patients. The only significant unfavorable prognostic factors were >4 LNs involved ( p =0.02) and LN density >60% ( p =0.01). Conclusion The results show that in RCC the current TNM stratification of positive LNs is not significantly correlated with prognosis. From our data it appears that classification as ≤4 or >4 LNs involved, supported by LN density, better reflects the impact of the disease on survival.

flow (ERPF) and regional Tc-MAG3 uptake to evaluate the benefit of AO clamping on postoperative renal function. METHODS: We included 58 patients who underwent laparoscopic partial nephrectomy for non-hilar exophytic renal tumors in this study. Arteryevein (AV) clamping was used for 26 of these patients, while arteryeonly (AO) clamping was used for 32. All patients had a functional contralateral kidney. We assessed effective renal plasma flow (ERPF) by Technetium-mercaptoacetyltriglycine (Tc-MAG3) renal scintigraphy preoperatively and at 1 week and 6 months postoperatively. In addition, we analyzed Tc-MAG3 uptake regionally in the surgically non-affected areas (Fig. 1). RESULTS: Mean tumor diameters were 3.0 cm in the AV group and 2.8 cm in the AO group. Warm ischemic time was significantly shorter in the AV group than the AO group (26.3 vs. 30.7 min, respectively, p 1⁄4 0.007). There were no differences in the estimated glomerular filtration rates or ERPF of the operated kidney between groups preoperatively or 1 week or 6 months postoperatively. The decrease in regional Tc-MAG3 uptake of the operated kidney at 1 week was correlated with warm ischemic time in both groups, being stronger in the AV group (p < 0.001) than in the AO group (p 1⁄4 0.027). This decrease was significantly less in the AO group when the ischemic time was 25 min (88.1% vs 102.5%, p 1⁄4 0.001). CONCLUSIONS: Ischemic renal damage during laparoscopic partial nephrectomy was lessened by applying AO clamping particularly in cases with prolonged ischemic time.

Background The advantages of robot-assisted radical prostatectomy (RARP) over laparoscopic radical prostatectomy (LRP) have rarely been investigated in randomised controlled trials. Objective To compare RARP and LRP in terms of the functional, perioperative, and oncologic outcomes. The main end point of the study was changes in continence 3 mo after surgery. Design, setting, and participants From January 2010 to January 2011, 120 patients with organ-confined prostate cancer were enrolled and randomly assigned (using a randomisation plan) to one of two groups based on surgical approach: the RARP group and the LRP group. Intervention All RARP and LRP interventions were performed with the same technique by the same single surgeon. Outcome measurements and statistical analysis The demographic, perioperative, and pathologic results, such as the complications and prostate-specific antigen (PSA) measurements, were recorded and compared. Continence was evaluated at the time of catheter removal and 48h later, and continence and potency were evaluated after 1, 3, 6, and 12 mo. The student t test, Mann-Whitney test, χ 2 test, Pearson χ 2 test, and multiple regression analysis were used for statistics. Results and limitations The two groups (RARP: n =60; LRP: n =60) were comparable in terms of demographic data. No differences were recorded in terms of perioperative and pathologic results, complication rate, or PSA measurements. The continence rate was higher in the RARP group at every time point: Continence after 3 mo was 80% in the RARP group and 61.6% in the LRP group ( p =0.044), and after 1 yr, the continence rate was 95.0% and 83.3%, respectively ( p =0.042). Among preoperative potent patients treated with nerve-sparing techniques, the rate of erection recovery was 80.0% and 54.2%, respectively ( p =0.020). The limitations included the small number of patients. Conclusions RARP provided better functional results in terms of the recovery of continence and potency. Further studies are needed to confirm our results.

Background Acute pyelonephritis (APN) is differently defined according to imaging or clinical criteria. In adults information on the relationship between imaging and clinical data is lacking. Our study was aimed at analysing the relationship between the clinical and imaging presentation of APN, defined according to imaging criteria (parenchymal involvement at MR or CT scan). Methods All consecutive patients hospitalized for "non-complicated" APN were considered (June 2005-December 2009). Clinical, biochemical and imaging data at hospitalization were analyzed by univariate and logistic regression analysis. Results There were 119 patients, all females, median age 32 years (15-72). At hospitalization, inflammatory markers were elevated (CRP median: 12.1 mg/dL, normal < 0.8). Incomplete presentations were frequent: fever was absent in 6.7%, pain in 17.8%, lower urinary tract symptoms in 52.9%. At CT or MR scan the lesions were bilateral in 12.6%, multiple in 79.8%; abscesses were present in 39.5%. Renal scars were found in 15.1%. Positive cultures were correlated with multiple foci (multivariate OR 4.2; CI 1.139-15.515). No other sign/symptom discriminated between small lesions, abscesses or multifocal involvement. Conclusions APN is a protean disease. In the absence of strict correlation with clinical or biochemical markers, imaging studies are required to assess the severity of kidney involvement.

Acute uncomplicated pyelonephritis (APN) is a complex clinical entity, which is defined differently based on clinical or imaging criteria. The aim of this study was to describe the clinical and radiological presentation of APN-upper urinary tract infection (UTI) cases observed between May 2005 and June 2006 and hospitalised in the Emergency Medicine ward of San Luigi Hospital, Orbassano, Turin, Italy. All patients underwent imaging scans and were differentiated on the basis of parenchymal involvement. Of around 45 000 patient visits to the emergency room between May 2005 and June 2006, 23 patients were diagnosed as having uncomplicated upper UTI (all female, age 15–57 years). Renal parenchymal involvement was confirmed by imaging in 16 cases (69.6%). The imaging spectrum ranged from a small single lesion to large multiple defects; on admission, 2 cases had no pain and 2 had no fever; lower urinary tract symptoms were present in only 13 patients (7 with parenchymal involvement). All patients with parenchymal involvement had at least one sign of systemic inflammation-infection. Most patients (15) had taken antibiotics before hospitalisation; consequently, urine cultures were negative in 21 cases (14 cases with positive imaging (87.5%)). The data from patients with and without parenchymal involvement overlapped, the only difference being a higher prevalence of high CRP levels in cases with parenchymal involvement.

OBJECTIVES: To present a pilot study of laparoscopic unilateral sural nerve grafting during radical prostatectomy, with the aim of preserving sexual potency. PATIENTS AND METHODS: Because they had localized prostate cancer, 29 men had a laparoscopic radical prostatectomy with deliberate wide unilateral neurovascular bundle resection and preservation of the contralateral bundle. Fifteen men (group A) had an interposition sural nerve graft on the sectioned bundle, and 14 (group B) had laparoscopic radical prostatectomy with preservation of the unilateral bundle only. The men were also involved in a rehabilitation programme, and erectile function was evaluated after surgery, and at 3, 8, 12 and 18 months, using the five-item version of the International Index of Erectile Function (IIEF-5) questionnaire. RESULTS: The two groups had similar clinical characteristics (age, prostate-specific antigen level, body mass index, prostate volume, clinical stage, Gleason score before and after surgery, postoperative stage). The follow-up was complete for 12 men in group A and 10 in group B. Group A had significantly higher erectile function scores on the IIEF-5 at 12 and 18 months than immediately after surgery (P < 0.01), whereas in group B the improvement was not statistically significant. Overall, by 18 months after surgery five of 12 men in group A had achieved spontaneous unassisted erection or erection assisted with sildenafil, while three of 10 in group B achieved an erection assisted with sildenafil (not significant). CONCLUSIONS: These data suggests that laparoscopic sural nerve grafting during radical prostatectomy is feasible and safe; nevertheless we cannot conclude that sural nerve grafting is more effective than preserving the neurovascular bundle alone in retaining sexual potency. More research is required to validate the effectiveness of this technique.