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- Cavernosograms were used in the investigation of 22 patients with prostatic cancer to determine the incidence of venous invasion. There were 21 patients with T3/T4 category tumours and one with a T2 tumour. All but one, a T3 tumour, had the radiological features of periprostatic venous malignant thrombosis. An attempt was made to correlate these findings with lymphography and tumour grade but no correlations could be made and the clinical relevance of these findings remains uncertain. [ABSTRACT FROM AUTHOR]

Infection with hepatitis C virus (HCV) is imerging as a major cause of morbidity and mortality in renal transplant recipients. The precise evaluation of the immunosuppressive degree in the context of this entity becomes imperative because of the risk of hepatocarcinoma emergence and the aggravation of the renal disease under overimmunosupression conditions. We included in this study a number of 62 pacients with renal transplant, 42 pacients presented HCV, 20 pacients without HCV infection. In HCV positive group we identified 15 patients with HBV coinfection and 15 with diabetes mellitus post transplant occurring. The acute reject occurred with 7 patients and the chronic one with 4 patients with the HCV positive group. We determined the lymphocyte subsets with all these patients as if under specific conditions of reject, diabetes mellittus and HBV coinfecion, using the flow cytometric method. The results demonstrated an increase in all lymphocyte subsets with HCV-infected patients. With HCV/HBV-infected patients, the level of all lymphocytes is reduced. In patients with diabetes mellittus and HCV infected, a substantial increase of CD8 can be noticed. With acute or chronic reject at HCV positive patients with renal transplant, a substantial increase of natural killers cells (NK) can be noticed, cells with an important part played in the promoting of the hepatocellular injury. HCV infection determines a stimulation of the cellular imunity mechanisms. HCV/HBV coinfection induces a decrease of the potential risk of reject. The increasing of LT CD8 may be related to the high risk of diabetes mellitus occurrrence. Under reject circumstances, either acute or chronic, the raise of NK may induce and promote lesions of the hepatic cells with patients with renal transplant HCV infected. [ABSTRACT FROM AUTHOR]

Introduction: With a growing shortage of organs for transplantation, finding ways of increasing the donor organ pool remains of utmost importance. Perfusion machines (PM) have been proven to enhance the potential for kidney transplants to function sooner, last longer, giving patients the opportunity for a better life quality., Objective: The aim of this study is to evaluate the relation between the resistance index provided by the PM, the postoperative resistance index measured by Doppler ultrasound and the initial graft outcome., Material and Method: Between January 2012-December 2012, clinical data obtained from 82 consecutive renal transplants from brain death donors (BDD) which underwent PM maintenance were analyzed in a transversal study. Prior transplantation we recorded the solution temperature, filtration rate and the resistance index provided by PM. After the surgical intervention, each patient had standard follow-up. Doppler ultrasound resistivity index (RI) was recorded on the first postoperative day., Results: Out of 115 renal transplants, 98 (85.21%) were performed with grafts from BDD. The PM was used for 82 renal grafts. The Doppler resistance index in relation to the resistance index shows a highly statistical correlation by linear regression (R=0.813, p<0.0001). Primary graft function was recorded in 74 patients (90.24%) and it was highly statistically significant correlated with the resistance index measured by PM. Out of 8 patients with primary non-function, 6 patients recovered with normal graft function at one year., Conclusion: The resistivity index recorded by the life-port machine is correlated with the vascular resistivity index measured by Doppler ultrasound and thus it may predicts the primary graft outcome.

Biomarker-based post-transplant immune monitoring for the prediction of impending graft rejection requires validation in specific patient populations. Serum of 28 pediatric renal transplant recipients within the framework of a well-controlled prospective randomized trial was analyzed pre- and post-transplant for soluble CD30 (sCD30), a biomarker reflecting mainly T-cell reactivity, and anti-human leukocyte antigen (anti-HLA) antibody reactivity, a biomarker for B-cell activation. A sCD30 concentration ≥40.3 U/ml on day 14 was able to discriminate between patients with or without biopsy-proven acute rejection (BPAR) with a sensitivity of 100% and a specificity of 76%. Six of seven patients (86%) with BPAR showed a sCD30 above this cut-off, whereas only 3/21 patients (14%) without BPAR had a sCD30 above this cut-off (P = 0.004). For pre- and post-transplant anti-HLA class II reactivities by enzyme-linked immunosorbent assay, a cut-off value of 140 optical density was able to discriminate rejecters from nonrejecters with a sensitivity of 86% or 71% and a specificity of 81% or 90%, respectively. Withdrawal of steroids was associated with a approximately twofold higher serum sCD30 compared to controls, but did not affect anti-HLA reactivities. An increased post-transplant sCD30 serum concentration and positive pre- and post-transplant anti-HLA class II reactivities are informative biomarkers for impending BPAR in pediatric renal transplant recipients. (TWIST, Clinical Trial No: FG-506-02-43)., (© 2012 The Authors Transplant International © 2012 European Society for Organ Transplantation. Published by Blackwell Publishing Ltd.)

For most patients with chronic kidney failure, kidney transplantation has the greatest potential for restoring a healthy and productive life. The risk of acute rejection is the highest in the first months after transplantation (induction phase) and diminishes afterwards (maintenance phase). Immunosuppression should be at the highest level in the early period and reduced for long-term therapy. At present, conventional immunosuppressive protocols consist of the triple therapy: a calcineurin inhibitor, an adjunctive agent, corticosteroids. The development of new immunosuppressives drugs is aimed not only at improving short-term outcomes, but also achieving better safety, less nephrotoxicity and minimal side effects.

Introduction: Acute rejection (AR) is a major determinant of renal allograft survival. The incorporation of new immunosuppressive agents explains the improvement seen in the results of transplantation in recent years., Objective: To assess the optimal immunosuppression regimen according to the immunological risk of renal transplant patients., Method: We performed a retrospective study of 977 consecutive patients transplanted in our institution between January 2000 and December 2011. Recipients were classified according to the immunological risk (high, intermediate and low) and the type of induction therapy received. We evaluated the incidence of early acute rejection (eAR) and late acute rejection (lAR) and their influence on graft and patients survival in relation to the immunological risk and induction regimen used., Results: The incidence of eAR was 5.4%, 6.4% and 1.4% in relation with the immunological risk, high, intermediate and low respectively. The most commonly used induction immunosuppression was rabbit antithymocyte globulin (ATG), followed by methylprednisolone and basiliximab. No statistical difference was found between the incidence of eAR according to the type of induction therapy and immunological risk. The graft survival was significantly better for the cases without eAR at 1 year (98.6% versus 94.4%, p=0.019), and 3 years (94.9% versus 88.9%, p=0.056). The patients survival was significantly better for those without eAR at 1 year after transplant (95.7% vs. 88.9%, p=0.051), 3 years (93.1% vs. 83.3%, p=0.008) and 5 years (92.2% vs. 79.6%, p=0.001). The incidence of lAR was between 0 and 7.1% according to the induction therapy, lacking any statistical significance (p=0.450)., Conclusion: Tailoring the induction immunosuppression according to the immunological risk reduces the incidence of early acute rejection.

We present the case of a 52-year-old Caucasian male, admitted to our institution for a verumontanum adenocarcinoma, partially resected endoscopically, a month earlier at another urological clinic. The prior pathological examination wasn't able to give diagnosis. The extensive assessment by clinical workup, ultrasound, flexible cystoscopy, CT scan, and MRI revealed a prostatic tumor extending from the verumontanum to the left lobe and seminal vesicle. The patient underwent radical prostatectomy. The pathological examination revealed a ductal like adenocarcinoma, positive on immunohistochemistry for pan cytokeratin (AE1/AE3), CD10, endomysial antibody EMA and progesterone receptors (PR) and negative for prostate specific antibody (PSA), prostatic specific acid phosphatase (PSAP) and androgen receptors (AR). Ductal like adenocarcinoma of the prostate with endometrioid immunohistological features in the absence of prostate markers is an unusual condition.

Introduction: The manner to extract the specimen after retro-peritoneoscopic nephroureterectomy varies to different surgical teams. The aim of the surgeon is to extract the specimen with minimum parietal injuries, according with oncologic principles. The objective of our study was to evaluate the ilio-inguinal approach to extract the specimen after retro-peritoneoscopic nephroureterectomy., Material and Method: Evaluation and follow-up of 71 patients with retroperitoneoscopic nephroureterectomy for urothelial cancer (65 pelvic urothelial carcinoma and 6 urothelial carcinoma of the ureter). Ilio-inguinal incision was used for 68 patients to extract the specimen., Results: The operating time was 110 +/- 47 min. Blood lost 101 +/- 57 ml. Retroperitoneoscopic approach 10 +/- 4 min. Ilio-inguinal approach 25 +/- 10 min. The weight of the specimen was 601 +/- 127g. Tumor dimension was 5.9 +/- 1.9 cm. No conversion to open surgery was made. No late post surgery complications were registered ( follow-up at 2 and 6 months)., Conclusions: The enlarged nephroureterectomy can be performed using retroperitoneoscopic approach and the specimen can be extracted through an incision at iliac fossa. This approach can be used to extract large specimens preserving the esthetic laparoscopic benefit as well as the oncologic salty and reducing the risk of post-operative eventration.

Introduction & Objective: Hypospadias surgery carries a hole list of precocious and late complications which may occur even years later after surgery such as a very late fistula or a recurrent chordee. The aim of this article was to investigate the reasons, why a significant number of patients with different types of hypospadias presents the same kind of postoperative complications., Materials and Methods: Records of 51 boys who underwent surgery for different types of hypospadias were reviewed. Primary repair was performed in 41 patients. 12 (29.4%) of them had postoperative complications. 10 boys had previously between 1 to 7 repairs. The complications were those mentioned in the literature (fistulas, stenoses, megalo-urethra and relapse of the ventral curvature). The etiology of the complications was evaluated according to the type of hypospadias, the surgical technique used for the initial corrective surgery and postoperative care., Results: The original malformation had been miss-classified in 10% of the cases; technical mistakes occurred in 70% of the cases; complications derived from the complexity of the repair procedure were documented in 10% of the cases, and in 10% of the cases the cause was complex: technical and postoperative care mistakes., Conclusions: Complications after hypospadias surgery appears due to five main reasons which usually coexist. In order to prevent complications, an accurate classification must be made, the surgical procedure has to be chosen accordingly, the surgical technique must be perfect and the postoperative care adequate.

Nephron-sparing surgery (NSS), has been demonstrated to be a safe and effective alternative to radical nephrectomy for selected cases. Retro-peritoneoscopic cryoablation (RCA), combine the benefits of minimal invasiveness of the laparoscopy with the advantage of preserving renal function of the nephron sparing surgery. The aim of our study was to assess the initial results with RCA of small renal tumors. Since Jan 2007, twelve consecutive patients, with small renal tumors (mean tumor size 3.89 cm) underwent RCA at our institution. The patients were assessed using: clinical exam, lab exam, ultrasound, contrast enhanced CT scan. For cryoablation, we used the Galil Medical SeedNet with 17 Gauge cryoprobes, under combined retro-peritoneoscopic and ultrasound guidance. Protocol follow-up design includes clinical exam, lab exam and contrast enhanced CT scan at 3,6 and 12 months and annually thereafter. Mean surgical time was 145.42 min. and mean blood loss was 179.17 ml. Two patients presented: bleeding at the extraction of the cryoprobes and urinary fistula which healed with surgical treatment. Histological examination of the core biopsy revealed clear cell carcinoma in 8 patients, papillary carcinoma in 3 patients and angiomyolipoma in 1 patient. Cryosurgical ablation of small renal tumors using multiple ultrathin 17 Gauge cryoprobes is a feasible treatment option. Retro-peritoneoscopic approach allows optimal access to the kidney and endoscopic real-time ultrasound control of the freezing process.

Unlabelled: Tumor location on the posterior aspect of the kidney or close to the renal hilum could increase the difficulty of the retro-peritoneoscopic radical nephrectomy. The aim of our study was to assess how tumor location influences the difficulty of the retro-peritoneoscopic radical nephrectomy., Patients and Method: We performed a nonrandomized prospective study in 116 patients with localized renal cell carcinoma who underwent RRN, between Jan. 2000 and Jan. 2005. Twenty-nine patients with a tumor located close to the renal hilum or on the posterior aspect of the kidney (Gr.A) were compared with 87 patients with a tumor at a distance from the renal hilum (Gr.B) in terms of operative time, intraoperative blood loss, and difficulty of the dissection. The difficulty of the dissection was subjectively estimated by the main surgeon using a three degree scale (G1-easy, G2-medium, and G3-difficult). All the operations were finalized by retro-peritoneoscopy and G4-very difficult degree--was not recorded. In the Gr. A, the operative time was longer (117.28 min vs. 94.63 min, p < 0.001) and blood loss was higher (291.86 ml vs. 199.54 ml, p < 0.001). The dissection of the renal pedicle was also more difficult in the Gr. A either for artery dissection (G3 27.59% vs. 11.49%, p = 0.0202) or for vein dissection (G3 20.69% vs. 8.05%, p = 0.0321), while peri-fascial dissection was less frequently difficult (G3 10.34% vs. 28.74%, p = 0.0237). Tumor location close to the renal hilum or on the posterior aspect of the kidney increases the difficulty of renal pedicle dissection.

Radical cystectomy is the standard therapy for invasive bladder cancer, with best oncological results compared to any other therapeutic alternative. Even if laparoscopic radical cystectomy (LRC) is a well established surgical procedure, performing the urinary diversion completely intracorporeal, is still a challenge due to technical difficulties and associated complications. The aim of our study is to present the first series of LRC with ureterosigmoidostomy. Since May 2004 were performed 7 LRC (5 males and 2 females) (Gr. A). All cases were T2N0 clinical stage. These patients were compared with a retrospective group of 50 patients who underwent open procedure (Gr. B) in term of: operative time, blood loss, analgesic requirements, and hospital stay. LRC has a longer operative time but with statistically significant lower blood loss, less analgesia, and shorter hospital stay. The resection margins of the surgical specimens were tumor free at pathologic examination. Long-term follow-up is pending. On short-term, the results of laparoscopic radical cystectomy are encouraging. When significant experience in laparoscopic surgery is lacking, surgeons should exercise caution with completely intracorporeal urinary diversion.

Purpose: To describe our experience and operative technique for retroperitoneoscopic nephrectomy for pyonephrosis and to compare the results with those of open surgery., Patients and Methods: Since October 1998, 23 successful retroperitoneoscopic nephrectomies for pyonephrosis were performed in our institution (Group A). These patients were compared with 23 patients, matched by age, sex, and body weight, who underwent classic lumbotomy for pyonephrosis (Group B). The two groups were compared in terms of operative time, blood loss, hospital stay, wound complications, and time of return to previous occupation., Results: All the features studied except operative time were significantly different in favor of laparoscopy., Conclusion: Although technically difficult, retroperitoneoscopic nephrectomy for pyonephrosis is feasible. The extraperitoneal approach allows direct access to the renal hilum and helps avoid spillage of pus into the peritoneum.

Background and Purpose: Extrinsic ureteral obstruction caused by various malignancies often necessitates urinary diversion. The use of single ureteral stents as a form of urinary diversion results in a high failure rate, while the use of two ipsilateral stents has shown promising results. We report our experience using the latter technique., Patients and Methods: Between 1996 and 2001, four male and three female patients with a mean age of 65 years (range 37-95 years) who had extrinsic compression of the ureters underwent single stent management to relieve obstruction. Ureteral obstruction was secondary to prostate cancer (N = 3), cervical cancer (2), non-Hodgkin's lymphoma (1), and transitional-cell cancer of the bladder and ureter (1). After failure of such management, two 7F stents or a combination of 8F/6F double-J ureteral stents were placed. The stents were changed every 4 to 6 months. Follow-up included serial renal ultrasound scans and serum creatinine measurements., Results: Ureteral stricture length ranged from 2 to 4 cm. Insertion of two double-J ureteral stents in a single ureter was successful in all cases. During the mean follow-up of 16 months (range 1-38 months), the ureteral stents were tolerated by all patients, without significant discomfort. Marked improvement of hydronephrosis and alleviation of flank pain was noted in all patients. Three patients have died at 1 to 3 months. Renal function improved, with a mean decline in the serum creatinine concentration from 3.2 mg/dL to 1.48 mg/dL in the five patients tested., Conclusion: Simultaneous placement of two double-J ureteral stents for the management of ureteral obstruction secondary to a malignancy is a safe and effective technique.

Renal ultrasonography was performed in 40 patients. Complex exploration was carried out in 12 patients with renal tumours, such as: urography, renal scintigrams, renal arteriography, ultrasonography and cavography. Laminography was proved to be an useful method in the positive and differential diagnosis of renal tumours, especially of cystic ones. Informations provided by this technique are not absolute, and these are some possibilities for errors which operate both ways: omission of malignancies or affirmation of malignancy when the lesion is benign. The method should be considered as complementary in the field of renal investigations and will be interpreted in the general context.