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Introduction and Objective: In this study, we reported the 2 years outcomes of orthotopic neobladder diversion according to the Studer modified technique described by Bianchi G. et al. This technique improves the stability of the reservoir and the urine-storage capacity. After radical cystectomy, urinary diversion is created with a spheroidal-shaped reservoir with a conic distal-part, obtained with 40 cm detubulized ileal segment, and a 15 cm of tubular afferent limb, where a Wallace ureteral anastomoses is made. The conic distal part of the neobladder that is anastomized to the urethral stump. After the reconstructive part, the neobladder and the afferent limb are attached to the elevator ani and psoas muscles, respectively. Materials and Methods: In all, 18 patients underwent radical cystectomy with the reconstruction of urinary diversion with the Modified-Studer Orthotopic technique, at S. Giuseppe Hospital. We studied the post-operative years of follow-up, especially with anamnesis of lower urinary tract, axial computerized tomography, and blood tests, according to the EAU guidelines. Results: We discover with TC 2 cases of low-grade bilateral hydronephrosis, associated with a slight increase in creatinine levels (1.4–1.8 mg/dL). No stricture at the neobladder-urethral anastomosis was detected. Three patients complain daytime urinary incontinence; only two patients report nocturnal urinary incontinence. One patient underwent ureteroscopy for lithiasis and 1 patient died for non-onco-urological disease. Conclusion: The modifications we applied to the Studer-Neobladder seems to improve urinary tract restoration, potentially decreasing long-term complications like hydronephrosis connected to ureteral anastomotic stenosis (11.1% vs 16.9% reported in literature) and urinary retention (0% vs 12% reported in literature). However, we discovered the same risk of diurnal and nocturnal incontinence reported in literature for the classic Studer Neobladder.

Renal colic is by far the most frequent urological emergency. Diagnosis relies on clinical history, physical examination, urine dipstick test, serum analysis (blood cell count and level of creatinine, uric acid, ionized calcium, sodium, C-reactive protein, procalcitonin, if available, glucose and lactate), ultrasound and sometimes computed tomography scan (CT). Contrast and full-dose radiation CT scan is rarely required and limited mainly to cases of acute flank pain with uncertain aetiology. Renal colic may be complicated by sepsis which should be early recognized and treated with antibiotics and renal drainage, either by ureteral catheterization or percutaneous nephrostomy placement. Pain control is subordinated to sepsis treatment and based on non-steroidal anti-inflammatory drugs and alpha-blockers. Acute urinary retention is mainly resolved by urethral catheter indwelling, but sometimes it is demanding, requiring suprapubic drainage or cystoscopy. Acute scrotal pain may harbour testicular torsion, especially in young adults. Therefore, immediate manual detorsion or surgical exploration is recommended unless an alternate diagnosis of scrotal pain is certain. Clinical history and physical examination are usually enough to suspect a torsion. Indeed, ancillary tests, like Doppler ultrasound of the testis or pertechnetate scintigraphy, should never delay treatment. Priapism is a rare urgency. Low-flow priapism should be identified and treated immediately to avoid permanent erectile dysfunction. Finally, Fournier’s gangrene, emphysematous pyelonephritis and emphysematous prostatitis are rare but life-threatening urological infections which may have a subtle presentation and occur mostly in subjects with uncontrolled diabetes. They need a multi-speciality approach including invasive procedures, like surgery or drainage.

We established diagnostic accuracy in terms of the sensitivity and specificity with which a rigorously trained canine olfactory system could recognize specific volatile organic compounds of prostate cancer in urine samples.Two 3-year-old female German Shepherd Explosion Detection Dogs were trained to identify prostate cancer specific volatile organic compounds in urine samples. They were tested on 362 patients with prostate cancer (range low risk to metastatic) and on 540 healthy controls with no nonneoplastic disease or nonprostatic tumor. This cross-sectional design for diagnostic accuracy was performed at a single Italian teaching hospital and at the Italian Ministry of Defense Military Veterinary Center.For dog 1 sensitivity was 100% (95% CI 99.0-100.0) and specificity was 98.7% (95% CI 97.3-99.5). For dog 2 sensitivity was 98.6% (95% CI 96.8-99.6) and specificity was 97.6% (95% CI 95.9-98.7). When considering only men older than 45 years in the control group, dog 1 achieved 100% sensitivity and 98% specificity (95% CI 96-99.2), and dog 2 achieved 98.6% sensitivity (95% CI 96.8-99.6) and 96.4% specificity (95% CI 93.9-98.1). Analysis of false-positive cases revealed no consistent pattern in participant demographics or tumor characteristics.A trained canine olfactory system can detect prostate cancer specific volatile organic compounds in urine samples with high estimated sensitivity and specificity. Further studies are needed to investigate the potential predictive value of this procedure to identify prostate cancer.

Background The National Research Council (CNR) prostate cancer monitoring project in Italy (Pros-IT CNR) is an observational, prospective, ongoing, multicentre study aiming to monitor a sample of Italian males diagnosed as new cases of prostate cancer. The present study aims to present data on the quality of life at time prostate cancer is diagnosed. Methods One thousand seven hundred five patients were enrolled. Quality of life is evaluated at the time cancer was diagnosed and at subsequent assessments via the Italian version of the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and the Short Form Health Survey (SF-12). Results At diagnosis, lower scores on the physical component of the SF-12 were associated to older ages, obesity and the presence of 3+ moderate/severe comorbidities. Lower scores on the mental component were associated to younger ages, the presence of 3+ moderate/severe comorbidities and a T-score higher than one. Urinary and bowel functions according to UCLA-PCI were generally good. Almost 5% of the sample reported using at least one safety pad daily to control urinary loss; less than 3% reported moderate/severe problems attributable to bowel functions, and sexual function was a moderate/severe problem for 26.7%. Diabetes, 3+ moderate/severe comorbidities, T2 or T3-T4 categories and a Gleason score of eight or more were significantly associated with lower sexual function scores at diagnosis. Conclusions Data collected by the Pros-IT CNR study have clarified the baseline status of newly diagnosed prostate cancer patients. A comprehensive assessment of quality of life will allow to objectively evaluate outcomes of different profile of care.

To critically review and synthesize data of ureteroscopy (URS) in different circumstances that all urologists may encounter during everyday clinical practice, such as pregnancy, obesity, bleeding diathesis, renal stones larger than 2 cm, calyceal diverticula, and kidney malformations. According to PRISMA guidelines, a systematic literature review was performed to identify articles published between 1990 and December 2013 that reported different indications and special circumstances for URS. Articles were separated into the following categories: pregnancy, obesity, bleeding diathesis, stones larger than 2 cm in diameter, calyceal diverticula, and kidney malformations. We used a narrative synthesis for the analyses of the studies, including a description of the characteristics and main outcomes reported in the articles. Records identified through database searching were 1396; at the end of study selection, articles included were 57. The majority of these are retrospective studies and involve small cohorts of patients. There does not exist a consensus about important parameters in ureterorenoscopy like stone size, stone free status and complication rate. Ureteroscopy is effective and reliable tool capable of treating the majority of stones even in the most complicated clinical scenarios and will have more fundamental roles in endourology. The lack of definitive conclusions is due to the great heterogeneity in collecting study’s results; multicentric randomized trials that define in advance the parameters to be studied should be encouraged.

Numerosi studi hanno dimostrato l’associazione tra l’uso di finasteride e la comparsa di disfunzioni sessuali e sindrome depressiva, che possono persistere dopo la sospensione del farmaco (Sindrome post-finasteride). I ridotti livelli di DHT e dei metaboliti della 5AR ad azione neuroattiva, in aree del SNC fondamentali per l’attivita sessuale e il tono dell’umore, sembrerebbero essere i responsabili della sindrome. In questo lavoro viene caratterizzata la sindrome, al fine di migliorarne la gestione.

Despite years of intensive investigation that has been made in understanding prostate cancer, it remains a major cause of death in men worldwide. Prostate cancer emerges from multiple alterations that induce changes in expression patterns of genes and proteins that function in networks controlling critical cellular events. Based on the exponential aging of the population and the increasing life expectancy in industrialized Western countries, prostate cancer in the elderly men is becoming a disease of increasing significance. Aging is a progressive degenerative process strictly integrated with inflammation. Several theories have been proposed that attempt to define the role of chronic inflammation in aging including redox stress, mitochondrial damage, immunosenescence, and epigenetic modifications. Here, we review the innate and adaptive immune systems and their senescent remodeling in elderly men with prostate cancer.

The actual gold standard for the diagnosis of prostate cancer includes the serum prostate-specific antigen, the digital rectal examination, and the ultrasound-guided systematic prostate biopsy sampling. In the last years, the real-time elastography has been introduced as an imaging technique to increase the detection rate of prostate cancer and simultaneously reduce the number of biopsies sampled for a single patient. Here, we evaluated a consecutive series of 102 patients with negative digital-rectal examination and transrectal ultrasound, and prostate-specific antigen value ranging between 2.5 ng/mL and 10 ng/mL, in order to assess the impact of real-time elastography versus the systematic biopsy on the detection of prostate cancer. We found that only 1 out of 102 patients resulted true positive for prostate cancer when analysed with real-time elastography. In the other 6 cases, real-time elastography evidenced areas positive for prostate cancer, although additional neoplastic foci were found using systematic biopsy sampling in areas evidenced by real-time elastography as negative. Although additional studies are necessary for evaluating the effectiveness of this imaging technique, the present study indicates that the limited accuracy, sensitivity, and specificity do not justify the routine application of real-time elastography in prostate cancer detection.

Study Type – Diagnosis (RCT) Level of Evidence 1b What’s known on the subject? and What does the study add? Transrectal gray-scale ultrasonography guided prostate biopsy sampling is the method for diagnosing prostate cancer (PC) in patients with an increased prostate specific antigen level and/or abnormal digital rectal examination. Several imaging strategies have been proposed to optimize the diagnostic value of biopsy sampling, although at the first biopsy nearly 10–30% of PC still remains undiagnosed. This study compares the PC detection rate when employing Colour Doppler ultransongraphy with or without the injection of SonoVueTM microbubble contrast agent, versus the transrectal ultrasongraphy-guided systematic biopsy sampling. The limited accuracy, sensitivity, specificity and the additional cost of using the contrast agent do not justify its routine application in PC detection. OBJECTIVE • To compare prostate cancer (PC) detection rate employing colour Doppler ultrasonography with or without SonoVueTM contrast agent with transrectal ultrasonography-guided systematic biopsy sampling. PATIENTS AND METHODS • A total of 300 patients with negative digital rectal examination and transrectal grey-scale ultrasonography, with PSA values ranging between 2.5 and 9.9 ng/mL, were randomized into three groups: 100 patients (group A) underwent transrectal ultrasonography-guided systematic bioptic sampling; 100 patients (group B) underwent colour Doppler ultrasonography, and 100 patients (group C) underwent colour Doppler ultrasonography before and during the injection of SonoVueTM. • Contrast-enhanced targeted biopsies were sampled into hypervascularized areas of peripheral, transitional, apical or anterior prostate zones. • All the patients included in Groups B and C underwent a further 13 systematic prostate biopsies. The cancer detection rate was calculated for each group. RESULTS • In 88 (29.3%) patients a histological diagnosis of PC was made, whereas 22 (7.4%) patients were diagnosed with high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation. • No significant differences were found among the three groups for cancer detection rate (P= 0.329). • Additionally, low sensitivity, specificity and accuracy of colour Doppler with or without SonoVueTM contrast agent were found. CONCLUSIONS • Prostate cancer detection rate does not significantly improve with the use of colour Doppler ultrasonography with or without SonoVueTM. • Although no collateral effects have been highlighted, the combined use of colour Doppler ultrasonography and SonoVueTM determines adjunctive costs and increases the mean time for taking a single prostate biopsy.

Prostate cancer is the fifth most frequent cancer in the world. However, none of the actual prognostic factors provide a valid index for predicting patient outcome. Here, we evaluate the two-dimensional vascularity in primary prostate tumors and surrounding non-tumoral parenchyma by means of fractal geometry, and assess any correlations between the results and some clinical and pathological parameters of prostate carcinoma. Prostate sections from 27 carcinoma patients were treated with CD34 antibodies. Two >10 mm 2 areas of tumoral and surrounding non-tumoral parenchyma were digitized using an image analysis system that automatically quantified the fractal dimension of the vascular surface. Data were correlated with patient's age, PSA level, clinical and pathological stage, Gleason score, tumor volume, vascular invasion, surgical margins, and biochemical relapse. Two groups of patients were distinguished on the basis of whether the fractal dimension of their tumoral vascular surface was higher ( group 1) or lower ( group 2) than that of the surrounding non-tumoral parenchyma. Statistically significant between-group differences were found in terms of serum PSA levels ( p =0.0061), tumor volume ( p =0.0017), and biochemical relapse ( p =0.031). The patients in group 2 had a poorer outcome. Our findings suggest a group of prostate cancer patients with a poor outcome, and the vascular surface fractal dimension as a helpful geometrical index in clinical practice.

Objectives To evaluate the complications and results of radical retropubic prostatectomy with the anatomic approach, at our center, to allow a comparison with published studies and precise patient counseling. Methods We reviewed the charts and records of the follow-up visits of all patients who consecutively underwent radical retropubic prostatectomy for clinically intracapsular prostate cancer between March 1997 and February 2002. Results The pathologic stage was pT0 in 4 patients (1.3%), pT2a in 83 (27.7%), pT2b in 116 (38.7%), pT3a in 52 (17.3%), pT3b in 38 (12.6%), and pT4 in the remaining 7 (2.4%). Extracapsular disease extension was present in 97 specimens (32.3%); it was associated with positive margins in 64 patients (21.3%). Intraoperative and postoperative complications were recorded in 19 patients (6.3%). Immediate surgical repair was necessary in 3 cases (1%) and delayed in 5 (1.7%). A stricture of the vesicourethral anastomosis was observed in 2 patients (0.7%). At a median follow-up of 29 months (range 6 to 57), a total of 262 patients (88.8%) was continent; 26 patients (8.8%) had stress incontinence, and 7 were incontinent (2.3%). Of 262 patients, 128 (48.2%) achieved continence within the first day of catheter removal. Conclusions Radical retropubic prostatectomy is associated with low complication rates; with the anatomic approach, a limited incidence of incontinence is attainable, consistent with major referral centers.

INTRODUCTION AND OBJECTIVES: The analysis of volatile organic compounds (VOCs) in urines is a promising approach to cancer detection. Here, we establish the level of accuracy at which a rigorously trained canine olfactory system can recognize specific prostate cancerVOCs in urine samples, thus reducing unnecessary prostate biopsies, and pinpointing patients at high-risk for prostate cancer. METHODS: A total of 677 subjects were investigated. All the subjects included in the study were placed in one of two main Groups: Prostate Cancer Group (n 1⁄4 320) and Control Group (n 1⁄4 357). Prostate Cancer Group includes patients with PC ranging from those at very-low risk to metastatic PC. Control Group includes a large and heterogeneous cohort of healthy subjects or patients affected by nonneoplastic diseases or non-prostatic tumors. Each patient’s clinical status and therapeutic regiment was known. We took into consideration all predictive values currently used in the clinical practice for prostate cancer management. Two dogs and a full-time, highly specialized, multidisciplinary team was dedicated. We have standardized a “work training” procedure and eliminated any possible olfactory interference. Each test was carried out blindfold. RESULTS: The dogs achieved the following performances: Dog 1: sensitivity 100%, specificity 97.8%, accuracy 98.9%. Dog 2: sensitivity 98.6%, specificity 95.9%; accuracy 97.3%. When considered together, Dogs 1 + 2, we found an accuracy of 98.1% with a sensitivity of 99.2% and a specificity of 97.1%. Whether excluded the female control sub-groups we found that Dog 1 achieved a sensitivity of 100% and a specificity of 97.9%, while Dog 2 a sensitivity of 98.6% and a specificity of 94.5%. When evaluating the wrongly detected cases no differences were found between epidemiological, clinical or histopathological characteristics. CONCLUSIONS: The present study first demonstrates that a trained canine olfactory system detects specific PC-VOCs in urine samples from a large number of patients with PC at different stages and risks versus a heterogeneous control group, which is unthinkable in current clinical urological practice. Thanks to the early intuition, we have definitely turned what used to seem a myth into a real clinical opportunity.

We recently developed a method for the isolation and purification of tumour-derived endothelium. In this study the phenotypic and functional properties of human tumour-derived microvascular endothelial cells (TdMEC) were examined. Endothelium obtained from human adrenal gland specimens (HAMEC) was used as a reference microvascular endothelial cell population. TdMEC formed a confluent monolayer with the typical morphological appearance of endothelium and were positive for endothelial markers such as Ulex-1 lectin, CD31 antigen, von Willebrand Factor and VE-cadherin. The addition of acidic Fibroblast Growth Factor (aFGF), basic FGF (bFGF) or Vascular Endothelial Growth Factor (VEGF) substantially improved proliferation of TdMEC; and kidney carcinoma derived endothelial cells were more responsive to FGFs, whereas glioblastoma derived endothelial cells greatly responded to VEGF. TdMEC expressed high levels of the VEGF receptors, KDR/flk-1 and Flt-1, as shown by northern blot analysis. TdMEC expressed the adhesion molecules ICAM-1, VCAM-1 and E-selectin that could be further increased by exposing TdMEC culture to interleukin-1. All the TdMEC expressed interleukin-8 mRNA. These findings show that TdMEC in vitro maintain several of the features described for microvasculature. Thus, TdMEC represent a useful tool to study markers for tumor vasculature.

In vertebrate organogenesis, the blood vessels constitute the first organ system that arises and reaches a functional state (Persson and Buschmann, 2011). Angiogenesis, the development of new branching vessels from existing vasculature, is a complex process observed in fetal growth, wound healing and endometrial hyperplasia associated with the menstrual cycle (Carmeliet, 2003). Under these conditions, it is highly regulated: i.e., “turned on” for brief periods of time and then completely inhibited. However, many human diseases, including tumors, are driven by persistently upregulated angiogenesis (Carmeliet, 2003, 2005; Hanahan and Weinberg, 2011). In some non-malignant diseases, such as lobular capillary hemangioma or keloid formation, angiogenesis is self-limited; however, this is not true of tumor angiogenesis, which, once begun, continues indefinitely until the entire tumor is eradicated or the host dies. Without blood vessels, tumors cannot grow beyond a critical size. Angiogenesis is regulated by a balance of proand anti-angiogenic molecules (Hanahan and Weinberg, 2011), secreted from cancer cells, endothelial cells and stromal cells (Fukumura et al., 1998), the relative contributions of which are likely to change with tumor type and site, as well as with tumor growth, regression and relapse. It is also ascertained that angiogenic vessels have a disorganized and irregular structure, and that the blood flow is abnormal. This is in contrast to the organized, regular structure and normal blood flow seen in mature vessels. Angiogenesis can be depicted as a non-linear dynamic process that is discontinuous in space and time, but advances through qualitatively different states. The term state defines the configuration pattern of the process at any given moment, and a dynamic process can be represented as a set of different states and a number of transitions from one state to another over a certain time interval. The continuum of these states generates a complex ramified structure that irregularly fills the surrounding environment. The main feature of the newly generated vasculature is the structural diversity of the vessel sizes, shapes, and connecting patterns. This is mainly due to the heterogeneous distribution of angiogenic regulators, such as vascular-endothelial growth factor, basic fibroblastic growth factor and angiopoietin, leading to hypoxic and acidic tumoral regions (Karlou et al., 2010). Moreover, although it is commonly believed that the endothelial cells making-up tumor vessels are genetically stable, tumor vasculature seems to be much more unpredictable (Streubel et al., 2004). These conditions all reduce the effectiveness of treatments, modulate the production of proand antiangiogenic molecules, and select a subset of more aggressive cancer cells with higher metastatic potential. The significance of angiogenesis in prostate cancer (PC) still remains controversial (Russo et al., 2012). While there are currently no markers of the net angiogenic activity of PC that can help investigators to design specific anti-angiogenic treatment strategies, it is reasonable to assume that the quantification of various aspects of tumor vasculature may provide an indication of angiogenic activity. One oftenquantified parameter of PC vasculature is microvessel density (MVD), which is used to allow a histological assessment of tumor angiogenesis. The results of studies carried out over the last decade have suggested the value of using MVD as a prognostic index in PC, and it has also assumed that MVD may reveal the degree of angiogenic activity in PC. MVD has, however, a number of limitations. The conflicting MVD results in PC are likely due to the differences in study designs: variability in patient population size, tumor topography, approach to selection of representative tumor areas, choice of endothelial marker, and actual counting method. The selection of the tumor area for MVD assessment has been based on two different approaches: (1) analysis of a few microscopic “hot spots” containing the maximal vascular density, and (2) selection of random representative areas of the tumor. The first approach is the most applied due to its simplicity, although there is no agreement among investigators regarding optimal microscope magnification, the number of vascular hot spots, and cutoff values for low vs. high MVD. The second approach of MVD assessment within larger representative areas or whole tissue may be more objective but involves more tedious examination. Despite its importance as a prognostic indicator in untreated tumors, MVD has not been shown to be a valid measure to guide or evaluate anti-angiogenic treatment (Hlatky et al., 2002). MVD does not appear to be predictive of tumor response under anti-angiogenic treatment and therefore may not be useful for stratifying patients for clinical trials (Rubin et al., 1999; Eberhard et al., 2000; Hlatky et al., 2002; Preusser et al., 2006; Erbersdobler et al., 2010). Low MVD does not portend a poor response to anti-angiogenic therapy (Vartanian and

BACKGROUND: To evaluate the feasibility and early side effects of a short course hypo-fractionated SBRT programme with Volumetric Modulated Arc Therapy (VMAT) and Flattening Filter Free (FFF) beams. METHODS: A prospective phase I-II study, started on February 2012. Inclusion criteria were: age

Prostate cancer (PC) remains a cause of death worldwide. Here we investigate whether a single microfocus of PC at the biopsy (graded as Gleason 6 or less, ≤5% occupancy) and the PSA

What's known on the subject? and What does the study add? Transrectal gray-scale ultrasonography guided prostate biopsy sampling is the method for diagnosing prostate cancer (PC) in patients with an increased prostate specific antigen level and/or abnormal digital rectal examination. Several imaging strategies have been proposed to optimize the diagnostic value of biopsy sampling, although at the first biopsy nearly 10-30% of PC still remains undiagnosed. This study compares the PC detection rate when employing Colour Doppler ultransongraphy with or without the injection of SonoVue™ microbubble contrast agent, versus the transrectal ultrasongraphy-guided systematic biopsy sampling. The limited accuracy, sensitivity, specificity and the additional cost of using the contrast agent do not justify its routine application in PC detection.• To compare prostate cancer (PC) detection rate employing colour Doppler ultrasonography with or without SonoVue™ contrast agent with transrectal ultrasonography-guided systematic biopsy sampling.• A total of 300 patients with negative digital rectal examination and transrectal grey-scale ultrasonography, with PSA values ranging between 2.5 and 9.9 ng/mL, were randomized into three groups: 100 patients (group A) underwent transrectal ultrasonography-guided systematic bioptic sampling; 100 patients (group B) underwent colour Doppler ultrasonography, and 100 patients (group C) underwent colour Doppler ultrasonography before and during the injection of SonoVue™. • Contrast-enhanced targeted biopsies were sampled into hypervascularized areas of peripheral, transitional, apical or anterior prostate zones. • All the patients included in Groups B and C underwent a further 13 systematic prostate biopsies. The cancer detection rate was calculated for each group.• In 88 (29.3%) patients a histological diagnosis of PC was made, whereas 22 (7.4%) patients were diagnosed with high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation. • No significant differences were found among the three groups for cancer detection rate (P= 0.329). • Additionally, low sensitivity, specificity and accuracy of colour Doppler with or without SonoVue™ contrast agent were found.• Prostate cancer detection rate does not significantly improve with the use of colour Doppler ultrasonography with or without SonoVue™. • Although no collateral effects have been highlighted, the combined use of colour Doppler ultrasonography and SonoVue™ determines adjunctive costs and increases the mean time for taking a single prostate biopsy.

Corporoplasty using plication of the albuginea is a simple technique but considered by many Authors at high risk for recurrence in respect to other corrective techniques using excision of the albuginea tunica. The aim of this study was to assess long-term functional and cosmetic results of this approach done in an outpatient environment.From January 1997 to December 2008 we submitted 217 patients presenting induratio penis plastica (183) or congenital curvature (34) to corporoplasty with albuginea plication. All patients were assessed preoperatively with history, physical examination and photographic documention of the erectile penis. These patients, all with vaginal penetration problems, were submitted to corporoplication with 2-4 sutures 2/0 (polyglycolic) contralateral to the curvature, using local anaesthesia on outpatient basis. Follow-up included functional and cosmetic results, eventual complications and level of patient satisfaction.Median follow-up of our study was 44 months (range 2-58). Complete correction of curvature was achieved in 206 patients (95%) whereas 87% reported good erectile function (IIEF-521). 145 patients (67%) reported penis shortening and 41% complained of palpating the sutures. Two patients required reoperation for recurring curvature. No perioperative complications or altered sensitivity of the glans were reported.Simple plication of the corpora cavernosa can be done on an outpatient basis using local anaesthesia with optimal functional and cosmetic results. The success of this minimally invasive approach makes it a valid alternative to standard excision of the tunica albuginea procedure. Detailed preoperative information concerning procedure expectations and treatment course are extremely important in obtaining complete functional and cosmetic patient satisfaction.

Prostate-specific antigen (PSA) levels can show wide fluctuations when repeatedly measured. Here we investigatewd if: (a) biopsy timing influences the prostate cancer (PC) detection rate in patients with fluctuating PSA (flu-PSA) in comparison with patients with steadily increasing PSA (si-PSA); (b) PSA slope estimated in patients with flu-PSA predicts a different risk of cancer detection; (c) flu-PSA and si-PSA patients develop PC in topographically different sites; (d) the behaviour of pre-operative PSA is an expression of a disease with defferent characteristics to the following radical prostatectomy.The study involved 211 patients who underwent at least a second biopsy after a first negative prostate biopsy. PSA Slope, PSA velocity (PSAV) and PSA doubling time (PSADT) were estimated. Flu-PSA level was defined as a PSA series with at least one PSA value lower than the one immediately preceding it.82 patients had flu-PSA levels and 129 si-PSA levels. There were no significant differences between the two groups in terms of cancer detection, clinical or pathological stage, but the si-PSA group with cancer had a higher Gleason score. No difference was found for PSA Slope between flu-PSA patients with cancer and those without.Our study demonstrates no difference in PC detection rate at repeat biopsy between patients with flu or si-PSA levels. PSA Slope, PSAV and PSADT were not found helpful tools in cancer detection.

To evaluate safety and outcomes of tubeless PCNL in comparison with standard PCNL.Since June 2002 we have performed 99 tubeless PCNL. Tubeless technique involves antegrade placement of a 6Fr double-J stent without nephrostomy tube at the end of the procedure. This series has been compared with a total of 110 patients in which revision of operative reports ruled out the presence of intraoperative conditions necessary to candidate a patient to tubeless procedure but standard PCNL was performed because prior to its introduction or because of surgeon's attitude afterward. Mean stone burden was 5.4 for standard group and 4.9 cm2 for tubeless group respectively. Mean BMI was 24.1 in the first group and 23.6 in the second one. In this retrospective study, complications rate, postoperative pain, length of hospitalization and convalescence were evaluated by chart review.Hematocrit drop did not differ significantly between tubeless PCNL and standard PCNL (5.5% vs 5.90%). Conversely, there was statistically significant difference between tubeless and standard PCNL in terms of the amount of analgesics (49.5 vs. 84.2 mg), immediate postoperative patients' discomfort, hospitalization (2.2 vs 5.3 days) and time to resume normal activities (11.0 vs 16.5 days).In our series, tubeless approach did not determine increase in complication rate. Conversely, tubeless PCNL reduced analgesics' requirement, patients' discomfort, hospitalization and time to recovery. As such, at our Institution, tubeless PCNL has become routine procedure that actually is feasible in almost 2/3 of renal calculi suitable for percutaneous treatment.

Background Appendiceal adenocarcinoma is rare with a frequency of 0.08% of all surgically removed appendices. Few cases of appendiceal carcinoma infiltrating the bladder wall for spatial contiguity have been documented. Case Presentation A case is reported of a 45-years old woman with mucinous cystadenocarcinoma of the appendix with bladder metastasis. Although ultrasonography and voided urinary cytology were negative, abdomen computed tomography (CT) scan and cystoscopy and subsequent pathological examination revealed a mass exclusively located in the anterior wall of the bladder. Histopathology of the transurethral bladder resection revealed a bladder adenocarcinoma [6 cm (at the maximum diameter) × 2,5 cm; approximate weight: 10 gr] with focal mucinous aspects penetrating the muscle and perivisceral fat. Laparotomy evidenced the presence of a solid mass of the appendix (2,5 cm × 3 cm × 2 cm) extending to the loco-regional lymph nodes. Appendectomy and right hemicolectomy, linfoadenectomy and partial cystectomy were performed. The subsequent pathological examination revealed a mucinous cystadenocarcinoma of the appendix with metastatic cells colonising the anterior bladder wall and several colic lymph nodes. Conclusions The rarity of the appendiceal carcinoma invading the urinary bladder and its usual involvement of nearest organs and the posterior bladder wall, led us to describe this case which demonstrates the ability of the appendiceal cancer to metastasize different regions of urinary bladder.

The objective of this study is to evaluate the safety and outcomes of tubeless PCNL in comparison with standard PCNL. Since June 2002, we have performed 99 tubeless PCNL. Tubeless technique involves antegrade placement of a 6Fr double-J stent without nephrostomy tube at the end of the procedure. This series has been compared with a total of 110 patients in which revision of operative reports ruled out the presence of intraoperative conditions necessary to candidate a patient to tubeless procedure but standard PCNL was performed because prior to its introduction or because of surgeon's attitude afterward. Mean stone burden was 5.4 for standard group and 4.9 cm(2) for tubeless group, respectively. Mean BMI was 24.1 in the first group and 23.6 in the second one. In this retrospective study, complications rate, postoperative pain, length of hospitalization and convalescence were evaluated by chart review. Hematocrit drop did not differ significantly between tubeless PCNL and standard PCNL (5.5 vs. 5.9%). Conversely, there was statistically significant difference between tubeless and standard PCNL in terms of the amount of analgesics (49.5 vs. 84.2 mg), immediate postoperative patients' discomfort, hospitalization (2.2 vs. 5.3 days) and time to resume normal activities (11.0 vs. 16.5 days). In conclusion, in our series, tubeless approach did not determine increase in complication rate. Conversely, tubeless PCNL reduced analgesics' requirement, patients' discomfort, hospitalization and time to recovery. As such, at our institution, tubeless PCNL has become routine procedure that actually is feasible in almost two-third of renal calculi suitable for percutaneous treatment.

It is now recognized that all human natural and diseased anatomic systems are characterized by irregular shapes and very complex behaviors. In geometrical terms, tumor vascularity (which is the result of a nonlinear dynamic process called angiogenesis) is an archetypal anatomic system that irregularly fills a 3-dimensional Euclidean space. This characteristic, together with the highly variable nature of vessel shapes and surfaces, leads to considerable spatial and temporal heterogeneity in the delivery of oxygen, nutrients, and drugs, and the removal of metabolites. Although these biologic features have been well established, the quantitative analysis of neovascularity in 2-dimensional histologic sections still fails to view its architecture as a non-Euclidean geometrical object, thus allowing errors in visual interpretation and discordant results concerning the same tumor from different laboratories. We discuss here the tumor-induced vascular system as a fractal object, and what changes this new way of observing may bring to the quantification of effective antiangiogenic therapies.

The aim of this study is to assess the therapeutic efficacy of nephron sparing surgery (NSS) in our experience applied to patients with either bilateral renal cancer or patients with cancer in a solitary functioning kidney, from an oncological viewpoint as well as renal function.From January 1997 to March 2006 we submitted 185 patients to NSS. Twenty-seven presented absolute indications with disease in functionally or anatomically solitary kidney. All but six patients presented with preoperative creatinine levels lower than 2 mg/dL. Access was always lombotomic. Nineteen patients underwent renal artery clamping and cold ischemia. Lesions were between 2 and 14 cm in size. In six cases the collecting system was formally opened.Follow-up was between 2 and 108 months. Final histology showed 17 patients with clear cell renal carcinoma, six papillary cell carcinomas, one chromophobe carcinoma, one oncocytoma and two angiomyolipomas. No major perioperative complications were recorded. Two patients died of lung metastases. Two patients present secondary tumours (lung and liver), whereas one patient is being treated with chemotherapy for colon cancer Twenty-two patients are disease-free. None of the 10 patients discharged with creatinine levels2 mg/dL, were submitted to dialytic therapy during follow-up. None of the patients discharged with normal renal function developed kidney failure.Conservative surgery for patients with absolute indications, is a valid alternative to radical surgery that obviously commits patients to long-term dialysis or renal transplantation. Our cases showed minimal surgical complications, brief hospital stay and limited invasiveness for patients with small incidence of kidney failure associated to the all important cancer control.

To determine whether a clinical significant adenocarcinoma of the cinoma (defined as a lesionor =1 mm. and too small for grading) at needle biopsy, even repeated, and through prostate specific antigen (PSA), PSA density (PSAD) and free-to-total PSA ratio (f/t ratio).Retrospectively 79/1610 consecutive patients undergoing prostatic needle biopsies presented one small focus of prostatic adenocarcinomaor =1 mm and too small for grading. All patients underwent PSA, PSAD and f/t ratio to evaluate positive predictive value for clinically significant disease. All patients were submitted to radical retropubic prostatectomy (RRP) and were divided into three groups: group A (28/79 patients, 35.4%) submitted to RRP after diagnosis of just one small focus of adenocarcinoma at first biopsy; group B (26/79 patients, 32.9%) submitted to RRP after two successive diagnoses of small focus of adenocarcinoma; group C (25/79 patients, 31.6%) submitted to RRP after diagnosis of adenocarcinoma larger than 1 mm at successive biopsy in which Gleason score had been applied.The three groups resulted comparable for age, PSA, f/t ratio and PSAD. Clinically significant disease was found in 48 of 79 patients (60.7%); 16 patients of group A (33.3%), 15 patients of group B (31.2%) and 17 patients of group C (35.4%) respectively. Finally, PSA, f/t ratio, and PSAD showed no predictive value neither globally nor in the single groups.No selective criteria with consolidated predictive values emerge from our study and this is in agreement with data in the literature, where the risk to find no significant clinical disease is 9-48% approximately. The aim of this retrospective study is to analyze the correlation between a single small focus of adenocarcinoma by prostatic biopsy, even repeated, and the clinical significant disease on the following radical retropubic prostatectomy. Furthermore, we verified whether some preoperative parameters could be helpful to identify the subgroups of patients which could need a more or less aggressive and/or timely treatment. Our data show that 30-40% of patients did not harbor a clinically significant disease at the following RRP. Furthermore, the assumed predictive value of repeat biopsies has not been confirmed in these patients and no other preoperative predictive values can be helpful.

The aim of this retrospective study was to evaluate the results of our miniperc series through comparison with results from standard percutaneous nephrolithotomy (PNL) and tubeless PNL series in the treatment of stones2 cm in diameter.A total of 134 percutaneous treatments were performed for renal stones2 cm in diameter. Among the treatments, 40 were minipercs, 67 were standard PNLs, and 27 were tubeless PNLs.Miniperc operative time was longer than that of standard PNL (155.5 vs 106.6 min, respectively) and tubeless PNL (95.9 min). Conversely, there was an advantage for miniperc over standard PNL in terms of a significantly reduced hematocrit drop (4.49% vs 6.31%). No miniperc patients required blood transfusions, whereas two did in the standard PNL group and one in the tubeless PNL group. There was no statistical difference in terms of the amount of analgesics between the standard PNL and miniperc groups, although this difference was statistically significant between the miniperc and tubeless PNL groups (73.8 vs 41.1mg, respectively). Hospitalization for the miniperc group was shorter than that required by the standard PNL group (3.05 vs 5.07 days), but tubeless PNL offered the best result (2.18 days). The stone-free rate was 100% in the tubeless PNL group, 94% in the standard PNL group, and 77.5% in the miniperc group.Our retrospective study failed to demonstrate significant advantages of the miniperc technique. As such, we no longer perform miniperc but instead use tubeless PNL when possible.

Conservative renal surgery (enucleation or segmentary resection) has become the gold standard treatment for small and peripheral malignant kidney lesions or in cases of reduced renal function or bilateral lesions. The aim of this study is to evaluate the incidence and treatment of complications of this technique in our experience.Between March 1997 and March 2005, 159 patients aged from 23 to 77 years (median 66 years) underwent conservative renal surgery. In 123 patients the indication was elective and in 36 imperative. In 92 patients lesions were located in the upper pole, 41 in the lower pole and 24 were meso-renal . Two patients suffered from von Hippel-Lindau (VHL) disease and therefore presented multicentric lesions. Mean lesion diameter was 3 cm ( range 1 to 9 cm). Retroperitoneal access with flank incision was the approach used in all patients. In 124 patients the technique consisted of enucleation with hypothermia from contact with sterile ice. Time to ischaemia was between 12 - 40 minutes. The collecting system was opened in 23 patients.Twelve cases of perioperative complications were encountered in this group of patients. Major complications were: two massive hemorrhage, two arteriovenous fistula, one lesion of the ureter, five cases of acute kidney failure. The two massive bleedings occurred within the first eight hours after surgery and necessitated surgical intervention to check a bleeding perinephric vessel. The arteriovenous fistulas, which occurred on the seventh and tenth postoperative day, were treated with selective percutaneous sclero-embolisation. The five acute kidney failures involved patients with functional or anatomical solitary kidney. No patient required dialysis in the post-operative period. Ureter lesion characterised the post-operative course of one solitary kidney patient affected by voluminous angiomyolipoma. Anuria and urine emission from drainage lead to exploratory lumbotomy which evidenced an iatrogenic lesion of the lumbar ureter that was treated with termino-terminal anastomosis. No other major complications were noted, with the exception of delay in intestinal canalization occurring in a 74 year old patient, and a wound infection in a patient with previous renal abscess associated to infundibular lithiasis and caliceal exclusion. There were no postoperative deaths.Conservative renal surgery is a valid alternative to radical surgery. In our study, as already reported in literature, surgical complications were slight in incidence and conservatively treatable. Therefore, nephron sparing surgery (NSS) can be performed with safety and maximum preservation of renal function.

A total of 13 patients with ureteral lesions wider than 12 cm in length and/or previous radiation treatment have been submitted to reconstructive treatment. Four patients with lesions after radiation therapy were treated with ileal ureter and contemporary bladder augmentation, one with ureteroneocystostomy combined with psoas hitch procedure and one combining psoas hitch and Boori Flap technique. The association of psoas hitch with Boari Flap technique were also used to treat two patients with the undesired outcome of vascular procedure. A patient after complete ureteral stripping following ureteroscopy was submitted to ileal bladder substitution. Two renal autotransplantations were performed in a patient with extensive stricture of the ureter following multiple endourological procedure and in a patient with negative outcome of previous attempt of open ureteral defect reconstruction following abdominal trauma.

Endopyelotomy is considered standard treatment for primary and secondary ureteropelvic junction obstruction. The aim of this study is to report our initial experience with the retrograde endopyelotomy technique.Between January 2000 and April 2003 we submitted to retrograde ureteroscopic holmium laser endopyelotomy 16 patients (9 males and 7 females) aged between 22 and 64 years. Obstruction was primary in 10 cases and secondary due to unsuccessful open pyeloplasty in the remaining six. No patient was affected by coexisting urinary lithiasis. Excretory urography and diuretic renal scintigraphy were performed preoperatively in all patients. Endopyelotomy was carried out using the holmium laser which delivered an energy level of 1.2 Joule at 10-15 Hertz. A double J ureteral stent remained indwelling postoperatively for 6 weeks and a vesical catheter for 24 hours. Average operative time was 75 minutes (range 50-90 minutes). Patients were assessed on follow-up by echotomography of the urinary tract and diuretic renal scintigraphy after 3 months and then at 6-month intervals.Patients were assessed on a mean follow-up of 18 months (range 6-41). Outcome was considered successful when symptoms were resolved and renal function improved. Success was obtained in 13 patients. Two patients were submitted to pyeloplasty with positive results and the procedure on one patient was converted to pyeloplasty due to intraoperative haemorrhage. Average postoperative stay was three days (range 1-4). No patient required blood transfusion with postoperative reduction in haematocrit of 0-9%, (mean 3%). Normal daily activity resumed after 3-4 days from discharge.Retrograde endopyelotomy in our initial experience is a safe and efficient technique that gives an excellent percentage of success with reduced complications and good patient compliance. The retrograde compared with the anterograde approach has the advantage of being less invasive, does not require nephrostomal derivation and further reduces hospital stay.

Introduction: The aim of this study was to apply a simple mathematical approach to calculate blood loss in 126 patients undergoing radical retropubic prostatectomy (RRP). Materials and Methods: Perioperative red blood cell loss (RBCL) was estimated by adding the difference in circulating red blood cells from before to after surgery to the allogeneic red blood cells transfused in the same period. Results: Mean preoperative hematocrit was 45 ± 4% and mean perioperative RBCL was 574 ± 297 ml, corresponding to a mean equivalent whole blood loss (WBL) of 1,479 ± 831 ml. Twenty of 126 patients (15.9%) received 42 units of allogeneic packed red blood cells (PRBC), for a mean of 2.1 ± 1.2 U/patient. The transfusion rate was higher in patients with a preoperative hematocrit of 40% or less (45 vs. 13%, p = 0.014). Conclusions: Anatomical RRP is still associated with appreciable operative blood loss. Owing to the high preoperative hematocrit values, the allogeneic blood transfusion rate is low and the transfusion requirement of the majority of patients is limited to about 2 units of PRBC. Preoperative autologous blood augmentation strategies may not be routinely needed for patients with a basal hematocrit of >40%.

Partial nephrectomy is an effective method of treatment for renal cell carcinoma. The aim of this study is to compare our experience with international literature dataBetween January 1997 and December 2000 a total of 50 renal units in 30 males and 18 women, 27 to 77 years old (mean age 60.6) with renal solid lesion of4 cm diameter were treated at our institution with nephron sparing surgery (NSS). The indications for NSS was elective in 43 case, imperative in 5. So far no local metastases, or vascular involvement have been encountered. The procedure was performed by 4 surgeons alternatively.In 25 patients histology revealed with clear renal cell carcinoma, one case of the chromophobe cell type, 6 papillary renal cell carcinoma, 8 oncocytomas, 8 angiomyolipomas, 1 multicystic and 1 simple cyst renal carcinoma. The complications were 1 acute reversible renal failure and 1 arteriovenous fistula. At the follow-up of 23 months no local or distant metastases were encountered. No significant differences in results were noted in regard to surgeon.Our results suggest that nephron sparing surgery is as effective as radical nephrectomy for treatment of localised RCC. The reduced incidence of complications associated with a minimum complexity of the procedure and the results make this technique approachable by surgeons of different technical experience.