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Purpose To assess the diagnostic accuracy of iXip, a novel biomarker for prostate cancer detection at initial biopsy based on an algorithm including patient age, prostate volume, PSA and PSA-IgM levels,. Materials and methods This was a prospective multicenter study involving 426 consecutive men undergoing initial prostate biopsy with at least 12 cores in a real-life clinical setting. Diagnostic accuracy of iXip for prostate cancer detection was calculated with AUC and compared to that of prostate volume, PSA and PSA-IgM levels. The correlation of iXip with tumor aggressiveness, defined as any cancer with Gleason score ≥7, was evaluated by Spearman ρ coefficient analysis. Results Prostate cancer was diagnosed in 193/426 patients (45%), of which 65 (35%) had Gleason score ≥7. iXip values were significantly higher in patients with cancer than in those without cancer (median value 55% vs. 39%, p Conclusions Our prospective multicenter study suggests that the novel biomarker iXip may be used with a 20% cut-off value in order to reduce the proportion of prostate biopsies by approximately 5%, without missing a single case of cancer. Moreover, higher iXip values are significantly correlated with tumor aggressiveness.

Our experience with laser treatment of urethral strictures with a 980-nm diode laser is reported.45 consecutive patients with relapsing urethral strictures (mean age 65, range 25-85 years) were treated between February 1995 and February 1998. The fibrous and scar tissue was cut and vaporized at the 6 o'clock position with the laser beam.44/45 patients were available for follow-up at 1 year and 32/43 at 2 years. At 12 months the average peak flow rates of the patients was 18 ml/s, and at the second year assessment it was 15.5 ml/s. Of the patients 21/44 (47.7%) were extremely satisfied (0-1 of the quality-of-life, QoL, assessment index) with the procedure, 14/44 (31.8%) were satisfied (2 of the QoL assessment index), and 9/44 (20.4%) were not satisfied (or = 3 of the QoL assessment index) due to the low flow rate or the recurrence of the stricture. (The sum of the first two categories is 79.5%.) At the second year assessment the percentage of satisfied patients reached 78%, with 71% of the patients stable without any dilatation.Usually in recurrent strictures of the urethra open surgery is suggested, but we believe that there is still a place for endoscopy. With the laser we can make an incision at the 6 o'clock position without significant bleeding, very easily opening the urethra. We had 79.5 and 71% good results at the 1- and 2-year assessments (mean peak flow rate of 18 and 15.5 ml/min), respectively. To date, no definitive conclusions can be drawn, but we believe that laser treatment is indicated for recurrent strictures in high risk or elderly patients and in those who demand a minimally invasive procedure.

Aim of the Study: To evaluate clinical, urodynamic efficacy and safety of TURP and TVP in patients with symptoms due to obstructive benign prostatic hypertrophy with a prospective m

The authors describe their experience over 10 years regarding the treatment of 131 patients with injury to their urogenital organs. The work highlights the different diagnostic and therapeutic approach between patients with multiple injuries and those with just one. Conclusions are given after reviewing the type of injuries and relevant treatment.

BPH patients may be asymptomatic or symptomatic and the latter with or without obstruction. Symptoms may be independent of the obstruction. The endoscopic or surgical ablation of the enlarged gland has a percentage of failure in all reports. The urodynamics study including uroflowmetry, pressure flow study with application of nomogram for the obstruction provides a certain diagnosis of obstruction in the majority of cases.

The Authors describe their limited but significant experience (101 cases) regarding the diagnostic and therapeutic approach to patients with multiple traumas with involvement of the urogenital tract. Approach to the renal trauma in these patients appears to be highly controversial. Experience has shown that in cases of severe renal trauma, when the urologist is called immediately to visit the patient so that a complete and correct urological diagnostic procedure can be planned, the possibilities of conservative treatment to save the kidney are greater.

— Laser treatment of benign prostatic hypertrophy (BPH) has gradually become more widespread over the last few years. In the USA it is considered an alternative to endoscopic resection as far as insurance payments are concerned. Different methods are used but the most common and suitable one for urologists is the removal and coagulation of the prostatic tissue under visual control (VLAP or ELAP). The Authors report their personal experience in this type of treatment where good results are due to: 1) combination of a powerful, stable laser source 2) durable side-emission contact fibre 3) laser resector, which also in the absence of epicystostomy maintains a good flow during the operation. However, “laser resection” should still be considered an experimental procedure to be used for randomised protocols or on selected patients (high risk of bleeding, Jehovah's witnesses, carriers of pace-maker, etc.).

Leydig Cell Tumours (LCT) account for 3% of all testicular tumours; 10% are malignant and are refractory to radio- and chemotherapy. The role of Retroperitoneal Lymph Node Dissection in clinical stage I LCT is therefore a particularly debated one. From March ‘83 to December ‘95, 10 patients with LCT were subjected to orchiectomy (1 of them bilaterally because of a metachronous tumour). In 10 out of 11 specimens the following pathological features – a) size larger than 50 mm, b) infiltration of spermatic cord, c) lymphatics and veins, d) capsule, e) necrosis, f) cellular pleomorphism, g) numerous mitoses, h) nuclear atypia – were absent. The only patient in which b) and d) were present was subjected to RPLND. After a follow-up ranging from 17 to 157 months all patients are disease-free. Abstention from RPLND in clinical stage I LCT therefore seems the more rational choice when the above- listed pathologic features are absent.

After having outlined the approaches for radical nephrectomy and after some critical considerations, the authors dwell upon the current indications for conservative surgery of renal cell carcinoma. They discuss the problems related to such therapy, emphasizing the advantages and possible risks. In particular, the problems connected with multifocal lesions and peritumoral spread are examined, the real clinical meaning of which is at present unknown, as shown by the discrepancy between experimental and clinical data. Then the authors present their own experience concerning 11 cases of renal carcinoma who underwent conservative surgical treatment between January 89 and September 92. None had relapses nor further progression. The conclusion is that, although the results of such surgery are very encouraging, nonetheless prospective studies and a wider selection of cases are required in order to define its role in the treatment of renal carcinoma.

Several different parameters, both clinical and pathological are used to prognosticate renal parenchymal carcinoma (RPC). In the present report we have analyzed prognosis according to our experience, based upon the pathological staging of disease performed at the time of nephrectomy, early diagnosis, nuclear grading, the infiltration of blood vessels and metastases.

Between 1980 and 1990, 135 patients underwent nephrectomy in our Department for renal cell carcinoma. Two groups were identified: Group 1 (72 patients) had the adrenal gland removed; group 2 (63 patients) did not undergo removal of the gland. In group 1 only one patient had ipsilateral adrenal gland neoplastic involvement. This patient also had hepatic metastasis and died 4 months after surgery. Differences in the time of survival after surgery were not statistically significant between groups. In the light of present findings and on the basis of data reported in literature, the problem of systematic adrenalectomy as part of radical nephrectomy is discussed.

– A retrospective analysis was carried out to assess the prognostic significance of microvascular invasion (mV) in 48 patients with pT3aN0M0 renal cell cancer. mV is defined in this study as the definite presence of neoplastic thrombosis, more or less adhering to and/or infiltrating the walls of the small venous vessels. Taking into consideration just neoplasms with a nuclear grading of 2 and 3 (according to Fuhrman), at the time of the study 65% of deceased patients were mV+, while 74% of living patients were in mV-. The probabilities of survival, according to Kaplan Mayer, in the two groups of patients appear to be significantly influenced by the mV+ and mV- factor. It can be concluded that this factor, histologically easy to determine, is useful for selecting a sub-group of patients with a more unfavourable prognosis.

Sixty-nine patients with localised prostatic cancer, who could not undergo radical prostatectomy due to loco-regional lymph node metastasis or anaesthesiological counter-indications, were subjected to a combined treatment, radiation therapy and androgen deprivation. All patients underwent pelvio-lymphadenectomy and those with cervico-urethral obstruction, endoscopic resection of the prostate. There was a progression of the disease in 33% of patients with lymph node metastasis (median time of progression 33 months) and in 27% of those without (median time of progression 22 months). Stable disease in 67% of patients (median follow-up over 3 years).

Four cystine stones immersed in water or aqueous solutions of carmine indigo (4% diluted 1:20) or methylene blue (1% diluted 1:20) with rifamycin (0.6% and 6%) and rifampicin (0.3% and 0.3%) were t...

To evaluate clinical, urodynamic efficacy and safety of TURP and TVP in patients with symptoms due to obstructive benign prostatic hypertrophy with a prospective multicentric randomized study.150 patients with BPH, urodynamically obstructed, were randomized to receive TURP or TVP. At the end of the recruitment phase, 80 patients underwent TURP and 70 patients underwent TVP. Patients were clinically evaluated by the I-PSS score at months 0, 1, 3, 6 and 12. Preoperative evaluation included complete blood routine examination, PSA, transrectal ultrasound and pressure/flow studies. Pressure/flow studies were also performed after 3 months.There was no statistical difference between groups in any of the preoperative parameters. All patients were considered urodynamically obstructed at preoperative pressure studies. As for catheter days and hospitalization days, statistical differences between TVP and TURP were found; catheter days were 2.71 days (SE 0.12) in the TURP group vs. 1.9 (SE 0.24) in the TVP group (p0.000). Hospitalization was 4.7 days (SE 0.22) after TURP and 3.9 days (SE 0.24) after TVP (p0.000). Mean preoperative I-PSS score was 18.84 and 18.19 in the TVP and TURP groups, respectively. At 3, 6 and 12 months, IPSS was 5.52 and 5.50, 3.77 and 4.94, 3.52 and 4.04 for TURP and TVP, respectively. Mean preoperative peak flow rate (PFR) was 8.78 and 7.26 ml/s for TURP and TVP, respectively; after 3, 6 and 12 months, PFR was 19.21 and 18.8, 20.77 and 20.13, 20.30 and 20.31 ml/s, respectively. After 3 months, 6 patients in the TURP group (7.5%) and 7 patients in the TVP group (10%) were borderline obstructed. 1 patient in the TVP group (1.4%) was still obstructed and underwent TURP. As for complications, 4 patients (5.7%) in the TVP group had stress urinary incontinence after 12 months vs. 1 (1.25%) in the TURP group.The present study clearly demonstrates that TVP is as effective as TURP in relieving urinary obstruction due to BPH, it offers some advantages in terms of catheterization and hospital stay, but at the price of a higher incidence of postoperative urine incontinence. Technical improvements might solve this problem in the future, perhaps combining TVP with TURP of the apical tissue.

In an open, randomized phase II pharmacokinetic study conducted in Germany and Italy, a total of 42 patients with advanced or metastatic prostate cancer (PCa) were treated for 9 months with the luteinizing hormone-releasing hormone analogue (LH-RH-a) leuprorelin acetate depot in two different formulations. Fifteen patients received the 1-month depot and 27 patients received the newly developed 3-month depot, containing 3.75 mg and 11.25 mg, respectively. In both groups, subcutaneous injections of leuprorelin acetate injected monthly or at 3-month intervals produced a complete down-regulation of the pituitary and led to persistent suppression of testosterone and dihydrotestosterone to the castrate range (≤50 ng/dl for testosterone) within the first month of treatment, which thereafter could be maintained over the entire observation period of 9 months. In 10 patients, pretreatment with an antiandrogen for the prevention of clinical flare-up resulted in a slightly more profound and earlier drop in serum testosterone. The 3-month depot showed a higher median peak serum concentration (Cmax) of leuprorelin at 20.8 ng/ml than the 1-month depot at 10.7 ng/ml but, conversely, this did not influence the rise in serum testosterone levels. Cmax occurred at 3 h for the 3-month and at 1 h for the 1-month depot formulation. During the steady state, constant release could be detected, starting on day 3 and day 7 for the 1-month and 3-month depot, respectively. A marked decrease in median prostate-specific antigen levels of 97.8% (1-month depot) and 96.6% (3-month depot) compared with baseline was observed, indicating an objective clinical response for more than 80% of all patients in both arms. Based on European Organization for Research and Treatment of Cancer criteria, the best response in terms of complete/partial remissions and stabilization was comparable in the two arms at 86.7% (1-month depot) and 85.2% (3-month depot). 6.7% in the 1-month group and 3% in the 3-month depot group showed progression of the disease. The most common side effects in both treatment groups were related to hormone deprivation. Both formulations of the potent LH-RH-a leuprorelin acetate were highly effective in the treatment of advanced PCa and led to comparable endocrine and clinical effects.

The 980 nm Ceralas D50 diode laser, produces homogeneous lesions on tissues of different nature. In our endourological tests we used the Ceralas D50 coupled with Comeg 24 ch laser resectoscope, and we treated 22 patients: n.5 bladder cancers, n.3 uretero pelvic junction obstructions, with hydronephrosis, n.3 urethra stenosis, n1 ureter stenosis, n.4 multiple upper tract transitional cell carcinomas, n.6 BPH treatments with VLAP modalities. Using the 1000 micrometers delivery fibers with different shaped tips, we obtained a bloodless sharp cut and easily vaporizations with minimum carbonizations, with power output in the range of 8-12 W, and 18-24W for VLAP.© (1996) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

A new 1,800-microns side fiber made of pure silica with laser beam deviation of 82 degrees and divergence of 18 degrees was inserted into a modified transurethral resectoscope and used to treat in vitro some prostates removed during radical prostatectomy. Sterilization of prostatic tissue with a depth of penetration of 12 mm was observed after treatment with 20 W for 2 min. Irradiation with 60 W for 1 min produced vaporization and explosion of the tissue and a depth of penetration of 15 mm. The laser resectoscope was then successfully employed for the treatment of 6 cases of benign prostatic hyperplasia (BPH) as well as in high risk patients with bulky bleeding bladder tumors (4 cases) and with transitional carcinoma of the prostate invading the parenchyma (2 cases). 3 patients with small size BPH underwent only laser irradiation. All others were submitted to traditional transurethral resection followed by laser treatment with Nd: YAG using the same instrument. Our laser resectoscope lowers costs since the side fiber is reusable for 4-5 treatments and brings laser treatment nearer to traditional endoscopic treatment, thereby making its application more comfortable for the urologist.

Optical fiber systems with lateral emission of laser radiation are currently used for laser treatment of benign prostatic hyperplasia (BPH). They can be classified in reflective or refractive systems in which a mirror or a prism, respectively, is connected to the fiber tip. Both systems are disposable making the cost of treatment too high. An alternative solution for refractive systems is the prismatic cut of the fiber tip. A side fiber of this type was conceived at the Department of Chemical Physics of the University of Venice and then patented. An Olympus 27ch transurethral resectoscope was also modified for use with our side fiber as well as with the resecting blade. Our modified resectoscope with a Nd-YAG laser has been clinically used for the laser treatment of BPH (6 cases), as well as in high risk patients with bulky bleeding bladder tumors (4 cases), and in transitional tumors of the prostate infiltrating the parenchyma (2 cases). Laser treatment with our resectoscope resembles traditional endoscopic treatment, guarantees the precision of fiber tip translation, and permits combined treatments with laser and traditional blade.

Laser lithotripsy is based on laser induced plasma formation. Successful stone fragmenting is dependent on power density at the fiber tip in contact with the stone and on the absorption of laser radiation by the stone itself. The use of the laser has been ineffective in the treatment of hard stones and of stones that absorb only minimal amounts of laser radiation. In our experimental and clinical studies we used Rifamycin (Rifocin) as a photosensitizer for the pulsed Dye laser and Sterile Indocyanine Green (Cardio Green) for the pulsed Alexandrite laser. We found that the use of these substances significantly increased the effectiveness of the laser in the treatment of those stones.© (1993) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Leiomyoma of the urethra is a small, benign and extremely rare tumor of mesenchymal origin. To date, about thirty cases have been reported in the literature. A case of leiomyoma of the urethral meatus that had been incidentally discovered is described. The anatomopathological aspects are presented and the clinical and therapeutic problems are discussed.

We report a case of paratesticular desmoplastic small cell tumor. In accord with the literature, the patient was subjected to treatment with combined chemotherapy, but he developed progression of disease and died 13 months later.

There are several diagnostic procedures that can identify patients with recurrent or primary transitional cell carcinoma (TCC) of the bladder. Cystoscopy is the best tool and the golden standard against which the other tools have to be compared. In our experience the BTA test has proved more accurate than urinary cytology, above all in diagnosing low-grade, low-stage TCC of the bladder.

The importance of early diagnosis is by now accepted. As urological pathologies predominantly involve men, it is natural for the urologist to seek co-operation regarding primary and secondary prevention with the Medical Corps. Paediatricians and family doctors are the other professional figures who play a fundamental role in this field. The records are given of the congress “Prevention and early diagnosis of urological diseases” between the Military Corps and the National Health Service, held at Belluno in June 1994.

— We present a case of scrotal localization of “small round cell tumour”. The patient, a 28-year-old man, underwent orchifunicolectomy and antiblastic chemotherapy (platinum, adriamycin, cyclophosphamide) and died after 13 months.

— The Authors describe a new software for prostate transrectal ultrasound biopsy (TRUSB) patient management.

Among urological tumors, renal carcinoma (CRP) is one of the most frequent. Unlike other cancers, clear therapeutic and prognostic progress has not yet been made. We are looking for adjuvant therapy to surgery, the latter giving the only real possibility of cure although strictly tied to a confined disease.

Cancer of the prostate is a statistically important disease in the field of urological neoplastic pathology. The usefulness of mass screening for this tumour is extremely controversial. The most important reports of the congress are given here.

Experience with Octoson water-path echotomography in examining 21 testicular masses is reported. Sonographic results were confirmed by surgical and pathologic findings in all cases. We believe this procedure to be of value in differential diagnosis of intrascrotal swellings.