[Treatment of invasive bladder cancer: robot-assisted radical cystectomy and intracorporeal urinary diversion]. / Therapie des invasiven Harnblasenkarzinoms : Roboterassistierte radikale Zystektomie und intrakorporale Harnableitung.

PURPOSE: Robot-assisted radical cystectomy (RARC) and intracorporeal urinary diversion are only performed in a few centers of excellence worldwide. Functional and oncologic outcomes are comparable. We report on our experience with RARC and intracorporeal diversion. PATIENTS AND METHODS: We retrospectively identified 86 RARCs in 72 men and 14 women (mean age 69.7 years). All patients underwent robot-assisted radical cystectomy and pelvic lymphadenectomy followed by intracorporeal urinary diversion using ileal conduit or neobladder. Of the 86 patients, 24 patients (28%) underwent intracorporeal ileal conduit and 62 patients (72%) underwent intracorporeal neobladder formation. A Studer pouch was created in all who underwent intracorporeal neobladder diversion. Cancer specific survival (CSS) and overall survival (OS) are reported. RESULTS: The mean operative time was 418.9 min (range 205-690 min) and blood loss was 380 ml (range 100-1000 ml). The mean hospital stay was 17.5 days (range 5-62 days). All the surgeries were completed with no open conversions. Minor complications (grade I and II) were reported in 23 patients, while major complications (grade III and above) were reported in 21 patients. The mean nodal yield was 20.3 (range 0-46). Positive margins were found in in 8%. The average follow-up was 31.5 months (range 3-52 months). Continence could be achieved in 88% of patients who received an intracorporeal neobladder. The cancer-specific survival (CSS) and overall survival (OS) were 80% and 70%, respectively. CONCLUSION: RARC with intracorporeal diversion seems to be safe and reproducible in tertiary centers with robotic expertise. Operative times are acceptable and complications as well as functional and oncologic outcomes are comparable. Further standardization of RARC with intracorporeal diversion may lead to a wider adoption of the approach.

Autonomic nervous system functions in children with nocturnal enuresis.

Nocturnal enuresis is involuntary urination during night sleep. The pathogenesis of nocturnal enuresis is controversial. Developmental delay, genetic factors, stress and psychological factors, and sleep abnormalities are considered to be the etiologic factors. Various urodynamic studies showed bladder hyperactivity in enuretic children. Since the cause of vesical hyperactivity is not clear, we investigated the possible role of autonomic nervous system dysfunction in these children. The study groups consisted of 41 enuretic (25 boys and 16 girls) and 30 healthy children (18 boys and 12 girls). Four non-invasive autonomic nervous system function tests (orthostatic test, Valsalva ratio, 30:15 ratio, heart rate responses to deep breathing) were carried out in both groups. The differences between the enuretic and control groups were statistically significant in the Valsalva and 30:15 ratios (P < 0.0005 and P < 0.005, respectively). The results of these two tests demonstrated parasympathetic nervous system hyperactivity. No abnormality of the sympathetic nervous system was found. We suggest that the parasympathetic nervous system hyperactivity shown in our study may be a cause of vesical hyperactivity in enuretic children.

Two synchronous primary tumors of the ovary and kidney: a case report.

Multiple malignancies in the same patient account for 1.84% to 3.9% of all cancers. However, multiple synchronous primary tumors in the same patient are extremely rare. Most synchronous double primary cancers are seen in both the genitourinary and gastrointestinal tracts. Synchronous double primary tumors involving kidney and ovary have been reported once in the Japanese literature; however, there are no reported cases in the English literature. This 66-year-old woman underwent radical nephrectomy for her renal cancer and optimal tumor-reductive surgery for her ovarian cancer. She was started on carboplatin and cyclophosphamide therapy for her residual ovarian cancer. On follow-up after 8 months, the patient is alive and well with no evidence of disease. In this report we present the first case in the English language literature of synchronous primary cancers in the right ovary and right kidney.

Detection of urinary interleukin-2, interleukin-2 receptor, and tumor necrosis factor levels in patients with superficial bladder tumors after intravesical BCG immunotherapy.

OBJECTIVES: To investigate the presence of urinary cytokines, after bacillus Calmette-Guérin (BCG) therapy, in order to provide further insight into the mechanisms of action of intravesical BCG therapy. METHOD: Urine levels of interleukin-2 (IL-2), interleukin-2 receptor (IL-2R), and tumor necrosis factor alpha (TNF alpha) levels were determined in 34 patients with superficial bladder tumors after a six-week course of intravesical BCG therapy. The urine samples were obtained at the fifth hour following the sixth course of therapy and the determinations were made by using an (enzyme-linked immunosorbent assay (ELISA)) technique. RESULTS: The pre-BCG levels of IL-2, IL-2R, and TNF (32.1 ng/L, 21.1 ng/L, 37.6 micrograms/L, respectively) were increased significantly after therapy (175.2 ng/L, 54.4 ng/L, 625.9 micrograms/L, respectively). These levels remained significantly increased after all patients were stratified according to tumor and patient characteristics. CONCLUSION: The results of this study provide further evidence for the immunologic basis of the mechanism of action of intravesical BCG therapy.

[Effects of prostatic massage on serum levels of prostatic acid phosphatase and specific antigen]. / Les effets du massage prostatique sur les taux de PAP et de PSA.

We studied the influence of prostatic massage on the seric levels of acid prostatic phosphatase (PAP) and prostatic specific antigen (PSA) before and 1, 24 and 48 h after the examination. Three groups of patients were studied: 13 patients with prostatic benign hypertrophy (PBH), six patients with metastatic prostate carcinoma and 10 control patients (urinary lithiasis). We observed a significant elevation of both seric markers 1 h after prostatic massage in the PBH and control groups. In both groups, seric marker levels returned to normal values within 24 h with PAP and 48 h with PSA. We recommend to assay serum PSA and PAP with an interval of at least 48 h after rectal digital examination.

Screening of asymptomatic siblings of patients with vesicoureteral reflux.

Familial trait in vesicoureteral reflux (VUR) has been revealed in many studies. This paper reports on 36 siblings of 25 patients operated for vesicoureteral reflux at our Department. Siblings aged 2 to 21 years were evaluated by urine examination, urine culture and voiding cystourethrogram (VCU) for VUR. All of the siblings were asymptomatic and VUR was found in only 4 of them (11%), unilateral in 3 cases and bilateral in one case. It is concluded that evaluation of siblings for VUR will be suitable for revealing the presence of urinary infection, and assessing them by VCU at the time they are first seen.