Multicentric study comparing intravesical chemotherapy alone and with local microwave hyperthermia for prophylaxis of recurrence of superficial transitional cell carcinoma.

PURPOSE: To compare the efficacy and local toxicity of the intravesical instillation of a cytostatic drug versus the same cytostatic agent in combination with local hyperthermia as an adjuvant treatment, after complete transurethral resection (TURB) of superficial transitional cell carcinoma (TCC) of the bladder. PATIENTS AND METHODS: The study was designed as a prospective, multicentric, randomized trial. Eighty-three patients suffering from primary or recurrent superficial (Ta-T1) TCC of the bladder, after a complete TURB, were randomly assigned to receive intravesical instillations of mitomycin C (MMC) alone, for 41 patients, and MMC in combination with local microwave-induced hyperthermia, for 42 patients. For the combined approach, a new system, Synergo101-1 (Medical Enterprises, Amsterdam, the Netherlands) was used. The effectiveness evaluation end points of the study were evaluation of recurrence-free survival and the estimated probability of recurrence. The safety evaluation end points included subjective and objective side effects and clinical complications. For the efficacy end point, Kaplan-Meier analysis was employed, with the log-rank test for significance. Minimum follow-up time was 24 months. RESULTS: Of the 83 randomly assigned patients, 75 completed the study according to the protocol and had valid cystoscopy results. Survival analysis of the 75 assessable patients demonstrated a highly significant difference in the survival curves in favor of thermochemotherapy. Subjective intolerance and clinical complications were significantly higher but transient and moderate in the combined treatment group. CONCLUSION: In our series, endovesical thermochemotherapy appears to be more effective than standard endovesical chemotherapy as an adjuvant treatment for superficial bladder tumors at 24-month follow-up, despite an increased but acceptable local toxicity.

[Prevention of venous thromboembolism in urologic neoplasms]. / Profilassi del tromboembolismo venoso in urologia oncologica.

PURPOSE: We report our past experience on a sample of patients who underwent pelvic surgery to treat infiltrating bladder tumours. RESULTS: We observed the highest incidence of TVP (33.3%, 3 out of 9) in those patients with higher risk due to anaesthesia and type of surgery. One of our patients died of pulmonary embolism. DISCUSSION: Abdominal pelvic surgery in tumour-bearing patients can be risky due to high incidence of distal and proximal venous thrombosis often resulting in fatal pulmonary embolism (EP). The general risk factors should be evaluated. The diagnosis of venous thrombosis can be difficult to achieve only by clinical examination. Heparin administration as well as surgical techniques and physiotherapy are used as prophylactic measures to reduce the risk of venous thrombosis and to speed up recovery. Nowadays, there is an increasing risk of running into legal problems if appropriate measures to minimise the thromboembolism are not taken.

[Obstructive uropathy secondary to recurrent pelvic endometriosis: description of a clinical case]. / Uropatia ostruttiva secondaria ad endometriosi pelvica recidivante: descrizione di un caso clinico.

The typical presentation of endometriosis is pelvic pain. Patients with with endometriosis often have associated fertility disorders even if their relationship with the symptoms and signs of endometriosis is not evident. The first line of treatment for endometriosis must be surgery. In case of infertility the preferred approach is laparoscopic, maybe in association with medical treatment and possibly followed up by a second-look. In cases with relevant pelvic pain and involvement of other organs, laparotomy is necessary, particularly when a deep endometriosis is infiltrating the uterosacral ligaments, the rectovaginal septum and the bladder. Medical treatment of endometriosis is based upon the hormone-dependency of the endometriotic lesions inducing a resting status. Adhesions, endometriomas or fibrous sequelae do not respond to medical treatment. We describe a case of recurrent endometriosis treated with radical surgery for relevant lesions and fibrous adhesions of ureters with consequent bilateral hydronephrosis.

Trombosis venosa profunda en pacientes con cistectomía radical de salvación / Deep venous thrombosis in patients undergoing salvage radical cystectomy

OBJETIVOS: La presentación de trombosis venosa profunda en pacientes tumorales, ya fue observada por Trousseau, el siglo pasado. Las alteraciones de la coagulación que ocurren en pacientes tumorales pueden causar trombosis venosa profunda (TVP), especialmente en pacientes con metástasis. La quimioterapia antitumoral, puede incluso incrementar el riesgo de trombosis. En este trabajo presentamos nuestra experiencia. MÉTODO: Hemos analizado las historias clínicas de pacientes sometidos a cistectomía radical de salvación. RESULTADOS: Hemos encontrado la incidencia muy alta de TVP (33,3 por ciento; 3 de 9), en pacientes con riesgo anestésico alto y necesidad de cirugía urgente. Uno de nuestros pacientes falleció de trombosis pulmonar. CONCLUSIONES: El diagnóstico de TVP y trombosis pulmonar, no siempre es fácil y es necesario hacer todas las pruebas para llegar al diagnóstico (examen clínico, test analíticos, etc...) (AU)