Value of Endorectal MRI in Romanian Men for High Risk of Prostate Cancer: MRI Findings Compared with Saturation Biopsy.

PURPOSE: To evaluate the potentials of T2 weighted (T2W)MRI and diffusion weighted (DW) MRI for prostate cancer(PCa) detection, local staging and treatment planning in high-risk group. MATERIAL AND METHODS: Endorectal MRI was performed in 17 Romanian men (median age: 66 years; range: 58 75 years), prostate specific antigen (PSA) serum levels (median: 20 ng mL; range: 8.6 100 ng mL) with positive findings for PCa(median Gleason score: 8; range: 7 - 9). Imaging findings were compared to standarised 20-core transperineal saturation biopsy. The prostate was divided into 16 standart sectors(10 posterior and 6 anterior). RESULTS: Overall, prostate cancer was detected in 16 patients(94%) on DW-MRI alone and in all 17 patients (100%) on T2W-MRI alone, and on combined imaging. On T2W-MRI165 sectors out of 272 were suspicious for PCa and 124 (75%)were cancer positive. On DW-MRI 126 sectors out of 272 were suspicious for PCa and 118 (95%) were cancer positive. On the combined imaging approach 134 sectors out of 272 were suspicious for PCa and 126 (94%) were cancer positive. This resulted in diagnostic accuracies per sector of 76% for T2WMRI, 86% for DW-MRI and 89% for combined imaging. Multifocal PCa was confirmed both on MR imaging and by biopsy in 8 of the 17 men (47%) Extra capsular extension(ECE) or seminal vesicles invasion (SVI) was highly suspected in 8 (47%) respectively 7 (41%) of the 17 patients. 6 patients(35%) presented both ECE and SVI. MRI findings were taken into account for treatment planning and none of these patients underwent radical prostatectomy and instead was treated with palliative cryotherapy, radiotherapy and hormone therapy. CONCLUSIONS: Endorectal MRI is highly accurate in PCa detection in the high-risk group and seems to have an important role in local staging and treatment planning for Romanian population.

[Role of retroperitoneal laparoscopic nephroureterectomy in the current treatment of upper urinary tract urothelial carcinoma]. / Locul nefroureterectomiei laparoscopice retroperitoneale in tratamentul actual al carcinomului urotelial de cai urinare superioare.

INTRODUCTION: Nowadays, the standard treatment for upper tract transitional cell carcinoma is open nephroureterectomy, by double lumbar and iliac approach, with peri-meat bladder cuff excision. Since the first laparoscopic nephroureterectomy was performed, several surgical teams were interested by this approach for the treatment of the upper tract transitional cell carcinoma. OBJECTIVE: To plead for retro-peritoneoscopic nephroureterectomy and to assess the surgical indications. MATERIAL AND METHOD: Were analyzed the results of the recent published series on nephroureterectomy for upper urinary tract transitional cell carcinoma. Were included studies on conventional, laparoscopic and retro-peritoneoscopic nephroureterectomy, with at least 10 cases, published after 2000. RESULTS: The advantages of retro-peritoneoscopic nephroureterectomy are: minimum blood loss, reduced analgesic intake, a shorter hospital stay and a faster return to previous activities, lower rate of intra- or postoperative complications compared with trans-peritoneal laparoscopy or conventional surgery. With a proper case selection the oncologic safety of the retro-peritoneoscopy is equivalent with open surgery. CONCLUSIONS: On short term, retro-peritoneoscopic approach shows similar oncological outcome with other techniques. Retroperitoneal laparoscopic nephroureterectomy is a viable alternative to conventional or trans-peritoneoscopic procedure, with clear cut benefits for the patient. Retro-peritoneoscopy is associated with a low morbidity.

[Advantages of ilio-inguinal extraction of the kidney after retroperitoneoscopic nephroureterectomy]. / Avantajele extragerii ilio-inghinale a rinichiului în nefroureterectomia retroperitoneoscopica.

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.

Retro-peritoneoscopic assisted cryoablation for small renal tumors: the first cases treated in Romania.

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.

Technical difficulties in retro-peritoneoscopic radical nephrectomy. Is tumor location important?

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.

[Laparoscopic radical cystectomy with enteric urinary diversion. Alternative to open cystectomy?]. / Cistectomia radicala laparoscopica cu derivatie urinara enterala. Alternativa la operatia clasica?

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.