[Orthotopic ileal neobladder: technical procedures and long-term follow-up]. / La neovescica ileale ortotopica: note di tecnica e rivalutazione a distanza.

From January 1992 to September 1997, 29 male patients between the age of 39 and 71 affected by localized bladder cancer underwent radical cystectomy and received detubularized orthotopic ileal neobladder. In most cases we performed the ileal neobladder utilizing the Studer technique, preferring the Wallace 1 method for the uretero-ileal anastomosis, that seems to reduce the risk of stenosis. In some patients we experimented different techniques. One of these was the utilization of staplers but, at present, we are no longer using this procedure due to its high costs without any real advantage in operative time. Another technique is the performance of continuous suture in catgut 000 on the ileal aperture edges for the anastomosis with the urethra, because we believe that this method makes the ileal wall stronger. Usually we apply 6 stitches in vicryl 000 for the urethro-ileal anastomosis. In 14-28 days, after a cystography to exclude the presence of urinary fistula, the catheter was removed. 6 months later an evaluation was made utilizing an auto-evaluation questionnaire, biochemical, radiological and urodynamic examinations. The diurnal continence (96%), the nocturnal continence (71%), the renal function preservation (normal in 86% of patients), the radiological, biochemical and urodynamic (low pressure and high capacity of the neobladder) results were comparable with those published in literature. The discrete percentage of urinary refluxes observed (39%) puts in doubt the real efficacy of the undetubularized ileal tract as an antireflux mechanism, however it does not seem to determine an important reduction of renal function, as confirmed in the check up five years later. In our experience, this operation reduces the risk of stenosis of the uretero-ileal anastomosis.

Ureteroscopy and stone lithotripsy with lithoclast: personal experience.

Ureteroscopy has become a common technique in the diagnosis and treatment of ureteral pathologies, but this procedure is quite invasive and some complications have been reported in literature. In our Institute 49 patients underwent ureteroscopy and ballistic lithotripsy with lithoclast for ureteral stones. The stones were localized both in the middle and distal part of the ureter. We used a small caliber 7-8.5 Wolf ureteroscope. The treatments were performed under antibiotic prophylaxis. Direct access to the ureter without dilation of the meatus was obtained in 97.96% of patients. The stones were easily reached in 93.88% of the cases and satisfactory fragmentation was obtained in 90.7%. In 4 patients (9.3%) one or more large stone fragments escaped into the kidney, requiring the patients to be treated with ESWL. No major complications occurred: no ureteral perforations, no important bleeding and no severe or persistent infections. All patients were discharged in one to four days postoperatively. The authors conclude that ureteroscopy using small caliber instruments with Lithoclast is a safe and satisfactory alternative to ESWL in the treatment of ureteral stones.

[Papillary cystadenoma of the epididymis. 2 case reports]. / Il cistoadenoma papillifero dell'epididimo. Presentazione di due casi clinici.

Tumors of the epididymis are very rare. They are benign tumors in 75 per cent of the cases. Papillary cystadenoma represents 4-9 per cent of epididymal benign tumors. Often associated with the syndrome of von Hippel Lindau and infertility, histologically it can be confused with metastatic renal cell carcinoma. We report two cases of papillary cystadenoma located in the head of the right epididymis, with no concomitance with the syndrome of von Hippel Lindau, cured by the removal of the neoplastic nodule. There was no recidivation, in confirmation of the neoplastic benignity.

[Renal oncocytoma in the single kidney after previous surgery of renal carcinoma. Apropos of 2 cases]. / Oncocitoma renale in rene unico chirurgico per pregresso carcinoma renale. A proposito di due casi.

Renal oncocytoma is a neoplasm which rarely occurs in patients with solitary kidney, the other being absent because of a previous nephrectomy performed for renal cancer. We present two case reports and a literature review. We have studied some important problems such as the histogenesis, the potential for malignancy, the diagnosis, the treatment and the follow up. The high incidence of coexistence of renal oncocytoma and renal cell carcinoma has important clinical implications. We would like to emphasize the importance of preoperatory FNAB, nephron sparing surgery and very careful follow up.

Systemic preoperative chemotherapy with cisplatin, methotrexate and vinblastine for locally advanced bladder cancer: local tumor response and early followup results.

A total of 44 patients with infiltrating, locally advanced bladder cancer (stages T 3a-b, T 4a-b and N+/N0) were treated with the systemic chemotherapy regimen of cisplatin, methotrexate and vinblastine (CMV) in the neoadjuvant setting, of whom 39 were evaluable for response. After planned radical cystectomy and 2 to 3 cycles of chemotherapy no tumor was found on the pathological specimen of 4 patients (10%), the tumor was downstaged in 19 (49%) and no change was observed in 16 (41%). Toxicity included leukopenia in 29 patients (66%), 1 of whom died of granulocytopenic sepsis, nausea and vomiting in 39 (89%) and mild to moderate mucositis in 18 (41%). Median followup is 12 months with a range of 6 to 39 months. Of 32 patients followed for longer than 6 months 6 (19%) experienced progression or recurrence of disease. We conclude that preoperative CMV chemotherapy is effective in inducing downstaging of the tumor, although systemic toxicity limits its use to cautiously selected patients.

[Neoadjuvant chemotherapy with MVC (methotrexate, vinblastine, cisplatin)in the treatment of infiltrating transitional carcinoma of the bladder]. / Chemioterapia neoadiuvante MVC (methotrexate, vinblastina, cisplatino) nel trattamento del carcinoma transizionale infiltrante della vesicica.

Of 19 patients with advanced transitional bladder cancer (T2-T4, N0-N+, M0) who received two or three cycles of pre-emptive MVC (Methotrexate, Vinblastine, Cisplatin), pathological partial (PR) and complete (CR) remissions were observed in 67% (50% and 17% respectively). The toxicity of chemotherapy was generally acceptable but 5 patients required hospitalization for neutropenia and thrombopenia . In one of them chemotherapy was stopped for severe sepsis. No death was observed. In 11 patients follow-up is greater than 12 months. In this group, 10 patients are actually alive and disease-free, while the other one was dead owing to brain metastasis, after eight months from surgery.

The role of partial cystectomy in the management of transitional bladder cancer.

A study on 81 patients who underwent partial cystectomy for bladder cancer is presented. The low postoperative mortality (2.46%) and the high 5-year survival (72%) show that this type of surgery is effective and without major complications. Thirty-eight patients were treated with endovesical thiotepa (OTT); the remaining 41 patients were untreated after surgery. Results showed that survival and number of relapses were similar in the two groups. This fact seems to prove that chemotherapy with OTT is not essential after segmental cystectomy. To explain this assertion, several hypotheses are presented.