Atypical ductal adenocarcinoma of the prostate with endometrioid immunohistological features.

We present the case of a 52-year-old Caucasian male, admitted to our institution for a verumontanum adenocarcinoma, partially resected endoscopically, a month earlier at another urological clinic. The prior pathological examination wasn't able to give diagnosis. The extensive assessment by clinical workup, ultrasound, flexible cystoscopy, CT scan, and MRI revealed a prostatic tumor extending from the verumontanum to the left lobe and seminal vesicle. The patient underwent radical prostatectomy. The pathological examination revealed a ductal like adenocarcinoma, positive on immunohistochemistry for pan cytokeratin (AE1/AE3), CD10, endomysial antibody EMA and progesterone receptors (PR) and negative for prostate specific antibody (PSA), prostatic specific acid phosphatase (PSAP) and androgen receptors (AR). Ductal like adenocarcinoma of the prostate with endometrioid immunohistological features in the absence of prostate markers is an unusual condition.

[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.

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.

[Hypospadias surgery--etiology of complications]. / Etiologia complicatiilor în chirurgia hipospadiasului.

INTRODUCTION & OBJECTIVE: Hypospadias surgery carries a hole list of precocious and late complications which may occur even years later after surgery such as a very late fistula or a recurrent chordee. The aim of this article was to investigate the reasons, why a significant number of patients with different types of hypospadias presents the same kind of postoperative complications. MATERIALS AND METHODS: Records of 51 boys who underwent surgery for different types of hypospadias were reviewed. Primary repair was performed in 41 patients. 12 (29.4%) of them had postoperative complications. 10 boys had previously between 1 to 7 repairs. The complications were those mentioned in the literature (fistulas, stenoses, megalo-urethra and relapse of the ventral curvature). The etiology of the complications was evaluated according to the type of hypospadias, the surgical technique used for the initial corrective surgery and postoperative care. RESULTS: The original malformation had been miss-classified in 10% of the cases; technical mistakes occurred in 70% of the cases; complications derived from the complexity of the repair procedure were documented in 10% of the cases, and in 10% of the cases the cause was complex: technical and postoperative care mistakes. CONCLUSIONS: Complications after hypospadias surgery appears due to five main reasons which usually coexist. In order to prevent complications, an accurate classification must be made, the surgical procedure has to be chosen accordingly, the surgical technique must be perfect and the postoperative care adequate.

[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.