Liposarcoma of the spermatic-cord: description of two clinical cases and review of the literature.

Spermatic cord liposarcoma is a rare tumor; currently only 161 cases are described in literature. Natural history of these tumors is marked by the high local recurrence rate. Radical surgery represents the therapy of choice whilst uncertain is the role of regional and retroperitoneal lymphadenectomy as well as the usefulness of adjuvant radiotherapy or chemotherapy. In this paper we describe our experience of two cases treated at our Department between 1995 and 2002 and discuss about the clinical management of this misleading tumor in the light of the several experiences reported in literature.

Preperitoneal prosthetic mesh hernioplasty for the simultaneous repair of inguinal hernia during prostatic surgery: experience with 172 patients.

OBJECTIVES: We report our experience with posterior preperitoneal prosthetic hernioplasty for inguinal hernia in patients undergoing concomitant pelvic surgery for prostatic pathologies. METHODS: 172 patients with unilateral or bilateral inguinal hernia underwent posterior preperitoneal prosthetic hernioplasty during pelvic surgery for BPH and malignant prostatic pathologies. RESULTS: There was no evidence of hernial recurrence after a mean of 30 months and no complications attributable to the hernial repairs, except for 1 patient who developed a small periprosthetic hematoma and 1 patient with a pelvic lymphocele, both spontaneously resolved. CONCLUSIONS: Posterior preperitoneal prosthetic hernioplasty for inguinal hernia combined with pelvic surgery for prostatic pathologies should be applied routinely by urologists because it is a relatively simple procedure and with a very low rate of complications and recurrence.

Role of nephron sparing surgery in the treatment of centrally located renal tumors.

OBJECTIVES: In recent years many long-term data have suggested that nephron sparing surgery can be considered as an effective method of treatment also in patients with small, solitary, unilateral renal cell carcinoma and a normal contralateral kidney. Generally, partial nephrectomy is performed for peripheral tumors and usually is limited to imperative indication for central tumors to avoid hemodialysis. We retrospectively evaluate the value of tumor location on technical and oncological results, particularly in patients with elective indication. PATIENTS AND METHODS: Between 1993 and 2002, 112 patients underwent nephron sparing surgery at our institution. The tumor was centrally and peripherally located in 22 and in 90 cases, respectively. The tumor was discovered in 13 (56%) central and in 57 (63%) peripheral tumors incidentally. The indication was imperative in 12 and elective in 10 patients for central group, while it was imperative in 34 and elective in 56 patients for peripheral group. RESULTS: The mean renal ischemia time was longer in central group compared to peripheral group (20.81 versus 18.8 minutes p<0.05) and the collecting system was violated more frequently in central group (53% versus 28% p<0.05). Postoperative complications were higher for central tumors compared to peripheral tumors (18% versus 4% p<0.05) but the ultimate mean serum creatinine level was similar for central and peripheral tumors (1.36 versus 1.22 mg/dl). The mean tumor size was 39.69 mm in central group and 32.77 mm in peripheral group (p<0.05). The mean diameter of central tumors in imperative indication was 42 mm while in elective indication was 32 mm (p<0.05). Pathological tumor stage was T1 to T3 in 18 (82%), 1 (4%) and 3 (14%) cases in central group and in 81 (88%), 6 (7%) and 5 (5%) cases in peripheral group. Grades was 1 to 3 in 4 (18%), 15 (68%) and 3 (14%) cases in central group and in 21 (23%), 61 (66%) and 10 (11%) cases in peripheral group. There was no difference in 5-year cancer specific survival (91% versus 98%) or postoperative local tumor recurrences (9% versus 6%) in central tumors compared to peripheral tumors and there was no local recurrence in elective partial nephrectomy performed in central tumors. CONCLUSIONS: Nephron sparing surgery is technically more demanding in patients with central tumors. However there were no significant differences in cancer specific survival and local recurrence between centrally versus peripherally located tumors. Elective partial nephrectomy can be performed also in patients with central tumors as long as really less than 4 cm.

Laparoscopic radical prostatectomy: oncological evaluation in the early phase of the learning curve comparing to retropubic approach.

OBJECTIVES: Radical prostatectomy is actually the gold-standard treatment for organ-confined prostate cancer. Since Schuessler et al. performed the first laparoscopical radical prostatectomy (LRP) in 1992 this surgical approach for prostate cancer treatment has been widely diffused among european urologists. In this study we report our initial experience with laparoscopic surgery focusing on the oncological assessments and comparing these results to those of the retropubic approach. MATERIAL AND METHODS: Between March 2002 and November 2003, 50 laparoscopic radical prostatectomy were performed at our Institute. We reviewed the operative times, intraoperative complications, mean catheterization and postoperative hospital stay of these first 50 cases. Moreover during the same period a group of 50 consecutive patients underwent retropubic radical prostatectomy (RRP) and data were analyzed and compared to laparoscopic issues. The laparoscopic approach was performed according to the Montsouris technique. Patient age, Gleason score at biopsy, PSA and clinical stage of the two groups were compared. Positive margins of the two groups were compared in relation to their location and pathological stage. RESULTS: No significative statistical differences of age, preoperatory PSA, Gleason score at biopsy and clinical stage were observed between the two groups (p > 0.05). Also in post-operative data no significative statistical differences regarding the pathological stage (p = 0.54) and the Gleason score (p = 0.714) were noted between the two groups. In RRP group the pathological stage was pT2 in 28 patients and pT3 in 22 patients; in LRP group was pT2 in 31 patients and pT3 in 19 patients. The mean Gleason score resulted 6.16 in RRP group and 6.10 in LRP group. The number of positive surgical margins was low in both groups and the location was similar in retropubic and laparoscopic specimens. We reported 13 positive surgical margins in RRP group and 12 in LRP (p = 0.8). CONCLUSIONS: Basing on our initial experience with 50 patients we can affirm that laparoscopic radical prostatectomy can be performed with a lower morbidity and oncological results similar to the retropubic approach even in the early phase of the learning curve. Our experience could be useful to encourage all the urologists approaching laparoscopy.

A case of tumor of the penis: interstitial brachitherapy after conservative surgical therapy.

The neoplasms of the penis are extremely rare and have an incidence of 1400 new cases for year in the United States. Higher is the percentage of incidence in Africa and Asia (10-20%) and in some areas of Brasil where the cancer of the penis constitutes 17% of all the male tumors. In Israel this neoplasm is rare, less than 0.1/100000 menfor year, because in Jewish population men are circumcised prematurely. Recently it has been placed attention to the possible aetiologic role of human papillomavirus (HPV-16 and HPV-18) in penis carcinoma. In fact, in the tumoral cells, DNA of this virus has been found with a percentage that varies from the 30 to 82%. Traditional surgical approach is total or partial penis resection basing on the extension of the disease. This procedure is associated to remarkable psycosessuals problems that greatly affect the quality of life. We bring back a case with organ sparing conservative treatment.