Histopathological findings after radiofrequency (RITA) treatment for prostate cancer.

Radiofrequency interstitial tumor ablation (RITA) is a thermal ablation method that uses needles and low radiofrequency (RF) energy. The aim of our study was to evaluate the histopathology of thermal lesions induced by RF energy delivered interstitially in prostate cancer patients who subsequently underwent prostatectomy, and to determine the feasibility, effectiveness and safety of this new method in a pilot study.

AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients.

OBJECTIVES: The aim of this study was to assess the longterm mechanical reliability of AMS (American Medical Systems) three-piece inflatable implants and their impact on patient-partner satisfaction in 200 consecutive patients with erectile dysfunction who underwent surgery in five different institutions. METHODS: Patient charts included in the study were collected and extensively assessed to record pre- and intraoperative data and postoperative complications. All patients and 120 partners were then seen often in the office at a mean follow-up of 59 months (range 6-130) and they were extensively questioned about function of the device and its impact on the couple's sexual life. RESULTS: At the long-term follow-up, 185 patients (92.5%) were still engaging in sexual intercourse with a mean frequency of 1.7/week. Patients and partners reported prosthetic erections as excellent, satisfactory or poor in 96 (48%), 100 (50%) and 4 (2%) cases, and in 20 (17%), 80 (66%) and 20 (17%) cases, respectively. Postoperative sexual activity was considered excellent, satisfactory or poor by 140 (70%), 44 (22%) and 16 (8%) patients and by 34 (28%), 81 (68%) and 5 (4%) partners, respectively. Reasons for patients' complaints included postoperative penile shortening in 60 (30%) cases and poor glandular engorgement in 40 (20%) cases. Partners' main complaint was unnaturalness of the prosthetic erection, a factor reported by 30 (25%) subjects. Complications requiring surgical exploration included infection in 12 patients (6%) and mechanical failure in 8 patients (4%). Kaplan-Meier estimates demonstrated significantly decreased mechanical survival for the Ultrex type of cylinders compared to the CX type of cylinders. CONCLUSIONS: AMS three-piece inflatable implants provide an overall patient and partner satisfaction rate of 92 and 96%, respectively. However, postoperative penile shortening and poor glandular engorgement were the causes of some complaints among the patient population as well as the unnaturalness of prosthetic erection among female partners. In the long-term, mechanically speaking, CX cylinders seem to be more reliable than the Ultrex ones.

Transurethral needle ablation (TUNA) of the prostate: a clinical and urodynamic evaluation.

OBJECTIVES: This prospective study evaluated the clinical and urodynamic changes in patients with obstruction due to benign prostatic hyperplasia (BPH) treated with transurethral needle ablation (TUNA). METHODS: One hundred twenty patients with obstructive uropathy due to BPH were treated with the TUNA procedure between January 1994 and December 1995. All patients were selected according to the criteria established by the guidelines proposed by the International Consensus Committee (World Health Organization, Paris, 1993). The TUNA procedure was performed in an outpatient setting using topical intraurethral anesthesia (2% lidocaine gel). RESULTS: Patients showed a decrease in irritative symptoms as measured by the international Prostate Symptom Score (IPSS) and postprocedure urodynamic parameters. The mean (+/- SD) pretreatment IPSS was 20.8 +/- 4.5. At 3 months, the IPSS decreased to 9.7 +/- 3.0 (108 patients) (P < 0.001). At 6 months it decreased to 6.8 +/- 3.1 (86 patients) and remained at 6.2 +/- 2.9 (72 patients) and 6.7 +/- 3.8 (42 patients) at 12 and 18 months, respectively (P < 0.001). At 1 year after treatment, the peak flow rate (Qmax) increased from 8.2 +/- 3.4 mL/s to 15.9 +/- 2.1 mL/s and was 14.1 +/- 2.5 mL/s at 18 months of follow-up (P < 0.01). Urodynamic re-evaluation performed in 72 patients 12 months after TUNA demonstrated the absence of obstruction in 30 (41.7%). An additional 30 patients (41.7%) had equivocal results, whereas the remaining 12 (16.6%) still had obstruction, according to the Abrams-Griffith nomogram. Mean detrusor pressure at Qmax decreased from 85.3 +/- 18.5 cm H2O to 63.7 +/- 24.9 cm H2O at 12 months of follow-up. CONCLUSIONS: Our results confirm that the TUNA procedure is safe and effective when performed as an outpatient procedure. In addition, TUNA produced better results in patients presenting with moderate to severe irritative symptoms and minimal obstruction as determined by pressure/flow studies.

[Comparison of orthotopic neobladders: Studer vs modified Camey II]. / Neovesciche ortotopiche a confronto: Studer vs. Camey II modificata.

A comparative study between modified Camey II and Studer ileal orthotopic neobladder was performed. The Camey II was modified as follows: 1) The ureters were implanted, using wallace technique, in an undetubularized ileal loop, 15-18 cm. long, to prevent vesico-ureteral reflux; 2) The neobladder was made using staplers. In such a way, time is saved (about one hour) and results are quite similar, with a low rate of ureteral stenosis in both groups.

Biological markers in transurethral biopsies from bladder-cancer - preliminary-results.

A biologic profile including proliferative.activity, evaluated as H-3-thymidine labeling index (H-3-dT LI), DNA ploidy, p53 tumor-suppressor gene and P-glycoprotein (P-170), as an expression of the multidrug resistance gene, was defined for 50 primary transitional cell carcinomas of the bladder. H-3-dT LI was evaluated by autoradiography on histologic sections after incubation of fresh tumor biopsies with H-3-thymidine. Ploidy was defined by flow cytometric analysis of DNA content on nuclei suspensions obtained from frozen material. Expression of p53 protein and P-170 glycoprotein was detected by immunohistochemistry using the PAb1801 and C219 monoclonal antibody respectively, on sections from paraffin-embedded tumor biopsies. Invasive tumors showed a higher median H-3-dT LI (12.7% vs 4.2%) and a higher frequency of aneuploidy (73% vs 43%) and more frequently expressed p53 (82% vs 36%) than superficial tumors. Further analysis showed that proliferative activity was higher in invasive than in superficial cancers only in p53-positive or aneuploid tumors and not in p53-negative or diploid tumors. Moreover, proliferative activity and p53 overexpression, but not ploidy, were directly related to histologic grading and tumor stage. Generally, P-170 was not significantly related to any biologic or clinico-pathologic factor. Kinetic and phenotypic biologic markers are differently related to clinico-pathologic factors. A panel of biologic features can be easily evaluated on small transurethral biopsies at diagnosis, during endocavitary treatment or follow-up in bladder cancer 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.

Micturitional dysfunction after anterior resection for rectal cancer. Rehabilitative treatment.

A clinical study was made of 21 patients (13 men and eight women) who had undergone anterior resection of the rectum for cancer at the National Tumour Institute of Milan between April 1984 and April 1985. After surgery, 13 patients (including three men with benign prostatic hypertrophy) showed voiding dysfunctions (hesitancy, dysuria, and weak stream) and bladder areflexia. Two of them also had positive Lapides' tests. An early rehabilitative treatment was started after surgery and the entire group was thoroughly reexamined one year later. Only the two patients with positive Lapides' tests still had bladder areflexia with residual urine greater than 100 ml. One of them also had a urinary tract infection. None of them showed decreased renal function.

Sacral chordoma and rehabilitative treatment of urinary disorders.

Sacral chordoma is one of the rarest tumors of the central nervous system (less than 1% of the entire group). Mictional disorders are among the most frequent symptoms and are caused by the extrinsic compression brought to bear on the cauda equina and by surgical demolition of the sacrum. Seven patients who had undergone sacral resection for chordoma, starting from S2, were followed for at least one year. It was observed that mictional disorders were often early symptoms signalling the presence of chordoma. Several patients were affected by a complete bladder denervation (infrasacral lesion) after surgery. Early rehabilitative treatment given after surgery for one year restored normal bladder functions in all the patients whose bladder denervation seemed to be not total (negative Lapides' test). Even when a complete infrasacral lesion of the bladder has been ascertained, early rehabilitative treatment may well prevent serious renal damage.

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.

Altered bladder function as the only and late presenting symptom of ependymoma of the filum terminale.

Tumors of the spinal cord present as a rule with posterior pain with or without radiation to the limbs, with loss of strength and/or sensory disturbances. We report a case in which acute retention of urine was the only presenting symptom.

Renal cell carcinoma and transitional cell carcinomas of the pelvis and bladder in a patient affected by chronic renal failure due to abuse of phenacetin.

This is a report on a case of 2 concurrent neoplasms of different histology within the same kidney: a renal cell carcinoma and a transitional cell carcinoma of the renal pelvis in a patient affected by chronic renal failure due to abuse of phenacetin. There was also a transitional cell carcinoma of the urinary bladder.

Bladder and urethral dysfunction after radical abdominal hysterectomy: rehabilitative treatment.

We studied bladder and urethral function prospectively in 64 patients before and after Wertheim's radical hysterectomy. Immediately after surgery, neurogenic bladder dysfunction of various degrees was found in 70% of all patients who presented difficulty of voiding, with high residual urine and/or stress incontinence. All the patients have received an early rehabilitative treatment with kinesitherapy and/or pharmacological therapy after the bladder catheter removal and the urodynamics' results. We have obtained a satisfactory functional recovery of the bladder activity in 91% of the symptomatic patients.

Bladder urethral dysfunction after abdominoperineal resection of the rectum for ano-rectal cancer.

We prospectively studied bladder and urethral function in 44 patients before and after abdominoperineal resection of the rectum for ano-rectal cancer. The patients were investigated with the following examinations: combined cystometry and electromyography, urethral pressure profile measurement, urecholine denervation test, urine culture, urethrogram and residual urine measurement after voiding. Urodynamic results after surgery demonstrated the partial or total denervation of the detrusor muscle with bladder areflexia in the 54% of the cases, the decrease in the urethral pressure profile in the 48% of the cases, and the absence of detrusor sphincter dyssynergia in all cases. Urethrogram results showed a high incidence of bladder dislocation into the presacral space (36%). Urine cultures were frequently positive in 52% of the patients. Most patients (52%) had difficulty in voiding with high residual urine and/or stress incontinence (4.5%). All the patients received an early rehabilitative treatment with kinesitherapy and/or pharmacologic therapy after bladder catheter removal and after urodynamic results. The patients with neurogenic bladder with residual urine volume had satisfactory functional recovery of the activity.

[Intrauterine torsion of the spermatic cord]. / Torsione intrauterina del funicolo spermatico.

A case is reported of intrauterine spermatic cord torsion. The authors underline the necessity for checking infants' genitalia carefully during postpartum examination. Spermatic cord torsion, during intrauterine life, often involves both testes and therefore early treatment must be initiated to avoid functional anorchia.