Robot-assisted renal surgery: current indications and results.

Robotic technology is the natural evolution and simplification of traditional laparoscopy. Robotic surgery has the same benefits of traditional laparoscopic surgery in terms of cosmetic results, pain control and short in-hospital stay. However, magnified three-dimensional vision and the use of fully articulated wristed-instruments allow to increase the precision control. Recently, robotic surgery has been even more used in urology. In fact, robot-assisted radical prostatectomy (RARP) is currently the most common treatment used for localized prostate cancer in the United States. Perioperative and functional outcomes resulted significantly better after RARP. As a consequence of the diffusion of RARP, other urological procedures were performed using the robotic approach. Particular attention has been paid to the use of robotic surgery for the treatment of benign and malignant renal diseases. In 2002 the first robot-assisted pyeloplasty was performed followed by the first robot-assisted partial nephrectomy. This last procedure had widespread a lot in the last years and it can currently be considered as the main alternative to the traditional open partial nephrectomy. Finally, the evolution of technology and surgeon skills allowed us to consider the less invasive approaches also for renal transplantation surgery and vena cava tumor thrombectomy. The objective of this review was to analyze current indications and outcomes of robot-assisted procedures for the treatment of benign and malignant renal diseases.

[Batson's paravertebral venous plexus and single vertebral metastases from renal cell carcinoma]. / Circolo venoso paravertebrale di Batson e metastasivertebrali singole da carcinoma renale.

OBJECTIVES: The presence of a single site bone metastasis in patients with renal cell carcinoma (RCC) is a rare clinical event. We report a single case of RCC with solitary vertebral metastasis and review of literature about renal tumor spreading in order to understand the anatomic explanation for this peculiar clinical case. METHODS: We have considered the single case and reviewed current and past literature to describe the anatomic and functional background of this clinical situation. RESULTS: There are rare cases of single vertebral metastasis from RCC and these are characterized from a contemporary neoplastic thrombus. The neoplastic thrombus could justify the tumoral back-flow into the paravertebral anasthomoses and so into vertebral venous sinusoids. The rich anasthomotic system that surrounds kidneys and the experimental evidence of anasthomotic links among perirenal Lejars venous system and paravertebral Batson's venous system could explain these clinical evidences. CONCLUSION: Enrolment of para-vertebral Batson's venous system could have a major role in the RCC vertebral metastatic diffusion.

[The role of non-invasive urodynamics in bladder outlet obstruction diagnosis in male patients]. / Il ruolo dell'urodinamica non-invasiva nella diagnosidell'ostruzione cervico-uretrale nell'uomo.

PURPOSE: Many methods have been suggested to assess bladder outlet obstruction, as defined by the gold standard of pressure flow studies. A comprehensive review of the literature on the different methods used to diagnose bladder outlet obstruction by non-invasive means was performed in order to compare those methods to invasive urodynamics in terms of sensitivity and specificity. MATERIALS AND METHODS: A MEDLINE search was done of the published literature covering from December 2003 on non-invasive methods, including only single measures to diagnose bladder outlet obstruction. We performed a comparison between all methods in terms of sensitivity and specificity for each test. For many techniques these values were calculated directly from the data presented in the article. RESULTS: There has been applied many methods to diagnose bladder outlet obstruction. Those methods were divided into uroflowmetry, condom-catheter method, penile cuff method and Doppler ultrasonography urodynamics. Each method has been described and discussed in terms of its role in adding information to the diagnostic work-up for bladder outlet obstruction. CONCLUSIONS: Pressure flow studies still remain the gold standard for assessing bladder outlet obstruction. However non-invasive urodynamics is a promising branch. Probably the most reliable information is given by the association of numerous methods together.

Metachronous bladder metastases from renal cell carcinoma: a case report and review of the literature.

INTRODUCTION: adrenal gland, parotid gland, pharynx, eye and bladder are rare localizations of metastases of renal cell carcinoma (RCC). We report a case of metachronous RCC metastases to the bladder in a patient with a medical history of transitional cell carcinoma (TCC) of the bladder. MATERIALS AND METHODS: a case study and review of the relevant literature are presented. RESULTS: during a follow-up cystoscopy examination following treatment of TCC, a single 5-mm lesion was detected and endoscopically resected. The histology of the resected sample was confirmed to be RCC, comparable to a primary kidney cancer and not recurrent TCC. CONCLUSION: the patient had a probability of metastases three years after nephrectomy of 62.9%. Survival rates following single metastasectomy are 60% and 38% at three and five years, respectively; metachronous diagnosis has a better prognosis than synchronous. During RCC follow-up, each lesion should be considered as a possible metastasis of RCC.