[Transurethral tissue vaporization: indications and limitations of the technique. Our experience in 105 cases]. / La vaporizzazione tissutale transuretrale: indicazioni e limiti della metodica. Nostra esperienza su 105 casi.

INTRODUCTION: Laser vaporisation of the prosthesis (LP) is now regarded as the most valid alternative to endoscopic resection (TUR). It is a safe, relatively non-invasive and clinically effective method but requires the use of very expensive instruments. AIM: In order to obtain the same results but at a lower cost, an innovative technique has recently been introduced: "prostatic electrovaporisation" which uses a combination of coagulation and electrosurgical tissue vaporisation, and achieves the same biological effect as laser treatment using equipment already available for standard TUR merely by modifying the operator electrode. METHODS: From February to September 1995, a total of 105 patients (38 with benign prostatic hypertrophy, 7 with advanced prostate carcinoma, 60 with multifocal superficial vescical carcinoma with a mean diameter of 2.5 cm) underwent transurethral tissue vaporisation using a rotary, constant flow ACMI resector with a grooved roller ball which enables the contemporary coagulation and vaporisation of tissues. RESULTS: In terms of benign and malignant prostate pathology, surgery is slightly shorter than TUR (5-10 minutes on average), blood loss is minimum (hemotransfusion is never required), the post-TVP catheter stage is comparable to that of TUR; late hematuria never occurs caused by scab removal and there are no episodes of urinary incontinence. Cervical deobstruction has always proved valid when controlled by RT scan, micturitional cystography and uroflowgraph with very slight irritative symptoms following the recovery of spontaneous micturition. In the case of vescical neoplasia it has always shown a good destructive effect on the oncotic mass with an oncological radicality comparable to that of TUR. There is a very low risk of accidental perforation of the vescica, and the intensity of the obturating reflex is also considerably diminished; bleeding is almost absent. This has led to a shorter hospital stay and a marked reduction in hospitalisation costs. Like LP, TVP does not allow a precise histological evaluation. In order to avoid this drawback, prior to tissue vaporisation treatment it is worth carrying out a clinical study to exclude malignant pathology (transrectal prostate ecotomography, PSA and/or PSA density and/or preoperative prostate biopsy), and intraoperative biopsy resection. CONCLUSION: In short, with due respect for the clinical indications, tissue vaporisation should be preferred: a) to standard TUR, essentially on account of limited bleeding and consequent drastic reduction in hospital stay; b) to laser treatment, basically because of the reduced costs and scarcity (or absence) or post-treatment irritative disorders.

[Urethro-vesical anastomosis after radical prostatectomy and bladder replacement with the Camey II approach]. / L'anastomosi uretro-vescicale dopo prostatectomia radicale e sostituzione vescicale secondo Camey II.

Owing to its numerous biological characteristics, Tissucol fibrin cement is widely used in general and specialised surgery. In urology it is used on both the renal parenchyma and on the entire urinary tract. The authors report their experience regarding the use of Tissucol in the execution of urethro-vescical anastomosis during radical prostatectomy and cystectomy with orthotopic neovescica according to Camey II. A group of 25 patients were examined of whom 10 with vescical neoplasia and 25 with cancer of the prostate. Anastomosis was always performed using four or five suture stitches in Dexon 2/0 and subsequently sealed with Tissucol. Suture condition was regularly checked using contrastography. The suture only gave way in one case of orthotopic neovescica with consequent urinary fistula; in all the other cases the anastomosis showed a perfect seal in both the short and long term. In the authors' opinion the good immediate result of anastomosis can significantly reduce the postoperative hospitalization.