Generalized Lymphadenopathy of Prostate Adenocarcinoma Origin. A Case Series.

Generalized lymphadenopathy is a rare manifestation of metastatic prostate cancer. We report on 2 cases of prostate adenocarcinoma, which clinically manifested as generalized lymphadenopathy. The origin of the primary tumor was confirmed by transrectal ultrasound-guided prostate biopsy. We underline the fact that a suspicion of prostate cancer in men with adenocarcinoma of undetermined origin is important for an adequate and complete diagnostic and therapeutic approach.

Previous Bladder Cancer History in Patients with High-Risk, Non-muscle-invasive Bladder Cancer Correlates with Recurrence and Progression: Implications of Natural History.

PURPOSE: The purpose of this study was to assess the correlation of previous bladder cancer history with the recurrence and progression of patients with high-risk non-muscle-invasive bladder cancer treated with adjuvant Bacillus Calmette-Guérin (BCG) and to evaluate their natural history. MATERIALS AND METHODS: Patients were divided into two groups based on the existence of previous bladder cancer (primary, non-primary). A logistic regression analysis was used to identify the possible differences in the probabilities of recurrence and progression with respect to tumor history, while potential differences due to gender, tumor size (> 3 cm, < 3 cm), stage (pTa, T1), concomitant carcinoma in situ (pTis) and number of tumors (single, multiple) were also assessed. Univariate and multivariate models were employed. In addition, Kaplan-Meier survival analysis was used to compare recurrence- and progression-free survival between the groups. RESULTS: A total of 192 patients were included (144 with primary and 48 with non-primary tumors). The rates of recurrence and progression for patients with primary tumors were 27.8% and 12.5%, respectively. The corresponding percentages for patients with non-primary tumors were 77.1% and 33.3%, respectively. The latter group of patients displayed significantly higher probabilities of recurrence (p=0.000; 95% confidence interval [CI], 4.067 to 18.804) and progression (p=0.002; 95% CI, 1.609 to 7.614) in a univariate logistic regression analysis. Previous bladder cancer history remained significant in the multivariate model accounting for history, age, gender, tumor size , number of tumors, stage and concomitant pTis (p=0.000; 95% CI, 4.367 to 21.924 and p=0.002; 95% CI, 1.611 to 8.182 for recurrence and progression respectively). Kaplan-Meier curves revealed that the non-primary group hadreduced progression- and recurrence-free survival. CONCLUSION: Previous non-muscle-invasive bladder cancer history correlates significantly with recurrence and progression in patients with high-risk non-muscle-invasive disease treated with adjuvant BCG.

Percutaneous nephrostomy in patients with tumors of advanced stage: treatment dilemmas and impact on clinical course and quality of life.

OBJECTIVES: The purpose of this study was to evaluate the outcome, in respect to safety, survival, and quality of life (QoL), after performance of percutaneous nephrostomy in patients with obstructive nephropathy caused by various types of advanced malignancy. PATIENTS AND METHODS: A cohort of 270 patients with established nephropathy because of advanced pelvic or nonpelvic tumors was evaluated. A decision to obtain percutaneous access was made; primary stenting had either failed or was not feasible because of complicated anatomy. Patients were divided in equal groups by type of malignancy (54 patients each). In addition, each malignancy group was further divided in two equal subgroups by tumor burden (27 patients each). Correlations were made with respect to renal function outcome, overall survival after the procedure, and QoL differences both before and after the procedure. RESULTS: No serious complications, such as severe bleeding or sepsis, were experienced because of the procedure. Statistical analysis showed no significant differences in survival among patients with different types of cancer. Only patients with prostate (P < 0.0365) and colorectal (P < 0.0307) cancer with lower tumor burden had significantly longer survival when compared with patients with large tumor burden. Regarding QoL scores, only patients with prostate cancer in the subgroup with low tumor burden demonstrated a positive statistically significant difference (P < 0.001). CONCLUSIONS: Despite the fact that percutaneous nephrostomy has shown good safety characteristics and beneficial impact on renal function, only patients with specific cancers most likely to respond to ongoing palliative therapy or with cancers that progress slowly by nature may statistically benefit from the procedure. This questions the universal application of this procedure for all types and stages of advanced malignancy.

Forgotten, encrusted ureteral stents: a challenging problem with an endourologic solution.

BACKGROUND AND PURPOSE: Forgotten, encrusted ureteral stents represent a difficult problem for urologists, and a consensus on the best therapeutic approach is lacking. We present our experience with endoscopic management of this challenging problem and discuss the chosen treatment combinations. PATIENTS AND METHODS: Five women and four men aged 31 to 71 years (mean 50.2 years) with 10 stents indwelling for 6 to 85 months (mean 24.1 months) were treated in our department. Stent encrustation and the associated stone burden were evaluated by plain radiographs and intravenous urography. Treatment decisions were based on the clinical presentation and imaging findings. Three stents in two patients had minimal or slight encrustations. RESULTS: The mean number of procedures per patient was 2.1 (range 1-4). Percutaneous nephrolithotomy was performed in eight patients and retrograde ureteroscopy with or without intracorporeal lithotripsy in seven cases. Cystolitholapaxy or percutaneous cystolithotripsy was used to manage the distal portion of the encrusted stent in two cases. Extracorporeal shockwave lithotripsy was performed in only two patients. All stents and the associated stones were eventually removed without any complications. CONCLUSIONS: Combined endourologic techniques can achieve safe removal of forgotten stents if treatment is tailored to the volume of encrustation and associated stone. Imaging evaluation and documentation of negative urine culture are imperative prior to any attempt to remove the stent.