Urological Melanoma: A Comprehensive Review of a Rare Subclass of Mucosal Melanoma with Emphasis on Differential Diagnosis and Therapeutic Approaches.

Melanoma is reported as the 19th most common cancer worldwide, with estimated age-standardized incidence rates of 2.8-3.1 per 100,000. Although the origin is most frequently cutaneous, mucosal melanoma has been described several times in literature, and despite its rarity (only 1% of all melanomas), increasing attention is being paid to this disease form. Within this subgroup, melanomas of the uropoetic apparatus are a rarity among rarities. Indeed, less than 50 cases of primary melanoma originating from the urinary bladder have been described, and even less originating from the kidney, renal pelvis and urethra. In this work, we present a detailed review of the literature related to this subclass of mucosal melanoma, delve into the biological landscape of this neoplasm and discuss current approaches, future perspectives and potential therapeutic approaches.

Transperineal interstitial laser ablation of the prostate, a novel option for minimally invasive treatment of benign prostatic obstruction.

BACKGROUND: In the algorithm of treatment of benign prostatic obstruction (BPO), the shift from medical therapy to surgery is steep in terms of invasiveness. Recently, a lively interest has developed on alternative micro-invasive options. Transperineal interstitial laser ablation (TPLA) was recently proposed for BPO treatment. OBJECTIVE: This work aims to illustrate feasibility, efficacy and safety profile of TPLA in BPO treatment. DESIGN, SETTING, AND PARTICIPANTS: We prospectively analyzed the results of TPLA performed between September 2018 and March 2019 for LUTS due to BPO, in men with prostate volume <100 ml. SURGICAL PROCEDURE: TPLA was performed in OR, under local anesthesia, using Soracte Lite-EchoLaserX4. Diode laser light is conveyed through 300 µm optical fibers introduced transperineally by 21 Ga needles and placed at a security distance from urethra and bladder neck. EchoLaser Smart Interface eases needle positioning and increases the safety. MEASUREMENTS: The primary endpoint was the variation of Qmax and IPSS at 1, 3 and 6 months. We also assessed the ejaculatory function and recorded complications. These outcomes were further investigated at 12 months by phone call. RESULTS AND LIMITATIONS: 21 men with prostate volume of 43.5 ± 8.5 ml underwent TPLA. All were discharged after 24 h, keeping the transurethral catheter for 8.7 ± 2.5d. At one month all patients but one discontinued medical therapy, showing significant advantage in Qmax (+3.4 ± 5.7 ml/s; p < 0.01) and IPSS (-5.6 ± 7.0; p < 0.01). Functional results were still progressing at 6 months, with Qmax (+4.7 ± 6.0 ml/s; p < 0.01) and IPSS improvement (-13.1 ± 4.7; p < 0.01). The ejaculatory function was preserved as the MSHQ-EjD increased (p < 0.05). The only complication was a prostatic abscess, treated with transperineal drainage and antibiotic. CONCLUSIONS: TPLA is a micro-invasive treatment for BPO showing good functional and safety outcomes. PATIENT SUMMARY: This work illustrates the results of TPLA to treat LUTS due to BPO, showing high efficacy, preservation of the ejaculation, and low complication rate.

Athermal versus ultrasonic nerve-sparing laparoscopic radical prostatectomy: a comparison of functional and oncological outcomes.

PURPOSE: Many urologists emphasize the concept of heat-related damage suggesting the avoidance of any energy to perform nerve-sparing radical prostatectomy. At our institution, both athermal and ultrasonic dissection have been used over the last years to perform a nerve-sparing laparoscopic radical prostatectomy (NSLRP). In this study, we compare functional and oncological outcomes of the two procedures. METHODS: All charts from patients undergoing NSLRP between January 2009 and June 2015 were reviewed. The International Index of Erectile Function (IIEF-5) was recorded preoperatively and 3, 12 and 24 months after surgery; continence was recorded at 3 and 12 months; PSA was recorded at last follow-up. Uni- and multivariate analyses were performed to assess the association of variables with functional and oncological outcomes. RESULTS: Ultrasonic NSLRP was used for 120 patients, while athermal NSLRP on 111. The impact of the cutting technique on erection recovery was different at 3 months, favoring athermal dissection (p = 0.002); however, significance was lost at 12 (p = 0.09) and 24 (p = 0.14) months. Continence recovery was comparable at 3 (p = 0.1) and 12 (p = 0.2) months; the rate of positive surgical margins and PSA recurrence were also similar (p = 0.2 and p = 0.06, respectively). At univariate analysis, age, Gleason sum, nerve-sparing laterality, and extension (intra- vs interfascial) were associated with overall erection recovery; only age and nerve-sparing laterality were independent predictors. Age and preoperative TRUS prostate volume were associated with continence recovery, both at uni- and multivariate analysis. CONCLUSIONS: The use of an ultrasonic device compared to athermal dissection during NSLRP does not affect long-term potency, nor continence and early biochemical recurrence.

[Incontinence after retropubic radical prostatectomy: correlation between ultrasonographic morphological data and urodynamic parameters]. / Incontinenza dopo prostatectomia radicale retropubica: correlazione tra dati morfologici ecografici e parametri urodinamici.

OBJECTIVE: The aim of this study is to evaluate the relationships existing between transrectal ultrasound and urodynamics in patients undergone radical retropubic prostatectomy and affected by stress incontinence. MATERIALS AND METHODS: 78 patients were suitabe for the study. They have been divided in three groups: group A, 18 incontinent patients (at least 1 pad a day); group B, 30 patients with occasional dribbling (no incontinence device needed); group C, 30 continent patients. All the patients have undergone urethral pressure profile (UPP), abdominal leak point pressure (ALPP) and transrectal ultrasound (TRUS). ultrasound has been performed injecting saline solution in the spongious and bulbar urethra to dilate it and better visualize a collapsed tract corresponding to the distal sphincter, that was measured. Different doctors performed TRUS and urodynamics, and each ignored the results of the other tests. RESULTS: The mean value of TRUS length of the collapsed urethral segment was 5.47 mm (range 4.9-6.0) for group A, 11.5 mm (9.5-12.9) for group B, 13.8 mm (10.4-14.7) for group C. the mean value of rest FUL was 36.6 (range 23-52) for group A, 31.7 (range 21-37) for group B, 13.8 (range 10.4-14.7) for group C. The mean value of stress FUL was 20.3 (range 5-29) for group A, 20.7 (range 18-27) for group B, 25.0 (range 20-35) for group C. The mean value of VLPP was 61.9 cm H2O for group A, 83.6 cm H2O for group B, > 90 cm H2O for group C. CONCLUSIONS: The ranges of values of VLPP were narrower and showed less overlap among the groups than UPP. TRUS length showed a good correlation with VLPP and permitted to differentiate incontinent patients from continent patients and patients with occasional dribbling. These data correlate well with the possible role of the length of the urethral stump and of damage to genitourinary diaphragm in post-prostatectomy incontinence.

[Tolerability to transperineal prostatic biopsy based on the number of specimens]. / Tollerabilità della biopsia prostatica transperineale in base ai numeri dei prelievi eseguiti.

Prostate biopsy is a fundamental step in the diagnostic flow chart of prostate cancer. We have evaluated the influence of the number of cores taken on the tolerability and morbidity of the transperineal ultrasound-guided prostate biopsy. We have compared a group of 240 pts undergone 16 core prostate biopsy to an historical cohort of 100 pts undergone 10 core prostate biopsy. All the patients in both groups have been investigated about tolerability and morbidity of the procedure. No significant differences emerge between the two groups, and then we conclude that the number of cores taken does not influence the safety and compliance to the transperineal biopsy. This is a significant advantage compared to transrectal biopsy, as the number of cores influences the detection rate of prostate carcinoma.