Prostate volume index and chronic inflammation of the prostate type IV with respect to the risk of prostate cancer.

BACKGROUND: Benign prostatic hyperplasia and prostate cancer (PCA) alter the normal growth patterns of zonal anatomy with changes of prostate volume (PV). Chronic inflammatory infiltrates (CII) type IV are the most common non-cancer diagnosis of the prostate after biopsy. OBJECTIVE: To evaluate associations of both PV index (PVI), i.e. the ratio of transitional zone volume (TZV) to peripheral zone volume (PZV), and CII with PCA in patients undergoing biopsy. SUBJECTS AND METHODS: Between January 2007 and December 2008, 268 consecutive patients who underwent prostate biopsy were retrospectively evaluated. PV and TZV were measured by transrectal ultrasound. PZV was computed by subtracting the PV from the TZV. CII were evaluated according to standard criteria. Significant associations of PVI and the presence of CII (CII+) with PCA risk were assessed by statistical methods. RESULTS AND LIMITATIONS: We evaluated 251 patients after excluding cases with painful rectal examinations, prostate-specific antigen (PSA) >20 µg/ml and metastases. The PCA detection rate was 41.1%. PVI was a negative independent predictor of PCA. A PVI ≤1.0 was directly [odds ratio (OR) = 2.36] associated with PCA, which was detected more frequently in patients with a PVI ≤1.0 (29.1%) than in those with a PVI >1.0 (11.9%). CII+ was inversely (OR = 0.57) and independently associated with PCA, which was detected less frequently in cases with CII (9.9%) than in those without CII (21.1%). Potential study limitations might relate to the fact that PV was not measured by prostatectomy specimens and there was PSA confounding for CII and PCA. CONCLUSIONS: Low values of PVI are directly associated with risk of PCA, which was almost 2.5 times higher in patients with a PVI ≤1.0. The PVI might be an effective parameter for clustering patients at risk of PCA. CII+ was inversely associated with risk of PCA and decreased the probability of detecting PCA by 43%. The role of the PVI and CII in PCA carcinogenesis needs further research.

Prognostic role of substaging in T1G3 transitional cell carcinoma of the urinary bladder.

This study was conducted to test a new substaging system in a population of patients with stage T1 bladder cancer (BC) at diagnosis and assess its prognostic role in terms of disease progression and disease-specific survival (DSS). Patients with primary stage T1G3 urothelial carcinoma of the bladder were stratified according to the following models: i) T1a [the tumour does not infiltrate the muscularis mucosae-vascular plexus, (MM-VP)]; T1b (the tumour partially infiltrates the MM-VP); and T1c (the tumour infiltrates and invades the MM-VP). ii) T1m (diameter of tumour infiltrating the lamina propria ≤0.5 mm under a high-resolution microscope; and T1e (diameter of tumour infiltrating the lamina propria >0.5 mm). Age, gender, tumour size and multifocality were not found to be of statistical significance. Using the T1a/T1b/T1c system, patients with stage T1a disease exhibited a 5- and 10-year progression rate of 13.3 and 20%, respectively, without reaching statistical significance. Moreover, patients with stage T1a disease exhibited a 5- and 10-year DSS of 93.3 and 73.3%, respectively, which was higher compared to T1b and T1c but not statistically significant. Using the T1m/T1e system, patients with stage T1m disease exhibited a disease progression rate of 8.3 and 16.7% at 5 and 10 years, respectively, which was not statistically significant. Moreover, patients in group T1m presented with DSS rates of 91.7 and 83.3% at 5 and 10 years, respectively, which were higher compared to those in the T1e group (71.4 and 60.7%), although not reaching statistical significance. In conclusion, in our study, neither of the two substaging systems of stage T1 BC reached the prognostic conventional significance level for tumour progression or DSS.

Portal vein thrombosis with renal cell carcinoma: a case report.

Portal vein thrombosis refers to an obstruction of blood flow in the portal vein; this rare disease can be both local and systemic. Local risk factors, accounting for about 70% of cases, can be abdominal cancers, inflammatory of infective diseases, surgical procedures or cirrhosis. A 62-year-old man, affected by hypertension and taking acetylsalicylic acid after a myocardial infarction in 1994, developed deep venous thrombosis on the right leg. Six months later the patient was admitted to the emergency unit due to abdominal pain. A CT scan revealed the presence of a complete splanchnic vein thrombosis and a primary tumor on the right kidney. The patient was treated with total parenteral nutrition and intravenous solution of heparin sodium first and then, because of occurrence of allergy, fondaparinux, with improvement of the abdominal pain. Subsequently he underwent right radical nephrectomy.

Functional results following vescica ileale Padovana (VIP) neobladder: midterm follow-up analysis with validated questionnaires.

BACKGROUND: Orthotopic bladder reconstruction is the preferred method of urinary diversion following radical cystectomy (RC). Several papers reported functional data of different orthotopic neobladders, although to date, no one has used validated questionnaires. OBJECTIVE: To evaluate the midterm functional results in a contemporary series of patients undergoing RC and vescica ileale Padovana (VIP) orthotopic neobladder by applying a set of validated questionnaires. DESIGN, SETTING, AND PARTICIPANTS: We conducted a cross-sectional study at a single academic centre. INTERVENTION: We included RC and VIP orthotopic techniques for bladder transitional cell carcinoma. MEASUREMENTS: The American Urological Association Symptom Index (AUA-SI), the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and the five-item version of the International Index of Erectile Function (IIEF-5) were used to evaluate functional outcomes. RESULTS AND LIMITATIONS: All 113 patients who were alive and disease free at 44-mo follow-up were evaluated. Sixteen patients (13%) were on clean intermittent catheterisation (CIC). The median AUA-SI score of the 97 voiding patients was 9 (interquartile range [IQR]: 4.5-16). Specifically, 48.5%, 40.2%, and 11.3% of the patients had mild, moderate, or severe lower urinary tract symptoms (LUTS), respectively. American Society of Anaesthesiologists class (odds ratio [OR]: 9.0; p=0.03) and body mass index (OR: 1.5; p=0.023) were independent predictors of the need for CIC, while only patient age at the time of surgery (OR: 0.920; p=0.01) was predictive of LUTS severity. The median ICIQ-UI SF score was 6 (IQR: 3-10). Twenty patients (17.7%) were fully continent, while 31.9%, 35.4%, and 15% had slight, moderate, and severe incontinence, respectively. About 90% of the patients during the day and 80% during the night used no pad or only a safety pad. Most of the patients leaked when asleep. No variable was predictive of return to continence. Finally, roughly 20% of the male patients were potent, having an IIEF-5 score ≥17. CONCLUSIONS: We reported midterm functional outcomes following RC and VIP neobladder using validated questionnaires. On the whole, the results are encouraging. However, in the absence of patient self-completed questionnaires, functional outcomes may be significantly overestimated.