Current status of salvage robot-assisted laparoscopic prostatectomy for radiorecurrent prostate cancer.

Radiation therapy (RT) is one of the treatment options for prostate cancer (PCa). Transperineal low-dose rate brachytherapy (BT) is another safe and effective technique for low-risk PCa. Recurrence after RT for localized PCa can be defined by a PSA value of 2 ng/mL above the nadir after RT, and biochemical recurrence (BCR) rate after RT is 40-60 %. In case of radiorecurrent PCa, treatment options include salvage radical prostatectomy (RP), cryotherapy, high-intensity focused ultrasound (HIFU), and salvage BT. Only salvage RP has cancer control results for over 10-year follow-up in a substantial portion of patients (30-40 %). However, salvage RP is technically demanding, and experienced surgeons are needed; in fact, RT-induced cystitis, fibrosis, and tissue plane obliteration can lead to significant complications, such as rectal injuries, anastomotic stricture, and urinary incontinence. This review describes indications, oncologic and functional outcomes, surgical techniques, and complications of salvage robot-assisted RP.

[Use of zoledronic acid in patients with prostate cancer bone metastases: control of pain and musculoskeletal complications]. / Utilizzo di acido zoledronico in pazienti con metastasi ossee da carcinoma prostatico: controllo del dolore e delle complicanze muscolo-scheletriche.

Background. Patients suffering from prostatic carcinoma are at high risk of having bone complications because of the metastatic progression of the disease to the skeleton and the consequences of androgenic deprivation. Zoledronic acid is a potent inhibitor of the bone resorption mediated by the osteoclasts, and is the only bisphosphonate whose capacity of reducing significantly the skeleton morbidity in patients with bone metastases is statistically proved. Methods. To attest tolerability and efficacy of zoledronic acid in preventing unfavorable skeletal events and in reducing osteomuscular pain, 25 patients - aged 75 years, suffering from hormone-responsive prostatic carcinoma under hormonal therapy with bone metastases, have been followed and subjected to IV monthly infusion of 4 mg zoledronic acid for 12 consecutive months, associated to daily intake of calcium and multivitamin supplementations. Results. At the end of the study, a sensible improvement in their clinical conditions and in their perception of the pain has been recorded in 23 patients and valued through a set of questions (Brief Pain Inventory). Conclusions. Zoledronic acid is therefore confirmed to be an effective medicine in preventing the skeleton complications and in controlling the painful symptoms in patients suffering from prostatic carcinoma with bone metastases.

Massive recurring angiomyxoma of the scrotum in a obese man.

Aggressive angiomyxoma (AAM) is a rare mesenchymal benign myxoid tumor, characterized by locally infiltrative nature and high recurrence rate. AAM occurs almost exclusively in adult females, arising from the soft tissue of the pelvic region: to our knowledge, only 43 cases occurring in men have been reported. We report a case of massive recurrence of scrotal AAM in a 46-year-old obese man, who already underwent surgery for the same disease in 2004 and 2005. The mass had a circumference of 106 cm and weighted 30 kg. It was impossible to appreciate the testes and to find the penis. The patient underwent scrotal resection, bilateral orchidopexia and transposition of the penis, by means of a preputial flap. Residual scrotal skin was modeled in order to create a neoscrotum, where the testes were placed and secured with interrupted sutures. Histologic examination showed diffuse angiomyxoma-like lipomatosis. After three months, the patient presented with local relapse which also involved the external urethral orifice.

[Ralp and Rocco stitch: original technique]. / Ralp e Rocco stitch: tecnica originale.

Incontinence and impotence are the two chief drawbacks of radical prostatectomy (RP). Incontinence is the most relevant for most of the patients, even if there is high variability in terms of prevalence and definition of continence. Incontinence seems the result of several factors, the most important being the surgical injury of some structures and the biomechanical instability associated with vesicourethral anastomosis. In the posterior urethra, which guarantees the continence mechanism, two functionally independent regions can be recognized: the proximal and the distal. The proximal region can be identified with the bladder neck, while the distal region is the rhabdosphincter urethrae. Concerning the distal functional region, two kinds of strategy can be applied: the preservation of puboprostatic ligaments and urethral attachments, or the reconstruction of the urethral rhabdosphincter, which can be anterior, posterior or total. We describe our technique of choice for posterior reconstruction, first described by Rocco and then modified by Patel et al.

[Reconstructive urethroplasty using porcine acellular matrix (SIS): evolution of the grafting technique and results of 10-year experience]. / Uretroplastica ricostruttiva con matrice acellularesuina (SIS): evoluzione della tecnica di impiantoe risultati di 10 anni di esperienza.

INTRODUCTION: Long tract urethral reconstruction still has no other resolution than two-stage techniques or graft and flap procedures, that are neither simple nor trouble-free. Tissue engineering simplifies this surgery using porcine acellular matrix, obtained from small intestine submucosa (SIS): thin but strong, ready for grafting, it is not immunogenic, being deprived of cells. It is a biological bridge for reconstruction, promoting the regeneration of surrounding tissue. We report our experience using SIS for urethroplasty. MATERIALS AND METHODS: After coronal or perineal-scrotal incision and penile degloving, the urethra is rotated of 180° and opened through the entire restricted tract. The graft is sutured dorsally and reinforced by the contact with the cavernous bodies to prevent pouching. From 1999 to 2005 we performed this grafting procedure in 36 men and 4 women. Afterwards, 16 more surgeries performed were with direct ventral graft procedure, without urethra isolation and rotation, with worthy simplification. RESULTS: A 10-year follow-up shows satisfactory urodynamic and subjective outcomes for both procedures, assessed by voiding urethrography, uroflowmetry, International Prostate Symptom Score, and Quality of Life perception. At urethroscopy the graft appears completely homogeneous to the native tissue, as confirmed by the histological examination. The ventral direct graft represents the more consistent innovation: we did not observe pouching and the results remained effective. For penile urethra, in a few patients, periodic dilatations were necessary. CONCLUSIONS: SIS can be considered as an alternative to more difficult grafting procedures, which are probably no more indispensable in urethral enlargement, even for critical strictures