Incidence and evolution of aortic aneurysm in patients with bladder cancer.

OBJECTIVE: The incidence of aortic aneurysm is increasing, due to age, hypertension, hyperlipemia and voluptuary abuse like smoking, the last one of the most important cause of bladder cancer. Our study analyzes the incidence of aortic aneurysm in a group of patients who underwent radical cystectomy for bladder cancer and its evolution during follow-up in relationship with surgical procedure and adjuvant therapy. MATERIALS AND METHOD: During pre-operative staging of 173 patients, all affected by bladder cancer and then treated with radical cystectomy, we studied aorta and iliac artery diameters, as a part of our ultrasound scan evaluation. All patients underwent post-operative measurement of normal and abnormal aorta and common iliac artery during follow-up. RESULTS: At the pre-operative staging 19 patients (10.9%) had aneurysms in the aortic-iliac axis (A.A.). During follow-up in 5 patients the A.A. did not develop, whereas in 14 cases it increased within 12 months after surgery and then with an increase <0.5 mm per year, with no relationship with type of surgical procedure, urinary diversion, adjuvant therapy. No cases required a vascular surgical approach during the follow-up. Only 1 patient of basal 154 normal ones developed an aneurysm of the common right iliac artery, treated with endoprosthesis. CONCLUSIONS: The natural development or risk of aneurysm rupture in patients with bladder cancer depends on its dimensions but also on radical surgery, urinary diversion or adjuvant therapies. In our experience all these factors seem not to influence aneurysms if present nor determine de-novo development.

Lichen sclerosus of the male genitalia and urethral stricture diseases.

INTRODUCTION: The true incidence of urethral involvement in patients with genital lichen sclerosus (LS) is unknown. We review the epidemiology and discuss the pathogenesis of LS and urethral stricture diseases. MATERIALS AND METHODS: During the period 1991-2002, of 925 patients who underwent urethroplasty for anterior urethral stricture, 130 patients (14%) received the diagnosis of LS. In all patients with LS the histology was re-examined to confirm the clinical diagnosis. Retrograde and voiding urethrography was used to establish urethral involvement in the disease. RESULTS: In 106 patients (82%) the histology provided the classical features of LS, and 24 patients (18%) showed some histological variations. In 49 patients (37%) the LS involved the pendolous urethra (meatus-navicularis-penile), and in 53 cases (41%) a panurethral stricture was evident. CONCLUSIONS: LS urethral involvement appears to be a much more common and extensive disease than previously reported, and requires particular care in its early diagnosis.

Clinical staging accuracy of renal tumors.

OBJECTIVE: To evaluate the reliability of measurements obtained using standard imaging techniques (ultrasound and CT scan) vs pathological measurements and the relationship between clinical staging and the choice of the type of surgery. We also analyzed the relationship between cancer parameters (size, site, type of surgery) and prognosis. MATERIALS AND METHODS: A retrospective analysis was conducted to examine a series of 140 patients with kidney cancer, all of whom underwent preoperative staging with abdominal ultrasound scan US and CT scan. To assess agreement between US and CT measurements and the pathologic size of renal tumors, we calculated the mean difference between the techniques, Pearson's correlation coefficient and Bland-Altman test. RESULTS: The comparison between imaging and pathological findings revealed a good classification of tumor dimensions between the two imaging methods and pathologic size (correlation coefficients all over 0.8), and with limits of agreement of +/- 2.2 cm for US measurement and of +/- 2.3 cm for CT measure. We observed that the range in which the measurement error is lowest is over 6 cm: in other words, when smaller lesions are present there is a greater likelihood of committing measurement errors. As expected, logistic regression analysis shows that the size of the tumors significantly influenced the surgical approach and survival at five years follow-up. CONCLUSIONS: The imaging methods used in clinical staging of renal tumors currently allow us to select the most appropriate surgical option with a certain amount of confidence. Tumor size continues to be one of the most important factors in prognosis and it can influence both the surgical approach and cancer-specific survival.

[Staging of prostatic carcinoma: TRUS prospective study versus endocoil MRI]. / Staging del carcinoma prostatico: studio prospettico TRUS vs RMN endocoil.

OBJECTIVE: Accurate staging of prostatic cancer is important for planning an optimal treatment, such as radical prostatectomy in clinical stage T2. About 40-50% of patients operated for cT2 disease show a pathological stage T3 disease. In a prospective study we analysed accuracy of TRUS and endocoil MRI in a group of patients before radical prostatectomy. MATERIALS AND METHODS: 33 consecutive patients suspicious of prostate neoplasms were studied and staged with TRUS and endocoil MRI before prostatic biopsy and before radical prostatectomy. One urologist trained in TRUS conducted the exam, while one radiologist interpreted the MRI studies in a blind mode. The criteria evaluated were accuracy of global staging, extracapsular extension (ECE) and seminal vesicle invasion (SVI). These results were correlated with the histopathological findings after radical prostatectomy. RESULTS: The histopathological results showed 14 patients (42%) with pT2 disease, 18 patients (54%) with pT3 disease and 1 case (4%) of pT4 disease. TRUS showed a low sensitivity (38%) and a good specificity (78%), with an overall accuracy of 50%; the best result was 96% specificity for SVI. Endocoil MRI showed a good sensitivity (70%) and specificity (76%), with an overall accuracy of 73%. Endocoilc was also useful to stage T1c disease when TRUS is negative. TRUS tends to understage, whereas endocoil MRI over-stages prostate cancer. CONCLUSIONS: TRUS and endocoil MRI may help in decision making about the appropriate treatment of prostatic cancer, even if they have limited current value, due to understaging or overstaging.