Nursing nel paziente urologico, anziano, operato: Nursing of the elderly urological patient

There are two important issues in the postoperative management of the urological elderly patient: complications and rehabilitation. Aging is associated with a loss of homeostatic reserve that may lead to postoperative complications due to drug interaction, malnutrition, infection, defects in wound healing, and poor psychological state. Furthermore rehabilitation, if not properly planned or implemented may influence not only the quality of life, but also the whole treatment results. The authors, in relation to pathogenetic aspects, describe what to do to prevent complications and to promote patient recovery. They conclude that both urologists and nurses must have specific geriatric training and that a psychiatrist, dietician, geriatrician and physiotherapist should be part of the team caring for the elderly surgical patient. Finally discharge from hospital must not be the end of therapy: in selected patients nursing management may continue at home reducing morbidity and mortality and helping better rehabilitation.

Alternative Mini-Invasive Nelle Ostruzioni Cervico-Uretrali Dell'anziano: La Laserterapia: Mini-Invasive Alternatives in Cervico-Urethral Obstructions in the Elderly: Laser Therapy

An ageing general population, increase in average life span and prevailing benign prostatic hypertrophy bring an increasing number of elderly men to surgery for cervico-urethral obstruction. Given the small but significant morbidity of TURP, recently new mini-invasive techniques have been introduced for BPH, laser therapy being the most popular. The authors report on the different methods for delivering laser energy to the prostate, discussing the benefits and defects. They also present their personal experience with 44 patients aged over 75 years subjected to Nd:YAG laser prostatectomy from 1992 until today. In these patients transurethral laser evaporation, as suggested by Narayan and al., produced significant symptomatic and clinical results with low morbidity and invasiveness. The authors therefore believe that this kind of therapy may improve management of the elderly patient with BPH.

A New Fibre (Quadralase) for Treating BPH with Laser ND:YAG

Laser photocoagulation, due to simplicity and good results, is the main alternative to TURP in BPH. The technical evolution of materials and procedures has favoured vaporisation of the prostate instead of simple coagulation. More energy has thus been required for the treatment, leading to fibre damage or malfunctioning and increasing cost for single treatment. We report our initial experience with the Quadralase fibre that has a specially designed distal cap, which always allows the laser beam to be transmitted through a clean surface. We believe this is a further technical improvement in prostatic vaporisation with Nd:YAG laser, which may reduce operating times and fibre damage.

[Renal lymphoma: an atypical mass in search of characterization]

We report the case of a B cell, renal non-Hodgkin lymphoma come to our attention due to urologic symptoms. A review of the literature is provided and it is discussed the differential diagnosis with renal cell carcinoma.

Critical Evaluation of Prostate Carcinoma Imaging

Since accurate clinical staging is the ideal presupposition for any therapeutic decision in prostate cancer (PC), the aim of this paper is to review sensitivity, specificity and accuracy of the imaging techniques routinely used to diagnose and stage PC. They are highly important parameters for selecting patients in whom the disease is confined to the prostate and who may benefit from radical surgery. This is particularly important when considering the high incidence of progression in patients with extracapsular disease or positive surgical margins and that 40–60% of patients with a clinically confined disease have extracapsular involvement shown at the histological examination.

Biological prognostic factors in renal cell carcinoma

– The authors have reviewed literature regarding the main contributions of molecular biology to renal cell carcinoma characterisation. The progress made in the analysis of chromosomal alterations, oncogenes, p53 protein, proliferation indices and adhesion molecules are described. The authors conclude that molecular biology, especially the analysis of chromosomal alterations and proliferation indices, may contribute to renal cell carcinoma diagnosis and to the understanding of its pathogenesis and prognosis.

Biological prognostic factors in renal cell carcinoma: Personal experience

– Histological specimens from 95 RCCs were immunostained for p53 protein, E-cadherin and Ki-67 antigen. Results, as well as stage and grade, were correlated to overall survival and disease-free interval. Markers were also correlated to each other. Statistically significant correlations were observed between stage, grade and Ki-67 versus both overall survival and disease-free interval and between Ki-67 and grade. The authors conclude that the analysis of cell proliferation by Ki-67 immunostaining may help improve understanding of the RCC prognosis.

Raro caso di adenocarcinoma dell'uraco

Urachal carcinoma represents less than 1% of all bladder neoplasms. A case is reported of a 66-year-old man who presented with episodes of macroscopic hematuria. Cystoscopy revealed the presence of a papillar neoplasm between the dome and the right bladder wall. The histological examination showed a “mucinous adenocarcinoma morphologically similar to intestinal neoplasms”. Heteroplasia of the urach was diagnosed following urography, CT and NMR.

Su di un caso di carcinoma a cellule chiare in nefroma cistico multiloculare

A case of adenocarcinoma of the kidney in a multilocular cystic disease is reported. The many diagnostic pitfalls of this rare association are underlined and the diagnostic role of selective renal artery angiography, which removed all doubt about the lesion.

Treatment of abacterial pseudomembranous trigonitis with Nd:YAG laser. Personal experience

— Pseudomembranous trigonitis is a syndrome characterized by urgency, frequency, dysuria, bearing down and dyspareunia, with a typical endoscopic appearance and repeatedly negative urine culture examinations. Cystoscopically it appears as a white patch on the mucosal surface, usually well demarcated and often irregular in shape. The lesion may be finely granular in appearance and extend upward toward the ureteral orifices. Histologically it is a squamous not keratinizing metaplasia. Fifty-four female patients were treated with Nd:YAG laser photocoagulation at our Urologic Department from January 1994 to June 1995. Cystoscopic follow-up showed uniform riepithelization, with linear healing, undoubtedly contributing to the relief of symptoms. In our experience, laser treatment gave good and lasting relief of symptoms like no other therapies; so, high patient compliance, easy technique and good results make Nd:YAG laser photocoagulation highly effective in PMT management.

Laser treatment of bladder cancer

— Many authors have reported safety and efficacy of laser treatment, expecially Nd:YAG Laser, for superficial bladder cancer. The many advantages of this treatment include a presumed smaller recurrence rate, also favoured by better laser ability to achieve a limphatic blockage, and an undoubtedly very small treatment-related mortality. This induces laser photocoagulation to be considered a safe procedure, feasible with a mild anaesthesia and under Day Hospital management. On the other hand the main limits of this procedure are the great difficulties in the histological evaluation of tumoral specimens after laser treatment and poor effectiveness on deep bladder wall infiltrating tumours. A critical analysis of literature data follows and our experience in the laser treatment of superficial bladder tumours.

[Urachal cyst. A case report and review of the literature]

The pathology of urachal disease is rarely seen. This article refers to a case of urachal cyst in a twenty-five-year-old male. In order to discuss the pathogenic, clinical and therapeutic aspects of this rare pathology, it is necessary to carry out a complete revision of the literature. Diagnosis is helped by ultrasound and CT scan of the lower abdomen, while fistulography is necessary when there is cutaneous drainage. The treatment consists of surgical approach which includes complete en-bloc excision of the cyst together with possible urachal residue. Such treatment is indispensable in order to avoid acute infection and/or malignant degeneration, frequent complications which are very serious.

Efficacy of visual laser ablation of the prostate (VLAP) in patients with BPH

From November 1992 to the present, 50 patients, most of whom suffering from severe cardiovascular, respiratory, neurological or hemocoagulative disorders, underwent laser prostatic ablation (VLAP) with Nd:YAG laser. Clinical and uroflowmetric follow-up at 6 weeks, 3 and 6 months showed significant improvement with low morbidity. We believe that VLAP is an alternative to TURP in patients with BPH. A better definition of techniques and overcoming the restrictions due to the learning curve could lead to even better results in the future.

Indici di proliferazione (Ki 67, TLI) ed espressione della p53. Introduzione: Proliferation indices (Ki 67, TLI) and p53 expression. Introduction

Histologic and pathologic findings are the most common and useful prognostic factors in transitional cell cancer of the bladder. Thus, clinicians know their peculiar limits very well. The Authors report the results of a literature review about an oncogenic-derivative protein (p53) and about indices of proliferation Ki 67 and TLI, which are frequently studied in bladder cancer.

Indici di proliferazione (Ki 67, TLI) ed espressione della p53. Esperienza personale: Proliferation indices (Ki 67, TLI) and p53 expression. Personal experience

The Authors report their experience on the study of urothelial bladder cancer by determining the overexpression of p53, DNA-content by flow-cytometry, Ki 67, TLI and cytofluorimetric S-phase in 81 patients. Ki 67, DNA content and p53 overexpression are statistically related with histologic grade, unlike TLI and S-phase. TLI, overexpression of p53 and Ki 67 are statistically related with stage, whereas ploidy and S-phase do not show any relation with stage. The Authors discuss these findings.

[Neoadjuvant chemotherapy in advanced-stage bladder carcinoma. A randomized prospective study comparing MVAC and MVEEC]

The Authors report the results with combination of cisplatin, methotrexate, vinblastine with adriamycin or epidoxorubicin (MVAC v MVEEC), in the neoadjuvant treatment of muscle-infiltrating bladder cancer (T2-4NO-1MO), before cystectomy. MVAC has been used in 29 patients and MVEEC in 25, who met eligibility criteria. Results from this prospective randomised trial show that MVAC and MVEEC can produce clinical and pathologic down-staging in 40-50% of cases: cCR+cPR are 15/28 (54%), pCR+pPR are 11/25 (44%). The survival duration of "pathologic" responders has been significantly longer than that of no responders (median no achieved at 200 weeks v 124 weeks for "pathologic" no responders). We conclude that neoadjuvant chemotherapy with MVAC or MVEEC select the more responsive patients, who have a longer survival.

Association of goserelin and flutamide in the treatment of advanced prostatic carcinoma

From January 1987 to June 1990, 40 previously untreated patients, 60–85 years old (mean 76.7 years) with C and D stage (according to AUS) prostatic adenocarcinoma, were administered analogous LH-RH goserelin and the non-steroid antiandrogen flutamide. The patients were followed until June 1992. 9 patients died from the disease. The treatment was well tolerated in 68% of the cases (27 patients); in the other 13 patients, the administration of flutamide caused secondary effects (gastro-intestinal intolerance, alterations of hepatic function). The administration of goserelin did not cause any secondary effect. The local response (assessed by transrectal echography) was good and in 31 cases consisted of a regression of the initial area from 25 to 50%. The performance status improved in 16 patients. 12 patients had a remission of pain. In all the patients, from the third month of treatment, the testosteronemia remained under 0.8 ng/ml; the prostatic alkaline phosphatase and the prostatic specific antigen presented a good correlation with the clinical evolution of the disease.

Day Hospital and resources utilization: A DRG-analysis of the relationship between costs and benefits

We present the results of our analysis on the operative efficiency of the Day Hospital since it opened on 27/04/92 in the Division of Urology of ULSS 4 Parma. This study has been performed by comparing both median stays in hospital for the numerically more representative surgical operations (prostatectomy, TURP, TURV) and by using the DRG system. The DRG specific cost for every hospitalization has also been calculated. Both systems show an increase in the number of treated cases and a decrease in the average hospitalization. This positive trend has been confirmed by the analysis of the costs.

[Small-cell carcinoma of the bladder: description of a case and review of the literature]

Small-cell carcinoma (also known as oat-cell carcinoma) is a rare tumor that previously concerns the lung; small-cell carcinoma of the bladder is extremely rare (0.5% of all bladder malignancies). The Authors report here the case of a 78th years old man. Fourteen months before our observation he was submitted to a partial cystectomy for a small-cell carcinoma of the bladder cupola. There was no evidence of extra-vesical location at that moment and the patient was not submitted to any adjuvant therapy. At the moment of our observation the disease was very advanced and the patient died in a few time. The Authors discuss about the therapy of bladder small-cell carcinoma in the few cases described by the literature and about the survival of those patients. A radical surgical treatment in association with an adjuvant chemo- or radiotherapy appears as a better way to treat these patients. On account of this case the Authors agree with this choice and conclude that only a combined treatment can allow a better survival.

Trattamento con laser Nd-Yag della schistosomiasi vescicale

We present the case of a young man from Ghana, who complained of dysuria and gross haematuria: he had bladder schistosomiasis. We associated Nd-Yag-laser photocoagulation of residual polipoid lesions with standard pharmacotherapy to obtain a linear cicatrization, without spreading infectious pathological material and with better riepithelialization, to reduce belated obstructive complications, common in this disease. A larger casuistry and longer follow-up are necessary to define the efficacy of this technique.

Antimuscarinic activity of telenzepine on isolated human urinary bladder: no role for M1-muscarinic receptors

1. The antimuscarinic activity of the selective M1-blocking drug, telenzepine, was investigated on the isolated human urinary bladder, contracted with exogenous muscarinic agonists and with field stimulation. 2. Telenzepine (3 x 10(-8)-10(-5) M) concentration-dependently shifted to the right the dose-response curves of bethanechol, acetylcholine and McN-A343, and partially depressed the electrically-evoked twitch responses. 3. pA2 values of telenzepine against bethanechol and McN-A343 were very close. 4. McN-A343 did not modify twitch responses elicited by field stimulation up to 10(-5) M. 5. The lack of muscarinic M1 receptors in human detrusor muscle is confirmed.

A Case of Gonadal Stromal Tumour

Gonadal stromal tumor is a rare neoplasm of the testis. 10% of these tumors are malignant, but malignant histological criteria are not established. The principal therapy is orchidofuniculectomy while lynphadenectomy is for uncertain malignant neoplasm. Radiotherapy and antiblastic therapy sensitivity is poor.

Sternum resection and nephrectomy together in renal carcinoma with solitary sternal metastasis

The role of surgery and adjuvant therapy in renal tumors with metastasis is considered purely palliative. However, in cases of solitary metastasis, an aggressive surgical approach is justified by results reported in current literature, in terms of survival rate and quality of life. In bone metastasis there are additional functional problems related to the site of the lesion and to the extend of the excision. In the reported case, the tumor became evident with a serious compressive cervical-mediastinal simptomatology, due to a solitary sternal metastasis, that was resected along with the primary renal tumor.

Transrectal ultrasound in prostatic malacoplakia: Description of 2 cases

Clinically, it is difficult to distinguish prostatic malacoplakia from carcinoma. Two cases of prostatic malacoplakia are described, highlighting the ultrasound aspects of the lesion.

Papillary renal cell cystoadenocarcinoma

Papillary renal cell carcinoma (RCC) is known by the tendency to avascularity shown by angiography. More uncommon is the cystic variant of papillary RCC called cystoadenocarcinoma. The majority of papillary tumors are in stage I. The survival for papillary RCC is significantly higher than that for non-papillary RCC. CT-scan MNR, although non diagnostic, enhance the suspicion of a heterologous process in so called “complicated cysts”. US-guided percutaneous needle aspiration may be helpful to diagnose these tumours. We report 2 cases of cystodenocarcinoma and our considerations.