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Longo N, Minervini A, Antonelli A, Bianchi G, Bocciardi AM, Cunico SC, Fiori C, Fusco F, Giancane S, Mari A, Martorana G, Mirone V, Morgia G, Novara G, Porpiglia F, Raspollini MR, Rocco F, Rovereto B, Schiavina R, Serni S, Simeone C, Verze P, Volpe A, Ficarra V, Carini M. Simple enucleation versus standard partial nephrectomy for clinical T1 renal masses: perioperative outcomes based on a matched-pair comparison of 396 patients (RECORd project). Eur J Surg Oncol 2014; 40:762-8. [PMID: 24529794 DOI: 10.1016/j.ejso.2014.01.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/23/2013] [Accepted: 01/09/2014] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To compare simple enucleation (SE) and standard partial nephrectomy (SPN) in terms of surgical results in a multicenter dataset (RECORd Project). MATERIALS AND METHODS patients treated with nephron sparing surgery (NSS) for clinical T1 renal tumors between January 2009 and January 2011 were evaluated. Overall, 198 patients who underwent SE were retrospectively matched to 198 patients who underwent SPN. The SPN and SE groups were compared regarding intraoperative, early post-operative and pathologic outcome variables. Multivariable analysis was applied to analyze predictors of positive surgical margin (PSM) status. RESULTS SE was associated with similar WIT (18 vs 17.8 min), lower intraoperative blood loss (177 vs 221 cc, p = 0.02) and shorter operative time (121 vs 147 min; p < 0.0001). Surgical approach (laparoscopic vs. open), tumor size and type of indication (elective/relative vs absolute) were associated with WIT >20 min. The incidence of PSM was significantly lower in patients treated with SE (1.4% vs 6.9%; p = 0.02). At multivariable analysis, PSM was related to the surgical technique, with a 4.7-fold increased risk of PSM for SPN compared to SE. The incidence of overall, medical and surgical complications was similar between SE and SPN. CONCLUSIONS Type of NSS technique (SE vs SPN) adopted has a negligible impact on WIT and postoperative morbidity but SE seems protective against PSM occurrence.
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Mottrie A, De Naeyer G, Schatteman P, Frumenzio E, Rossanese M, Ficarra V. Robot-assisted radical prostatectomy: tips, tricks and pitfalls. MINERVA UROL NEFROL 2012; 64:89-96. [PMID: 22617304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In the last decade, we have assisted to the progressive standardization of the surgical technique of robot-assisted radical prostatectomy (RARP). This article describes in details our current surgical technique to perform nerve-sparing RARP. Specifically, we took in consideration the tips, tricks and pitfalls of each step of RARP according to our experience.
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Ficarra V, Bhayani S, Porter J, Buffi N, Giacomo N, Lee R, Cestari A, Mottrie A. 35 Predictors of warm ischemia time and perioperative complications in a multicenter, international series of robot-assisted partial nephrectomy. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s1569-9056(12)60034-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ficarra V, Novara G. 12 Radical prostatectomy. Crit Rev Oncol Hematol 2011. [DOI: 10.1016/s1040-8428(11)70031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ficarra V, Mancini M, lafrate M, Dal Moro F, Novara G. 344 speaker WILL OUR GUIDELINES BE RESHAPED BY: ROBOTIC SURGERY? Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70466-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zucchi A, Costantini E, Martorana G, Schiavina R, Antonelli A, Simeone C, Minervini A, Carini M, Simonato A, Carmignani G, Novara G, Siracusano S, Brunelli M, Bertini R, Zattoni F, Longo N, Mirone V, Ficarra V. 2000 PROGNOSTIC FACTOR OF PAPILLARY RENAL CELL CARCINOMA: RESULTS OF THE SATURN PROJECT. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Novara G, Antonelli A, Bertini R, Carini M, Cosciani Cunico S, Gontero P, Longo N, Martignoni G, Martorana G, Minervini A, Mirone V, Montorsi F, Simonato A, Siracusano S, Volpe A, Zattoni F, Ficarra V. 1991 PROGNOSTIC ROLE OF HISTOLOGIC SUBTYPE IN RENAL CELL CARCINOMA: RESULTS OF THE SATURN PROJECT. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Antonelli A, Novara G, Simeone C, Corti S, Cosciani Cunico S, Martorana G, Minervini A, Serni S, Simonato A, Longo N, Imbimbo C, Montorsi F, Volpe A, Gontero P, Carmignani G, Mirone V, Zattoni F, Ficarra V. 1762 PARTIAL AND RADICAL NEPHRECTOMY FOR PT1 RENAL CELL CARCINOMA: RESULTS OF THE SATURN PROJECT. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Novara G, Antonelli A, Bertini R, Carmignani G, Cosciani Cunico S, De Cobelli O, Lapini A, Longo N, Minervini A, Montorsi F, Serni S, Simonato A, Siracusano S, Volpe A, Zattoni F, Ficarra V. 1993 PROGNOSTIC ROLE OF MICROVASCULAR INVASION IN CLEAR CELL RENAL CELL CARCINOMA: RESULTS OF THE SATURN PROJECT. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ficarra V, Mottrie A, Porter J, Buffi N, De Wil P, Scatteman P, Robin L, Tosco L, Novara G, Suardi N, Cestari A, Guazzoni G. 2002 MULTICENTRIC VALIDATION OF PADUA SCORE IN PATIENTS WHO UNDERWENT ROBOTIC PARTIAL NEPHRECTOMY. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Selice R, Di Mambro A, Garolla A, Ficarra V, Iafrate M, Ferlin A, Foresta C. Spermatogenesis in Klinefelter syndrome. J Endocrinol Invest 2010; 33:789-93. [PMID: 20332707 DOI: 10.1007/bf03350343] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Klinefelter syndrome (KS) (47,XXY) is the most common sex chromosomal disorder, and it is a frequent form of male hypogonadism and infertility. Although the majority of these patients are azoospermic, they might have severe oligozoospermia or residual single-residual foci with spermatogenesis in the testis. AIM We report our experience on sperm retrieval in the ejaculate and testis, and evaluate the frequency of chromosome abnormalities in sperm of KS. SUBJECTS AND METHODS Eighty-four 47,XXY KS were evaluated with seminal analysis, body hair distribution, reproductive hormones, ultrasonographic scanning of the testis and prostate, bilateral testicular sperm extraction (TESE), sperm or testicular cells sex chromosomes aneuploidies. RESULTS Out of 84 patients, 7 (7/84; 8.3%) had sperm in the ejaculate. Out of the 77 azoospermic patients, 24 underwent TESE and 9 (9/24; 37.5%) had successful sperm recovery. The comparison of reproductive hormones, age and testicular volume did not show significant differences between patients with and without successful sperm recovery in semen or TESE . Patients without successful sperm recovery in semen analysis or TESE had signs of hypoandrogenism more evident than patients with successful sperm recovery. Patients with KS produced a higher number of sperm aneuploidy with respect to normozoospermic fertile controls and non-genetic severely oligozoospermic men. CONCLUSIONS Men with KS are not always sterile. In some of these patients sperm can be found in semen or in the testis, but the proportion of sperm aneuploidy is high. Signs of hypoandrogenism seem to be associated with low sperm recovery rate.
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Novara G, Ficarra V, D'elia C, Secco S, Cioffi A, Cavalleri S, Artibani W. Evaluating Urinary Continence and Preoperative Predictors of Urinary Continence After Robot Assisted Laparoscopic Radical Prostatectomy. J Urol 2010; 184:1028-33. [DOI: 10.1016/j.juro.2010.04.069] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Indexed: 11/30/2022]
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Bigot P, Bernhard JC, Crepel M, Bensalah K, Azzouzi AR, de la Taille A, Salomon L, Tostain J, Ficarra V, Pantuck AJ, Belldegrun AS, Méjean A, Ferrière JM, Pfister C, Albouy B, Colombel M, Zini L, Villers A, Montorsi F, Shariat S, Rioux-Leclercq N, Patard JJ. [How radical nephrectomy compares to partial nephrectomy for the treatment of pT1a papillary renal cell carcinomas?]. Prog Urol 2010; 20:350-5. [PMID: 20471579 DOI: 10.1016/j.purol.2010.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 12/22/2009] [Accepted: 01/19/2010] [Indexed: 01/20/2023]
Abstract
PURPOSE Our objective was to compare oncologic results of nephron sparing surgery (NSS) versus radical nephrectomy (RN) in T1aN0-x M0 papillary renal cell carcinoma (PRCC). PATIENTS AND METHODS We retrospectively reviewed 277 patients treated for a pT1aN0M0 PRCC selected from an academic database from 12 centres. We compared the clinico-pathological features by using Chi-square and Student statistical analyses. Survivals analyses using Kaplan-Meier and Log-rank models were performed. RESULTS The two groups were composed by 186 patients treated by NSS and 91 by RN. The TNM stage was fixed and the two groups were, in terms of age and Fuhrman grade, comparable. Median age at diagnosis was 59 years (27-85). Median tumor size was 2.7 cm (0.4-4). The average follow-up was 49 months (1-246). Very few events arose in both groups: two local recurrences were observed in the NSS group (1.07%), three patients died of cancer in the NSS treated group (1.6%) and five in the RN treated group (5.5%). The five and 10 cancer-specific survival rate were comparable in the two groups (98% vs. 100% and 98% vs. 97%). The specific survival curves were perfectly similar for both groups (log rank test, p=0.25). CONCLUSION NSS is equivalent to RN as far as oncologic control of pT1aN0M0 PRCC is concerned.
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Galfano A, Novara G, Salvetti M, Agostini A, Ficarra V, Artibani W. 389 IMPACT OF TRANSPERINEAL PROSTATE BIOPSY ON ERECTILE FUNCTION: A PROSPECTIVE STUDY USING THE INTERNATIONAL INDEX OF ERECTILE FUNCTION (IIEF). ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1569-9056(09)60391-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Brunelli M, Gobbo S, Cossu-Rocca P, Cheng L, Ficarra V, Novara G, Menestrina F, Chilosi M, Martignoni G. Fluorescent cytogenetics of renal cell neoplasms. Pathologica 2008; 100:454-460. [PMID: 19475886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Renal cell neoplasms are a heterogeneous group of tumours in terms of pathological features and prognostic behaviour. The genetics of these tumours may aid in correct diagnosis and accurate assessment of prognosis. In ambiguous cases it may be necessary to utilise new markers that are capable of further discerning renal cell neoplasms. Fluorescence in situ hybridization (FISH) on formalin-fixed, paraffin-embedded tissue is an increasingly useful technique in the detection of many diagnostic chromosomal abnormalities, among which chromosomes 1, 2, 3p, 6, 7, 10, 17 and Y are the most common. The addition of FISH to histological evaluation improves the diagnostic accuracy of core biopsies from renal masses, which may have an important impact in clinical management of many cases due to newer therapeutic approaches, including cryo- or radiofrequency ablation, nephron-sparing surgeries and target therapies.
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MESH Headings
- Adenocarcinoma, Mucinous/diagnosis
- Adenocarcinoma, Mucinous/genetics
- Adenocarcinoma, Mucinous/pathology
- Adenoma/diagnosis
- Adenoma/genetics
- Adenoma/pathology
- Adenoma, Oxyphilic/diagnosis
- Adenoma, Oxyphilic/genetics
- Adenoma, Oxyphilic/pathology
- Adult
- Aneuploidy
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Carcinoma, Renal Cell/diagnosis
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/pathology
- Child
- Chromosome Aberrations
- Chromosomes, Human/ultrastructure
- Chromosomes, Human, X/ultrastructure
- Humans
- In Situ Hybridization, Fluorescence
- Kidney Failure, Chronic/complications
- Kidney Neoplasms/diagnosis
- Kidney Neoplasms/genetics
- Kidney Neoplasms/pathology
- Translocation, Genetic
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Patard J, Bensalah K, Pantuck A, Klatte T, Crepel M, Verhoest G, Guille F, Manunta A, Vincendeau S, Avakian R, Bellec L, Soulie M, Rischmann P, Albouy B, Pfister C, Bernhard J, Ferriere J, Lacroix B, Tostain J, De La Taille A, Abbou C, Salomon L, Colombel M, Ficarra V, Cindolo L, Bertini R, Karakiewicz P, Montorsi F, Belldegrun A. RADICAL NEPHRECTOMY IS NOT SUPERIOR TO NEPHRON SPARING SURGERY IN PT1B-PT2N0M0 RENAL TUMOURS: A MATCHED COMPARISON ANALYSIS IN 546 CASES. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1569-9056(08)60490-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wagner B, Patard J, Méjean A, Zigeuner R, Bensalah K, Schips L, Ficarra V, Tostain J, Mulders P, Chautard D, Descotes J, De La Taille A, Salomon L, Cindolo L, Prayer-Galetti T, Valeri A, Meyer N, Jacqmin D, Lang H. 546 PROGNOSIS VALUE OF RENAL VEIN (RV) AND INFERIOR VENA CAVA (IVC) INVOLVEMENT IN RENAL CELL CARCINOMA (RCC). ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1569-9056(07)60544-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Prostate biopsy can be performed through different approaches, with several differences in patient preparation, procedural technique and post-biopsy patient management. On the basis of our personal experience, and comparing it with literature data, this paper presents our data reviews regarding enema and antibiotic prophylaxis administration, biopsy technique, prostate sampling, core pathological management and post-operative management. We also provide a possible standardization of these procedures in patients undergoing transperineal TRUS-guided prostate biopsy. We accordingly classify antibiotic prophylaxis and bowel preparation as optional/advisable, ultrasound prostate examination before biopsy and local anaesthesia as recommended. Prostate sampling should be performed with at least 8 cores, to be increased proportionally to prostate volume. Each sample should be sent to the pathologist in single containers, according to the pre-embedding sandwich method. Finally, the patient should be evaluated for early complications before discharging, and for delayed complications within one month after the procedure. (Urologia 2007; 74: 1–7)
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Galfano A, Ficarra V. Age-related sperm abnormalities due to varicocele: is there an answer? J Postgrad Med 2007; 53:1. [PMID: 17244957 DOI: 10.4103/0022-3859.30313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Patard JJ, Leray E, Rioux-Leclercq N, Cindolo L, Ficarra V, Zisman A, De La Taille A, Tostain J, Artibani W, Abbou C, Lobel B, Guillé F, Chopin D, Mulders P, Wood C, Swanson D, Figlin R, Belldegrun A, Pantuck A. Prognostic Value of Histologic Subtypes in Renal Cell Carcinoma: A Multicenter Experience. J Urol 2006. [DOI: 10.1016/s0022-5347(05)00434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ficarra V, Righetti R, Martignoni G, D'Amico A, Pilloni S, Rubilotta E, Malossini G, Mobilio G. Prognostic value of renal cell carcinoma nuclear grading: multivariate analysis of 333 cases. Urol Int 2002; 67:130-4. [PMID: 11490206 DOI: 10.1159/000050968] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the independent predictive value of the nuclear grading system according to Fuhrman in relation to the disease-specific survival of patients with renal clear cell carcinoma. MATERIAL AND METHODS 333 patients who underwent radical nephrectomy for renal clear cell carcinoma between 1983 and 1999 were evaluated. In all patients we retrospectively studied nuclear grading, average tumor size, multifocality, pathologic stage of primary tumor, vein invasion, lymph node involvement and distant metastases. The Kaplan-Meier method was applied to evaluate disease-specific survival rates. The log rank test was used to compare survival curves and for univariate analysis. The Cox proportional hazards model was used for the multivariate analysis. RESULTS Histologic grade was G1 in 83 cases (25%), G2 in 117 cases (35%), G3 in 110 cases (33%) and G4 in 23 cases (7%). Our data showed that nuclear grading according to Fuhrman is related to medium tumor size (p < 0.0001), pathologic stage of cancer (p < 0.001), venous system invasion (p < 0.001), lymph node involvement (p < 0.001) and distant metastases (p < 0.001). The disease-specific survival after 5 and 10 years was 94 and 88%, respectively, in patients with G1, 86 and 75% in patients with G2, 59 and 40% in patients with G3 and 31% in patients with G4 (log rank p value < 0.0001). Multivariate analysis showed that nuclear grading by Fuhrman has a prognostic independent predictive value (hazard ratio = 1.8461, p = 0.002). CONCLUSIONS Nuclear grading is an important independent predictive factor of disease-specific survival in patients with renal cell carcinoma.
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Novella G, Porcaro AB, Righetti R, Cavalleri S, Beltrami P, Ficarra V, Brunelli M, Martignoni G, Malossini G, Tallarigo C. Primary lymphoma of the epididymis: case report and review of the literature. Urol Int 2002; 67:97-9. [PMID: 11464129 DOI: 10.1159/000050957] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report an extremely rare clinical pathological observation of a case of primary lymphoma of the epididymis, without testicular or systemic involvement, and to update the relevant literature. MATERIALS AND METHODS A 25-year-old white male patient complaining of right scrotal pain was referred to our department. Clinical examination detected a hard painful mass at the right epididymal head. Epididymitis was diagnosed and conservative therapy with antibiotics and anti-inflammatory drugs was given. After 2 months of therapy the patient was admitted to our department because a tumor was suspected. Tumor markers were normal. Right scrotal exploration was performed through a standard inguinal incision. The epididymal head was completely replaced by a hard white mass. Fresh frozen sections indicated a malignant tumor. Right radical orchiectomy was performed. RESULTS High-grade primary epididymal non-Hodgkin's lymphoma with diffuse large cells (group G according to the Working Formulation) was diagnosed. Clinical pathological staging detected stage IE (extranodal) primary epididymal lymphoma. The patient was referred to the Hematologic Unit for combined chemotherapy, according to the VACOP-B protocol. After an 18-month follow-up the patient is well and disease free. CONCLUSIONS When an epididymal mass does not benefit from medical treatment, scrotal exploration and fresh frozen sections of the lesion should be done. The possible bilateral involvement by primary epididymal lymphoma has to be kept in mind. Radical orchiectomy is the treatment of choice for primary lymphoma of the epididymis. Adjuvant chemotherapy is indicated in high-grade malignant lymphoma. Prognostic parameters of the disease may be the grade of malignancy and the size of the tumor.
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Ficarra V, Porcaro AB, Righetti R, Cerruto MA, Pilloni S, Cavalleri S, Malossini G, Artibani W. Antegrade scrotal sclerotherapy in the treatment of varicocele: a prospective study. BJU Int 2002; 89:264-8. [PMID: 11856108 DOI: 10.1046/j.1464-4096.2001.02418.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the results of our experience in correcting primary varicocele using a modified technique of antegrade scrotal sclerotherapy. PATIENTS AND METHODS From December 1997 to February 2000, 201 patients with primary varicocele underwent antegrade scrotal sclerotherapy. Before treatment all patients were evaluated by a physical examination, colour Doppler ultrasonography of the spermatic cord, and abdominal and scrotal ultrasonography. Sperm samples were analysed only in patients aged > 18 years. The treatment was administered using a special venous catheter system with a Y-adapter. Complications after treatment and the rate of persistence of reflux were assessed 3 and 6 months after the antegrade scrotal treatment, by clinical examination and colour-Doppler ultrasonography of the spermatic cord. RESULTS The mean operative duration was 15 min; there were no significant complications during treatment and all patients were discharged within 4 h. Complications after treatment occurred in 10 of the 201 patients (5%); four patients had epididymo-orchitis, three a scrotal haematoma, one a surgical wound infection, one persistent scrotal pain and one persistent flank pain on the same side as the surgery. Reflux was persistent in 12 patients (6%). CONCLUSIONS Antegrade scrotal sclerotherapy is a simple, minimally invasive and highly effective technique for blocking spermatic vein reflux, with a low rate of complications. The technical changes simplified the cannulation of the spermatic vein and facilitated antegrade phlebography and sclerotherapy using the air-block technique.
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Porcaro AB, Novella G, Ficarra V, Curti P, Antoniolli SZ, Suangwoua HS, Malossini G. Adrenal incidentalomas: surgical treatment in 28 patients and update of the literature. Int Urol Nephrol 2002; 32:295-302. [PMID: 11583337 DOI: 10.1023/a:1017587312369] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Adrenal masses discovered by imaging techniques for reasons unrelated to adrenal diseases are called adrenal incidentalomas (Al). The aim of this study was to find out the clinical outcome of 28 patients operated for incidentally discovered adrenal mass and to update the literature concerning this topic. PATIENTS AND METHODS From September 1976 to December 1999 we operated on 28 patients for adrenal incidentaloma. Adrenal masses were unilateral in 25 cases and bilateral in 5. Average age was 57 years (range 10-73). Hormonal study was performed in all patients. All patients underwent adrenalectomy by the transabdominal subcostal approach. RESULTS Histopathology assessed the adrenal masses as primary in 19 patients and secondary in 9. 24-hour urinary vanillylmandelic acid (VMA) excretion was elevated in 2 patients. Adrenal insufficiency was detected in 1 case. Average tumor diameter resulted 5.8 cm (range 2-17). Histopathologic features of primary adrenal masses included pheochromocytoma in 5 cases, cysts in 4, myelolipomas in 3. nodular hyperplasia in 2, tuberculous mass in 1, cortical adenoma in 1, extra-bone marrow hemopoiesis in 1, cortical carcinoma in 1 and neuroendocrine tumor of the adrenal medulla in 1. The 9 adrenal metastasis resulted by renal cell carcinoma in 7 patients, urothelial carcinoma of the upper urinary tract in I and primary renal lymphoma in 1. Average follow-up was 68 months (range 6-246). Patients alive were 18 (64%), deal 10 (36%). Of the 19 patients with primary adrenal tumors 16 (84%) were alive and disease free and 3 (16%) died (I for disease and 2 for reasons unrelated to the primary tumor). Of the 9 patients with adrenal metastasis 2 (22%) were alive (I disease free and I with progression of the disease) and 7 (78%) died for disease. Replacement therapy for adrenocortical hormones was given 5 patients. CONCLUSIONS Management of Al need CT or MRI and hormonal investigation in order to detect malignancy and subclinical hypersecretory syndromes. Subclinical functional adrenal masses, single adrenal metastasis and primary nonhypersecretory adrenal tumors sized 4 cm are treated by surgery. A close morpho-functional follow-up is indicated for primary adrenal incidentalomas when nonhypersecretory and smaller than 4 cm.
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