NEUROENDOCRINE RENAL CARCINOMA - THERAPEUTIC AND DIAGNOSTIC ISSUES

Introduction

Neuroendocrine renal carcinoma represents less than 1% of all primary neoplasia of the kidney. Most frequently poorly differentiated carcinoma is diagnosed in advanced stages and they have an aggressive evolution and limited survival rate. Neuroendocrine carcinomas that arise from the renal pelvis are frequently associated with squamous cell carcinoma or adenocarcinoma.

Material and method

We present the case of a female patient, known for 3 years before with an undefined retroperitoneal lymph node metastasis, being diagnosed at present with a left large cell neuroendocrine renal carcinoma, who initially had lymph node metastasis.

Results

Until now, 118 cases of primary neuroendocrine renal carcinomas have been reported. A limited number of poorly differentiated neuroendocrine carcinomas have been reported.

Discussion

Due to the clinical and biological findings, the aggressive evolution with early metastasis of lung and bone, the patient is included in the group of poorly differentiated carcinomas. In these cases, multimodal treatment is a gold standard. After surgical treatment and palliative chemotherapy with platinum salts, we obtained a partial remission of the disease and the control of symptoms.

Conclusions

Regarding large cell neuroendocrine carcinoma, the surgical treatment remains the treatment of choice. Chemotherapy can determine limited results, improve the quality of life and enhance the overall survival rate.

VESICOVAGINALS FISTULAS: THE EXPERIENCE OF OUR CLINIC ON SURGICAL TREATMENT AND RESULTS

Vesicovaginals fistulas are the most common type of urogenital fistulas resulting after radical hysterectomy with or without radiotherapy. In most cases, surgery is necessary for healing. The present study was conducted over a period of 5 years. In all cases, the diagnosis was made on medical history, a complete clinical examination, intravenous pyelography and cystoscopy. Surgical closing technique of fistula tract could be applied in 28 cases (68.29%), out of which in 9 (22%) patients the exicision of the fistula tract and separate suture of the bladder and the vagina were performed while in 19 ( 46.3%) patients a flap was interposed too. All 25 patients who presented fistula after radical hysterectomy were feasible to surgical treatment of demolition of fistula and only 3 of 16 (18.75%) of the cases of hysterectomy and radiotherapy had indication for surgical closing technique of fistula tract. In 4 cases (9.7%) an external urinary diversion as the only therapeutic solution was performed. In 3 cases (7.3%) a percutaneous nephrostomy was inserted. Two patients (4.8%) presented vesicovaginal fistula and rectovaginal fistula as well. 24 (85.71%) of the 28 cases that have benefited from surgery remained continent, without loss of urine vaginally after the removal of urethro-bladder catheter. In 13 (31.7%) cases the success could not be obtained due to radiotherapy associated with hysterectomy. In the 25 cases where radiotherapy was not enforced, the success rate of surgery was 92%, while in patients who have benefited from radiotherapy too it goes down drastically (33%).The surgical closing technique of the vesicovaginal fistula has a very high success rate. The success of the operation can be obtained from the first surgery. The associated radiotherapy has a big influence in the approach of this pathology surgery.

Transarterial embolization of renal vascular lesions after percutaneous nephrolithotomy

INTRODUCTION

Percutaneous nephrolithotomy (PCNL) represents a safe and efficient procedure in the surgical management of renal lithiasis. Nevertheless, surgeons have to face specific complications during and after the procedure, hemorrhage being one of the most common. In most cases the injuries are self-limited and do not need a surgical intervention. Renal arteriography with selective angiographic embolization is needed in patients with massive hemorrhage or continuous hematuria. Our objective was to evaluate the effectiveness of percutaneous transarterial embolization for the treatment of renal arterial post-PCNL bleeding.

MATERIAL AND METHOD

This retrospective study was performed between March 2007 and October 2012 and included 22 patients who had undergone renal embolization due to significant post-PCNL renal artery bleeding. The site, number, and type of bleeding lesions, and the result of the embolization procedure were recorded. We report on the incidence, treatment, radiological and clinical results of these serious vascular injuries at our institution.

RESULTS

Our study has included a large group of patients, the 95.45% angiographic success rate confirming that percutaneous transcatheter embolization is a valuable treatment for most renal vascular injuries. Renal angiography revealed pseudoaneurysm in 15 patients, arteriovenous fistula in 5 and arterial laceration in 2 patients. Significant risk factors on univariate analysis for severe hematuria requiring superselective angiography were multiple staghorn calculi, upper calix puncture and history of pyelonephritis. The severity of the hematuria after PCNL is influenced by many factors, including mean stone size and mean operative time and is correlated with duration of hospitalization and mean hemoglobin drop.

CONCLUSIONS

Percutaneous transarterial embolization of the injured vessel is an effective, minimally invasive and relatively easy procedure in experienced centers, with high rate of success and immediate benefits, thus saving the patient from the morbidity that results from severe renal bleeding.

Efficacy and safety of repeated dosing of netupitant, a neurokinin-1 receptor antagonist, in treating overactive bladder

AIM

NK-1 receptors in sensory nerves, the spinal cord and bladder smooth muscle participate in complex sensory mechanisms that regulate bladder activity. This study was designed to assess the efficacy and safety of a new NK-1 receptor antagonist, netupitant, in patients with OAB.

METHODS

This was a phase II, multicenter, double-blind study in which adults with OAB symptoms >6 months were randomized to receive 1 of 3 doses of netupitant (50, 100, 200 mg) or placebo once daily for 8 weeks. The primary efficacy endpoint was percentage change from baseline in average number of daily micturitions at week 8. Urinary incontinence, urge urinary incontinence (UUI), and urgency episodes were also assessed.

RESULTS

The primary efficacy endpoint was similar in the treatment groups (-13.85 for placebo to -16.17 in the netupitant 200 mg group) with no statistically significant differences between netupitant and placebo. The same was true for most secondary endpoints although a significant difference for improvement in UUI episodes and a trend for the greatest decrease in urgency episodes were seen in the netupitant 100 mg group. Netupitant was well tolerated with most treatment emergent adverse events (AEs) being mild. While the overall incidence of AEs increased with netupitant dose, there was no evidence for this dose dependency based on relationship to treatment, intensity, or time to onset.

CONCLUSIONS

The study failed to demonstrate superiority of netupitant versus placebo in decreasing OAB symptoms, despite a trend favoring netupitant 100 mg. There were no safety concerns with daily administration of netupitant over 8 weeks.

Radical prostatectomy in the treatment of prostate cancer. The experience of the Urology Clinic of Prof. Dr. Th. Burghele Clinical Hospital

INTRODUCTION

radical prostatectomy remains a real challenge for most of the urologists. Our study's objective is bringing into discussion the main aspects related to the technique we use, the intra and post-operatory complications, as well as the short-term analysis of the results in PC treatment using RP in the Prof. Dr. Th. Burghele Clinical Hospital - Clinic of Urology.

MATERIAL AND METHODS

between 1999 and 2007, 59 patients with PC, aged 48-74, were operated in our clinic. We began to recommend prostate biopsy (PB) to all patients with PSA higher than 4 ng/ml and, in the last years, higher than 2,5 ng/ml. A change in our attitude is related to the PB. At the beginning, we tried to perform "targeted" punctions, ultrasound guided especially in suspect zones, afterwards, we performed randomised punctions at all the patients, no matter the aspect of TRUS and we have increased the number of punctions accordingly to the prostate volume (minimum 6 punctions, maximum 12). The most used was the 10 core punction. The T classification, according to the clinical diagnosis, of the 59 operated patients: T1 cT1 a-b--4 cases; cT1 c--39 cases; T2 cT2 a--12 cases; cT2 b-c--4 cases. The RP surgical technique was the classic one, described by P.C. Walsh--the first surgical step, in all cases was lymphadenectomy.

RESULTS

of all the patients that went through RP, 56 cases are still in our records. We can consider healed 24 patients with PC, followed for 3 years post-surgery, because they had no need of therapy and the PSA is maintained below 0.02 ng/ml. The Gleason score--between the pre-operatory established diagnosis by punction and the anatomic-pathological examination of the piece, there were some differences: the concordance was in 48% of the cases; in 39% of the patients, the biopsy specimen had a lower Gleason score than the surgery specimen, and in 13% a higher score, the most common error was caused by sampling. The correlation between the pre-operatory evaluated clinical stage and the pathological clinical stage was of 57%. The most important late postoperative complications of RP were: urinary incontinence and erectile dysfunction. In our study, we have recorded late postoperative: complete urinary incontinence in 4 cases (6.7%), erection was maintained after bilateral preservation of neurovascular bandelets in 90% of cases and after unilateral preservation in 71% of cases. Due to the short following period, we can't say if the operated patients by us had a benefit regarding the general surviving period; The personalized interpretation of the increase of serum PSA levels after surgery represents a possible problem regarding the indication of complementary treatment.