Valore Predittivo del Mapping Prostatico Nella Valutazione Preoperatoria Del Volume Della Neoplasia Prostatica: Studio Ecografico ed Anatomopatologico su 25 Pazienti Sottoposti a Prostatectomia Radicale Retropubica

Quantitative tumour volume is reported to be the single most important morphologic predictor for lymph node metastases and distant spread in the individual patient with prostatic cancer. 25 patients with histologically proved prostatic cancer underwent Prostatic Mapping before Radical Retropubic Prostatectomy. Surgical specimens were processed and prostatic cancer volume was calculated according to abbreviated standard procedure that avoids the serial blocking of prostatectomy specimens required by standard techniques. Our study demonstrated a strong correlation between Prostatic Mapping categories and prostatic cancer volumes. This ability of Prostatic Mapping to estimate preoperatively the tumour volume may be a useful clinical tool to help guide surgical therapy and assess prognosis.

Clinical staging of prostatic carcinoma by prostatic mapping

The exact preoperative stage of prostatic cancer is the major problem involved in the indications for radical retropubic prostatectomy. A personal technique of prostatic mapping (PM) by means of strategic transrectal ultrasound guided core biopsies is presented as an effort to improve the staging of clinically localized prostatic cancer. PM is able “to photograph” intraprostatic neoplastic spread revealing infiltration of the apex and of the seminal vesicle beaks. Our hope is that, if our results are confirmed, PM will become an important tool in preoperative prostatic cancer staging.

[Valves of the anterior urethra without diverticulum. Description of 3 cases]

Anterior urethral valves are rare entities, especially in case they are not associated to urethral diverticulum. Because of their obstructive effects on the urinary tract, they must be searched in case of clinical evidence of lower obstructive uropathy. Three cases of anterior urethral valves without urethral diverticulum are herein reported. Differential diagnosis with urethral diverticula, endoscopic features and treatment are discussed and emphasized.

[Ureteral ectopy. The residual stump syndrome]

Anatomy and symptoms of ureteral ectopy in childhood can greatly vary. In most cases the site of ectopies in the urethral tract, so that a complete excision of the distal ureter is difficult and may cause damage to the sphincteric structures. When lower ureterectomy is performed below iliac vessels, symptoms secondary to residual ectopic ureter are rare. In our experience, residual ureteral stumps were symptomatic in two cases, with continence and micturation disturbances, which were codified as "residual ureteral stump syndrome". Clinical features and treatment are herein reported.

[Morphological findings on the terminal tract of the ureter in patients with vesico-ureteral reflux associated with neurogenic bladder]

Vesico-ureteral reflux (VUR) associated to neurogenic bladder dysfunctions is well known as pathologic entity; in particular, its radiologic and urodynamic aspects have been widely debated in recent years, even in infancy and childhood. In our study, histologic features of the vesico-ureteral junction have been investigated in a group of patients with neurogenic bladder and VUR, who underwent antireflux surgery. Structural aspects of these vesico-ureteral junctions have been then compared to refluxing junctions taken from non-neurogenic bladders and non-refluxing junctions from normal bladders.

[Morphologic findings on the terminal tract of the ureter in patients with primary vesico-ureteral reflux]

Primary vesico-ureteral reflux (V.U.R.) in children has been widely investigated in several reports in the last two decades, but the morphologic aspects of refluxing vesico-ureteral junction are still incompletely codified or incompletely described. The authors report the results of a histologic study on the terminal refluxing ureter in a group of 20 patients with primitive V.U.R., random chosen from a series of over 400 subjects who underwent antireflux surgery for primitive V.U.R. at the Pediatric Surgery Department of the University of Bologna. Connections between muscular hypertrophy and reflux degree are herein reported and discussed.

Inverted papilloma of the ureter: two cases of conservative therapy

We report 2 cases of inverted urothelial papilloma of the ureter. The second case demonstrates inverted papilloma and papillary transitional cell carcinoma in a single polypoid lesion. Conservative therapy was performed and a follow-up 12 months later shows no evidence of recurrences.

Rhabdomyosarcoma of the diaphragm in a 4-year-old girl

Rhabdomyosarcoma of the diaphragm is a very rare entity, especially in childhood. A case of a 4-year-old girl is reported. The mass extended completely into the abdominal cavity, causing problems in differential diagnosis with other abdominal masses. Dimensions, structure and limits of the mass had been outlined by several examinations (IVP, sonography, CT, angiography), but its actual nature could not be shown, so that a surgical exploration was needed. A pedunculated, well-capsulated mass, arising from the left diaphragmatic portion, was found. A complete excision could be performed and histologic findings were compatible with rhabdomyosarcoma of the diaphragm.

Sigmoid volvulus in children: a case report

Sigmoid volvulus in childhood is a rare entity. Dolichosigmoid, i.e. an abnormally long sigmoid flexure, and or absence of mesosigma are predisposing factors in most cases. A case of a 9-year-old black male child is reported. The patient presented with the typical symptoms and, at operation, a necrotic segment of the sigma of huge dimensions was found. Volvulus consisted of three complete counterclockwise rotations of the proximal on the distal tract.

[Papilloma of the bladder in childhood. Description of a case]

Epithelial tumours of the bladder are very rare entities in childhood. A case of a bladder papilloma in a 10 years old boy is herein reported. Basing on this observation, the pathological, therapeutic and prognosis aspects are mainly discussed.

[Combination of oxybutynin chloride (Ditropan) with intermittent catheterization in the treatment of neurogenic bladder in childhood: results on continence]

Nowadays Intermittent Catheterization (I.C.) is considered the treatment of choice in patients with neurogenic bladder dysfunction, because of its easy handling and good results. Renal function preservation, urinary tract infections prevention and continence can be achieved by this method. In particular, I.C. per sè improves continence quality in many cases, but, in the majority of them the best results can be obtained by drug therapy addition, having in mind a more direct action on to detrusor compliance and/or bladder neck tone. Oxybutynin Chloride (Ditropan)(-) is the first choice drug, even in childhood, in cases of neurogenic bladder dysfunction, for its anticholinergic, antispastic and analgesic properties. From 1978, 48 children with neurogenic bladder have been treated by I.C. Out of them, 27 have had drug therapy (Oxybutynin Chloride-Ditropan) in addition to I.C., according to indications of clinical, radiologic and urodynamics findings. Results on continence are discussed.

Os penis

The presence of os penis in man is very rare. To date only 11 cases have been published. A close study of these cases shows their extreme heterogeneity. We think that the os penis should be considered as a heterotopic bone structure similar to that found in the animal world. To confirm this we present our personal case study.

Abdominoscrotal hydrocele in childhood. Case report and review of the literature

Abdominoscrotal hydrocele in infancy and childhood is a very rare entity. A review of the literature reveals only five cases at this stage. Symptoms are often poor and non-specific and the mass must be differentiated from other abdominal ones; to achieve this, I.V.P., cystography and sonography play an important role. Total excision is necessary to obtain permanent cure.