Long-Term Outcomes Following Bipolar Transurethral Plasma Enucleation of the Prostate: 10-Year Follow-Up

Background and Purpose: The aim of our study is to assess the long-term outcomes and safety of bipolar transurethral plasma enucleation of the prostate (B-TUEP) in patients with lower urinary tract symptoms (LUTS) in a single-center cohort study. Our focus is to evaluate the impact on outcomes after 10 years of follow-up (FUP) in terms of recurrence, LUTS, and patients' quality of life after B-TUEP in prostates between 30 and 80 cc. Materials and Methods: Between May 2010 and December 2011, all consecutive patients with benign prostatic hyperplasia undergoing B-TUEP were prospectively enrolled in our study. Data on patients' history, physical examination, prostate volumes, erectile function, prostate-specific antigen levels, International Prostate Symptoms Score (IPSS), and uroflowmetry were collected at 0, 1, 3, 6, 12, 24, 36, 60, and 120 months. Early and long-term complications were recorded. Results: A total of 50 consecutive patients underwent B-TUEP in our facility, all performed by a single surgeon (R.G.). Twelve patients were excluded during the 10 years. No patients had persistent bladder outlet obstruction (BOO) requiring reoperation. In terms of results, the improvement in IPSS was sustained throughout 5 years, and the mean difference from baseline at 5 years was 17 points, with similar results at 10 years. Erectile function was also slightly improved after surgery and maintained for the next 5 years, with a slight age-related decrease at 10 years. Furthermore, the improvements in maximum urine flow rate (Qmax) were maintained at 5 years, with a mean improvement of 16 mL/s, while at 10 years, it settled on a mean improvement from baseline of 12 mL/s. Conclusions: In our 10 years' experience, B-TUEP is a safe and highly effective technique for relieving BOO, with excellent outcomes and no recurrence at 10 years of FUP. Further multicenter studies should confirm our results.

How many procedures are needed to achieve learning curve of Millin simple laparoscopic prostatectomy

BACKGROUND

Aim of our study was to evaluate learning curve of the Millin simple prostatectomy analysing three expert laparoscopic surgeons.

METHODS

Learning curve of 3 expert laparoscopic surgeons with excellent radical prostatectomy training was evaluated. Surgeon 1 had more than 20 years of experience, while other surgeons had 10 years of experience. The first 45 procedures of the surgeons were considered for analysis. The cumulative sum (CUSUM) technique, one of the methods developed to monitor the performance and quality of the industrial sector, was adopted to analyse learning curves. The variables included to evaluate learning curve of the surgeons were: operative time (OT), hospitalisation (HO) and complication rate.

RESULTS

Overall 135 patients were included in the analysis. Median age was 68 (64/74), median prostate volume was 83 (75/97), median Qmax 9 ml/s (6/11) and median IPSS 20 (18/22). Complications included: 9/135 (7%) transfusion, 4/135 (3%) Urinary retention, 3/135 (2%) fever, 1/35 (<1%) reintervention and 1/135 (<1%) conversion. Surgeon 1 presented a lower median operative time when compared to surgeon 2 and 3. No significant differences were recorded in terms of hospitalisation, blood loss and transfusion rate as well as postoperative outcomes. According to the CUSUM analysis the number of procedures needed to achieve a plateau in surgical time is 10/15 procedures (fig 1).

CONCLUSIONS

In conclusion, according to our results 15 procedures are needed to reach a plateau in surgical time for trained laparoscopic surgeons.

The role of immune PSA complex (iXip) in the prediction of prostate cancer

PURPOSE

To analyse the performance of iXip in the prediction of prostate cancer (PCa) and high-grade PCa.

METHODS

A consecutive series of men undergoing MRI/FUSION prostate biopsies were enrolled in one centre. Indications for prostate biopsy included abnormal prostate-specific antigen (PSA) levels (PSA > 4 ng/ml) and/or abnormal digital rectal examination (DRE) and/or abnormal MRI. All patients underwent the evaluation of serum PSA-IgM concentration and the iXip ratio was calculated. Accuracy iXip for the prediction of PCa was evaluated using multivariable binary regression analysis and receiver operator characteristics (ROC) curves.

RESULTS

Overall 160 patients with a median age of 65 (62/73) years were enrolled. Overall, 42% patients were diagnosed with PCa and 75% of them had high-grade cancer (Epstein ≥ 3). Patients with PCa were older and presented higher PSA levels, higher PIRADS scores and lower prostate volumes (PVs). On ROC analysis iXip presented an area under the curve (AUC) of 0.57 in the prediction of PCa and of 0.54 for the prediction of high-grade PCa.

CONCLUSIONS

In our experience, immune PSA complexes are not predictors of PCa. iXip analysis should not be included in the diagnostic pathway of patients at increased risk of PCa.

Laparoscopic simple prostatectomy vs bipolar plasma enucleation of the prostate in large benign prostatic hyperplasia: a two-center 3-year comparison

PURPOSE

To compare surgery outcomes and safety of button bipolar enucleation of the prostate vs laparoscopic simple prostatectomy in patients with large prostates (> 80 g) in a two-center cohort study.

METHODS

All patients with lower urinary tract symptoms due to benign prostatic enlargement (Prostate volume > 80 cc) undergoing button bipolar enucleation of the prostate (BTUEP) or laparoscopic simple prostatectomy (LSP) in two centers were enrolled. Data on clinical history, physical examination, urinary symptoms, uroflowmetry and prostate volume were collected at 0, 1, 3 6, 12, 24 and 36 months. Early and long-term complications were recorded.

RESULTS

Overall, 296 patients were enrolled. Out of them, 167/296 (56%) performed a LSP and 129/296 (44%) performed a BTUEP. In terms of efficacy both procedures showed durable results at three years with a reintervention rate of 8% in the LSP group and of 5% in the BTUEP group. In terms of safety, BTUEP and LSP presented similar safety profiles with a 9% of transfusion rate and no major complications.

CONCLUSION

LSP and BTUEP are safe and effective in treating large-volume adenomas with durable results at three years when performed in experienced centers.

Bipolar Plasma Enucleation of the Prostate: 5 Years Outcomes

Background: Aim of our study is to assess outcomes and safety of button bipola transurethral enucleation of the prostate (B-TUEP) in patients with lower urinary tract symptoms (LUTS) caused by benign prostatic enlargement (BPE) in a single-center cohort study. Materials and Methods: All patients with LUTS caused by BPE undergoing button B-TUEP between May 2012 and December 2013 were prospectively enrolled in our study. Data on clinical history, physical examination, urinary symptoms, erectile function, uroflowmetry, and prostate volume were collected at 0, 1, 3, 6, 12, 24, 36, 48, and 60 months. Early and long-term complications were recorded. Results: Overall 50 patients were enrolled at baseline. Nine patients were excluded during the 5 years. All patients completed the procedure without severe complications. In terms of outcomes, improvement in International Prostate Symptom Score (IPSS) were sustained for all 5 years and mean difference from baseline at 5 years was 17 points. As well, improvements in Q_max (maximum urinary flow rate) were sustained for all 5 years and mean improvement at 5 years was 16 mL/second. Erectile function was slightly improved after surgery and maintained for the following 5 years. Conclusions: Our single-center study suggests that B-TUEP may have excellent outcomes at 5 years with no recurrence. Further multicentre studies should confirm our results.

Urotensin II receptor expression in prostate cancer patients: A new possible marker

BACKGROUND

Urotensin II receptor has been poorly studied in prostate cancer. To evaluate the expression of urotensin II receptor (UII-R) in patients undergoing radical prostatectomy.

METHODS

Overall, we identified 140 patients treated with retropubic radical prostatectomy (RP) in one center. UII-R was evaluated in prostate biopsies with immunohistochemical staining, resulting in a granular cytoplasmic positivity, through automated system using the kit Urotensin II Receptor Detection System provided by Pharmabullet srl. Immunostained slides were independently and blindly evaluated by ten uro-pathologists. To evaluate UTII-R expression three different parameters were considered: localization, granules dimensions and intensity of expression. A score from 0 to 3 was applied to each parameter to obtain a score from 0 to 9. Each parameter and the total score were evaluated as predictors of high grade disease on surgical pathology and of advanced stage disease. Accuracy of total score for the prediction of upgrading and upstaging was analyzed using receiver operator characteristics curve and decision curve analysis (DCA).

RESULTS

On radical prostatectomy 92/140 (66%) presented high grade disease on surgical pathology. Patients with high grade disease presented an apical distribution of the receptor, larger granules and a more intense expression when compared to patients with low grade disease. A well they presented a higher total score. Subscores and total scores were found to be predictors of upgrading and upstaging. On ROC analysis total score presented an AUC of 0.72 and 0.70, respectively, for the prediction of upgrading and upstaging. On DCA total score showed a clinical benefit in the prediction of adverse pathological outcomes.

CONCLUSION

Urotensin II receptor is a potential marker of adverse pathological outcomes. Further studies should confirm our data and evaluate its role as a prognostic marker.

Narrow Band Imaging reduces persistence of cancer in patients with pT1 high grade bladder cancer

PURPOSE

To evaluate persistence rate on repeated transurethral resection of the bladder (re-TURB) 6 weeks after the first TURB in patients with pT1HG disease undergoing resection of the margins and bed on Narrow Band Imaging.

MATERIALS AND METHODS

A consecutive series of patients undergoing TURB and a diagnosis of pT1 high grade disease were prospectively enrolled. On initial TURB patients underwent classic white light resection of the tumour followed by narrow band image (NBI) resection of margins and bed. After 6 weeks from the initial TURB, patients underwent a re-TURB under white light. Persistence rates on re-TURB were recorded.

RESULTS

Overall 797 patients underwent TURB, out of them 126 patients with pT1 high grade disease were included in the study. The total number of lesions was 226 meaning 1.79 lesions per patient. On re-TURB 24/126 (19%) of the patients presented residual disease with a total of 28/226 (12%) lesions identified. All these patients presented a pTa residual disease. Out of them 8/21 (38%) presented bladder cancer on the resection bed and 13/21 (62%) presented bladder cancer on margins.

CONCLUSION

Narrow Band Imaging trans-urethral resection of the bladder is an oncological effective procedure in the treatment of pT1HG disease. The procedure has a 19% of persistence rate which is inferior when compared to the available evidence on white light TURB. Further multicenter studies are needed in order to validate our results.

Can re-cTURBT be useful in pT1HG disease as a risk indicator of recurrence and progression? A single centre experience

INTRODUCTION

Understaging after initial transurethral resection is common in patients with high-risk non muscle infiltrating bladder cancer (NMIBC) and can delay accurate diagnosis and definitive treatment. The rate of upstaging from T1 to T2 disease after repeated transurethral resection ranges from 0 to 28%, although the rate of upstaging may be even higher up to 49% when muscularis propria is absent in the first specimen. A restaging classic transurethral resection of bladder tumour (re-cTURBT) is the better predictor of early stage progression. According to some reports, the rate of positivity for tumor in re-cTURBT performed within eight weeks after initial cTURBT was as high as 18-77%, and in about 40% of the patients a change in tumor stage was reported. We aimed to investigate, in high risk group, the presence of residual tumor following white light classical transurethral resection of bladder tumor (WLre-cTURBT) and the different recurrence and progression rate between patients with persistent or negative (pT0) oncological disease after WLre-cTURBT.

MATERIALS AND METHODS

A cohort of 285 patients presenting with primitive bladder cancer underwent to WLcTURBT from January 2011 to December 2015; out of them 92 (32.28%) were T1HG. In according to EAU guidelines 2011, after 4-6 weeks all HG bladder cancer patients underwent a WL recTURBT . All patients were submitted to a subsequent followup including cystoscopy every 3 months with multiple biopsies, randomly and in the previous zone of resection; urinary citology on 3 specimens and kidney/bladder ultrasound every 6 months. The average follow-up was 48 months.

RESULTS

Following WLre-cTURBT we observed a persistent disease in 18 (15.2%) patients: 14 (77.7%) with a HG-NMIBC and 4 (22.2%) with a high grade (HG) muscle invasive bladder cancer (pT2HG). After follow up of all 92 patients according to the guidelines EAU, we observed recurrence in 36/92 (39.1%) and progression in 14/92 (15.2%). Of 14 NMIBC with persistent disease, 10 patients (71.4%) showed recurrence: 4 patients (40%) were pT1HG with concomitant carcinoma in situ (CIS), 3 patients (30%) multifocal pTaHG, 2 (20%) patients CIS and one patient (10%) a muscle invasive neoplasm (pT2HG). Instead of the group of 48 patients pT0 following WL recTURBT, we observed recurrence in 26 patients (54.1%) and in two patients (4.1%) progressions, who presented after 3 months in association with CIS. The remaining 22 patients (45.9%) with initial pT1HG are still progression free. Multivariate analysis showed that the most important variable of early progression were persistent neoplasm and histopathological findings at WLre-cTURBt (p = 0.01), followed by the Summary No conflict of interest declared. INTRODUCTION Bladder cancer is a common genito-urinary malignancy, with transitional cell carcinoma comprising nearly 90% of all primary bladder tumours. At the first diagnosis 70% to 80% of urothelial tumours are confined to the epithelium, the remainder is characterized by muscle invasion. A significant number of patients with high risk non-muscle invasive bladder tumours (HG-NMIBT) treated with white light classic transurethral resection of bladder tumours (WLcTURBT) and intravesical BCG will progress to invasive disease (1-3). Progression to muscle invasion (pT2) mandates immediate radical cystectomy (4). WLcTURBT is the standard initial therapy for NMIBT, but the high percentage of recurrence after surgery is still an unresolved problem (5). High grade pT1 bladder neoplasm (pT1HG) really represents a therapeutic challenge due to the high risk of progression (about 15-30%) to muscle-invasive disease, usually within 5 years (6). However, no consensus exists regarding the treatment of patients with recurrent bladder tumours that invade the lamina propria (pT1) (7-9). Recent studies suggested that the first cTURBT may be incomplete in a significant number of cases (10). Understaging at the time of the initial transurethral resection is common for patients with high-risk NMIBC and can delay accurate diagnosis and definitive treatment. It is therefore recommended for patients with high-risk disease and in those with large or multiple tumors or when the initial transurethral resection is incomplete, to repeat WLre-cTURBT within 2-6 DOI: 10.4081/aiua.2017.4.272 result of the first cystoscopy (p = 0.002) and presence of CIS (p = 0.02).

DISCUSSION

Following WLre-cTURBt in HG-NMIBC patients we identified in 15% of cases a persistent disease with a 4.3% of MIBC. In the high risk persistent bladder neoplasms group we observed recurrent and progression rate higher than in T0 bladder tumours group (Δ = + 17.3% and = Δ + 62.5%, p < 0.05.

Narrow band imaging (NBI) cystoscopy and assisted bipolar TURBT: A preliminary experience in a single centre

OBJECTIVE

The aim of this study was to compare, in order to increase our ability to detect bladder cancer, the predictive power of narrow band imaging (NBI) versus white light cystoscopy (WL). The secondary objective was to evaluate how the preoperative use of NBI cystoscopy can increase the ability to detect bladder lesions in terms of status, multi-focality and dimensions.

MATERIALS AND METHODS

Between June 2010 and April 2012, 797 consecutive patients, 423 male and 374 female, affected by suspected bladder cancer lesions, underwent to WL plus NBI cystoscopy and subsequently to WL Bipolar Gyrus PK (Olympus, Tokyo, Japan) transurethral resection of bladder tumour (WL-TURBT). The average follow-up was 24 (16-38) months. Mean age was 67.7 yrs. (range 46-88). All the patients underwent by same surgeon to WL resection (WL-TURBT) of the previously identified lesions by same surgeon. All the removed tissue was sent separately for histological evaluation after mapping the areas of resection on a topographic sheet.

RESULTS

In our study we considered 797 patients that matched our inclusion criteria. Through the use of WL cystoscopy, we identified 603 patients (75.53%) with suspicious lesions, instead, with the use of light NBI, we found 786 patients with suspicious lesions (98.49%).The use of NBI cystoscopy increases by approximately 30% the specific ability to detect lesions not otherwise visible with WL cystoscopy (OR 21.9 and RR 1.30), in particular for patients with lesions size &lt; 3 cm (OR 24.00; RR 1.40), unifocal (OR: 22.28; RR 1.47) and recurrent (OR 58.4; RR 1.34). Pathology demonstrated the presence of cancer in 512 (64.2%) patients, of whom 412 (51.8%) were visible both with WL cystoscopy and NBI cystoscopy. In our experience, only 11 (1.38%) lesions were only positive at WL cystoscopy (negative at NBI cystoscopy) thus 501 (62.8%, OR 10.13; RR 1.21) patients showed bladder oncological lesions positive at NBI cystoscopy. In these patients, the use the NBI Cystoscopy has better highlighted a recurrence (p &lt; 0.005; OR 22.8, RR 1.23; 95% CI-1.13 to 0.24) or a lesion &lt; 3 cm (p &lt; 0.05; OR 11.4 , RR 1.30; 95% CI-0.18 to 0.29) or a unifocal lesion (p &lt; 0.005; OR 10.38, RR 1.34, CI 0.18 to 0.30).

CONCLUSIONS

The use of NBI cystoscopy, significantly increases by approximately 30% our predictive power to identify neoplastic lesions, especially unifocal or &lt; 3 cm or recurrent lesions. Following WLTURBT, stage, dimension and focaliity are statistically significant determinants (p &lt; 0.001) of the bladder oncological lesions detected by NBI cystoscopy rather than by WL cystoscopy.

Bipolar Plasma Enucleation of the Prostate (B-TUEP) in Benign Prostate Hypertrophy Treatment: 3-Year Results

OBJECTIVE

To investigate numerous endoscopic techniques that have been described for the treatment of benign prostate enlargement. Plasma-button enucleation of the prostate (B-TUEP) is a successful treatment option because the large surface creates a fast enucleation process, vaporization, and concomitant hemostasis. The aim of this study was to evaluate the efficacy of bipolar button electrode transurethral adenoma enucleation (B-TUEP) in saline solution. The second end point was to determine the change of International Prostate Symptom Score (IPSS), post-void residual urine, International Index of Erectile Function, transrectal ultrasound gland volume evaluation, and prostate-specific antigen.

MATERIALS AND METHODS

Between July 2011 and March 2012, 50 consecutive patients underwent B-TUEP in our facility, all performed by a single surgeon (R.G.). All patients were preoperatively assessed with maximum urinary flow rate, single-question quality of life assessment, IPSS and the International Index of Erectile Function questionnaires, transrectal ultrasound gland volume evaluation, prostate-specific antigen, and post-void residual urine.

RESULTS

We observed a significant improvement at 12, 24, and 36 months in terms of maximum urinary flow rate (22.3 ± 4.74 mL/s, 23.2 ± 0.30 mL/s, and 23.6 ± 1.26 mL/s, respectively, P <.01) and quality of life (5.28 ± 0.97, 5.69 ± 0.90, and 5.73 ± 0.87). IPSS and IEEF scores improved significantly (P <.05). Gland volume evaluation and post-void residue decreased (P <.001). The prostate-specific postoperative antigen levels were 0.76 ± 0.61 ng/mL, 0.7 ± 0.51 ng/mL, and 0.62 ± 0.18 ng/mL, at 12, 24, and 36 months, respectively. Two patients (4%) had persistent bladder outlet obstruction requiring reoperation.

CONCLUSION

After 3-year follow-up, B-TUEP represents an effective, durable, and safe form of surgical intervention. B-TUEP is an alternative treatment for symptomatic benign prostate enlargement.

Vesico-vaginal fistula and bladder stone caused by a protruding spiral tacker 4 years after a laparoscopic sacrocolpopexy: Case report

Our case report demonstrates that the use of tackers or other devices in a improper way should be avoid and it can be correlated with late complication of laparoscopic colposacropexy.

A very rare case of adult-type granulosa cell tumor

Granulosa cell tumor (GST) of the testis is a rare neoplasm. Here we describe a case of an adult type GST. More than a year after surgical treatment, without any other treatment, the patient is alive without sign of disease.

Low-cost semirigid ureteroscopy is effective for ureteral stones: experience of a single high volume center

AIM OF THE STUDY

To demonstrate how, in a center with a large number of patients, as our center is, it is possible to perform ureterolithotripsy using a limited set of instruments.

METHODS

We evaluated medical charts of our center related to semirigid ureteral ureteroscopy (URS) with ureterolithotripsy using Holmium laser performed from July 2004 to July 2011. Overall, 658 URS for ureteral stones were performed in 601 patients, of which 204 in proximal ureter (31%), 86 in the mid (13.06%) and 368 (57.76%) in the distal ureter. In 504 patients (76.5%) ureterohydronephrosis (Grade II-III) was observed. In 57 patients (8.6%), we performed a bilateral approach at the same time, but most patients had a solitary distal ureteral stone. 106 patients (16.1%) had more than one stone in their distal ureter and 96 (14.8%) had a proximal ureteral stone treated in the same surgery as well.

RESULTS

The overall stone-free rate for ureteral stones was 86.1% (567/658). Success rates for proximal, medial and distal ureteral stones were 68.13% (139/204 patients), 84.8% (73/86 patients) and 96.4% (355/368 patients), respectively. One hundred and twenty patients (18.3%) required additional surgical treatment for their stones beyond the initial URS, including a second URS in 97 patients (14.74%) and URS plus Retrograde Intra-Renal Surgery (RIRS) in 23 patients (3.54%). The overall stonefree rate after the second treatment was 99.3%. Intra-operative complications accounted for 5.92% and consisted of ureteral perforations in 16 pts (2.4%), erosions of urothelium leading to significant bleeding in 15 pts (2.27%), severe pain in 4 pts (0.6%), fever in 3 pts (0.45%) and one case of ureteral avulsion (0.15%).

CONCLUSIONS

This study demonstrates that the use of Holmium laser lithotripsy is a safe and effective means of treating ureteral stones regardless of sex, age, stone location, or stone size. The instrumentation we used was extremely limited, in order to reduce costs related to the procedure to an absolute minimum whilst maintaining the two quality indicators for the procedure, namely success rate and length of hospitalisation (86.1% and 34 hours).

Comparative randomized study on the efficaciousness of endoscopic bipolar prostate resection versus monopolar resection technique. 3 year follow-up

Objective: Transurethral resection of the prostate (TURP) is the current optimal thera- py for the relief of bladder outflow obstruction, with subjective and objective success rate of 85 to 90%. Aim of this study was to evaluate efficacy and safety of Plasmakinetic ener- gy (Gyrus electro surgical system), which produces vaporization of tissue immersed in isotonic saline against standard monopolar transurethral resection of the prostate. Methods: From January 2002 to April 2002, 160 consecutive patients, who had low urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH) were enrolled in this study. Patients were randomised to undergo bipolar TURP (80 patients) or monopolar TURP (80 patients). Preoperative work-up was assessed by administering IPSS, IIEF-5 and Qol questionnaires. All patients were submitted to uroflowmetry, transrectal ultrasound (TRUS), post-voidal residual urine measurement and PSA determination. In the two groups, IPSS, IIEF-5 and Qol, uroflowme- try, TRUS, post-voidal residual urine measurement, PSA determination and number of reopera- tions were evaluated at 1, 3, 6, 12, 18, 24, 30 and 36 months follow up, and then every year. Furthermore, in both groups operative time, resected tissue weight and perioperative complica- tions were analysed. Total postoperative catheter time, total post-operative hospital stay, haemo- globin loss were also recorded in the two groups. Results: Comparative data on IPSS symptom score, IIEF-5, Qol, PSA, peak urinary flow rate and post-void residual urine volume were similar in the two groups but showed a significant improve- ment respect to baseline values. The postoperative haemoglobin levels, postoperative catheteri- zation time, hospital stay and 3-year overall surgical re-treatment-free rate were significantly better in the bipolar group. Conclusions: Bipolar TURP has a comparable outcome to standard monopolar TURP at short and medium term regard to subjective and objective outcome measurements. Its impact on blad- der outlet function is also similar to that of monopolar TURP. Improvement in IPSS, Qol index, IIEF-5, Qmax and post-void residual urine volume were comparable in both group denoting sim- ilar efficacy of the techniques.

Dynamic contrast-enhanced MR evaluation of prostate cancer before and after endorectal high-intensity focused ultrasound

PURPOSE

The authors sought to determine the diagnostic performance of dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging in the evaluation of prostate cancer before and after transrectal high-intensity focused ultrasound (HIFU) treatment.

MATERIALS AND METHODS

We analysed 25 patients with prostate cancer. The prostate-specific antigen (PSA) value was evaluated 1, 4 and 6 months after treatment. DCE-MR imaging was performed the day prior to and 1, 4 and 6 months after HIFU treatment. Transrectal prostate biopsies were obtained at the time of diagnosis and 6 months after treatment.

RESULTS

Before treatment, intraglandular lesions were considered to be potential sites of neoplasm and subsequently confirmed as sites of prostate adenocarcinoma in all 25 patients based on prostatespecific antigen (PSA) values and histological examinations (rho=1; p<0.001). Using histology as the gold standard, DCE-MR imaging displayed 100% sensitivity, 100% specificity, 100% positive predictive value and 100% negative predictive value before treatment. After HIFU treatment, DCE-MR imaging showed 100% sensitivity and 96% specificity.

CONCLUSIONS

DCE-MR imaging can be used to visualise prostate adenocarcinoma. Several morphological and postgadolinium modifications in the follow-up DCE-MR images after HIFU treatment were also observed.

A case of angiomyolipoma of the spermatic cord and testicle

Angiomyolipomas (AML) are mesenchymal tumors of the kidney consisting of varying proportions of vascular, immature smooth muscle and mature fat cells. A rare case of testicular AML is described. A 53 year old male with a history of congenital motor defects, mental retardation, and hypertension, presented to the emergency room with sudden onset, severe left testicular pain. Scrotal sonography demonstrated an hypoechoic mass in the patient's left testicle. The patient was offered and underwent a trans-inguinal exploration of the left testicle which ended in a left inguinal orchiectomy. Pathologic examination of the mass revealed medium to large calibre thick-walled blood vessels with ectatic lumina, surround by sclerotic, fibrous smooth muscle bundles in a fatty milieu. Immunohistochemistry of the lesion demonstrated positive staining for smooth muscle actin (SMA+) and endothelial marker CD34. The lesion did not, however, stain positively for smooth muscle antigen S100 or melanocytic antigen HMB-45.

Multicentre study on the efficacy and tolerability of an extract of Serenoa repens in patients with chronic benign prostate conditions associated with inflammation

INTRODUCTION

Chronic benign prostate diseases are very common and certainly feature significantly in urological practice.The treatment of chronic benign prostate diseases is a common problem in clinical practice: few studies have been conducted in routine clinical practice to evaluate the efficacy of the treatments for this clinical condition. The objective of this study was to evaluate the efficacy of an extract of Serenoa repens (Permixon) in the treatment of lower urinary tract symptoms (LUTS) in patients with chronic benign prostate diseases with associated inflammation, also taking into consideration the influence of treatment on sexual function and, therefore, on patients' quality of life.

MATERIALS AND METHODS

All the 591 eligible subjects were evaluated on entering the study; after a screening visit, including medical history, physical examination, physical examination and digital rectal examination (DRE) and laboratory tests, the patients underwent uroflowmetry. The subjects under investigation were also asked to complete the IPSS, NIH-CPSI and IIEF-5 questionnaires, for the purpose of evaluating urinary symptoms and erectile function in relation to sexual activity in the previous 6 months.

RESULTS

The analysis of the uroflowmetry results showed that treatment with extract of Serenoa repens distinctly improves bladder voiding and lower urinary tract symptoms, as highlighted also by the improvement in the scores for the IPSS and NIH-CPSI questionnaires which serve as a basis for evaluating the urinary symptoms of patients with prostatic hyperplasia and chronic prostatitis respectively. The results also suggest that using an extract of Serenoa repens for 6 months in patients with chronic benign prostate diseases gives rise to an improvement in erectile function, as demonstrated by the increase in the scores for the IIEF-5 questionnaire after 6 months of treatment.

CONCLUSIONS

The results of this study demonstrate how treatment for 6 months with an extract of Serenoa repens in routine clinical practice gives rise to a statistically significant improvement in Qmax values and in the IPSS, NHI-CPSI and IIEF-5 questionnaire scores, resulting not only in an improvement in urinary symptoms but also in an overall improvement in patients' quality of life.

Saturation biopsy technique increase the capacity to diagnose adenocarcinoma of prostate in patients with PSA < 10 ng/ml, after a first negative biopsy

OBJECTIVE

Aim of this study was to evaluate if saturation biopsy (SB) technique increases the cancer detection rate in patients with PSA < 10 ng/ml, after a first negative biopsy.

MATERIAL AND METHODS

From January 2004 to January 2006, 780 patients underwent prostate ultrasound guided transrectal (UGT) core biopsy: 186 (23.8%) presented prostate cancer (PCa) while 594 pts (76.2%), were disease free. For 1 year all the patients with no evidence of cancer were observed according to a follow-up schedule including PSA every 3 months and DRE every 6 months. During this period 140 patients showed an increase of PSA (< 10 ng/ml) or a low PSA free/total. This group underwent a second prostate UGT core biopsy with SB technique. In all the patients we evaluated PCa detection rates (DR) according to the PSA range. We also checked peri/post-operative complication rate (total post-operative hospitalization time, haemoglobin loss, catheterisation rate, pain rate, QOL).

RESULTS

Of the 140 patients 50 (35.7%) had PCa showing a Gleason score (GS) of 4 or 5 in 26%, 6 or 7 in 75% and 8 to 10 in 9% respectively. Sectors apical biopsies carried out in the anterior horn of peripheral zone tissue presented over 70% (35 patients) of cancer detection rate. Rectal bleeding was the major common complication. Cancer was clinically significant in 47 patients (94%) but 34 (68%) presented an organ confined disease after radical surgery.

CONCLUSIONS

SB technique increases of 35.7% the cancer detection rate (DR) in patients with PSA < 10 ng/ml, after a first negative biopsy, showing a higher positivity (70% PCaDR) if the SB included the anterior horn of peripheral zone tissue. No significantly pain and side effects were observed.

Comparative randomized study on the efficaciousness of treatment of BOO due to BPH in patients with prostate up to 100 gr by endoscopic gyrus prostate resection versus open prostatectomy. Preliminary data

OBJECTIVES

With the advent of medical management and minimally techniques for benign prostate hypeplasia (BPH), invasive surgical procedures such open prostatectomy (OPSU) have become less common, although selected patients may still benefit from open prostatectomy. Aim of this study was to evaluate efficacy and safety of Bipolar TURP (Gyrus electro surgical system) versus standard open prostatectomy in patients with lower urinary tract symptoms (LUTS) due to bladder outlet obstruction (BOO) with markedly enlarged glands refractory to medical therapy.

METHODS

From January 2003 to January 2004, 140 patients affected by mild-severe LUTS, secondary to BOO from BPH, refractory to medical therapy, with markedly enlarged glands, were randomized in two groups (1:1), and subjected to open prostatectomy (OPSU) carried out with traditional method (Bracci Thechnique) versus transurethral resection of the prostate (TURP) utilizing the bipolar methodology. Preoperative work-up included IPSS, IIEF-5 and Qol questionnaires. All patients were submitted to uroflowmetry, transrectal ultrasound (TRUS), measurament of postvoidal residual urine and PSA determination. IPSS, IIEF-5 and Qol, uroflowmetry, TRUS, measurement of post-voidal residual urine, PSA determination and number of reoperations were evaluated at 1, 3, 6, 12, 18, 24, 30 and 36 months. Operative time, resected tissue weight and perioperative complications were also registered. Total post-operative catheter time, total postoperative hospital stay, haemoglobin loss were recorded in the 2 groups.

RESULTS

Comparative data on IPSS symptom score, IIEF-5 and Qol, PSA, peak urinary flow rates and post-void residual urine volume in the 2 groups were similar but showed a significative improvement with respect to baseline value. Postoperative haemoglobin levels, postoperative catheterization, hospital stay and 3-yr overall surgical re-treatment-free rate were significantly better in the Bipolar group.

CONCLUSIONS

In the treatment of LUTS due to bladder outlet obstruction (BOO) with markedly enlarged glands refractory to medical therapy, Bipolar TURP has a comparable outcome to open prostatectomy at short and medium term according to both subjective and objective outcome measures.

Risk of prostate cancer at first saturation re-biopsy in a patient with previous diagnosis of HGPIN

INTRODUCTION

It is advisable to submit a patient with isolated HGPIN to re-biopsy every 3-6 months, performing an increasing number of samples in order to increase the detection rate. The aim of this study is to evaluate if the use of saturation needle biopsy technique may increase this rate.

MATERIALS AND METHODS

From January 2004 to June 2006, 780 patients with hypoecogenic nodule at TRUS and/or PSA values between 2.5 and 10 ng/ml, underwent TRUS 10-core prostate needle biopsy, performed by the same operator Isolated HGPIN was detected in 26 cases (3.3%). Within a year all these patients underwent saturation needle re-biopsy. This procedure consisted of 24 samples obtained using a tru-cut needle 18 G under soft anesthesia by a major opiate. All the patients received a single dose of Levofloxacin per os before the biopsy and for the following 2 days.

RESULTS

Prostate cancer was found in 8 (33.3%) of the 24 eligible patients: 40% showed a Gleason Score 6 and 60% > 7. Concerning PSA, we observed 35% of neoplasms for values between 2.5 and 3.9 ng/ml and the remaining 65.0% for values between 4.0 and 9.9 ng/ml.

CONCLUSIONS

The use of saturation needle biopsy allowed to detect 30.8% of prostatic cancer performing the first re-biopsy within a year. This result does not differ from others obtained with 8-10 cores techniques, therefore the indication of the 24-cores procedure should be limited to carefully selected patients with a high risk of developing cancer after that other techniques had not been successful.

Neoplasie primitive della vescica pT1-G3: Recidive e progressioni. Dieci anni di follow-up: Primitive bladder neoplasms pT1-G3: Recurrences and progression. Ten years of follow-up

72 primitive bladder cancer patients pT1G3, 64 males and 8 females, mean age 62.3, underwent T.U.R. or T.V.R. In this series we evaluated the percentage of recurrences, progression and survival, with a follow-up of 10 years. Among 72 patients, 26 showed unifocal lesions and 46 multifocal lesions. In the case of progression, patients underwent radical surgery (cystectomy). After 10 years the 26 patients with unifocal lesions showed a 90% recurrence rate and 56% progression rate, while the 46 patients with multifocal lesions showed 100% recurrence rate and 71% progression rate. A multivariate analysis was done, considering patient age and sex, number of lesions (unifocal or multifocal) and DNA ploidy (diploid/aneuploid). Only the DNA pattern was a determining factor for selecting progression risk cases. PT1 bladder cancers must be considered as invasive forms. Very careful therapeutic evaluation is therefore necessary.