Carlotta Palumbo

Perineural invasion as a predictor of extraprostatic extension of prostate cancer: a systematic review and meta-analysis.

Abstract A systematic review of the literature was performed to assess the relationship between the presence of perineural invasion (PNI) at prostate biopsy and extraprostatic extension (EPE) of prostate cancer. In August 2012, Medline, Embase, Scopus and Web of Science databases were searched. A “free-text” protocol using the terms “perineural invasion prostate cancer” was applied. Studies published only as abstracts and reports from meetings were not included in this review. In total, 341 records were retrieved from Medline, 507 from Embase, 374 from Scopus and 65 from the Web of Science database. The records were reviewed to identify studies correlating the presence of PNI with that of EPE. A cumulative analysis was conducted using Review Manager software v. 5.1 (Cochrane Collaboration, Oxford, UK). In univariate analysis, PNI showed a statistically significant association with pT3 tumours (p < 0.00001), which could be observed for both pT3a (p < 0.0001) and pT3b (p < 0.0001). In conclusion, the cumulative analysis shows a statistically significant higher incidence of EPE in patients who had PNI at needle biopsy. The main limitation of the analysis was that it was not possible to perform a multivariate analysis. Further attempts to build a nomogram for the prediction of EPE could include the presence of PNI at needle biopsy.

Robotics in uro-oncologic surgery.

In urology, the main use for the robotic technique has been in radical prostatectomy for prostate cancer. Robotic surgery for other organs, such as the kidneys and bladder, has been less explored. However, partial nephrectomy or radical nephroureterectomy can be difficult for inexperienced laparoscopic surgeons. The advent of the da Vinci robot, with multijointed endowristed instruments and stereoscopic vision, decreases the technical difficulty of intracorporeal suturing and improves the reconstructive steps. The objective of this article is to offer an overview of all robotic procedures recently developed in the field of urology. We evaluate the feasibility of these procedures and their potential advantages and disadvantages. We also describe perioperative, postoperative, and oncologic outcomes of robot-assisted surgery as well as perform a comparison with open and laparoscopic techniques. Comparative data and an adequate follow-up are needed to demonstrate equivalent oncologic outcomes in comparison with traditional open or laparoscopic procedures.

Massive recurring angiomyxoma of the scrotum in a obese man.

Aggressive angiomyxoma (AAM) is a rare mesenchymal benign myxoid tumor, characterized by locally infiltrative nature and high recurrence rate. AAM occurs almost exclusively in adult females, arising from the soft tissue of the pelvic region: to our knowledge, only 43 cases occurring in men have been reported. We report a case of massive recurrence of scrotal AAM in a 46-year-old obese man, who already underwent surgery for the same disease in 2004 and 2005. The mass had a circumference of 106 cm and weighted 30 kg. It was impossible to appreciate the testes and to find the penis. The patient underwent scrotal resection, bilateral orchidopexia and transposition of the penis, by means of a preputial flap. Residual scrotal skin was modeled in order to create a neoscrotum, where the testes were placed and secured with interrupted sutures. Histologic examination showed diffuse angiomyxoma-like lipomatosis. After three months, the patient presented with local relapse which also involved the external urethral orifice.

Robotic prostatectomy: an update on functional and oncologic outcomes

Since the first procedure performed in 2000, robotic-assisted radical prostatectomy (RARP) has been rapidly gaining increasing acceptance from both urologists and patients. Today, RARP is the dominant treatment option for localised prostate cancer (PCa) in the United States, despite the absence of any prospective randomised trial comparing RARP with other procedures. Robotic systems have been introduced in an attempt to reduce the difficulty involved in performing complex laparoscopic procedures and the related steep learning curve. The recognised advantages of this kind of minimally invasive surgery are three-dimensional (3D) vision, ten-fold magnification, Endowrist technology with seven degrees of freedom, and tremor filtration. In this article, we examine this technique and report its functional (in terms of urinary continence and potency) and oncologic results. We also evaluate the potential advantages of RARP in comparison with open and laparoscopic procedures.

Primary large cell neuroendocrine carcinoma of the renal pelvis: a case report.

We report a case of primary large cell neuroendocrine carcinoma of the renal pelvis, diagnosed in a 79-year-old man. The abdominal computed tomography showed a solid, vegetant lesion in the left renal pelvis, conditioning marked hydronephrosis. The patient underwent radical nephroureterectomy. The histological examination showed a large cell neuroendocrine carcinoma associated with a high-grade urothelial carcinoma, with local invasion (pT3). Large cell renal neuroendocrine carcinomas are rare tumors with an aggressive course and a bad prognosis. At present, only five cases were reported in literature.

MP11-02 OUTCOMES OF A PHASE III RANDOMIZED CONTROLLED TRIAL COMPARING PREVENTIVE VERSUS DELAYED LIGATION OF DORSAL VASCULAR COMPLEX DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY

Primary endpoint was estimated blood loss (EBL); considering significant a difference 330 ml, a sample size of 226 patients were calculated (two-sided α of 0.05 and 80% power). Secondary endpoints were: transfusion rate, positive surgical margins (PSMs), apical PSMs and 1-month PSA and continence (0-1 security pad/day). Differences were compared using Pearson chi-square test or MannWhitney test as appropriate (p<0.05 was considered statistically significant).

Shock wave lithotripsy in the elderly: our experience related to literature review

Background The more and more common use of abdominal ultrasonography and of other imaging techniques, the increase of the life expectancy and therapies for calcium metabolism, has led to a higher diagnosis rate of renal stones in the elderly. At the moment, extracorporeal shock wave lithotripsy is considered the first-line therapy in the majority of reno-ureteral stones. Objectives To prove the efficacy and safety of extracorporeal shock wave lithotripsy also in the elderly population. Materials and Methods We proceeded to a retrospective study on patients aged over 70 years, who underwent SWL at our division from January 1996 to April 2005, with Storz Modulith SLX electromagnetic lithotripter. We defined as stone-free those patients who did not show any stone fragment in the following ultrasonography and abdomen X-ray control. In addition, we performed a medium/long-term follow-up. We adopted as “control group” 115 patients aged less than 60 years, who underwent lithotripsy with the same lithotripter from June 2007 to January 2008. Results In the short-term follow-up, at the end of the single treatment or of the course of treatments (1-3 months after treatment), we observed: 72.1% (83/115) stone-free subjects, 20% (23/115) of cases with stone fragments that could be eliminated (<4 mm), 3.5% (4/115) with stone fragments >4 mm, 4.3% (5/115) unchanged cases; 2 of these (1.7%) underwent endoscopic lithotripsy and one percutaneous lithotripsy (0.9%). Concerning the medium/long-term follow-up (mean 59.2 months, range 7 mo-108 mo), we observed: 59.8% (67/112) stone-free cases, 25.9% (29/112) recurring stones, 11.6% (13/112) re-growth, 2,7% (3/112) unchanged cases. In the short-term follow-up, comparing the study group with the control one we observed: – No statistically significant difference regarding the treatment side effects in the two groups; – A lower stone-free percentage in caliceal stones in the elderly than in the younger patients (SFR = 62.5% vs 70.3%) – A stone-free percentage for non-caliceal stones similar in the older and the young patients (SFR = 79.1% vs 80.4%). Conclusions Shock wave lithotripsy proves to be effective in the first-line treatment of renal stones in the elderly, yielding good results with no increase of side effects.