Emanuele Castelli

Stage-specific impact of extended versus standard pelvic lymph node dissection in radical cystectomy

To evaluate the impact of an extended versus a standard pelvic lymph node dissection on disease‐free survival and cancer‐specific survival of patients with non‐metastatic muscle‐invasive urothelial carcinoma of the bladder treated with radical cystectomy.

Laparoscopic Microwave Ablation and Enucleation of Small Renal Masses: Preliminary Experience

Advancements in imaging and laparoscopy have led to the expansion of minimally invasive techniques in the ablation of small renal masses (SRMs). We report the results of a study aimed at assessing the efficacy of thermoablative microwave (MW) effects on SRMs and the haemostatic as well as necrotic MW effects on the parenchyma surrounding the neoplasm. From November 2008 to October 2010, 10 patients with SRMs underwent laparoscopy-guided Tru-Cut biopsy, MW tumour ablation, and enucleation. Mean age was 66 yr (range: 46-84 yr). Mean renal tumour diameter was 2.75 cm (range: 1.3-4.2 cm). MW antennas were applied one to three times depending on tumour volume, location, and shape. After MW thermoablation, laparoscopic enucleation was performed to evaluate the histopathologic and haemostatic effects of MW. The mean MW antenna application time was 14.1 min (range: 4-30 min). Enucleation did not require renal pedicle clamping in any of the cases because no significant bleeding took place. Preablation pathology revealed clear cell renal carcinoma of Fuhrman grade I-II in all cases. Postablation pathology showed extensive coagulative necrosis without skipped tumour areas. No intra- or postoperative complications were reported. Histopathologic effects on SRMs provide consistent proof of principle for future studies.

Seminal-sparing cystectomy: technical evolution and results over a 20-year period.

OBJECTIVE To demonstrate the oncologic and functional results of seminal-sparing cystectomy (SSC) in patients with bladder cancer (BC) and to describe the evolution of our surgical technique over a 20-year period. METHODS From 1990 to 2009 we performed SSC in 88 patients with non-muscle-invasive BC and in 10 patients with muscle-invasive BC away from the bladder neck. Sixty-one of the 98 patients (1990-2002) underwent cystoadenomectomy with ileocapsuloplasty (ICP), consisting of the anastomosis between the Camey II ileal reservoir and the upper edge of the prostatic capsule. This technique was affected by a relevant percentage of anastomotic stricture (11%). From 2003 to 2009, we performed the endocapsular ileourethral anastomosis (EIUA) in 30 patients, on the basis of the direct anastomosis between the ileal reservoir and the urethral stump inside the prostatic apex. Seven patients were lost to follow-up. RESULTS After a mean follow-up of 102 months, 81 patients (89%) were alive, and 10 patients (11%) had died (8 of disease progression). Early and late complication rates were 25% and 24%, respectively. Complete daytime continence was obtained in 87 patients (95.6%), and nighttime continence was achieved in 34 patients (37%). In the ICP group, stricture of the prostatic fossa affected 7 patients (11%), whereas no neobladder-urethral anastomosis stricture was noticed in the EIUA group. Normal erectile function was preserved in 87 patients (95.6%). CONCLUSION SSC offers good oncologic and functional results in carefully selected patients. EIUA represents an evolution from ICP because EIUA reduces the risk of stenosis.

Huge Anterior Sacral Meningocele Simulating Bladder Retention

Anterior sacral meningocele (ASM) is a rare congenital disorder involving herniation of the dural sac through a defect in the anterior surface of the sacrum. We report the case of a young patient with an enormous ASM that simulated bladder retention in terms of symptoms as well as on physical examination and at ultrasonography. After introducing a catheter that excluded urinary retention, computed tomography (CT) scan and magnetic resonance imaging (MRI) showed the ASM. The patient underwent surgical repair of the ASM through a sacral laminectomy and recovered normal lower urinary tract function.

Editorial Comment from Dr Castelli to Thulium laser ablation facilitates retrograde intra‐renal surgery for upper urinary tract urothelial carcinoma

1 Rouprêt M, Babjuk M, Comp erat E et al. European association of urology guidelines on upper urinary tract urothelial cell carcinoma: 2015 update. Eur. Urol. 2015; 68: 868–79. 2 Seisen T, Peyronnet B, Dominguez-Escrig JL et al. Oncologic outcomes of kidney-sparing surgery versus radical nephroureterectomy for upper tract urothelial carcinoma: a systematic review by the EAU non-muscle invasive bladder cancer guidelines panel. Eur. Urol. 2016; 70: 1052–68. 3 Bader MJ, Sroka R, Gratzke C et al. Laser therapy for upper urinary tract transitional cell carcinoma: indications and management. Eur. Urol. 2009; 56: 65– 71. 4 Xia SJ, Zhuo J, Sun XW, Han BM, Shao Y, Zhang YN. Thulium laser versus standard transurethral resection of the prostate: a randomized prospective trial. Eur. Urol. 2008; 53: 382–9. 5 Emiliani E, Herrmann TR, Breda A. Thulium laser for the treatment of upper urinary tract carcinoma (UTUC)? Are we there, yet? World J. Urol. 2015; 33: 595–7. 6 Defidio L, De Dominicis M, Di Gianfrancesco L, Fuchs G, Patel A. First collaborative experience with thulium laser ablation of localized upper urinary tract urothelial tumors using retrograde intra-renal surgery. Arch. Ital. Urol. Androl. 2011; 83: 147–53.

The Latest Technique for Laparoscopic Nephropexy Using Cyanoacrylic Glue

Aim: To evaluate the use of cyanoacrylic glue to fix the kidney in laparoscopic nephropexy for symptomatic nephroptosis. Patients and Methods: From 1998 to 2006 we performed nephropexy in 10 women with symptomatic nephroptosis. In all patients we performed transperitoneal laparoscopic nephropexy using cyanoacrylic glue to fix the kidney. Preoperatively all patients were investigated by clinical exami-nation, urography (intravenous pyelogram, IVP) and split renal scintigram in supine and upright positions. After a minimum follow-up of 30 months, all patients were evalu-ated for symptoms, were asked about their satisfaction and underwent IVP and renal scintigraphy. Results: The mean operative time was 53 minutes. No intra- or post-operative complication occurred. The mean hospital stay was 4.5 days. After a mean follow-up of 88 months, improvement in symp-toms was reported in all cases, with complete and significant relief in 9 (90%) and 1 (10%) case respectively. Postoperative IVP and renal scintigraphy in supine and upright positions showed the resolution of renal ptosis and the normal distri-bution of split renal function in both positions. Conclusions: Our series seems to demonstrate that cyanoacrylic glue may be a safe and efficient agent to fix the kidney in laparoscopic nephropexy.