Gianluigi Taverna

A SINGLE INJECTION OF LIDOCAINE AS LOCAL ANESTHESIA FOR ULTRASOUND GUIDED NEEDLE BIOPSY OF THE PROSTATE

PURPOSE We evaluated the effectiveness of a single injection of lidocaine on patient tolerance of multiple needle biopsies of the prostate. MATERIALS AND METHODS In 100 consecutive group 1 patients local anesthesia was achieved by a single bolus injection of 10 ml. lidocaine and multiple prostatic needle biopsies was performed under ultrasound guidance. At the end of the procedure patients were asked to complete a questionnaire regarding the level of pain. Answers were compared with those of 100 group 2 patients who underwent prostatic biopsy before the introduction of local anesthesia. RESULTS Of the group 1 patients 93% had only slight discomfort during the procedure and 7% required a further 1 cc bolus of lidocaine. In 55% of group 2 patients the level of pain during the procedure was significant but bearable, in 35% it was considered unbearable and in 10% sedation with midazolam was necessary. There was no significant difference in complications in the 2 groups. CONCLUSIONS A single injection of local anesthesia for prostatic biopsy proved to be efficient, well tolerated by patients and effective for decreasing the pain associated with the procedure.

Evaluation of complications and results in a contemporary series of 300 consecutive radical retropubic prostatectomies with the anatomic approach at a single institution

OBJECTIVES To evaluate the complications and results of radical retropubic prostatectomy with the anatomic approach, at our center, to allow a comparison with published studies and precise patient counseling. METHODS We reviewed the charts and records of the follow-up visits of all patients who consecutively underwent radical retropubic prostatectomy for clinically intracapsular prostate cancer between March 1997 and February 2002. RESULTS The pathologic stage was pT0 in 4 patients (1.3%), pT2a in 83 (27.7%), pT2b in 116 (38.7%), pT3a in 52 (17.3%), pT3b in 38 (12.6%), and pT4 in the remaining 7 (2.4%). Extracapsular disease extension was present in 97 specimens (32.3%); it was associated with positive margins in 64 patients (21.3%). Intraoperative and postoperative complications were recorded in 19 patients (6.3%). Immediate surgical repair was necessary in 3 cases (1%) and delayed in 5 (1.7%). A stricture of the vesicourethral anastomosis was observed in 2 patients (0.7%). At a median follow-up of 29 months (range 6 to 57), a total of 262 patients (88.8%) was continent; 26 patients (8.8%) had stress incontinence, and 7 were incontinent (2.3%). Of 262 patients, 128 (48.2%) achieved continence within the first day of catheter removal. CONCLUSIONS Radical retropubic prostatectomy is associated with low complication rates; with the anatomic approach, a limited incidence of incontinence is attainable, consistent with major referral centers.

Colour Doppler and microbubble contrast agent ultrasonography do not improve cancer detection rate in transrectal systematic prostate biopsy sampling

Study Type – Diagnosis (RCT)

Olfactory System of Highly Trained Dogs Detects Prostate Cancer in Urine Samples

PURPOSE We established diagnostic accuracy in terms of the sensitivity and specificity with which a rigorously trained canine olfactory system could recognize specific volatile organic compounds of prostate cancer in urine samples. MATERIALS AND METHODS Two 3-year-old female German Shepherd Explosion Detection Dogs were trained to identify prostate cancer specific volatile organic compounds in urine samples. They were tested on 362 patients with prostate cancer (range low risk to metastatic) and on 540 healthy controls with no nonneoplastic disease or nonprostatic tumor. This cross-sectional design for diagnostic accuracy was performed at a single Italian teaching hospital and at the Italian Ministry of Defense Military Veterinary Center. RESULTS For dog 1 sensitivity was 100% (95% CI 99.0-100.0) and specificity was 98.7% (95% CI 97.3-99.5). For dog 2 sensitivity was 98.6% (95% CI 96.8-99.6) and specificity was 97.6% (95% CI 95.9-98.7). When considering only men older than 45 years in the control group, dog 1 achieved 100% sensitivity and 98% specificity (95% CI 96-99.2), and dog 2 achieved 98.6% sensitivity (95% CI 96.8-99.6) and 96.4% specificity (95% CI 93.9-98.1). Analysis of false-positive cases revealed no consistent pattern in participant demographics or tumor characteristics. CONCLUSIONS A trained canine olfactory system can detect prostate cancer specific volatile organic compounds in urine samples with high estimated sensitivity and specificity. Further studies are needed to investigate the potential predictive value of this procedure to identify prostate cancer.

Sky is no limit for ureteroscopy: extending the indications and special circumstances

AbstractPurposeTo critically review and synthesize data of ureteroscopy (URS) in different circumstances that all urologists may encounter during everyday clinical practice, such as pregnancy, obesity, bleeding diathesis, renal stones larger than 2 cm, calyceal diverticula, and kidney malformations.MethodsAccording to PRISMA guidelines, a systematic literature review was performed to identify articles published between 1990 and December 2013 that reported different indications and special circumstances for URS. Articles were separated into the following categories: pregnancy, obesity, bleeding diathesis, stones larger than 2 cm in diameter, calyceal diverticula, and kidney malformations. We used a narrative synthesis for the analyses of the studies, including a description of the characteristics and main outcomes reported in the articles.ResultsRecords identified through database searching were 1396; at the end of study selection, articles included were 57. The majority of these are retrospective studies and involve small cohorts of patients. There does not exist a consensus about important parameters in ureterorenoscopy like stone size, stone free status and complication rate.ConclusionUreteroscopy is effective and reliable tool capable of treating the majority of stones even in the most complicated clinical scenarios and will have more fundamental roles in endourology. The lack of definitive conclusions is due to the great heterogeneity in collecting study’s results; multicentric randomized trials that define in advance the parameters to be studied should be encouraged.

Geometry of human vascular system: Is it an obstacle for quantifying antiangiogenic therapies?

It is now recognized that all human natural and diseased anatomic systems are characterized by irregular shapes and very complex behaviors. In geometrical terms, tumor vascularity (which is the result of a nonlinear dynamic process called angiogenesis) is an archetypal anatomic system that irregularly fills a 3-dimensional Euclidean space. This characteristic, together with the highly variable nature of vessel shapes and surfaces, leads to considerable spatial and temporal heterogeneity in the delivery of oxygen, nutrients, and drugs, and the removal of metabolites. Although these biologic features have been well established, the quantitative analysis of neovascularity in 2-dimensional histologic sections still fails to view its architecture as a non-Euclidean geometrical object, thus allowing errors in visual interpretation and discordant results concerning the same tumor from different laboratories. We discuss here the tumor-induced vascular system as a fractal object, and what changes this new way of observing may bring to the quantification of effective antiangiogenic therapies.

Inflammation and prostate cancer: friends or foe?

IntroductionProstate cancer is the most common non-cutaneous malignancy diagnosed in men. Moving from histological observations since a long time, it has been recognized that innate and adaptive immunity actively participates in the pathogenesis, surveillance, and progression of prostate cancer.Materials and methodsA PubMed and Web of Science databases search was performed for studies providing evidence on the roles of the innate and adaptive immunity during the development and progression of prostate cancer.ConclusionsThere are growing evidences that chronic inflammation is involved in the regulation of cellular events in prostate carcinogenesis, including disruption of the immune response and regulation of the tumor microenvironment. This review discusses the role played by the innate and adaptive immune system in the local progression of prostate cancer, and the prognostic information that we can currently understand and exploit.

Fractal analysis of two-dimensional vascularity in primary prostate cancer and surrounding non-tumoral parenchyma

Prostate cancer is the fifth most frequent cancer in the world. However, none of the actual prognostic factors provide a valid index for predicting patient outcome. Here, we evaluate the two-dimensional vascularity in primary prostate tumors and surrounding non-tumoral parenchyma by means of fractal geometry, and assess any correlations between the results and some clinical and pathological parameters of prostate carcinoma. Prostate sections from 27 carcinoma patients were treated with CD34 antibodies. Two >10mm(2) areas of tumoral and surrounding non-tumoral parenchyma were digitized using an image analysis system that automatically quantified the fractal dimension of the vascular surface. Data were correlated with patients age, PSA level, clinical and pathological stage, Gleason score, tumor volume, vascular invasion, surgical margins, and biochemical relapse. Two groups of patients were distinguished on the basis of whether the fractal dimension of their tumoral vascular surface was higher (group 1) or lower (group 2) than that of the surrounding non-tumoral parenchyma. Statistically significant between-group differences were found in terms of serum PSA levels (p=0.0061), tumor volume (p=0.0017), and biochemical relapse (p=0.031). The patients in group 2 had a poorer outcome. Our findings suggest a group of prostate cancer patients with a poor outcome, and the vascular surface fractal dimension as a helpful geometrical index in clinical practice.

Robot-Assisted Laparoscopic Partial Nephrectomy with the ALF-X Robot on Pig Models

Advances in laparoscopic surgery have made laparoscopic partial nephrectomy a standard procedure in centers with expertise [1]. Exophytic renal masses <7 cm are ideal cases [2]. The da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was approved for clinical use in the United States in 2000 and has been used to perform different urologic procedures including robot-assisted laparoscopic partial nephrectomy (RALPN) [3,4]. We tested the same theoretical and tangible benefits of RALPN performed with a new robotic device, ALF-X (SOFAR SpA, Milan, Italy) [5], on pig models. The ALF-X robot consists of a remote-control unit called the ‘‘cockpit,’’ with haptic handles, a three-dimensional (3D) high-definition (HD) monitor, an infrared eye-tracking system (ETS), a keyboard and touchpad, one foot pedal, up to four detached and independent robotic arms, a connection node, and reusable endoscopic instruments (Fig. 1). Regarding ergonomics, the surgeon is positioned on a fully adjustable seat, and the manipulating arms are reached naturally and used as in laparoscopic procedures. The ETS and the naturally seated position enable the surgeon to share the 3D view and simultaneously communicate with the other surgeons present in the operating room. These aspects are quite different from the position of the surgeon using the da Vinci system and the possibility of easily interacting with other surgeons. A random decision about the kidney to be tested and which pole (upper or lower) to excise was made before the operation. One surgeonwas placed at the computer console, and one surgeon was placed at the surgical table. RALPN was performed through one supraumbilical 10-mm port and three 5-mm ancillary ports. We used three robotic arms: one for the 3D-HD 10-mm scope and two laterals for the operative instruments. An additional lateral 5-mm port was placed for the assistant instruments. During trocar placement, the operating room nurses supported the surgeon in the docking procedures (median time: 7 min). Through the operative ports, we used reusable graspers

Mast cells as a potential prognostic marker in prostate cancer.

Despite years of intensive investigation that has been made in understanding prostate cancer, it remains one of the major mens health issues and the leading cause of death worldwide. It is now ascertained that prostate cancer emerges from multiple spontaneous and/or inherited alterations that induce changes in expression patterns of genes and proteins that function in complex networks controlling critical cellular events. It is now accepted that several innate and adaptive immune cells, including T- and B-lymphocytes, macrophages, natural killer cells, dendritic cells, neutrophils, eosinophils, and mast cells (MCs), infiltrate the prostate cancer. All of these cells are irregularly scattered within the tumor and loaded with an assorted array of cytokines, chemokines, and inflammatory and cytotoxic mediators. This complex framework reflects the diversity in tumor biology and tumor-host interactions. MCs are well-established effector cells in Immunoglobulin-E (Ig-E) associated immune responses and potent effector cells of the innate immune system; however, their clinical significance in prostate cancer is still debated. Here, these controversies are summarized, focusing on the implications of these findings in understanding the roles of MCs in primary prostate cancer.