M.T. Filocamo

Renal Cell Carcinoma of Native Kidney After Renal Transplantation: Clinical Relevance of Early Detection

BACKGROUND Life expectancy after transplantation has improved, and cancer may soon be the leading cause of late death after transplantation. The guidelines of the American and European societies of nephrology and urology have not yet established the optimal frequency for screening for renal cell carcinoma (RCC) of native kidneys in patients who have undergone renal transplantation. OBJECTIVE To evaluate the prevalence, prognosis, and risk factors of RCC in a series of patients followed up for 16 years in our transplantation unit. MATERIALS AND METHODS Our study is a follow-up observational cohort study conducted in 694 consecutive renal transplant recipients admitted to our institution from July 1991 through July 2007. At our institution, ultrasound studies of the native kidneys were performed every 6 months after renal transplantation. RESULTS In the patient cohort studied, 10 patients developed a renal tumor (1.6% incidence). Three patients died of causes other than recurrence of RCC. Seven patients are alive with no evidence of RCC recurrence or metastatic disease after a mean (range) follow-up of 41 (12-96) months. Acquired cystic kidney disease and dialysis duration were positively associated with development of RCC. CONCLUSIONS The incidence of RCC in the literature varies between 0.3% and 4.8%. The variability depends on the timing of follow-up, with a higher incidence in prospective studies with strict follow-up. We advise ultrasound studies performed by specialized physicians every 6 months after transplantation. More detailed guidelines designed by the major international transplantation societies are necessary.

Uterus-Sparing Vaginal Surgery of Genitourinary Prolapse Employing Biocompatible Material

Objective: The study presents an original uterus sparing technique for transvaginal repair of total genitourinary prolapse. The technique employs a synthetic mesh of mixed polypropylene and 910 polyglactin fibers. Methods: The prosthesis creates a support for the cystocele, the cervix and the enterocele. It has four anchoring sites: two at the rear in the sacrospinous ligaments and two at the front in the arcus tendineous of the levator ani muscle. Between February 2001 and December 2004, 24 patients (mean age 66.9 years), presenting symptoms of uterine prolapse, cystocele and enterocele (POP-Q stage III-IV Aa associated to II-III-IV C), were treated with our procedure. Pre- and postoperative parameters were evaluated statistically. Results: No patient had any serious complications. The mean follow-up was 31.1 months (range 6–52). 19 patients (79.1%) have shown excellent results and have been completely cured. In 5 other cases (20.8%), the cystocele was completely cured and there was a significant improvement in the hysterocele and the enterocele. One patient required surgical treatment for postoperative stress incontinence. Statistical analysis of data regarding the pre- and postoperative prolapse stage demonstrated a high degree of objective cure rates (p < 0.0001). Conclusions: While hysterectomy remains the habitual treatment for severe uterine prolapse, our technique provides a promising alternative solution. It is also significant that there were no complications of erosion or infection associated with the prosthesis.

Urological dysfunction in young women: an inheritance of childhood?

To investigate the correlation of a history of lower urinary tract symptomatology during childhood with lower urinary tract dysfunction in young adult women.

1106 Urological dysfunctions in young women. “Is it an inheritance of childhood?”

Costantini E, Illiano E, Balsamo R, Natale F, Maruccia S, Carbone A, Pastore A, Prestipino M, Fragalà E, Filocamo M T, Bini V, Appignani A 1. Department of Medical-Surgical Specialties and Public Health, Section of Urology and Andrology, University of Perugia, Perugia, Italy, 2. Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, Naples,Italy, 3. Urology Unit, Second University of Naples, Napoli, Italy, 4. Urogynecology San Carlo – IDI-Hospital Rome, Italy, 5. Department of Urology, San Donato Hospital, Milan, Italy, 6. Department of MedicoSurgical Sciences and Biotechnologies, Sapienza University of Rome, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Latina, Italy, 7. Department of Paediatric Surgery, University of Perugia, Perugia, Italy, 8. Department of Urology, University of Catania, Catania, Italy, 9. Department of Urology, ASL CN1, Savigliano (CN), Italy, 10. Department of Medicine Section of Internal Medicine Endocrine & Metabolic Sciences, Perugia,Italy