Marcos F. Dall'oglio

The influence of bladder neck mucosal eversion and early urinary extravasation on patient outcome after radical retropubic prostatectomy : a prospective controlled trial

To evaluate the role of bladder neck (BN) mucosal eversion during retropubic radical prostatectomy (RRP) on the rate of BN sclerosis and urinary incontinence, with the hypothesis that BN mucosal eversion is not essential to improve the clinical outcome after RRP.

Orthotopic ileal neobladder : the influence of reservoir volume and configuration on urinary continence and emptying properties

The authors from Sao Paulo describe their experience with orthotopic urinary reservoirs using segments of intestine after radical cystectomy. They felt that orthotopic ileal neobladders with a spherical configuration were not associated with better continence rates and were prone to progressive enlargement, leading to atomy and progressive failure of emptying.

Experience with the orthotopic ileal neobladder in women: a mid‐term follow‐up

Authors from Sao Paulo describe their experience with the orthotopic ileal neobladder in women. They describe it as currently being the urinary diversion of choice for women in their institution. They found it to be safe and associated with a high continence and low urinary retention rates.

Sarcomatoid differentiation in renal cell carcinoma: prognostic implications

INTRODUCTIONnRenal cell carcinoma with sarcomatoid differentiation is a tumor with aggressive behavior that is poorly responsive to immunotherapy. The objective of this study is to report our experience in the treatment of 15 patients with this tumor.nnnMATERIALS AND METHODSnWe retrospectively analyzed 15 consecutive cases of renal cell carcinoma with sarcomatoid differentiation diagnosed between 1991 and 2003. The clinical presentation and the pathological stage were assessed, as were the tumors pathological features, use of adjuvant immunotherapy and survival. The studys primary end-point was to assess survival of these individuals.nnnRESULTSnThe sample included 8 women and 7 men with mean age of 63 years (44-80); follow-up ranged from 1 to 100 months (mean 34). Upon presentation, 87% were symptomatic and 4 individuals had metastatic disease. Mean tumor size was 9.5 cm (4-24) with the following pathological stages: 7% pT1, 7% pT2, 33% pT3, and 53% pT4. The pathological features showed high-grade tumors with tumoral necrosis in 87% of the lesions and 80% of intratumoral microvascular invasion. Disease-free and cancer-specific survival rates were 40 and 46% respectively, with 2 cases responding to adjuvant immunotherapy.nnnCONCLUSIONSnPatients with sarcomatoid tumors of the kidney have a low life expectancy, and sometimes surgical resection associated with immunotherapy can lead to a long-lasting therapeutic response.

Inguinal hernia repair with polypropylene mesh during radical retropubic prostatectomy: an easy and practical approach

To report the results of the simultaneous inguinal hernia repair during radical retropubic prostatectomy (RRP) with the preperitoneal tension‐free Stoppa technique, using a polypropylene mesh.

The percentage of positive biopsy cores as a predictor of disease recurrence in patients with prostate cancer treated with radical prostatectomy.

To analyse the prognostic value of the percentage of positive biopsy cores (PPBC) in determining the pathological features and biochemical outcome of patients with prostate cancer treated by radical prostatectomy, as published data evaluating the prognostic value of PPBC in such patients have limitations.

Renal lymphoma: atypical presentation of a renal tumor

Primary renal lymphoma is a rare lesion that represents less than 1% of the kidneys lesions. The authors discuss the case of a 67-year-old woman with a renal mass identified 7 years after treatment of a non-Hodgkins lymphoma, and analyze clinical and prognostic aspects of renal lymphomas. Radiological findings in this case showed an uncommon presentation of the renal lymphomatous lesion which served as a warning that tumors might appear during follow-up as atypical and uncommon lesions.

Radical cystectomy with preservation of sexual function and urinary continence: description of a new technique

OBJECTIVEnTo describe the original cystoprostatectomy technique which allows the preservation of sexual and urinary function in the majority of treated patients.nnnSURGICAL TECHNIQUEnThe described technique presents some details that distinguish it from classic cystectomy: 1) a more efficient control of prostate venous and arterial tributaries; 2) preservation of prostatic capsule and enucleation of prostatic parenchyma, which is removed in block together with the bladder, without violating the vesical neck; 3) no manipulation of the distal urethral sphincteric complex; 4) preservation of seminal vesicles and maintenance of cavernous neurovascular bundles; 5) wide anastomosis between the ileal neobladder and the prostatic capsule.nnnCOMMENTSnThe proposed maneuvers allow the performance of radical cystectomy with integral preservation of distal urethral sphincter and of cavernous neurovascular bundles, without jeopardizing the oncological principles.

A new nomogram to predict pathologic outcome following radical prostatectomy

OBJECTIVEnTo develop a preoperative nomogram to predict pathologic outcome in patients submitted to radical prostatectomy for clinical localized prostate cancer.nnnMATERIALS AND METHODSnNine hundred and sixty patients with clinical stage T1 and T2 prostate cancer were evaluated following radical prostatectomy, and 898 were included in the study. Following a multivariate analysis, nomograms were developed incorporating serum PSA, biopsy Gleason score, and percentage of positive biopsy cores in order to predict the risks of extraprostatic tumor extension, and seminal vesicle involvement.nnnRESULTSnIn univariate analysis there was a significant association between percentage of positive biopsy cores (p < 0.001), serum PSA (p = 0.001) and biopsy Gleason score (p < 0.001) with extraprostatic tumor extension. A similar pathologic outcome was seen among tumors with Gleason score 7, and Gleason score 8 to 10. In multivariate analysis, the 3 preoperative variables showed independent significance to predict tumor extension. This allowed the development of nomogram-1 (using Gleason scores in 3 categories - 2 to 6, 7 and 8 to 10) and nomogram-2 (using Gleason scores in 2 categories - 2 to 6 and 7 to 10) to predict disease extension based on these 3 parameters. In the validation analysis, 87% and 91.1% of the time the nomograms-1 and 2, correctly predicted the probability of a pathological stage to within 10% respectively.nnnCONCLUSIONnIncorporating percent of positive biopsy cores to a nomogram that includes preoperative serum PSA and biopsy Gleason score, can accurately predict the presence of extraprostatic disease extension in patients with clinical localized prostate cancer.

Incidental and symptomatic renal tumors: impact on patient survival

CONTEXTnRenal cell carcinoma is the third most frequent genitourinary neoplasia, and there is currently an increase in the incidental diagnosis of tumors confined to the kidneys.nnnOBJECTIVEnTo study the survival of patients with incidental and symptomatic renal tumors who have undergone nephrectomy.nnnDESIGNnRetrospective.nnnSETTINGnHospital Sírio Libanês and Hospital Beneficência Portuguesa de São Paulo.nnnPARTICIPANTSn115 patients with diagnosis of renal cell carcinoma, operated on by the same group of surgeons and evaluated by a single pathologist.nnnMAIN MEASUREMENTSnSex, age and diagnosis method, analyzed in two groups, according to the tumor diagnosis: Group 1 with incidental diagnosis and Group 2 with symptomatic tumors. The anatomopathological characteristics and patient survival in both groups were evaluated. A statistical analysis was performed using the Student t, chi-squared, log rank and Kaplan-Meyer tests.nnnRESULTSnAmong the studied patients, 59(51%) had an incidental diagnosis, with 78% diagnosed by ultrasonography, 20% by computerized tomography scan and 2% during surgeries; 56 patients (49%) were symptomatic. Tumor locations were equally distributed between the two kidneys, and the surgery was conservative for 24% of the incidental and 9% of the symptomatic group. In the incidental group only one patient had tumor progression and there was no death, while in the symptomatic group there were 5 progressions and 10 deaths. The 5-year specific cancer-free survival was 100% in the incidental and 80% in the symptomatic group (p = 0.001) while the disease-free rate was 98% in the incidental and 62% in the symptomatic group (p < 0001).nnnCONCLUSIONnIncidental renal tumor diagnosis offers better prognosis, providing longer disease-free survival.