Maria Abbinante

The Role of Inflammation in Lower Urinary Tract Symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) and Its Potential Impact on Medical Therapy

A chronic prostatic inflammation seems to play a crucial role in benign prostatic hyperplasia (BPH) pathogenesis and progression. Therefore, inflammation could represent a new potential target for medical therapy of lower urinary tract symptoms (LUTS) due to BPH (LUTS/BPH). This review article analyzes the evidence supporting the role of inflammation in the onset and progression of BPH, and it assesses the potential impact of previous mechanisms on medical therapy of LUTS/BPH. Literature data support the role of inflammation as a relevant factor in the pathogenesis of BPH. Indeed, several data favour the role of infiltrating lymphocytes in the development and progression of prostate adenoma as an effect of a self-maintaining remodeling process. Although available drugs commonly used in the treatment of LUTS/BPH do not exhibit an anti-inflammatory activity, it seems to be obvious considering the inflammation as a new target in the treatment of LUTS/BPH. Drugs currently investigated for the treatment of prostatic inflammation include the hexanic lipidosterolic extract of Serenoa repens, nonsteroidal anti-inflammatory drugs, and vitamin D receptor agonists.

Will Multi-Parametric Magnetic Resonance Imaging be the Future Tool to Detect Clinically Significant Prostate Cancer?

Multi-parametric magnetic resonance imaging is an emerging imaging modality for diagnosis, staging, characterization, and treatment planning of prostate cancer. In this report, we reviewed the literature for studies assessing the accuracy of multi-parametric magnetic resonance imaging in detecting clinically significant prostate cancer, and we critically examined the future role of this imaging tool in various clinical diagnostic settings. There is accumulating evidence suggesting a high accuracy of multi-parametric magnetic resonance imaging in ruling out clinically significant disease. Although definition for clinically significant disease widely varies, the negative predictive value is very high at up to 98%. Multi-parametric magnetic resonance imaging should, thus, be further evaluated for application in different clinical scenarios in which it is desirable to reduce the proportion of unnecessary prostate biopsies and to limit the detection of indolent disease, such as opportunistic screening, persistent prostate cancer suspicion in men with previous negative prostate biopsies, and eligibility for active surveillance. Continued improvement in standardization of technical parameters, functional sequences, and image reporting systems is a pre-requisite for a rapid and successful dissemination of this imaging modality.

Geometrical stepper-guided navigation system for ProACT implant under transrectal ultrasound control: preliminary data.

Purpose: To describe a new geometrical stepper-guided navigation system for positioning ProACT®. Methods: The sizing of the stepper-guided navigation system was calculated using the distance from the ideal position of the device to anatomic referral points previously measured by ultrasound. The trocar and subsequently the device were maneuvered to the ideal position in accordance with the navigation system. Measurements: Treatment efficacy was evaluated with daily pad count, 1-hour pad test, Incontinence Quality of Life questionnaire (IQoL), visual analog scale and overall impression. Complications, balloon volume and number of adjustments were reported at 1, 3, 6 and 12 months follow-up visits. Results: Mean follow-up was 12 (range 3–19) months. Daily pad count showed 30 patients (71%) dry and 9 patients (21%) improved. 1 hour pad test showed 28 patients were dry (66%) and 11 patients improved (26%). IQoL increased from an average of 35.3 to 80. Average visual analog scale score was 8. Complications requiring device removal occurred in 3 patients (7%). Mean balloon volume was 3.1 ml. Conclusions: The stepper-guided navigation system to implant ProACT is feasible and extremely reproducible making this procedure more standardized.

Batson’s paravertebral venous plexus and single vertebral metastases from renal cell carcinoma

OBJECTIVES The presence of a single site bone metastasis in patients with renal cell carcinoma (RCC) is a rare clinical event. We report a single case of RCC with solitary vertebral metastasis and review of literature about renal tumor spreading in order to understand the anatomic explanation for this peculiar clinical case. METHODS We have considered the single case and reviewed current and past literature to describe the anatomic and functional background of this clinical situation. RESULTS There are rare cases of single vertebral metastasis from RCC and these are characterized from a contemporary neoplastic thrombus. The neoplastic thrombus could justify the tumoral back-flow into the paravertebral anasthomoses and so into vertebral venous sinusoids. The rich anasthomotic system that surrounds kidneys and the experimental evidence of anasthomotic links among perirenal Lejars venous system and paravertebral Batsons venous system could explain these clinical evidences. CONCLUSION Enrolment of para-vertebral Batsons venous system could have a major role in the RCC vertebral metastatic diffusion.

[Cavernous hemangioma of the spongious body of the urethra: a case report].

Urethral hemangiomas are rare and benign tumors, probably originating from a unipotent angioblastic stem cell. They can vary in size and the clinical appearance can range from asymptomatic lesions to urethral bleeding or gross hematuria. We present the case of an 18-year-old male, with a history of urethral bleeding. Cystourethoscopy revealed a solitary bulging mass into the lumen, about 6 cm far from the external meatus. Doppler study confirmed that the lesion was in communication with the vessels of the left spongious body. The patient underwent surgical removal of the lesion. The post-procedure Doppler study revealed an inflammation-based remodeling of the spongoius urethra and the absence of the previous vascular connection. At the time of publication the patient is still symptom-free. The surgical removal of urethral hemangiomas is by far the technique of choice for treating such lesions in young patients, thus avoiding side effects of LASER treatments.

[Current role of training in robot-assisted urological procedures].

The rapid introduction of robotic procedures necessitates new training methods. Currently, we can estimate that in a considerable proportion of the hospitals in Europe, the criteria for the surgeons competence before starting with robotic surgery are insufficient. Therefore, the development of structured robotic training programs should be considered as one of the priorities that the urologic community must take into account in the near future.

Spontaneous prostatic hematoma: an unusual presentation of prostatic cancer.

Prostatic fluid collection is not uncommon in urological practice. Prostatic abscess is the most frequent finding in this clinical setting. Spontaneous prostatic hematoma is rare, and may be related to prostatic cancer. Every case of prostatic collection must be considered with attention, and further evaluation is needed when the diagnosis is not clear. Here we report the case of a spontaneous prostatic hematoma, which was eventually found to be due to prostatic cancer, describing in detail the clinical features, differential diagnosis and treatment options.

Prostate biopsy after abdominoperineal resection: a diagnostic challenge

Prostate biopsy in patients who underwent abdominoperineal resection (APR) of the rectum is commonly considered a technical challenge even for experienced urologists, although tissue diagnosis is essential in prostate cancer management. Transperitoneal, transperineal and transgluteal approaches have been reported, under US, CT or MRI guidance. Transperineal biopsy seems to be the safest and most cost-effective technique. At our institution we developed a modified transperineal biopsy approach with combined transperineal and suprapubic US guidance. Here we report the cases of two patients who came to our institution for PSA raise years after APR procedure, describing in detail the modified transperineal technique and the results of tissue sampling.

The role of non-invasive urodynamics in bladder outlet obstruction diagnosis in male patients

PURPOSE Many methods have been suggested to assess bladder outlet obstruction, as defined by the gold standard of pressure flow studies. A comprehensive review of the literature on the different methods used to diagnose bladder outlet obstruction by non-invasive means was performed in order to compare those methods to invasive urodynamics in terms of sensitivity and specificity. MATERIALS AND METHODS A MEDLINE search was done of the published literature covering from December 2003 on non-invasive methods, including only single measures to diagnose bladder outlet obstruction. We performed a comparison between all methods in terms of sensitivity and specificity for each test. For many techniques these values were calculated directly from the data presented in the article. RESULTS There has been applied many methods to diagnose bladder outlet obstruction. Those methods were divided into uroflowmetry, condom-catheter method, penile cuff method and Doppler ultrasonography urodynamics. Each method has been described and discussed in terms of its role in adding information to the diagnostic work-up for bladder outlet obstruction. CONCLUSIONS Pressure flow studies still remain the gold standard for assessing bladder outlet obstruction. However non-invasive urodynamics is a promising branch. Probably the most reliable information is given by the association of numerous methods together.