Martino P

Role of imaging and biopsy to assess local recurrence after definitive treatment for prostate carcinoma (surgery, radiotherapy, cryotherapy, HIFU)

PurposeDefining the site of recurrent disease early after definitive treatment for a localized prostate cancer is a critical issue as it may greatly influence the subsequent therapeutic strategy or patient management.MethodsA systematic review of the literature was performed by searching Medline from January 1995 up to January 2011. Electronic searches were limited to the English language, and the keywords prostate cancer, radiotherapy [RT], high intensity focused ultrasound [HIFU], cryotherapy [CRIO], transrectal ultrasound [TRUS], magnetic resonance [MRI], PET/TC, and prostate biopsy were used.ResultsDespite the fact that diagnosis of a local recurrence is based on PSA values and kinetics, imaging by means of different techniques may be a prerequisite for effective disease management. Unfortunately, prostate cancer local recurrences are very difficult to detect by TRUS and conventional imaging that have shown limited accuracy at least at early stages. On the contrary, functional and molecular imaging such as dynamic contrast-enhanced MRI (DCE–MRI), and diffusion-weighted imaging (DWI), offers the possibility of imaging molecular or cellular processes of individual tumors.Recently, PET/CT, using 11C-choline, 18F-fluorocholine or 11C-acetate has been successfully proposed in detecting local recurrences as well as distant metastases. Nevertheless, in controversial cases, it is necessary to perform a biopsy of the prostatic fossa or a biopsy of the prostate to assess the presence of a local recurrence under guidance of MRI or TRUS findings.ConclusionIt is likely that imaging will be extensively used in the future to detect and localize prostate cancer local recurrences before salvage treatment.

Prospective randomized trial comparing high lumbotomic with laparotomic access in renal cell carcinoma surgery.

Objective: We compared laparotomic with lumbotomic access in renal cell carcinoma (RCC) surgery by means of a prospective randomized trial, in order to evaluate differences in surgical time, blood loss, number of lymph nodes removed, duration of postoperative ileus and hospitalization, perioperative complications and progression‐free and cancer‐specific survival rates. Material and Methods: Between November 1991 and November 1996, 94 patients with RCC were recruited and randomly assigned to undergo surgery by lumbotomic (n = 50) or laparotomic (n = 44) access. All patients underwent radical nephrectomy and lymph node dissection. Results: The mean surgical time was 59.1 min (range 20–140 min) and 84.4 min (range 40–180 min) for lumbotomic and laparotomic access, respectively (p < 0.01). Blood loss was 502 ml (range 200–1800 ml) for lumbotomic and 648 ml (range 200–2000 ml) for laparotomic access (p < 0.005). Mean hospital stay was 6.8 days (range 3–13 days) for lumbotomic and 8.2 days (range 5–15 days) for laparotomic access (p < 0.001). The perioperative complication rates were 6.1% and 13.6% for lumbotomic and laparotomic access, respectively. After a mean follow‐up period of 7.5 years, cancer‐specific and progression‐free survival rates were 88% and 75%, respectively for lumbotomic and 88% and 72.7%, respectively for laparotomic access (p = NS). Multivariate analysis of risk factors showed that pathological stage was the best prognostic indicator of tumor progression, while other variables (age, tumor grade, surgical access, tumor size and incidental diagnosis of tumor) were not predictive of the prognosis of patients with RCC. Conclusions: During radical nephrectomy, control of the renal vessels is easier and faster with high lumbotomic access. The suggested risk of tumor cell spread due to manipulation of the kidney before vessel ligature was not confirmed in our study. Because of the shorter surgical time, lower blood loss, lower perioperative and late complication rates and shorter hospital stay involved, lumbotomic access should be preferred to laparotomic access in radical nephrectomy for RCC.

Incidental Prostatic Cancer: Repeat TURP or Biopsy?

An incidental diagnosis of carcinoma is made in about 15% of patients undergoing transurethral or open surgery for prostatic adenoma. The importance of correct staging lies in the different clinical behaviors of the tumor according to the stage, which means that it will require different treatment. We present a review article on the diagnosis of residual neoplasia following transurethral resection of the prostate.

Practical recommendations for performing ultrasound scanning in the urological and andrological fields

AIM US scanning has been defined as the urologists stethoscope. These recommendations have been drawn up with the aim of ensuring minimum standards of excellence for ultrasound imaging in urological and andrological practice. A series of essential recommendations are made, to be followed during ultrasound investigations in kidney, prostate, bladder, scrotal and penile diseases. METHODS Members of the Imaging Working Group of the Italian Society of Urology (SIU) in collaboration with the Italian Society of Ultrasound in Urology, Andrology and Nephrology (SIEUN) identified expert Urologists, Andrologists, Nephrologists and Radiologists. The recommendations are based on review of the literature, previously published recommendations, books and the opinions of the experts. The final document was reviewed by national experts, including members of the Italian Society of Radiology. RESULTS Recommendations are listed in 5 chapters, focused on: kidney, bladder, prostate and seminal vesicles, scrotum and testis, penis, including penile echo-doppler. In each chapter clear definitions are made of: indications, technological standards of the devices, the method of performance of the investigation. The findings to be reported are described and discussed, and examples of final reports for each organ are included. In the tables, the ultrasound features of the principal male uro-genital diseases are summarized. Diagnostic accuracy and second level investigations are considered. CONCLUSIONS Ultrasound is an integral part of the diagnosis and follow-up of diseases of the urinary system and male genitals in patients of all ages, in both the hospital and outpatient setting. These recommendations are dedicated to enhancing communication and evidence-based medicine in an inter- and multi-disciplinary approach. The ability to perform and interpret ultrasound imaging correctly has become an integral part of clinical practice in uro-andrology, but intra and inter-observer variability is a well known limitation. These recommendations will help to improve reliability and reproducibility in uro-andrological ultrasound scanning.

Incidentally detection of non-palpable testicular nodules at scrotal ultrasound: What is new?

The increased use of ultrasound in patients with urological and andrological symptoms has given an higher detection of intra-testicular nodules. Most of these lesions are hypoechoic and their interpretation is often equivocal. Recently, new ultrasound techniques have been developed alongside of B-mode and color-Doppler ultrasound. Although not completely standardized, contrast-enhanced ultrasound (CEUS) and tissue elastography (TE), added to traditional ultrasonography, can provide useful information about the correct interpretation of incidentally detected non-palpable testicular nodules. The purpose of this review article is to illustrate these new techniques in the patient management.

Obstetric and gynecological lesions of the ureter: Experience with 88 injuries

Over the past 17 years, 65 patients have been treated in our department for a total of 88 obstetric and gynecological ureteral lesions. Bilateral injury was involved in 23 cases. Conservative treatment was used in 13 injuries, diverting procedures in 8, nephrectomy in 5, and various surgical reconstructive techniques in 45. Seventeen patients refused therapy.An evaluation of the data shows that significantly better results were obtained when treatment was immediate (92%) than in cases in which treatment was purposely delayed (48%). Furthermore, in the latter group both nephrectomy and definitive diverting procedures were carried out in larger numbers. For optimal results, ureteral lesions must be repaired as soon as they are diagnosed, as long as the general condition of the patient permits.

Predictive value of resistive index in graft survival after kidney transplant

INTRODUCTION The intrarenal resistance index (RI) is a calculated parameter for the assessment of the status of the graft during the follow-up ultrasound of the transplanted kidney. Currently it is still unclear the predictive value of RI, also in function of the time. MATERIALS AND METHODS We retrospectively investigated the correlation between the RI and the graft survival (GS) and the overall survival (OS) after transplantation. We evaluated 268 patients transplanted between 2003 and 2011, the mean followup was 73 months (12-136). The RI was evaluated at 8 days, 6 months, 1 year and 3 years. The ROC analysis was used to calculate the predictive value of RI and the Kaplan Mayer curves was used to evaluated the OS and PS. RESULTS The ROC analysis, correlated to the GS, identified a value of RI equal to 0.75 as a cut-off. All patients was stratified according to the RI at 8 days (RI ≤ 0,75: 212 vs RI > 0.75: 56), at 6 months (RI ≤ 0.75: 237 vs RI > 0.75: 31), at 1 year (RI ≤ 0.75: 229 vs RI > 0.75: 39) and at 3 years (RI ≤ 0.75: 224 vs RI > 0.75: 44). The RI showed statistically significant differences between the two groups in favor of those who had an RI ≤ 0.75 only at 8 days and at 6 moths (p = 0.0078 and p = 0.02 to 8 days to 6 months) on the GS. On the contrary, we observed that the RI estimated at 1 year and 3 years has not correlated with the GS. The same RI cut-off was correlate with PS after transplantation. We observed that there are no correlations between the RI and OS. CONCLUSIONS The RI proved to be a good prognostic factor on survival organ when it was evaluated in the first months of follow- up after transplantation. This parameter does not appear, however, correlate with OS of the transplanted subject.

Atlas of Ultrasonography in Urology, Andrology, and Nephrology

martino p galosi a b eds atlas of ultrasonography in. atlas of ultrasonography in urology andrology and. applications of ultrasound in emergency springerlink. bladder ultrasound anatomy and scanning methods. atlas of ultrasonography in urology andrology and. atlas of ultrasonography in urology andrology and. atlas of ultrasonography in urology andrology and. atlas of office based andrology procedures 1st edition pdf. contrast enhanced ultrasonography in the diagnosis of. atlas of ultrasonography in urology andrology and. atlas of equine ultrasonography wiley. atlas of ultrasonography in urology andrology and. ultrasonography radiologyme. atlas of ultrasonography in urology andrology and. atlas of offi ce based andrology procedures. atlas of ultrasonography in urology andrology and. download pdf atlas of male genital disorders free online. atlas of ultrasonography in urology andrology and. curran s

Interventional Ultrasound: Puncture and Sclerotherapy of Renal Cysts

Ultrasound-guided puncture and alcoholization are the gold standard technique for the treatment of simple renal cysts. The main indications for the treatment of simple cysts are pain due to the mass compression effect, obstruction of the excretory tract, arterial hypertension, and patient anxiety. In addition, it is preferable to treat all renal cysts with a longitudinal diameter of 9 cm or more. The treatment method consists of the insertion of a sclerosing substance inside the cyst cavity, after having emptied it under US guidance. The aim is to sclerose the cyst walls so as to reduce the risk of recurrence. The treatment can be repeated two or three times, but in many experiences, a single treatment was sufficient to guarantee comparable results to multiple sclerosing sessions. The success of the treatment seems to depend on how long the ethyl alcohol remains in contact with the cyst walls. There is a negligible incidence of complications, so the method can be considered safe and reliable.

Normal and Pathological Adrenal Glands

The adrenals are endocrine glands located cranially to the kidneys, deep in the abdomen, sheathed inside the opening of Gerota’s fascia. Since the introduction, in relatively recent times, of high-resolution probes and devices, it has been possible to perform ultrasound (US) studies of the adrenal glands. In 1980, Sample was the first to describe the ultrasound approaches best suited to studying the normal adrenal gland [1]. Although other imaging techniques (MRI, CT, scintigraphy) are considered primary techniques in the study of adrenal diseases, US can offer an important contribution both in pediatric patients and in adults, when disease induces an increase in the volume of these glands. The adrenals are studied together with the kidneys using convex 3.5 MHz probes or, preferably, multifrequency 5–2 MHz probes. Higher frequencies can be used to study the adrenal glands in children, in whom the glands are relatively larger and better defined. When available, tissue harmonics is routinely employed to reduce reverberation artifacts and obtain more detailed images.