P. Beltrami

Impact of anatomical pielocaliceal topography in the treatment of renal lower calyces stones with extracorporeal shock wave lithotripsy

Abstract  Aim:  There is wide consensus that the lowest success rate of extracorporeal shock wave lithotripsy (ESWL) is in the complete clearance of renal stones located in the lower calyces. We assess the effectiveness of extracorporeal shock wave lithotripsy monotherapy for lower pole renal calculi to determine the relationship between the spatial anatomy of lower pole and the outcome of ESWL.

Primary lymphoma of the epididymis: case report and review of the literature

Objective: To report an extremely rare clinical pathological observation of a case of primary lymphoma of the epididymis, without testicular or systemic involvement, and to update the relevant literature. Materials and Methods: A 25-year-old white male patient complaining of right scrotal pain was referred to our department. Clinical examination detected a hard painful mass at the right epididymal head. Epididymitis was diagonsed and conservative therapy with antibiotics and anti-inflammatory drugs was given. After 2 months of therapy the patient was admitted to our department because a tumor was suspected. Tumor markers were normal. Right scrotal exploration was performed through a standard inguinal incision. The epididymal head was completely replaced by a hard white mass. Fresh frozen sections indicated a malignant tumor. Right radical orchiectomy was performed. Results: High-grade primary epididymal non-Hodgkin’s lymphoma with diffuse large cells (group G according to the Working Fromulation) was diagnosed. Clinical pathological staging detected stage IE (extranodal) primary epididymal lymphoma. The patient was referred to the Hematologic Unit for combined chemotherapy, according to the VACOP-B protocol. After an 18-month follow-up the patient is well and disease free. Conclusions: When an epididymal mass does not benefit from medical treatment, scrotal exploration and fresh frozen sections of the lesion should be done. The possible bilateral involvement by primary epididymal lymphoma has to be kept in mind. Radical orchiectomy is the treatment of choice for primary lymphoma of the epididymis. Adjuvant chemotherapy is indicated in high-grade malignant lymphoma. Prognostic parameters of the disease may be the grade of malignancy and the size of the tumor.

Unilateral Laparoscopic Retroperitoneal Lymph Node Dissection for Clinical Stage I Nonseminomatous Germ Cell Testicular Neoplasm

Objective: The aim of this study is to evaluate the reliability of laparoscopic retroperitoneal lymph node dissection (LRPLND) in the management of clinical stage I nonseminomatous germ cell tumors (NSGCT). Methods: Since June 1993, unilateral LRPLND was performed in 6 patients diagnosed with clinical stage I NSGCT. All patients had undergone prior radical orchiectomy. The testicular cancer was left-sided in 3 cases and right-sided in the other 3 cases. Preoperative staging by means of tumor marker assessment, computerized tomography scan of the chest and abdomen and chest X-ray was unremarkable for metastatic disease. Results: All procedures were accomplished without any complications in a mean time of 325 min (275–420 min). The estimated perioperative blood loss was minimal (<50 ml), and none of the patients required blood transfusion. In the case of the first patient, the hospital stay was 18 days due to a widespread subcutaneous emphysema. In the remaining 5 cases, the average hospitalization was 4.8 days, ranging from 4 to 6 days. The patients resumed normal activities within 12–27 days (mean 16.16 days) postoperatively. The mean number of lymph nodes removed was 6.8, ranging from 5 to 9. Histologic examination of the dissected lymph nodes revealed microscopic metastases from embryonal carcinoma in 2 patients. Both of these patients received adjuvant chemotherapy. The mean follow-up period is 21.3 months, ranging from 6 to 36 months. To date, no relapses have been observed. Conclusion: In accordance with other reports, we believe that LRPLND is both feasible and effective. However, the definitive assessment of the efficacy and morbidity of this diagnostic procedure requires a larger and more comprehensive series as well as longer follow-up.

Are prostate biopsies mandatory in patients with prostate‐specific antigen increase during intravesical immuno‐ or chemotherapy for superficial bladder cancer?

Aim of this study was to evaluate if there was a significant association between intravesical immuno‐ or chemotherapy and the increase of PSA serum level. It could be important to avoid useless prostate biopsies.

An unusual pathological finding of chronic lymphocitic leukemia and adenocarcinoma of the prostate after transurethral resection for complete urinary retention: case report

BackgroundWe describe a patient who underwent transurethral resection of the prostate for urinary obstructive symptoms and had histological findings of adenocarcinoma of the prostate with prostatic localization of chronic lymphocitic leukemia (CLL).The contemporary presence of CLL, adenocarcinoma of the prostate and residual prostatic gland after transurethral resection has never been reported before and the authors illustrate how they managed this unusual patient.Case presentationA 79-years-old white man, presented with acute urinary retention, had a peripheral blood count with an elevated lymphocytosis (21.250/mL) with a differential of 65.3% lymphocytes and the prostate-specific antigen (PSA) value was 3.38 ng/mL with a percent free PSA of 8.28%. The transrectal ultrasound (TRUS) indicated an isoechonic and homogenic enlarged prostate of 42 cm3 and the abdomen ultrasound found a modest splenomegaly and no peripheral lymphadenophaty. The patient underwent transurethral resection of the prostate and had a pathological finding of adenocarcinoma in the prostate with a Gleason Score 4 (2+2) of less than 5% of the material (clinical stage T1a), associated with a diffused infiltration of chronic lymphocitic leukemia elements.ConclusionsThe incidental finding of a prostatic localization of a low-grade non-Hodgkins lymphoma does not modify eventually further treatments for neither prostate cancer nor lymphoma. The presence of a low-grade and low-stage lymphoma, confirmed by a hematological evaluation, and the simultaneous evidence of an adenocarcinoma after transurethral resection of the prostate for acute urinary retention do not require any immediate treatment due to its long-term survival rate and the follow-up remains based on periodical PSA evaluation and complete blood count.

Using computed tomography to predict in vivo stone chemical composition

OBJECTIVES. Several authors hypothesized the usefulness of the non-contrast helical computed tomography (NCHCT) with the determination of stone Hounsfield Unit (HU) values in order to predict urinary stone compositions. Preoperative knowledge of stone composition might be interesting in pre-operative decision-making process. The aim of this study was to evaluate the possible correlation between stone chemical composition and correspondent stone HU value in an in-vivo experience. METHODS. Forty patients with urinary stones were preoperatively studied with abdominal NCHCT, where stone HU values were reported. Stone chemical composition was obtained in each patient, using the colorimetric method. The HU value of each stone was compared with the correspondent chemical analysis. Results. The median HU values of calcium oxalate (n=10), mixed calcium oxalate and phosphate (n=19), calcium phosphate (n=2), uric acid (n=6) and mixed uric acid and calcium oxalate (n=3) stones were 1060 HU [interquartile range (IQR) 743.75-1222.5]; 900 HU (IQR 588.5-1108.5); 774 HU (range 720-828); 371 HU (IQR 361.25-436.25) and 532 HU (range 476-626), respectively. CONCLUSIONS. Our results confirmed a statistically significant difference of the HU values between calcium and pure uric acid calculi, suggesting a correlation between stone chemical composition and CT-density. Hounsfield unit.

Ureterorenoscopy with a flexible instrument

Flexible ureterorenoscopy should be routinely used at the Urological Centers that deal with urinary stones. Flexible instruments should be used for both diagnostic and therapeutic purposes, allowing a safe exploration of the whole upper urinary tract. Thanks to their flexibility and to the active and passive deflection of their distal part, these instruments allowed to successfully treat several difficult situations, such as renal caliceal calculi in the lower calices or even in some middle/upper calices or in horseshoe kidneys. The therapeutic potential of this approach is enhanced by the large availability of ancillary instrumentation, such as baskets, grasps, holmium laser fibers, etc, which is continuously growing. On the other side, a steep learning curve of the technique is usually required for the surgeon. Furthermore, the intrinsic fragility of the instrument components and a potentially lower quality, when compared to that of the rigid and semi-rigid ureteroscopes, should be considered.

Periorbital emphysema after laparoscopic nephrectomy: case report and literature review.

A 40-year-old lady presented with marked swelling and inability to open her left eye immediately after laparoscopic nephrectomy for a left pyelonephritic kidney. A diagnosis of periorbital emphysema was made and within 7 days the emphysema spontaneously disappeared. Periorbital emphysema is a rare benign condition that may complicate a laparoscopic nephrectomy.

Notice of Duplicate Publication

Upon close scrutiny of Figure 2 in the article by Webley and coworkers published in AJRCCM (1) and Figure 2 from the article by Cirino and coworkers published in BMC Infectious Diseases (2), we realized that the figure in BMC Infectious Diseases was a lower magnification of part of the same field as that used in the AJRCCM article. These figures both describe the growth of Chlamydia from clinical samples on the same tissue culture substrate (J774A.1 cells) and were in a single database of figures with different numeric designations. The experiments that led to the data for these two articles were generated around the same time and were compiled and stored in the same folder since pictures are taken in bulk at our microscopy facility where we pay a fee for the microscopy services. We believe that sometime during the compilation and annotation process, Figure 2 in the BMC Infectious Diseases article was incorrectly labeled as being generated from the normal donor project and was later used in that manuscript. In fact, this figure was taken from a culture coverslip that was infected with lysates from pediatric bronchial lavage samples. The AJRCCM figure was a 600 immunofluorescence image of a field on a coverslip, part of which can be seen in the lower magnification image (400 ) in the BMC Infectious Diseases article. The authors will supply the editor ofBMC Infectious Diseases with the appropriate representative culture image from normal donor infection of J774A.1 cells to replace the existing one. We deeply regret this error in image annotation and later image selection and hope that this will in no way detract from the important data contained in these two manuscripts.