An uncommon case of sarcomatoid urothelial carcinoma in covered bladder exstrophy

Abstract We report a case of a woman affected by covered exstrophy, uterus didelphys and external genital malformation presenting with advanced bladder cancer. After neoadjuvant therapy and anterior pelvic exenteration, the abdominal wall was reconstructed with a pedicled myocutaneous muscle-sparing vastus lateralis flap.

Compliance to therapy with Dapoxetine in comparison to a conventional selective serotonin reuptake inhibitor (Citalopram) in 118 patients with premature ejaculation.

Premature Ejaculation (PE) is a sexual dysfunction that concern 20-30% of the male population. Dapoxetine is a new serotonine re-uptake inhibitor (SSRI)specific for PE treatment.Aim of the study is to assess compliance and effectiveness of the treatment with dapoxetine compared to the treatment with citalopram (a classic SSRI used to treat PE).

Fibronectin urothelial gene expression as a new reliable biomarker for early detection of local toxicity secondary to adjuvant intravesical therapy for non-muscle invasive bladder cancer.

Background: A marker of urothelial damage could be helpful for early detection and monitoring of local toxicity due to intravesical therapy for non-muscle invasive bladder cancer (NMIBC). The aim of the study was to investigate the correlation between fibronectin (FN) gene expression in bladder washings and local toxicity secondary to adjuvant intravesical therapy. Materials and methods: Patients undergoing adjuvant intravesical therapy for NMIBC and age-matched healthy patients were enrolled. Real time polymerase chain reaction was performed to analyze FN expression in bladder washings. Local toxicity was classified as: 0–1 mild (no medical therapy), 2 moderate (medical therapy and/or inst…

The clinical value of PSA increase during intravesical adjuvant therapy for nonmuscle-invasive bladder cancer.

Introduction Prostatic Specific Antigen (PSA), Bacillus Calmette-Guerin (BCG) increase after intravesical BCG has been reported. The need of prostate biopsy in these patients is object of debate. The aim of our study was to evaluate the effect of intravesical therapy on PSA after transurethral resection (TUR) of nonmuscle-invasive bladder cancer (NMIBC). Materials and methods Patients undergoing intravesical chemotherapy or immunotherapy for NMIBC were entered. PSA was measured before TUR, before the first and after the sixth instillation, 30 and 90 days after the last instillation. Patients with PSA ≥4 ng/ml or palpable prostate nodule were excluded. Results Out of 130 patients, 105 were e…

MULTI-ISTITUTIONAL CONTROLLED STUDIES DO NO REFLECT THE PATIENT’S COMPLIANCE TO BCG ENCOUNTERED IN CLINICAL PRACTICE. RESULTS ON 411 PATIENTS

Compliance to therapy with Dapoxetine in patients affected by Premature Ejaculation

Introduction Premature ejaculation (PE) is a sexual dysfunction with high prevalence. According to some reports, it is present in about 20-30% of the male population. Since 2009 PE has been treated with a novel inhibitor of serotonin re-uptake, Dapoxetine, which has been reported to be specifically active for PE. Materials and Methods 59 patients have been selected among the patients affected by PE observed at the outpatient department of Urology and Andrology of the “Paolo Giaccone” University Policlinic Hospital of Palermo. Diagnosis was confirmed unequivocally in all patients, who were suitable for drug treatment and accepted to participate in the study. They were divided in 2 groups: on…

Clinical Pitfalls in Diagnosis of Nonmuscle-Invasive Bladder Cancer

Current global economic crisis imposes healthcare system to reduce unnecessary investigations and increase early detection of tumors, to decrease the costs of an advanced disease. Several diagnostic pitfalls may occur dealing with bladder cancer (BC), particularly in nonmuscle-invasive (NMIBC) one. Hematuria, the commonest sign in NMIBC, is often underestimated. Urinary cytology is highly specific for high-grade tumors, but has a low sensitivity for low-grade BC, is operator dependent, and not always obtainable in clinical practice. Numerous urinary tests are available to ameliorate the accuracy of cytology, but none of them is routinly used in urological practice. Ultrasound could hardly …

Mitomycin C from birth to adulthood.

Mitomycin C (MMC) intravesical therapy for “superficial” papillary bladder tumors was firstly introduced in the early seventies with promising results. In the following years, several pharmacokinetic studies investigated its mechanism of action to optimize the intravesical administration. Numerous studies confirmed thereafter both the ablative and the prophylactic efficacy and the low toxicity of MMC when intravesically given. In 1984, a complete response rate of 42% in 60 patients not responsive to thiotepa was reported with intravesical MMC at the dose of 40 mg diluted in 40 ml for 8 weeks. In the following decades, many large randomized studies showed the benefit of intravesical prophyla…

WHATSAPP MESSENGER AS A REAL-TIME TOOL FOR A LONG-DISTANCE ACTIVITY OF A MULTIDISCIPLINARY

CORRELATION BETWEEN FIBRONECTIN GENE EXPRESSION AND LOCAL TOXICITY INDUCED BY ADJUVANT INTRAVESICAL THERAPY

THE ROLE OF INTRAVESICAL GLYCOSAMINOGLYCANS IN TOXICITY INDUCED BY ADJUVANT INTRAVESICAL THERAPY: GENETIC LABORATORY EVIDENCE

LOWER RESPONSE TO INTRAVESICAL ADJUVANT THERAPY IN HIGH-RISK BLADDER CANCER COULD BE RELATED TO THE UROTHELIAL EXPRESSION OF EGFR

Radium-223 treatment in castration resistant bone metastatic prostate cancer. Should be the primary tumor always treated?

Introduction: Radium-223 (223Ra) improves symptoms and survival in patients with bone metastatic castration-resistant prostate cancer (mCRPC). Study aim: To evaluate the impact of a previous radical prostatectomy (RP) on the outcome of 223Ra therapy in mCRPC patients. The primary prostate tumor left untreated could progress during 223Ra treatment. Materials and methods: mCRPC symptomatic patients treated with 223Ra were enrolled. Luteinizing Hormone-Releasing Hormone analogue was maintained. No other anticancer therapy was given. 223Ra was administered i.v. at the dose of 55 kBq/kg every 4 weeks for 6 cycles. Patients were stratified according to previous RP or not. Hematological toxicity w…

Characterization of human infiltrating and circulating gamma-delta T cells in prostate cancer

Purpose The aim of our study was to prospectively evaluate the distribution of gamma-delta (γδ)1 and γδ2 T cells and their phenotypes in peripheral blood and prostate samples of patients diagnosed with or without prostate cancer (PCa) at prostate biopsy. Materials and methods A consecutive series of 43 outpatients underwent trans-rectal echo-guided prostate biopsy for suspected PCa. Flow cytometry analysis was used to identify and characterize the γδ T cells populations in peripheral blood and tissue samples. Patients were stratified according to the presence or not of PCa, and its International Society of Urological Pathology (ISUP) grade (1 vs. ≥2). Results The distribution of γδ T cells …

Clinical implications of a rare renal entity: Pleomorphic Hyalinizing Angiectatic Tumor (PHAT)

Abstract Pleomorphic Hyalinizing Angiectatic Tumor (PHAT) is a rare benign lesion characterized by slow growth, infiltrative behavior and high rate of local recurrences. Only one case has been described in retroperitoneum, at renal hilum, but not involving pelvis or parenchyma. Here we present the first case of PHAT arising in the renal parenchyma. A nodular lesion in right kidney lower pole was diagnosed to a 61 year old woman. The patient underwent right nephrectomy. Microscopically, the lesion showed solid and pseudo-cystic components with hemorrhagic areas characterized by aggregates of ectatic blood vessels. Pleomorphic cells were characterized by large eosinophilic cytoplasm with irre…

Epidermal Growth Factor Receptor (EGFR) Cell Expression During Adjuvant Treatment After Transurethral Resection for Non-Muscle-Invasive Bladder Cancer: A New Potential Tool to Identify Patients at Higher Risk of Disease Progression

Abstract Background The aim of the study was to investigate the feasibility of Epidermal Growth Factor Receptor (EGFR) measurement in bladder washings of patients affected by non–muscle-invasive bladder cancer (NMIBC) and its prognostic role in identifying risk subgroups and predicting disease recurrence and progression. Patients and Methods Patients with NMIBC treated with transurethral resection of bladder tumor (TURBT) from 2012 to 2015 were enrolled. Samples of bladder washings were collected and stored at −80°C until RNA extraction. The cDNA obtained from RNA was used to perform a gene expression analysis by a real time polymerase chain reaction. Results An adequate cellular pellet was…

MP26-19 A PROSPECTIVE STUDY ON THE INFLUENCE ON RECURRENCE OF QUITTING CIGARETTE SMOKING AT DIAGNOSIS OF PRIMARY NON MUSCLE INVASIVE BLADDER CANCER

Cancer of the Penis

Penile carcinoma is a rare and aggressive disease. Its incidence is related with age over 60 and presence of comorbidities such as HPV infection. The higher incidence rate is reached in developing countries. Penile carcinoma is generally a squamous cell carcinoma and it is frequently foregone by a premalignant lesion. Because of its short time to progression, an early detection is mandatory. Good physical examination is the first step toward a correct diagnosis and staging. CT scan and chest X-ray are useful for nodal stage while US and MRI can provide a preoperative assessment of local invasion. Surgical approach depends on invasion and nodal involvement, varying from a local laser ablatio…

Premature Ejaculation: Comparison of treatment. Pharmacotherapy vs Pharmacotherapy in association with group psychotherapy vs group psychotherapy

Introduction & Objectives: The aim of our study was to compare and analyse the effectiveness of pharmacological treatment and the psychotherapy alone or in association in terms of increase of Quality of Life (QoL) measured through Premature Ejaculation Diagnostic Tool (PEDT) and increase of intravaginal eiaculation latency time (IELT) in patients affected by primitive premature ejaculation(PE). Material & Methods: Between January and December 2012, in our department underwent to medical examination 540 patients complaining PE. Criteria for enrollment were primitive PE with IELT ≤ 2 minutes, PEDT > 9 and absence of psychiatric disease, severe chronic disease, drugs and alcool abuse. Out of 5…

Clinical and biochemical markers of visceral adipose tissue activity: Body mass index, visceral adiposity index, leptin, adiponectin, and matrix metalloproteinase-3. Correlation with Gleason patterns 4 and 5 at prostate biopsy

Context: The correlation between aggressive prostate cancer and obesity mainly based on body mass index (BMI) and pathology after surgery remains controversial. Aims: The aim of the study was to correlate BMI, visceral adiposity index (VAI), and the plasmatic levels of leptin, adiponectin, and matrix metalloproteinase-3 (MMP-3), and biomarkers of adipose tissue function, with the detection of Gleason patterns 4 and 5 at biopsy. Subjects and Methods: Consecutive patients with prostate cancer at 12-core transrectal biopsy were enrolled. BMI, waist circumference (WC), blood samples to evaluate the plasmatic levels of triglycerides (TG) and high-density lipoproteins (HDL), adiponectin, leptin, …

Sexual dysfunctions after transurethral resection of the prostate (TURP): evidence from a retrospective study on 264 patients

Objectives: Benign prostatic hyperplasia (BPH) and sexual dysfunctions are diseases with a high prevalence in aged men. Several studies have found a link between BPH and LUTS resulting from deterioration in sexual function in men aged 50 years and older for whom TURP is considered the gold standard. The impact of TURP on sexual functions still remain uncertain, nor is it clear what pathophysiological mechanism underlying the emergence of new episodes of Erectile Dysfunction (ED) following TURP in patients with normal sexual function before surgery, while retrograde ejaculation and ejaculate volume reduction represent a clear side effect; derived from BPH treatment. The aim of this study was…

Whatsapp messenger as a tool for the multidisciplinary management in everyday clinical practice

Introduction & Objectives Communication between doctors is traditionally conducted by written clinical charts. Mobile health is becoming an integral part of modern healthcare system, improving accessibility and quality of medical care. Recent papers suggest that an increasing number of doctors are using in their practice mobile tools to communicate clinical informations (1,2). The aim of our study was to verify the adoption of WhatsApp Messenger in everyday clinical practice to obtain a real-time multidisciplinary collaboration among medical centers located in different areas of the city. Material & Methods In January 2016 a WhatsApp Messenger group was created among 25 specialists:…

Effetto antalgico “immediato” nella malattia di La Peyronie: TECAR Terapia. Studio di fase uno

Introduzione. Con lo scopo di valutare la TECAR terapia quale nuovo possibile trattamento medico della malattia di La Peyronie (PD), abbiamo condotto uno studio di fase uno senza placebo né gruppo di controllo. La TECAR terapia si basa sull’utilizzo di radiofrequenze in grado di trasferire energia ai tessuti trattati causando movimenti ionici. Ciò provoca una stimolazione cellulare in senso replicativo e riparativo. La TECAR terapia ha ottenuto risultati eccellenti nel trattamento di alcune patologie del tesuto connettivo, così abbiamo deciso di condurre uno studio circa l’applicabilità e la sicurezza della TECAR nel trattamento della PD. MATERIALI E METODI. Da giugno a settembre 2012 sono …

PLEOMORPHIC HYALINIZING ANGIOECTATIC TUMOR (PHAT) OF RENAL PARENCHYMA. FIRST CASE REPORTED IN LITERATURE

L’agobiopsia prostatica

Genitourinary Symptoms—Patient Help-Seeking and General Practitioner Management: An Outpatient Based Survey at a Tertiary Hospital in Southern Italy

Abstract Introduction General knowledge of most common genitourinary diseases is often lacking. In this survey we evaluated the attention given by patients and general practitioners to genitourinary symptoms, and particularly to hematuria and potential early signs of genitourinary cancer. Methods A structured self-administered questionnaire was administered to outpatients before the urological consultation. The questionnaire consisted of 4 multiple choice questions to record the level of patient awareness of urological symptoms, the importance given to gross hematuria, the interval between the onset and the visit, the regularity of physical examination and the first-level investigations ind…

Does the Compliance to Intravesical BCG Differ between Common Clinical Practice and International Multicentric Trials?

<b><i>Introduction:</i></b> The aim of this study was to analyze the reasons for intravesical BCG interruption in clinical practice. BCG for at least one year is advocated as the best regimen to treat high-risk non-muscle invasive bladder cancer (NMIBC). However, almost 50% of patients don't complete it. Toxicity accounts for 10% of dropouts in international trials. <b><i>Materials and Methods:</i></b> Patients with T1HG NMIBC undergoing 1-year BCG were enrolled in this study. BCG was administered for one year. Toxicity and causes of treatment interruption were recorded. <b><i>Results:</i></b> A total of 411 patients we…

Intravesical chemotherapy for intermediate risk non-muscle invasive bladder cancer recurring after a first cycle of intravesical adjuvant therapy

Context: The therapeutic strategy in intermediate risk (IR) non-muscle invasive bladder cancer (NMIBC) recurring after intravesical therapy (IT) is not well defined. Most patients are usually retreated by Bacillus Calmette-Guerin (BCG). Aims: To evaluate the efficacy of intravesical chemotherapy (ICH) given at recurrence after the first cycle of ICH in IR-NMIBC recurring 6 months or later. Settings and Design: Retrospective analysis of the efficacy of ICH given after previous IT. Materials and Methods: The clinical files of IR-NMIBC patients recurring later than 6 months after transurethral resection (TUR) and IT and retreated by IT were reviewed. The patients should be at intermediate risk…

A PROSPECTIVE STUDY ON THE INFLUENCE ON RECURRENCE OF QUITTING CIGARETTE SMOKING AT DIAGNOSIS OF PRIMARY NON MUSCLE INVASIVE BLADDER CANCER

Does Smoking Cessation at Primary Diagnosis Reduce the Recurrence Risk of Nonmuscle-Invasive Bladder Cancer? Results of a Prospective Study.

<b><i>Introduction:</i></b> Evidence that smoking cessation at first diagnosis of nonmuscle-invasive bladder cancer (NMIBC) reduces the risk of recurrence is lacking. The aim of our prospective study was to analyze the association between patients’ changes in smoking habits after diagnosis and recurrence-free survival (RFS). <b><i>Patients:</i></b> After transurethral resection of primary NMIBC, patients were classified as “ex-smokers,” i.e., those definitively stopping, and as “active smokers,” i.e., those continuing or restarting to smoke. Smoking status was reassessed every 3 months during the first year and every 6 months thereafter. Data …

sj-jpg-1-tau-10.1177_1756287221995683 – Supplemental material for Fibronectin urothelial gene expression as a new reliable biomarker for early detection of local toxicity secondary to adjuvant intravesical therapy for non-muscle invasive bladder cancer

Supplemental material, sj-jpg-1-tau-10.1177_1756287221995683 for Fibronectin urothelial gene expression as a new reliable biomarker for early detection of local toxicity secondary to adjuvant intravesical therapy for non-muscle invasive bladder cancer by Fabrizio Di Maida, Cristina Scalici Gesolfo, Riccardo Tellini, Andrea Mari, Chiara Sanfilippo, Luca Lambertini, Antonio Andrea Grosso, Marco Carini, Andrea Minervini and Vincenzo Serretta in Therapeutic Advances in Urology