Archivio italiano di urologia, andrologia : organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia
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Arch Ital Urol Androl · Dec 2000
[Ultrasound-guided biopsy: screening of prostate cancer with a single set of 14 systematic biopsies].
Standard sextant prostate biopsy may underestimate cancer in men in whom clinical finding and transrectal ultrasound are negative and prostate-specific antigen (PSA) value suspicious for localized prostate cancer (4-10 ng/ml). We describe our experience with a 14 systematic multisite biopsy scheme to detect carcinoma of the prostate (stage T1c). Between January 1999 and February 2000, a total of 177 consecutive patients (mean age 64.1 +/- 7.7 years) underwent systematic transrectal ultrasound (TRUS) guided biopsy for normal digital rectal examination, normal TRUS and abnormal prostate specific antigen 4 ng/ml or greater (4-13 ng/ml). ⋯ Biopsies of the alternate sites are easy, feasible and reproducible. This strategy enhance prostate cancer detection of a 30% compared to conventional sextant biopsies alone. In conclusion, the 6 systematic biopsy of the peripheral zone are inadequate and a minimum of 12 with extensive core in peripheral and transitional zone should routinely be performed to detect a more significant number of men with prostate cancer at stage T1c.
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Since October 1994 we performed endoscopic treatment of bladder diverticula, in combination with the resolution of cervico-urethral obstruction, in 12 patients. In a first group of five patients we used the incision of the diverticular neck, while in a second group of seven patients we associated the electrocoagulation of the diverticular mucosa to the opening of the diverticular neck. The better results have been obtained in the second group of patients in which the diverticula had markedly shrunk in two cases and had totally disappeared in five. Transurethral treatment of bladder diverticula, with incision of the diverticular neck and the fulguration of the diverticular mucosa, combined with transurethral operations for removing the obstruction of the lower urinary tract, is a safe, fast and effective method.
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Aetiology of testicular cancer is still poorly characterized, so the prevention is unlikely to achieve. A fundamental issue is early detection as delay in presentation is a common feature in patients affected by this disease. Moreover there is much evidence suggesting a significant association between delay in diagnosis and clinical stage at presentation particularly for nonseminomas. 176 valuable patients with non seminomatous germ cell tumors of the testis had a clearly identifiable interval from first symptoms until diagnosis; mean delay was 13.9 weeks, and there was a correlation between difference in delay of I clinical stage patients (mean: 10.0 weeks) and III stage patients (mean: 18.6 weeks) ANOVA: p < 0.035. These data suggest that encouraging programmes in order to provide more informations on testicular cancer and testicular self examination (TSE) may contribute to reduce the number of young men requiring toxic treatment and major surgery and even may reduce mortality.
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Radical cystectomy represents the gold standard for locally advanced bladder cancer. Orthotopic neobladder is considered the surgical option which may offer the least modification of body image and the best life condition to the unfortunate patient requiring radical cystectomy. Objective of this study was to investigate long term clinical outcome of orthotopic ileal bladder substitute with special reference to late complications and patient compliance. ⋯ Our experience suggests that careful compliance of patients to the new life style imposed by the orthotopic neobladder is of importance to avoid its decompensation. The possible causative role of gastrointestinal hormones such as enteroglucagon (EG) and peptide tyrosine-tyrosine (PYY) in the elongation of the afferent limb of the Studer neobladder is proposed. In conclusion, we believe that orthotopic ileal neobladder is an ideal surgical option on in the young, educated and cooperative patients.
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Arch Ital Urol Androl · Jun 1998
[Urethral and prostatic urologic endoscopic surgery in day hospital].
We evaluated urethral and prostatic urological endoscopical surgery in Day Hospital, following rules proposed by Veneto Region in 1996. We made surgical treatments for urethral strictures, BPH obstruction, and sclerosis of the bladder neck in 44 patients (age: 67-84). Laser therapy and classical surgical techniques were used. Our results were good: complete resolution of obstruction, lack of bleeding, early catheter removal, and acceptable costs.