Treatment of Large Non-Muscle-Invasive Bladder Cancer: The Potential Role of Neoadjuvant Intravesical Chemotherapy.

Introduction: The endoscopic resection of large and bulky bladder cancers represents a challenge. To reduce the tumor and make it more easy to resect, we used neoadjuvant short and intensive intravesical mitomycin (MMC) therapy.

Methods: Patients with large bladder tumors were evaluated for this study.

Thulium laser enucleation of the prostate (ThuLEP): Results, complications, and risk factors in 139 consecutive cases.

Objectives: To report our experience with the emerging technique of thulium laser enucleation of the prostate (ThuLEP) for the treatment for prostate hyperplasia.

Patients And Methods: Our inclusion criteria were an International Prostate Symptom Score (IPSS) of >15 and a quality-of-life (QoL) score of >3 in patients with confirmed bladder outflow obstruction, no longer responsive to medical therapy, with a significant post-void residual urine volume (PVR; >100 mL), with or without recurrent urinary tract infection and/or acute urinary retention. Patients with neurogenic bladder, urethral strictures, bladder stones, and previously failed transurethral prostate surgery were excluded.

Transrectal ultrasound guidance for early transurethral recatheterization after radical prostatectomy.

Purpose: To study the usefulness of transrectal ultrasound (TRUS) for catheter guidance in cases of early reinsertion after radical prostatectomy (RP).

Methods: Since 2007, we have used TRUS for catheter guidance when early reinsertion after RP is required. A preliminary TRUS examination is done to carefully check the state of the vesicourethral anastomosis.

Prostate saturation biopsy following a first negative biopsy: state of the art.

Introduction: Saturation prostate biopsy (SPBx) has been initially introduced to improve prostate cancer (PCa) detection rate (DR) in the repeat setting. Nevertheless, the optimal number and the most appropriate location of the cores, together with the timing to perform a second PBx and the eventual modification of the PBx protocols according to the different clinical situations, are matters of debate. The aim of this review is to perform a critical analysis of the literature about the actual role of SPBx in the repeat setting.

Leydig cell tumor of the spermatic cord in an adolescent affected by congenital adrenal hyperplasia.

We report the first case of a patient with extratesticular Leydig cell tumor associated with congenital adrenal hyperplasia. An 18-year-old congenital adrenal hyperplasia patient presented with a palpable and asymptomatic right extratesticular mass. Color Doppler sonography confirmed the presence of a capsulated and vascularised lesion.

Unilateral positive biopsies in low risk prostate cancer patients diagnosed with extended transrectal ultrasound-guided biopsy schemes do not predict unilateral prostate cancer at radical prostatectomy.

Unlabelled: Focal therapy is an emergent therapeutic option for prostate cancer. Focal therapy includes a variety of therapeutic approaches ranging from lesion treatment to sub-total gland treatment. In this context, an accurate selection of patients having unilateral prostate cancer is closely related to the success of these strategies, especially when a hemi-ablative approach is considered.

Preoperative circulating sex hormones are not predictors of positive surgical margins at open radical prostatectomy.

Purpose: To examine the association between positive surgical margins (PSMs) and preoperative circulating estradiol (E(2)), total testosterone (tT), and sex hormone-binding globulin (SHBG) in patients undergoing retropubic radical prostatectomy (RRP).

Methods: A cohort of 665 non-screened patients who underwent RRP at a single institute was studied. Serum tT, E(2), and SHBG were measured the day before surgery (8-10 AM: ) in all cases.

Does the transrectal ultrasound probe influence prostate cancer detection in patients undergoing an extended prostate biopsy scheme? Results of a large retrospective study.

Objective: • To compare the prostate cancer detection rate and tolerance profile between a transrectal biopsy made with a 'side fire' (SF) and an 'end fire' (EF) ultrasound probe.

Patients And Methods: • We selected patients undergoing first biopsy and re-biopsy of the prostate with a 14- and 18-core template using EF and SF transrectal probes, respectively. • We compared the cancer detection rate between the two probes on first biopsy and re-biopsy and gauged patient tolerance using a visual analogue scale (VAS).

The optimal rebiopsy prostatic scheme depends on patient clinical characteristics: results of a recursive partitioning analysis based on a 24-core systematic scheme.

Background: The most beneficial number and the location of prostate biopsies remain matters of debate, especially after an initial negative biopsy.

Objective: To identify the optimal combination of sampling sites (number and location) to detect prostate cancer (PCa) in patients previously submitted to an initial negative prostatic biopsy.

Design, Setting, And Participants: A transrectal ultrasound-guided systematic 24-core prostate biopsy (24PBx) was performed prospectively in 340 consecutive patients after a first negative biopsy (at least 12 cores).

Anaesthesia in transrectal prostate biopsy: which is the most effective technique?

Background: Prostate biopsy (PBx) techniques have changed significantly since the original Hodge's scheme, with an increase in the number and location of cores. These improvements have been realized in part because of the introduction of different local anaesthesia techniques. We critically analysed the literature discussing the role of anaesthesia techniques for use during PBx to find which technique provides the best pain relief for the patient and safety for the urologist.

Diagnosis of high-grade prostatic intraepithelial neoplasia: the impact of the number of biopsy cores at initial sampling on cancer detection after a saturation re-biopsy.

Objectives: To evaluate factors that may predict prostate cancer (PCa) detection after initial diagnosis of high-grade prostatic intraepithelial neoplasia (HGPIN) on 6-24 cores prostatic biopsies (PBx).

Material And Methods: We retrospectively evaluated 193 patients submitted from 1998 to 2007 to prostate re-biopsy after initial HGPIN diagnosis in three urologic departments. HGPIN diagnosis was obtained on initial systematic PBx with 6 to 24 random cores.

Trans-rectal versus trans-perineal saturation rebiopsy of the prostate: is there a difference in cancer detection rate?

Objective: To test the hypothesis that there is no significant difference in the rate of prostate cancer (PCa) detection rate between the transrectal and transperineal approach in men undergoing a saturation (24-core) prostate rebiopsy.

Methods: We evaluated 472 consecutive men who underwent a 24-core prostate rebiopsy at 2 tertiary referral centers. Of these, 70% (332) underwent a transrectal biopsy, and 30% (140) underwent a transperineal biopsy.

Elasto-sonography of the testis: preliminary experience.

Objectives: We report our experience in elastosonography, a new developed ultrasonographic diagnostic dynamic technique used to provide an estimation about tissue stiffness.

Methods: 41 patients who presented with scrotal pain, painless enlargement of the scrotum or testicular nodules and infertility were submitted to ultrasound examination (US), color Doppler ultrasonography (CDU), elastosonography examination (E). During ultrasonography examination we obtained conventional B-mode images.

Early detection of urothelial premalignant lesions using hexaminolevulinate fluorescence cystoscopy in high risk patients.

Background: To evaluate fluorescence cystoscopy with hexaminolevulinate (HAL) in the early detection of dysplasia (DYS) and carcinoma in situ (CIS) in select high risk patients.

Methods: We selected 30 consecutive bladder cancer patients at high risk for progression. After endoscopic resection, all patients received (a) induction BCG schedule when needed, and (b) white light and fluorescence cystoscopy after 3 months.

The role of transrectal saturation biopsy in tumour localization: pathological correlation after retropubic radical prostatectomy and implication for focal ablative therapy.

Objective: • To evaluate the accuracy of an initial 24-core prostate biopsy scheme (PBx24) in predicting unilateral prostate cancer (PCa) in radical prostatectomy (RP) specimens.

Patients And Methods: • Between 2005 and 2008, 203 consecutive patients underwent PBx24 followed by RP for PCa. The area under the curve (AUC) was used to evaluate the accuracy of unilateral PCa on PBx24 to predict unilateral PCa in RP specimens.

Is extended and saturation biopsy necessary?

Prostate biopsy (PBx) techniques have significantly changed since the original Hodge's 'sextant scheme', which should now be considered obsolete. The feasibility of carrying out a biopsy scheme with a high number of cores in an outpatient setting is a result of the great improvement and efficacy of local anesthesia. Peri-prostatic nerve block with lidocaine injection should be considered the 'gold standard' because it provides the best pain relief to patients undergoing PBx.

Biopsy schemes with the fewest cores for detecting 95% of the prostate cancers detected by a 24-core biopsy.

Background: The most efficient number and location of prostate biopsies remains a matter of debate.

Objective: To identify the combination (number and location) of sampling sites that permits the detection of 95% of the prostate cancers (PCa) detected by a 24-core biopsy (24PBx).

Design, Setting, And Participants: Six hundred and seventeen consecutive patients with a suspicion of PCa were prospectively enrolled.

Quantitative sensory testing of peripheral thresholds in patients with lifelong premature ejaculation: a case-controlled study.

Introduction: The main functional factors related to lifelong premature ejaculation (PE) etiology have been suggested to be penile hypersensitivity, greater cortical penile representation, and disturbance of central serotoninergic neurotransmission.

Aims: To quantitatively assess penile sensory thresholds in European Caucasian patients with lifelong PE using the Genito-Sensory Analyzer (GSA, Medoc, Ramat Yishai, Israel) as compared with those of an age-comparable sample of volunteers without any ejaculatory compliant.

Methods: Forty-two consecutive right-handed, fully potent patients with lifelong PE and 41 right-handed, fully potent, age-comparable volunteers with normal ejaculatory function were enrolled.

Initial extended transrectal prostate biopsy--are more prostate cancers detected with 18 cores than with 12 cores?

Purpose: We retrospectively investigated the detection rates of prostate cancer, high grade prostatic intraepithelial neoplasia and atypical glands suggestive of carcinoma by initial 18 and 12-core prostate biopsy.

Materials And Methods: A total of 3,460 consecutive patients with prostate specific antigen between 2.5 and 15 ng/ml underwent 12 (1,684) or 18 (1,776) core prostate biopsy under local anesthesia at 2 departments that adopted the same indications for performing biopsy.

Topical prilocaine-lidocaine cream combined with peripheral nerve block improves pain control in prostatic biopsy: results from a prospective randomized trial.

Objectives: To compare pain control results between periprostatic nerve block alone and combined with topical prilocaine-lidocaine cream as local anesthesia of prostate biopsy.

Methods: Three hundred patients were randomized to receive PNB (group 1), topical anesthesia of the anal ring, anal canal, and anterior rectal wall combined with PNB (group 2) and placebo (group 3). Patients were asked to use scale of 0-10 to complete a visual analogue scale questionnaire about pain during probe insertion (VAS1), periprostatic infiltration (VAS2), and cores (VAS3).

Radical prostatectomy after previous prostate surgery: clinical and functional outcomes.

Purpose: Radical prostatectomy has progressively become an elective treatment for primary localized prostate cancer as well as for incidental or subsequent prostatic cancer after previous surgery for obstructive benign disease. This increased acceptance opens concerns about oncological and functional outcomes.

Materials And Methods: Between July 1999 and August 2003, 109 patients underwent radical retropubic prostatectomy for prostate cancer as a second line approach after surgery for primary bladder outlet obstruction.

Detection and diagnosis of prostate cancer: what's new.

Objective: Prior the widespread use of PSA screening in asymptomatic men, prostate cancer was historically detected by a simple digital rectal examination. Although the gold standard for prostate cancer still remains prostate biopsy, current researches in the area of detection and diagnosis of prostate carcinoma are focusing on identification of better sampling protocols, biologic markers and imaging strategies in order to detect disease at an earlier stage. We reviewed all the recent literature on the detection of clinically meaningful prostate cancer.

Perianal and intrarectal anaesthesia for transrectal biopsy of the prostate: a prospective randomized study comparing lidocaine-prilocaine cream and placebo.

Objectives: To assess the effectiveness of perianal and intrarectal lidocaine-prilocaine cream for prostate biopsy.

Patients And Methods: In a prospective, randomized, double-blind, placebo-controlled study, 200 consecutive patients were randomized to receive 5 mL lidocaine-prilocaine cream or 5 mL placebo peri-anally and transrectally before transrectal ultrasonography (TRUS)-guided prostate needle biopsy (mean number of cores, 12). The men were asked to grade the pain when the TRUS probe was inserted and during the biopsy procedure using a 10-point linear visual analogue pain scale.

Dorsal onlay graft urethroplasty using penile skin or buccal mucosa for repair of bulbar urethral stricture: results of a prospective single center study.

Objective: To compare the outcomes of dorsal onlay graft urethroplasty using penile skin (PS) or buccal mucosa (BM) free grafts in the repair of adult bulbourethral strictures.

Methods: From January 1998 to March 2003, 30 patients with bulbar urethral strictures underwent urethral reconstruction with PS (17) or with BM free graft (13). Follow-up was done at 6, 12 and 18 months postoperatively, and every year subsequently.

Atypical small acinar proliferation (ASAP) on extended prostatic biopsies: predictive factors of cancer detection on repeat biopsies.

Objective: To evaluate the clinical and histopathologic factors that may help to predict cancer detection by means of extended repeated prostate needle biopsies in patients with Jumma atypical small acinar proliferation (ASAP) results on initial prostate biopsy.

Materials And Methods: From 1998 to September 2003, 105 out of 121 (86%) patients with a diagnosis of ASAP after a first set of 10 to 12 systematic biopsies, were rebiopsied using the same technique plus additional biopsies on the ASAP site (mean number of repeat biopsy samples, 12.6).