En Bloc Transurethral Resection of Bladder Tumors: A New Standard?

Objective: To assess safety and efficacy, namely pathological assessment of the specimen and recurrence rate, of en bloc transurethral resection (EBTUR) of bladder tumor.

Materials And Methods: We performed a systematic review of the available literature on PubMed. Seventeen articles, mainly prospective case series, were found.

Narrow band imaging and bladder cancer: when and how.

Narrow band imaging (NBI) is an optical enhancement technology for endoscopy. NBI works filtering the standard white light in two bandwidths of illumination of 415 nm, blue, and 540 nm, green. As a result, capillaries on mucosal surface appear brown and veins in connective subepithelial layer cyan, enhancing the contrast among epithelial, subepithelial tissue and its vascularisation.

The role of narrow-band imaging in the management of non-muscle-invasive bladder cancer.

Narrow-band imaging is a young optical enhancement technology for endoscopy. It is a filter to the standard white light which increases the contrast between underlying vasculature and epithelial strata of the mucosa, improving the detection of bladder cancer with particular regard to high grade, flat lesions. Narrow band imaging is absolutely safe, may be used any time during a procedure, either during office cystosopy or transurethral resection, and implies a minimal burden for the healthcare provider given the absence of a learning curve and the limited cost of the camera and light source.

Development and external validation of lymph node density cut-off points in prospective series of radical cystectomy and pelvic lymph node dissection.

Objective: To identify lymph node density thresholds and their prognostic role in patients who underwent radical cystectomy and pelvic lymph node dissection, and to validate findings in an external series.

Methods: Between May 2001 and September 2009, data from 750 radical cystectomies carried out at "Regina Elena" National Cancer Institute (Rome, Italy) were collected in a prospectively-maintained database. Once patients who had undergone neoadjuvant treatments and those who had undergone salvage radical cystectomy were excluded from the 210 pN+ patients, 156 patients with urothelial carcinoma were selected for analysis.

Safety and efficacy of periurethral constrictor implantation for the treatment of post-radical prostatectomy incontinence.

Objective: To assess safety and efficacy of the periurethral constrictor for the treatment of postprostatectomy urinary incontinence.

Methods: Periurethral constrictor is a minimally invasive, low-cost (€ 2000) device based on an adjustable occlusive mechanism. From December 2004 to March 2010 the device was implanted in 66 patients with mild to severe incontinence (3 or more pads per day) through a 3- to 5-cm perineal incision.

En bloc transurethral resection of bladder lesions: a trick to retrieve specimens up to 4.5 cm.

The present technique maintains the integrity of voluminous lesions during extraction. Pathological analysis is consequently improved and a proper evaluation of the surgical margins is also possible. Papillary lesions of up to 4.

A randomized prospective trial to assess the impact of transurethral resection in narrow band imaging modality on non-muscle-invasive bladder cancer recurrence.

Background: Narrow band imaging (NBI) is an optical enhancement technology that filters white light into two bandwidths of illumination centered on 415nm (blue) and 540nm (green). NBI cystoscopy can increase bladder cancer (BCa) visualization and detection at the time of transurethral resection (TUR). NBI may therefore reduce subsequent relapse following TUR.

Long-term PSA-free survival and castration-free survival with delayed antiandrogen therapy in patients with one versus two or more positive nodes at prostatectomy.

Purpose: To analyze time in relation to biochemical recurrence (BCR) and antiandrogen therapy (ADT) in patients with node metastasis at retropubic prostatectomy (RRP) and to identify prognostic factors of BCR- and ADT-free survival.

Methods: Positive node patients at RRP and extended pelvic lymph node dissection (ePLND) were recruited retrospectively. Neoadjuvant and adjuvant therapy were exclusion criteria.

Effect of age, family history of prostate cancer, prostate enlargement and seasonality on PSA levels in a contemporary cohort of healthy Italian subjects.

We assessed the joint effect of age at enrollment, age at follow-up, family history of prostate cancer, prostate enlargement and seasonality on prostate-specific antigen (PSA) estimated through log-normal mixed-effects modeling in an Italian cohort of healthy, 45- to 65-year-old subjects over a 4-year period. The median ratio was used as the measure of effect. Median and mean baseline PSA were 0.

Late-onset incontinence in a cohort of radical prostatectomy patients.

A cohort of 235 subjects, who underwent radical prostatectomy from 1994 to 2002, completely continent at the 2-year follow up and with the last follow-up visit in 2009, was examined to assess incidence and risk factors of late-onset incontinence. Median follow up was 100 months, range 84-176. At the last follow-up visit, 209 (89%) maintained continence, and 26 (11%) became incontinent.

Genetic polymorphisms of CYP17A1, vitamin D receptor and androgen receptor in Italian heredo-familial and sporadic prostate cancers.

Background: Searching for genetic and environmental factors predisposing to prostate cancer, common single-nucleotide polymorphisms in CYP17A1, CYP19A1, VDR genes, and the number of CAG repeats from AR were investigated in Italian heredo-familial prostate cancer (HFPC) patients controlled for dietary intake and life style habits.

Methods: We evaluated differences between HFPC and sporadic cancers, in the pattern of common single-nucleotide polymorphisms in CYP17A1, CYP19A1, VDR genes, and the CAG repeat from AR, controlling for dietary intake and lifestyle habits in a regionwide population. Ninety-five patients with HFPC were identified and 378 sporadic prostate cancers were randomly selected as controls.

Laparoscopic radical cystectomy. Where do we stand?

Laparoscopic Radical Cystectomy (LRC) has been proposed since 1999 as a less invasive alternative to Open Radical Cystectomy (ORC). Pioneers of the technique claim that LRC led to faster recovery, shorter hospital stay and more rapid return to daily activities respect to ORC while offering the same functional and oncological results. About 900 cases are published in peer reviewed papers.

Feasibility of transurethral resection of bladder lesion performed entirely by means of narrow-band imaging.

Purpose: To assess the feasibility of transurethral resection (TUR) of bladder lesions performed entirely by means of a narrowband imaging (NBI) modality.

Patients And Methods: Data from an ongoing prospective randomized trial (NCT01004211) were extracted. Quality outcomes of standard TUR and NBI TUR were compared.

New Italian guidelines on bladder cancer, based on the World Health Organization 2004 classification.

OBJECTIVE To provide evidence-based recommendations on bladder cancer management METHODS A multidisciplinary guideline panel composed of urologists, medical oncologists, radiotherapists, general practitioners, radiologists, epidemiologists and methodologists conducted a structured review of previous reports, searching the Medline database from 1 January 2004 to 31 December 2008. The milestone papers published before January 2004 were accepted for analysis. The level of evidence and the grade of the recommendations were established using the GRADE system.

Narrow band imaging for detecting residual/recurrent cancerous tissue during second transurethral resection of newly diagnosed non-muscle-invasive high-grade bladder cancer.

Objective: To determine if narrow-band imaging (NBI) can be used to detect high-grade cancerous lesions missed with the white light at the time of a second transurethral resection (TUR) of high-grade non-muscle-invasive bladder cancer (NMIBC).

Patients And Methods: Consecutive patients with newly diagnosed high-grade NMIBC were enrolled in a prospective observational study. Patients with incomplete resection or absence of muscle tissue in the specimen were excluded.

Bipolar transurethral resection in saline (TURis): outcome and complication rates after the first 1000 cases.

Objective: TURis((R)) is an emerging technique that shows the same efficacy of monopolar resection. However, there is currently little available data on the safety of bipolar devices. We assessed outcome and safety of TURis on a large cohort of patients with at least 6 months' follow-up.

Predictors of symptomatic lymphocele after lymph node excision and radical prostatectomy.

Objectives: To identify the prognostic factors of symptomatic lymphocele.

Methods: From January 2004, 359 patients underwent pelvic lymph node excision during radical prostatectomy at our center, of whom, 347 were followed up for > or = 6 months.

Results: At a median follow-up of 14.

Prognostic factors of persistently detectable PSA after radical prostatectomy.

Objectives: To determine predictive factors of detectable prostate-specific antigen (PSA) in patients submitted to radical prostatectomy (RP) and to define the prognostic role of this event.

Methods: A total of 318 patients who underwent RP between 2002 and 2007 were selected from our prospective database. Selection criteria were: no neo-adjuvant therapy; surgical specimens analyzed and reviewed according to a standardized protocol by two pathologists; clinical stage T1,T2 or T3 N0; pathological stage T2-3/N0-1.

Potency preserving cystectomy with intrafascial prostatectomy for high risk superficial bladder cancer.

Purpose: We report the oncological and functional results of potency sparing cystectomy with intrafascial prostatectomy for high risk, superficial bladder cancer.

Materials And Methods: A total of 37 patients underwent potency sparing cystectomy and orthotopic urinary substitution from 2001 to 2005. Inclusion criteria were age younger than 70 years, Charlson comorbidity index less than 2, high risk superficial bladder cancer, prostate specific antigen less than 4 ng/ml, free-to-total PSA ratio greater than 20% and normal digital rectal examination.

Omission of lymphadenectomy in low risk prostate cancer.

Unlabelled: THE AIM of the present study was to evaluate if lymphadenectomy could be safely spared in low risk prostate cancer (PC) patients.

Patients And Methods: From 5/1998 to 10/2005, 100 patients with low risk prostate cancer who had undergone radical prostatectomy (RP) and did not have positive surgical margins were selected. The series included 34 patients submitted to lymphadenectomy including the iliac and obturatory nodes without documented nodal metastasis.

Surgery insight: advantages and disadvantages of laparoscopic radical cystectomy to treat invasive bladder cancer.

Laparoscopic radical cystectomy (LRC) is a challenging technique, but it has been proposed as an alternative to open radical cystectomy (ORC), which is currently the gold standard treatment for muscle-invasive or high-risk superficial bladder cancer. So far, approximately 200 cases treated with LRC have been reported in the peer-reviewed literature, but follow-up has generally been short (all <48 months). A shorter hospital stay and a quicker recovery of the patient seem to be the main advantages of LRC over ORC.

Can biopsy be a reliable predictor of spatial distribution of prostate cancer? Comparison of a novel biopsy regimen with radical prostatectomy findings.

Objectives: To obtain accurate spatial information on cancer distribution with a novel prostate biopsy regimen.

Methods: From 2003 to 2005, 265 patients underwent a three fan-shaped biopsy (3FSB) technique of 12 to 14 cores and sextant biopsy (SB) simultaneously. When both techniques had positive findings, and radical prostatectomy was performed, the concordance among the positive biopsy locations of the SB, 3FSB, and the combination of both (the reference standard biopsy [RSB]), the proven locations of cancer, and the presence of extracapsular extension and positive surgical margins was calculated.