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Clinical and surgical predictors of urinary incontinence after radical retropubic prostatectomy.
No full textRenal malignant solitary fibrous tumor with single lymph node involvement: report of unusual metastasis and review of the literature.
No full textSolitary fibrous tumors are rare mesenchymal spindle cell neoplasms that are usually found in the pleura. The kidneys are an uncommon site and only few cases of renal solitary fibrous tumor exhibit malignant behavior metastasizing to the liver, lung, and bone through the hematogenous pathway.
PURPOSE:
To describe the first case of lymph node metastasis from renal solitary fibrous tumor in order to increase the knowledge about the malignant behavior of these tumors.
PATIENTS AND METHODS:
A 19-year-old female patient had intermittent hematuria for several months without flank pain or other symptoms. A chest and abdomen CT scan was performed and showed a multi-lobed bulky solid mass of 170 × 98 × 120 mm in the left kidney. One day before the surgery, the left renal artery was catheterized and the kidney embolization was performed using a Haemostatic Absorbable Gelatin Sponge and polyvinyl alcohol. We then performed a radical nephrectomy with hilar, para-aortic, and inter-aortocaval lymphadenectomy.
RESULTS:
Estimated intraoperative blood loss was 200 mL and the operative time was 100 minutes. No postoperative complications occurred. The hospital stay was 7 days long. The histological examination was malignant solitary fibrous tumor of the kidney. Cancerous tissue showed cellular atypia, with an increased mitotic index (up to 7 × 10 hpf). Immunohistochemical analysis showed positive results for CD34, BCL2, partial expression of HBME1, and occasionally of synaptophysin. Histological evaluation confirmed the presence of metastasis in one hilar node. The patient did not receive any other therapy. At 30-month follow-up, the patient was in good health and no local recurrence or metastases had occurred.
CONCLUSION:
This is the first case of lymph node metastasis from a renal solitary fibrous tumor showing unusual malignant behavior; this finding adds new information about the biology and progression of these tumors, which remain unclear
10 cm angiomyolipoma of the right adrenal gland: robotically assisted laparoscopy.
No full textIntroduction: Angiomyolipoma is apparently a part of a family of neoplasms that derive from perivascular
epithelioid cells. It is a rare mesenchymal tumor, usually found in the kidney. Extrarenal angiomyolipoma is
uncommon, and the most common extrarenal site is the liver. Only five cases have been reported so far. We
report the case of a woman with a large adrenal mass that we treated with robot assisted partial
adrenalectomy six months later .
Methods: Due to abdominal pain a 47 years-old woman has undergone to abdominal ultrasound scanner that
showed a well-defined 10 × 9 cm right adrenal mass (incidentaloma); moreover it revealed an uterine solid
mass 3 x 4 cm. A computerised tomography (CT) scan and abdominal RM showed a right adrenal mass with
features of angiomyolipoma and an uterine mass suspicious for leiomyoma. Laboratory investigations, that is,
serum catecholamine, cortisol, and urinary, VMA were within normal limits. We performed a laparoscopic
excision of uterine mass that the frozen section examination revealed to be a leiomyoma. The patient was
positioned in lateral decubitus on his left side. A total of six trocars was inserted, including: the optical camera
placed along mammary line, above the umbilical transverse line; two robotic ports placed along the pararectal
line and one along the anterior ascellar line, focused on the adrenal fossa. A 10 mm auxiliary port placed along
median line above umbilicus and a 5 mm auxiliary port placed along median line to lift up the liver. The robotic
cart is docked into position at the patient’s right shoulder.
Results: The frozen section examination revealed to be an adrenal angiomyolipoma, so we performed a
laparoscopic robotically assisted partial adrenalectomy. Operative time was 180 minutes and blood loss was
150 ml. Histological diagnosis was adrenal angiomyolipoma of 10 x 9 cm; the himmunohistochemical analysis
showed negative for melanocytic markers: S100, HMB45, melan-A/MART1. Overall hospital stay was 5 days. No
post-operative complications occurred. No hormonal replacement therapy was necessary.
Conclusions: Surgery is indicated if the patient is symptomatic or the tumor is more than 5 cm since the risk of
malignancy increases with size. Also, the risk of spontaneous rupture increases with size. Improvements such as
new instruments, smaller robotic arms, tactile feedback, and a fourth arm would represent an undeniable
advantage and prompt us to reevaluate the clinical indications for its use in adrenal surgery
Robotic pyeloplasty: trans- and retro-peritoneal approach.
No full textIntroduction & Objectives: Robotic pyeloplasty can be performed either retroperitoneally or transperitoneally.
In this video we show our technique of pyeloplasty for both approaches.
Materials & Methods: In first case we preferred the transperitoneal approach because there was a big
redundant renal pelvis in a thin patient. We incised the peritoneum and exposed the pelvis and the ureter. The
stenotic junction is transected. The ureter is spatulated and an Anderson-Hynes pyeloplasty is performed using
a 4-0 vicryl stitch. In second case the renal pelvis was small. We preferred not to enter the peritoneum and to
adopt a retroperitoneal approach. The Psoas muscle is identified. The Gerota’s fascia is incised. The
ureteropelvic junction is dissected an the pyeloplasty is performed.
Results: Operative time was 90 minutes and 110 minutes for the transperitoneal and retroperitoneal approach
respectively. We had no intraoperative complications. Postoperative stay was easy and uncomplicated. Both
patients removed the double J stent three weeks after surgery. At three months postop. the ultrasonography
was normal.
Conclusions: robotic pyeloplasty can be performed successfully either transperitoneally or retroperitoneally.
We believe that the transperitoneal approach must be preferred in case of a large redundant pelvis because it
offers the surgeon a larger working space and because it makes easy to identify the renal pelvis.
Retroperitoneal approach is more appropriate in case of relatively small renal pelvis
Body mass index and lower urinary tract symptoms in women
No full textIntroduction: The prevalence of obesity has been rising sharply in industrialised countries over the past decade. As the Body Mass Index (BMI) is recognized as an accurate and objective measurement of individual body mass, this study investigated whether BMI is associated with lower urinary tract symptoms in women. Materials and Methods: This retrospective study analysed a database of 750 female patients who were referred to the Uro-Gynaecohgy Unit from 2002 to 2004 because of urinary and sexual disturbances. Patients were divided into four classes (I, II, III, IV). Each class was analysed as a function of the following variables: type and grade of urinary incontinence, number of daily pads, irritative symptoms, sexual activity, micturitional urgency or detrusor hyperactivity, urine leakage during urodynamics testing while coughing or performing Valsava's manoeuvre, dysuria, abdominal straining, stop-go micturition, feeling of incomplete bladder emptying, feeling of perineal heaviness, hypovalid stream, constipation, grade and type of urogenital prolapse. Results: In BMI class I did not complain of urinary incontinence. 155 70.8% referred urinary leakage while coughing or under physical effort. In Class II BMI 78.9% referred urinary incontinence. The incidence rose as the BMI increased. In BMI class III, 95.1% referred urinary incontinence and all 16 patients in BMI class IV were incontinent. Conclusions: Obese women are more prone to urinary incontinence which has a negative impact on the patient's quality of life and depression status. Mental status as well as anatomic deficits may explain the relationship between obesity and incontinence
Robot-Assisted Surgery in Urology: The Show Must Go On
No full textInitially, robot-assisted surgery (RAS) was developed by the USA forces as a tele-surgery tool in order to perform procedures in war zones without endangering the surgeon [...
Robotic radical cystectomy with intracorporeal orthotopic ileal neobladder: original technique
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