1,721,479 research outputs found
High-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation: is repeat biopsy still necessary?
No full text
Surgical Outcomes of Glansectomy and Split Thickness Skin Graft Reconstruction for Localized Penile Cancer
No full textIntroduction: The management of localized penile cancer is based on organ-sparing approaches. Our aim is to report surgical outcomes of glansectomy (GS) and split thickness skin graft (STSG) reconstruction in a consecutive series of penile cancers. Patients and Methods: Patients with a localized penile cancer underwent GS and STSG reconstruction in tertiary referral center. Data were extrapolated from a single center prospective database starting from May 2013 to August 2019. Two different techniques are presented in the video abstract: - a standard GS with dissection over the Bucks’ fascia. - a salvage GS with dissection under Bucks’ fascia. Results: A total of 34 patients were enrolled. 30 patients underwent a standard GS, whether a salvage GS was performed in the remainders. The apex of corpora cavernosa was transected in 5 cases due to suspicious of local invasion. Median follow-up was 12 (12-41) months. Operative time was 150 (105-180) minutes. Hospital stay was 2 (1-3) days. A modified TODGA compressive dressing and a catheter were applied and left in place for 5 days. After that a saline washing was used for 2 weeks. The incidence of intraoperative complications was minimal (2.9%). Positive surgical margins were detected in 2.9% of cases, requiring a salvage surgery. The incidence of postoperative complications was 29.4%: 11.7% were classified as Grade 1, 8.8% as Grade 2 and 8.8% as Grade 3a according to Clavien-Dindo classification. 1-year recurrence free-survival (RFS) was 88.2%. 1-y cancer-specific (CSS) and overall survival (OS) resulted 91.2% in both cases. Limitations of the study were the retrospective and single centre nature of the study, the lack of comparative group, the limited number of cases and of follow-up. Conclusions: GS and STSG reconstruction represents a safe procedure burden by a low incidence of postoperative complications providing a satisfactory cancer control, with a minimal risk of local recurrence
Effect of finasteride on the sensitivity of PSA to detect prostate cancer in rebiopsy series.
No full textTo evaluate, in a prospective study, the diagnostic accuracy of PSA in patients with a prior negative prostate biopsy who were given finasteride for 6 months.
MATERIALS AND METHODS:
91 men with prior negative biopsy findings, including HGPIN and excluding ASAP, were instructed to take finasteride for 6 months. All patients were evaluated at study onset and after 6 months by clinical examination, digital rectal examination (DRE), International Prostate Symptom Score (IPSS) and National Institutes of Health Chronic Prostatitis Symptom Index (NHI-CPSI). Prostate biopsy was repeated at 6 months. PSA levels were measured at baseline and after 1, 3 and 6 months. We calculated the receiver operating characteristics (ROC) curve of PSA under the effect of finasteride for detecting prostate cancer.
RESULTS:
The median PSA level decreased similarly both in those with prostate cancer and in those without findings of cancer. There was no statistically significant difference between the two groups. The areas under the ROC curve (AUC) of PSA at study onset and after 6 months of therapy with finasteride were, respectively, 0.48 (95% CI 0.36-0.61) and 0.54 (95% CI 0.42-0.66). There was no statistically significant difference between the two areas.
CONCLUSIONS:
The results of our study show that PSA itself has a low diagnostic accuracy for detecting prostate cancer in men with prior negative prostate biopsy findings. Finasteride does not seem to improve the accuracy of PSA in this particular population of patients
Primary adenocarcinoma of the rete testis: diagnostic problems and therapeutic dilemmas
No full textWe describe a rare case of a malignant tumour of the rete testis which was diagnosed incidentally during scrotal surgery for an apparently benign left hydrocele. Adenocarcinoma of the rete testis is a malignancy with a poor prognosis. The beneficial role of prophylactic retroperitoneal lymphadenectomy is controversial due to the extremely low number of reported cases and the occasional description of primary lymphatic spread outside the retroperitoneal space
Erectile dysfunction induced by topiramate: Aetiology and treatment [Disfunzione erettile da topiramato: Cause e trattamento]
No full textDebulking surgery in the setting of very high-risk prostate cancer scenarios
No full textStudy Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Nowadays radical prostatectomy (RP) is considered an effective treatment in high-risk prostate cancer (PCa) and the indications for a surgical approach are expanding, even in cases of very high PSA or node-positive disease. We explored the outcomes of debulking surgery in the setting of these very high-risk PCa patients, in order to assess its feasibility. This review confirms the important role achieved by surgery in the complex setting of patients with very high-risk PCA. Excellent survival rates have been reported, even when PSA exceeds 100 ng/mL. The completion of RP with lymphadenectomy might give a survival benefit in patients who were found intraoperatively to be node-positive. Furthermore, salvage RP confirmed to be the most effective treatment option after RT failure. On the contrary, up-to-date surgery of isolated nodal recurrences has shown only little benefit. Finally, there is no evidence supporting the efficacy of debulking surgery in metastatic or in hormone-refractory tumours. An accurate selection of the patient is essential.
OBJECTIVE:
• To conduct a critical analysis of the available literature on the feasibility of debulking surgery in the setting of very high-risk prostate cancer (PCa) scenarios.
PATIENTS AND METHODS:
• We performed a systematic literature search of PubMed and Embase using combinations of the following keywords: radical prostatectomy, surgery, high-risk, high PSA (prostate-specific antigen), radiorecurrent, hormone-refractory, metastatic prostate cancer, salvage. • With the term 'very high-risk PCa' we indicated a clinical disease beyond the common definition of high-risk PCa, i.e. any clinical stage > T3, N0 or N+, any PSA level > 50 ng/mL and any recurrent disease after primary treatment.
RESULTS:
• Radical prostatectomy (RP) achieved excellent survival rates in high-risk PCa, even in patients with very high PSA level. The completion of RP with lymphadenectomy might give a survival benefit in patients who were found intraoperatively to be node-positive. • Salvage RP was confirmed to be the most effective treatment option after radiotherapy failure, with increased functional outcomes and decreased side-effects in the most recent series. • Surgery of isolated nodal recurrences after previous radical therapy has shown little benefit according to the few available series. • There is no evidence supporting the efficacy of debulking surgery in metastatic or hormone-refractory PCa.
CONCLUSION:
• Debulking surgery achieved an important role in several aggressive PCa scenarios. An accurate selection of the patient is essential
A prospective evaluation of efficacy and compliance with a multistep treatment approach for erectile dysfunction in patients after non-nerve sparing radical prostatectomy
No full textObjective To assess the response rate to different erectile aids in a consecutive series of patients treated with non-nerve sparing radical prostatectomy (NNSRP). Patients and Methods Ninety-four potent men were counselled about the different treatment options to restore an assisted erection before they had NNSRP. They were invited to participate in a multiphase protocol involving the sequential use of different erectile aids which aimed at restoring erectile function after surgery. The first proposed treatment was oral apomorphine sublingual. Patients with a positive response to the 1-item overall efficacy question and a minimum score of 3 in both question 3 and 4 of the International Index of Erectile Function were considered responders to oral pharmacotherapy. Treatment with sildenafil was then suggested to those not responding. If patients did not respond to oral pharmacotherapy a trial with a vacuum erectile device was offered; those not responding to this were then offered intracavernosal injection therapy with prostaglandin-E alone as the first option, followed by a mixture of vasoactive agents if needed. In those in whom injections also failed, a penile implant was recommended. At the 1-year follow-up visit all patients were offered a second trial with oral therapy regardless of the treatment currently in use. Results Seventy-six patients entered the protocol; there was no response to apomorphine. Five of 59 (8%) patients responded to sildenafil when they first used it at a mean of 7 months after NNSRP, while there were three additional responders in 22 patients who tried it for a second time a year later. Of patients achieving at least a complete tumescence sufficient for vaginal penetration, 52% and 60% were considered responders to the vacuum device and intracavernosal injections, respectively. Overall, 44% of patients enrolled in the protocol chose to use an erectile aid for at-home use. At the 1-year follow-up, only 20% of patients were still using an erectile aid, including two who had had a penile implant. Conclusions Up to 10% of patients may achieve a clinically significant erection with sildenafil after NNSRP, but 80% will not be using any erectile aid at 1 year after surgery. In the present study protocol the proposed erectile aids were largely inadequate for treating the permanent erectile dysfunction that follows NNSRP
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