Simple enucleation versus standard partial nephrectomy for clinical T1 renal masses: perioperative outcomes based on a matched-pair comparison of 396 patients (RECORd project)

OBJECTIVES

To compare simple enucleation (SE) and standard partial nephrectomy (SPN) in terms of surgical results in a multicenter dataset (RECORd Project).

MATERIALS AND METHODS

patients treated with nephron sparing surgery (NSS) for clinical T1 renal tumors between January 2009 and January 2011 were evaluated. Overall, 198 patients who underwent SE were retrospectively matched to 198 patients who underwent SPN. The SPN and SE groups were compared regarding intraoperative, early post-operative and pathologic outcome variables. Multivariable analysis was applied to analyze predictors of positive surgical margin (PSM) status.

RESULTS

SE was associated with similar WIT (18 vs 17.8 min), lower intraoperative blood loss (177 vs 221 cc, p = 0.02) and shorter operative time (121 vs 147 min; p < 0.0001). Surgical approach (laparoscopic vs. open), tumor size and type of indication (elective/relative vs absolute) were associated with WIT >20 min. The incidence of PSM was significantly lower in patients treated with SE (1.4% vs 6.9%; p = 0.02). At multivariable analysis, PSM was related to the surgical technique, with a 4.7-fold increased risk of PSM for SPN compared to SE. The incidence of overall, medical and surgical complications was similar between SE and SPN.

CONCLUSIONS

Type of NSS technique (SE vs SPN) adopted has a negligible impact on WIT and postoperative morbidity but SE seems protective against PSM occurrence.

Which Technical Aspects have an Impact on Perceived Pain during Transperineal Prostate Biopsy? A Prospective Study Involving 445 Cases

To assess the technical aspects determining the perceived pain during prostate biopsy via transperineal access.

Materials and Methods

We conducted prostate biopsy with transperineal access in local anesthesia. Between January 2007 and January 2008, data on prostatic biopsies were prospectively surveyed. The patient was requested to assess perceived pain by means of a Visual Analogue Scale ranging from 0 (no pain) to 10 (unbearable pain). Complications were recorded by telephone interviews 30 days after the biopsy. The histological diagnosis was recorded.

Results

445 prostate biopsies were conducted. The average perceived pain score amounted to 2.60. At univariate analysis, a lower score was recorded in cases where the anesthetic agent was diluted with physiological saline, those in which a single cutaneous access was chosen along the middle line, those in the first bioptic series as compared to the following series and those in which no sampling involved the transition region. However, the multivariate analysis showed that only the single cutaneous access was statistically significant. In those cases, also the rates of delayed perineal pain were significantly lower. The cancer diagnosis rate showed no correlations with the type of cutaneous access.

Conclusions

A single median cutaneous access reduces the pain associated to transperineal prostatic biopsy.

Aminolevulinic Acid in Diagnosis and Treatment of Bladder Urothelial Carcinoma

It might be difficult to diagnose either bladder's flat lesions, such as CIS, or small papillary lesions using white-light endoscopy.

Neoplastic cells can be differentiate from the normal bladder mucous membrane by using Hexyl-ALA. Hexyl aminolevulinate produces protoporphyrin's overstock inside cancer cells causing a clearly visible red fluorescence when these are hit by a predetermined wavelenght light. The purpose of this study is to evaluate effectiveness of PDD (photodynamic diagnosis) by using Hexyl-ALA to identify and treat bladder's surface cancer.

This study considers 39 patients (33 men and 6 women) from November 2008 to January 2009. On these patients were taken, previous filling of their bladders with hexyl aminolevulinate solution, 106 hystological samples (among these: 38 were first step diagnosis, 15 were a second look and 53 were taken for a relapse suspect). The 72.6% of these samples (77) were positive for cancer, while the 27,4% (29) was normal.

Of those 77 samples, 30 were discovered to be positive exclusively by using PDD and include CIS (66.6%), Ta G1–2 (20%), reactive hyperplasia (3.3%) and incipient papillary neoplasia (10%). (Anatomopathologist described the last two lesions as partial nuclear alterations not fullfilling the criteria of pathology). This research proves that, among other diagnostic methods, photodynamic diagnosis has a higher sensibility, although the specificity is lower.

Multitechnical pathological diagnosis in chromophobe renal cell carcinoma

Two new cases of chromophobe renal cell carcinoma were diagnosed on the basis of their morphology and their karyotype complemented by flow cytometry. In one of these cases, however, all these investigations were not sufficient and additional histochemistry investigation had to be used to completely rule out other renal tumors such as oncocytoma, the prognosis of which is totally different.

Guided dilatation and transurethral resection in one session for treatment of post-prostatectomy obstructive complications

53 patients presenting with post-prostatectomy obstructive complications above the colliculus seminalis were treated in a single session by means of guided dilatation of the stricture followed by transurethral resection of the stenosing fibrotic tissue. No failures or complications with the guided dilatation technique have been observed. The results obtained after resection in cases of bladder neck stenosis were very encourging. Unsatisfactory results were observed in cases of prostatic urethral stenosis because resection is not a technique sufficient for stable resolution of the obstruction.