A New Regimen of Cisplatin, Epirubicin and Methotrexate (PEM-3) as Primary Chemothfrapy for Locally Advanced Bladder Cancer

In this phase II study, 41 patients with locally advanced urothelial bladder cancer (T2-4, NO, MO) were treated with primary chemotherapy (cisplatin, epirubicin, methotrexate: PEM-3). All the patients were assessable for response and toxicity. Clinical monitoring was performed with computerized tomography and cystoscopy. Nineteen clinical complete remissions (46%) and 10 partial remissions (24.5%) were obtained (CR + PR, 70.5%; 95% confidence interval, 57%-85%). Ten patients were considered to have clinically stable disease (24.5%), and 2 patients progressed (5%). Surgery after chemotherapy was performed in 22 cases: in 6 patients (27%) a pathologic complete response was achieved. The pathologic stage was lower than the initial clinical stage in 13 patients (59%). After a median follow-up of 3 years (range, 1-4), the median time to progression was 104 weeks. At this writing, 20 patients, 12 of which were submitted to surgery and 8 were not operated, are disease-free. The 3-year survival rate is 52%. No one had to interrupt the treatment because of toxicity. In conclusion, the PEM-3 regimen is a very active and well-tolerated regimen in locally advanced bladder cancer.

Positron-emission tomography in imaging and staging prostate cancer

With increasing application of positron-emission tomography (PET) imaging, familiarity with the applications of PET in genitourinary oncology, especially prostate-cancer (PCa) imaging, becomes important. PET studies provide functional information using radiolabeled tracers, with fluoro-dexoxy-glucose (FDG) being the most commonly used. Nevertheless FDG has limitations for evaluation of PCa patients and therefore alternative tracers are being investigated. To date, the best results have been obtained with 11C-choline and 11C-acetate PET, which seem to demonstrate similar values in this field. We review the current role of PET in PCa patients based on data published in the literature as well as our own experience. Most studies of PET imaging of PCa address three goals: a) detecting primary PCa; b) staging PCa; and c) assessing PCa recurrence. From available results, routine clinical use of 11C-choline PET cannot be recommended for detecting and staging primary PCa. At present, the only clinical indication for imaging PCa with 11C-choline-PET is evaluation of suspected recurrence after treatment.

Rehabilitation Therapy and Urinary Incontinence Post Radical Prostatectomy

Urinary incontinence rates after radical retropubic prostatectomy vary widely among the different series and depending on the different scoring systems, from 2–10% up to 87%. Rehabilitation therapy is the safest and simplest treatment available so far, although a wide consensus on the efficacy of its results is still lacking.

In our experience, treating post radical prostatectomy incontinent patients with rehabilitation therapy has been safe, reproducible and without side effects; nevertheless, our results suggest its use only in mild to moderate cases of post radical prostatectomy urinary incontinence.

In situ echoguided extracorporeal shock wave lithotripsy of ureteric stones with the Dornier MPL 9000: a multicentric study group

OBJECTIVE

To study the efficacy of the Dornier MPL 9000 lithotripter with a real time ultrasound transducer in the localization and treatment of upper and prevesical ureteric stones.

PATIENTS AND METHODS

Two-hundred and eighty-five patients with pre-vesical ureteric stones and 247 patients with upper ureteric stones underwent extracorporeal shock wave lithotripsy (ESWL) using ultrasound targeting, under no regional or general anaesthesia.

RESULTS

At follow-up after 3 months 97% of patients with pre-vesical stones and 96% with upper ureteric stones were stone free. Ninety-nine patients were treated more than once. The average number of sessions of ESWL for all patients was 1.19 (1.17 for patients with prevesical stones and 1.22 for those with upper ureteric stones). Ureteric stenting was employed in 6% of cases. The infrequent use of ureteric stenting did not reduce ESWL efficacy, nor increase either the complication or the retreatment rates. In many cases upper urinary tract dilatation was provoked by administering intravenous fluid and a diuretic.

CONCLUSION

In situ echoguided ESWL is a simple, safe and effective technique for treating ureteric stones which can be detected on ultrasound.

Ectopic ureter: Case report

An ectopic ureter is one which opens anywhere other than on the posterolateral extremity of the trigone and is an uncommon urological anomaly with a female predominance. The aim of this study is to consider an unusual case of ectopic ureter with a large distal diverticula simulating a bladder duplicity.