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Radical prostatectomy is the best treatment for patients with T1-2 prostate cancer and a life expectancy of over 10 years, but no pN1 patient that underwent only surgery, was progression free at 10 years (Partin 1994). In the last 10 years we performed 441 consecutive pelvic lymphadenectomy in patients with prostate cancer. We examined 32 patients pN1 (7.2%), with preoperatory PSA < 10 ng/ml. Mean age was 66.7, all these patients were clinically T1-2, mean PSA was 6.89 ng/ml and mean Gleason score 6.7 (< or = 7 in 27/32). Frozen sections and orchiectomy were performed in 8 patients who had macroscopic nodal involvement. In 24 patients with microscopic nodal involvement retropubic radical prostatectomy was performed. Pathologic stadiation (TNM 1997) was: 1 pT2a N1, 6 pT2b N1, 2 pT3a N1, 14 pT3b N1 and 1 pT4 N1. Seminal vesicle involvement was found in 14 of patients; in 13 of these positive surgical margins was found. Definitive Gleason score was > or = 7 in 22/24 patients (mean 7.7). Five patients underwent adjuvant radiotherapy, 13 radiotherapy and hormonotherapy and 6 only hormonotherapy. Mean follow up was at 66.6 months, but data are available for only 29/32 patients, with 8 (27.5%) biochemical progressions and 2 deaths (10.3%) for metastatic disease. Our experience indicates that the pelvic lymphadenectomy is very important for correct staging, also when PSA <10 ng/mI, bioptic Gleason score < or = 7 and clinical stage T1-2. In pN1 patients the adjuvant hormonotherapy allows a significant extension of disease free survival. [ABSTRACT FROM AUTHOR]

(High intensity focused ultrasound) HIFU is a minimally invasive treatment based on thermal ablation of tissues which are warmed up to 85°C in the focal area. From May 2002 to March 2008, 145 patients with prostate cancer, aged 44 to 86 years (mean 74.4) underwent 170 HIFU treatments. Mean PSA was 28. 1 ng/ml (range 0, 1-143) and mean Gleason sum 6.3 (range 3-9). The prognosis subgroups were defined as low-risk in 29 patients (clinical stage T1-T2a, PSA < or = 10 ng/mL, and Gleason score lower than 7), intermediate-risk in 21 patients (clinical stage T2b or PSA 10 - 20 ng/mL, or Gleason score of 7), and high-risk in 95 patients (clinical stage > or = T2c, or PSA > 20 ng/mL, or Gleason score higher than 7). At a mean follow-up of 47.1 months, biochemical success rate (PSA constantly <0.5 ng/ml) was obtained in 84.0% of low and intermediate risk patients and in 43. 1% of high risk patients; post-treatment biopsies (6 months after treatment) revealed no residual tumor in 92.8% of low or intermediate risk patients and in 62.3 % of high risk patients. Complication included: asymptomatic urinary tract infection (17.5%), pros tatitis (2.9%), epididymorchitis (1.7%), hemorrhoidal pain (0.5%), hematuria (3.5%), prostatic urethra structures (7.6%%), bladder neck sclerosis (12.3%) and rectourethral fistula (0.5%). Light stress incontinence occurred in 4.1% of the patients and erectile dysfunction in 77.8%. HIFU seems to be a promising alternative and less invasive treatment modality with an encouraging success rate, at least in the short-term. [ABSTRACT FROM AUTHOR]

Laparoscopic radical nephrectomy is a standard procedure performed in many institutes. Major vascular complications, especially vena cava injury, are uncommon but serious. Early recognition and conversion to open procedure may be required. We report a case of vena cava injury during transperitoneal laparoscopic radical nephrectomy managed laparoscopically by a surgeon with an extensive experience with intracorporeal suturing, who operated at our institute as a tutor. Major vascular injuries during Iaparoscopic surgery are rare, with an incidence of 0.05%; they are due to malfunction of the instruments, errors made during dissection, misplacement of stapling devices during ligation and disorientation of the surgical field. In literature only two cases of vena cava transection during laparoscopic nepherectomy are reported. The result of these injuries is usually hemorrhage; traditional therapy is emergency laparotomy, consultation with a vascular surgeon and open repair, especially during retroperitoneal laparoscopy, where the available working space is limited and creates a special challenge for control of vascular accidents and performance of laparoscopic suturing maneuvers. The occurrence of major vascular accidents during laparoscopy and the rate of open conversion are related to operator. Vena cava injury during laparoscopic radical nephrectomy is a highly unlikely but potentially devastating complication, that in selected circumstances, can be managed laparoscopically only by surgeons with an extensive experience especially in intracorporeal suturing. [ABSTRACT FROM AUTHOR]

Nephroureterectomy with excision of a cuff of bladder remains the standard for managing upper tract transitional cell carcinoma, which could, in selected cases, be managed conservatively. In 10 years we have treated 67 reno-ureteral unities (r.u.u.) for urothehal tumors; 36 r.u.u. with low-stage and low-grade disease (28 patients, 8 with bilateral tumor and 2 solitary kidney), were treated by an endoscopic approach; in 34 cases (3 for high grade recurrences after conservative approach) nephroureterectomy was performed. In 36 r.u.u. treated by ureteroscopic approach, we observed 3 high-grade recurrences (nephroureterectomy) and 22 low-grade (G1-G2) recurrences. Each r.u.u. received an average of 2.08 ureteroscopic operative procedures. The patients were followed up fora mean of 47.6 months after initial treatment and currently they are all recurrence free. Nine patients (13,4%) with suspect tumor of the upper tract had no carcinoma in the ureteroscopic biopsy. Ureteroscopic approach of upper urinary tract urothelial tumors in the current literature has been used successfully, resulting in recurrence rates ranging from 31% to 65% and disease-free rates of 35% to 86%. Progression and metastatic rates are low and correlate with tumor grade. [ABSTRACT FROM AUTHOR]