Search

BACKGROUND Physical activity (PA) is associated with favorable outcomes in prostate cancer (PCa) patients. We assessed its effect on the risk of PCa reclassification (PCaR) during active surveillance. METHODS Anthropometric, demographic, and clinical data concerning men diagnosed with a low-risk PCa and initially managed with active surveillance at the two participating institutions were retrospectively collected. The Physical Activity Scale for the Elderly (PASE) was used for patients' self-assessment of their daily exercise and their consequent stratification into three groups: sedentary (PASE ≤ 65), moderately active (65

Aggressive angiomyxoma is a rare lesion with infiltrative growth and a tendency to recur locally. We present the images of a rare case of aggressive angiomyxoma in the pelvic region of a male patient presenting as a retrovesical, paraprostatic mass causing urinary symptoms.

INTRODUCTION AND OBJECTIVES:Prostate biospy is the gold standard procedure to diagnose prostate cancer. The technique is usually performed under transrectal ultrasound (TRUS) guidance with transrec...

The natural history of urolithiasis includes the risk of recurrence and of the development of chronic kidney and/or bone disease, which is why a thorough clinical and metabolic evaluation of these patients is of the utmost importance at disease onset. This paper is aimed at identifying the type of urolithiasis, the related risk factors, and the corresponding treatment options. The diagnostic and therapeutic approach described here includes 1) accurate history taking to detect secondary nephrolithiasis and screen for the main risk factors for kidney and bone disease; 2) metabolic evaluation graded according to different complexity levels based on the severity of the disease and the presence of risk factors; 3) carrying out appropriate imaging procedures. The resulting information allows to plan treatment based either on general rules of lifestyle and diet, or on selected medical intervention, if necessary. This report, which is based on current guidelines, was produced by the Gruppo Italiano di Studio Multidisciplinare per la Calcolosi Renale. It is addressed to all professionals involved in the management of patients suffering from nephrolithiasis, first of all general practitioners, who often become involved immediately at the onset of the disease.

To perform a systematic review and meta-analysis of randomized clinical trials (RCTs) reporting the efficacy and safety of silodosin in the treatment of non-neurogenic male LUTS suggestive of benign prostatic enlargement. A systematic review searching multiple dataset for the term "silodosin". A meta-analysis was conducted using Review Manager software (Cochrane Collaboration, Oxford, UK). Our systematic search retrieved four studies summarizing the data of five RCTs. Silodosin was more effective than placebo with regard to mean change in all the parameters related to the IPSS and Q(max) (all p values < 0.0003). Adverse events (AE), abnormal ejaculation (AEj), and withdrawal due to AE were all more common with silodosin (all p values < 0.001). The prevalence of dizziness and adverse events other than AEj was similar with silodosin and placebo. Silodosin was more effective than tamsulosin 0.2 mg with regard to some IPSS-related parameters and Q(max) (p a parts per thousand currency sign 0.05). Silodosin and tamsulosin 0.4 mg were similarly effective in all the efficacy analyses. AEj was less common with tamsulosin 0.2 and 0.4 mg (p values < 0.00001); adverse events other than AEj were more common with tamsulosin 0.2 and 0.4 mg (p values a parts per thousand currency sign0.05). Silodosin was significantly more effective than placebo and tamsulosin 0.2 mg in improving symptoms and as effective as tamsulosin 0.4 mg. With regard to adverse events, AEj was more common with silodosin. All the adverse events other than AEj were significantly more common with tamsulosin 0.2 and 0.4 mg and as frequent with silodosin and placebo.

Purpose: To evaluate whether pathological outcomes of ReTURB have a prognostic impact on recurrence and progression of primitive T1HG bladder cancer. Material and methods: Patients affected by primitive T1HG TCC of bladder underwent restaging TURB (ReTURB). Patients with muscle invasive disease at ReTURB underwent radical cystectomy; those with non-muscle invasive residual (NMI-RT) and those with no residual tumour (NRT) received an intravesical BCG therapy. We compared recurrence and progression in NMIRT patients and NRT patients at restaging TURB. Patients were followed every 3-6 months with cystoscopy and urine cytology. Results: 212 patients were enrolled in the study. At ReTURB, residual cancer was detected in 92 of 196 (46.9%) valuable patients: 14.3% of these were upstaged to T2. At follow up of 26.3 ± 22.8 months, there were differences in recurrence and progression rates between NRT and NMIRT patients: 26.9% and 45.3% (p < 0.001), 10.6% and 23.4% (p 0.03), respectively. Recurrence-free and progression-free survivals were significantly higher in NRT compared to NMIRT patients: 73.1% and 54.7% (p < 0.001), 89.4% and 76.6 (p 0.03), respectively. Conclusions: ReTURB allows to identify a considerable number of residual and understaged cancer. Patients with NMIRT on ReTURB have worse prognosis than those with NRT in terms of recurrence and progression free survival. These outcomes seem to suggest a prognostic impact of findings on ReTURB that could be a valid tool in management of high grade T1 TCC.

Due to a technical error, Dr. Manuel Ferraro was omitted from the author list of this article. The correct author details appear above.

Background: The first Italian national guidelines were developed by the Italian Association of Urologists and published in 2007. Since then, a number of new drugs or classes of drugs have emerged for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH), new data have emerged on medical therapy (monotherapies and combination therapies), new surgical techniques have come into practice, and our understanding of disease pathogenesis has increased. Consequently, a new update of the guidelines has become necessary. Methods: A structured literature review was conducted to identify relevant papers published between 1 August 2006 and 12 December 2010. Publications before or after this timeframe were considered only if they were recognised as important milestones in the field or if the literature search did not identify publications within this timeframe. The quality of evidence and strength of recommendations were determined according to the Grading of Recommendations Assessment, Development and Evaluation framework. Main findings: Decisions on therapeutic intervention should be based on the impact of symptoms on quality of life (QoL) rather than the severity of symptoms (International Prostate Symptom Score (IPSS) score). A threshold for intervention was therefore based on the IPSS Q8, with intervention recommended for patients with a score of at least 4. Several differences in clinical recommendations have emerged. For example, combination therapy with a 5α-reductase inhibitor plus α blocker is now the recommended option for the treatment of patients at risk of BPH progression. Other differences include the warning of potential worsening of cognitive disturbances with use of anticholinergics in older patients, the distinction between Serenoa repens preparations (according to the method of extraction), and the clearly defined threshold of prostate size for performing open surgery (>80 g). While the recommendations included in these guidelines are evidence based, clinical decisions should also be informed by patients’ clinical and physical circumstances, as well as patients’ preferences and actions. Conclusions: These guidelines are intended to assist physicians and patients in the decision-making process regarding the management of LUTS/BPH, and support the process of continuous improvement of the quality of care and services to patients.

INTRODUCTION AND OBJECTIVES: To evaluate whether splitting TURP and Hifu in two session can reduce complication rate in patients with localized prostate cancer. METHODS: From November 2004 to September 2010, 103 patients affected by localized prostate cancer underwent HIFU following TURP. In 39 patients both procedures were performed in the same session (Group A); in 64 patients HIFU was delayed (Group B). Follow up included serial PSA measurements and prostate biopsies 6 months after the treatment in all patients. Biochemical recurrence was defined as PSA nadir 2ng/ml (ASTRO 2005 criteria). We have evaluated complication rate in the Group A and B. RESULTS: The mean age, PSA and prostate volume were 73.3 ( 5.4) years, 8.2 ( 19.3) ng/ml and 29 ( 8,3) cc, respectively. Mean procedure time was 128 minutes and mean hospitalization was 3.4 days. Complications occurred in 30 patients. Complication rate was not associated with clinical stage (T1 vs T2) (p0,67), Gleason score (p0,62), age (p0,2), prostate volume (p0,06), PSA (p0,9). Complications rate was lower when HIFU has been delayed after TURP (Group B) [see table]. Complications occurred in 61% (24/39) of Group A patients and in 9,3% (6/64) of Group B patients (p 0,001). No significant differences were seen between Group A and B patients in terms of clinical stage (p0,9), Gleason score (p0,2), prostate volume (p0,3), age (p0,4) and PSA (p0,46). CONCLUSIONS: Splitting TURP and HIFU in two different sessions seems to reduce postoperative complications and improve patient tolerance of the procedure. Longer follow up and larger patient population are needed to obtain more robust evidence.