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Background: Carcinoma of the bladder represents the fourth most common cancer in men and the eighth most common malignancy in women in Europe and the United States. Prognostic factors for recurrence and survival are tumor stage and dimension, tumor grade and the presence of lymph node metastasis. We assess the impact and the role of lymphovascular invasion (LVI) on the prognosis of patients treated for lower and upper tract urothelial carcinoma by reviewing the literature curentable., Materials and Methods: We performed a detailed review of the literature to assess the prognostic role of LVI assessed in histological specimens of urothelial cell carcinoma of the upper and lower urinary tract., Results: We presented the definition of lymphovascular invasion in histological specimens of urothelial carcinoma. LVI in histological specimens was correlated significantly with increasing tumor stage and grade. Moreover, LVI is significantly correlated with earlier disease recurrence and a lower cancer-specific survival, and seems to be an independent predictor of recurrence-free survival on multivariate Cox analysis., Conclusion: LVI in histological specimens seems to have an important prognostic value for patients with urothelial cell carcinoma of the upper and lower urinary tract, and could be a useful tool for the urologist in choosing the best and most appropriate management during disease treatment and follow-up.

Background: Radical cystectomy is the standard treatment for patients with invasive bladder cancer. Many aspects regarding the role of concomitant pelvic lymph node dissection (PLND), its extension and the oncological impact are still under discussion., Materials and Methods: A detailed literature review is presented to assess the impact of pelvic lymph node dissection during radical cystectomy in terms of staging and therapeutic procedure. Analysis of evidence: The study presented the role of imaging in the assessment of lymph node status, the anatomical account of bladder lymphatic drainage and the techniques for dissection. The evidence from the literature examined showed that pathological stage of the bladder, the extent of PLND in both node-negative and - positive disease, the lymph node density and the extracapsular involvement of metastatic lymph nodes are significant independent prognostic factors for disease-free survival., Conclusion: Radical cystectomy with bilateral pelvic iliac lymphadenectomy is a standard treatment for high-grade, invasive bladder cancer, providing the best survival outcomes and the lowest local recurrence rates. Even if the precise extent of lymph node dissection is still not standardized, many studies support a more extended lymphadenectomy to obtain better cancer-specific survival rates without significantly increasing the morbidity or mortality of the surgery. The concept of lymph node density may become a useful prognostic variable in high-risk node-positive patients.

Background: Bladder cancer is the fourth most frequently diagnosed cancer among males and the eleventh among females. At present, radical cystectomy is considered the standard therapy in patients with muscle invasive disease or in some cases of high-grade superficial cancer. TNM classification includes as independent predictors of disease-specific survival the grade, the pathological stage and the presence of lymph node involvement, whilst the prognostic value of lymphovascular invasion (LVI) still remains controversial. The aim of the study was to assess the prognostic role of LVI at final pathology., Patients and Methods: From June 1995 to January 2007, 340 consecutive patients underwent radical cystectomy. Surgical specimens were examined according to our pathological protocol. Patients with a non-transitional cell carcinoma or submitted to a salvage procedure or neoadjuvant/adjuvant chemo-radiotherapy were excluded. The follow-up consisted of abdominal ultrasound every 3 months, blood sampling every six months and both computerized tomography and urethroscopy yearly., Results: The median patient age was 69 years. Of the 265 patients, 218 were males and 47 females. LVI was present in 77 pathological specimens (29.1%). LVI was not significantly associated with age (p=0.908) or sex (p=0.382), but was significantly associated with high pathological grade (p=0.028) and stage (p<0.001), and the presence of node metastasis (p<0.001). At the multivariate analysis, pathological staging, presence of LVI and node metastasis were independent significant prognostic factors for disease-specific survival., Conclusion: In our series, LVI is an independent prognostic factor for disease specific survival in patients who underwent radical cystectomy for transitional cell carcinoma.

Background: This study evaluated the accuracy of a new echographic method named RULES (radiofrequency ultrasonic local estimators) in the diagnosis of prostate cancer., Patients and Methods: A double-blind prospective study was carried out on 105 patients mean age 66.6 years, prostate specific antigen (PSA) >4 ng/ml with clinical and/or biochemical suspicious of prostate cancer. Patients were submitted to transrectal prostate biopsy (8 to 12 cores) using a traditional echograph connected to a new hardware/ software platform named FEMMINA (fast echographic multiparameter multi image novel apparatus) that processes the echo signal by a RULES (radiofrequency ultrasonic local estimators) algorithm. Histological findings were compared to B-mode and RULES modality., Results: Cancer was detected in 32/105 patients, of which 26/32 were determined as positive with the RULES method. RULES had better positive predictive value, negative predictive value, sensitivity, specificity and accuracy than B-mode., Conclusion: Results obtained with RULES are encouraging and, if further confirmed, could help to reduce the number of unnecessary prostatic biopsies.

Small and large cell neuroendocrine carcinomas of the urinary bladder are rare and usually coexist with urothelial carcinoma in elderly patients. Here we report the clinical case of a young smoker who was referred to our institution for a primary pure neuroendocrine carcinoma of the bladder, and review the existing literature on small and large cell neuroendocrine carcinomas of the urinary bladder.

Background: Prostate cancer (PCa) is the most common non-skin cancer among men in Western countries. Inflammation appears to be involved in the pathogenesis of PCa. Recent studies have shown that many inflammatory genes are associated with the risk of PCa. Alpha 1 antichymotrypsin (ACT) is an acute phase protein and it is part of the circulating prostate specific antigen (PSA)., Patients and Methods: Allele and genotype frequencies of a promoter single nucleotide polymorphism (SNP) in ACT gene were investigated in patients with benign prostate hypertrophy (BHP) or PCa and controls., Results: The G allele was more represented in PCa patients (odds ratio = 2.349). The PSA levels and prostatic volume did not correlate with the ACT genotype. However, stratifying subjects by age, a correlation of PSA levels and the GG genotype in young PCa patients was found., Conclusion: Carriers of the ACT G allele are at risk of developing PCa and genotyping healthy subjects could be a new approach for early prevention.

Over the past ten years nephron sparing surgery for renal cancer has been compared to radical nephrectomy for what concern oncological results, even in elective situations but it is necessary to consider functional results (renal function) as well. Clamping renal artery, inducing a temporary renal ischemia that might represent the major known cause of permanent renal damage, is advised for both open and laparoscopic conservative approach. Data from literature show that before the clamping, the patient should be adequately hydrated and receive mannitol. Ischemia should last preferentially less than 30 minutes and kidney cooling should be advised in case of more prolonged ischemia. Artery reclamping should be avoided. Both in warm and cold ischemia, the renal tissue should be perfused by mannitol once the circulation is resumed.