Biomedical subjects

V Pansadoro

Publications and source records attributed to V Pansadoro.

At least 19 recordsLinked to original sources

PubMed1999

Iatrogenic prostatic urethral strictures: classification and endoscopic treatment.

OBJECTIVES: The treatment of posterior urethral strictures is a controversial subject. For proper treatment, it is important to differentiate between iatrogenic prostatic urethral strictures and post-traumatic membranous urethral strictures. METHODS: Iatrogenic strictures of the prostatic urethra have been classified according to location and etiology into three categories: type I, located exclusively at the bladder neck; type II, located in the midportion of the prostatic fossa; and type III, when the whole prostatic fossa is replaced by stricture. From 1970 to 1996, 163 patients with postoperative strictures of the prostatic urethra were treated endoscopically. RESULTS: The results obtained in 122 patients are reported; 41 patients are not evaluable. The median follow-up was 63 months (range 12 to 239). Seven patients required a second endoscopic procedure to attain cure. Good results were achieved in 54 (91%) of 59 patients with type I strictures, in 45 (98%) of 46 patients with type II strictures, and in 13 (76%) of 17 patients with type III strictures. The overall success rate was 92% (112 of 122). Complications occurred in 21 patients (17%), including postoperative urinary tract infection (11%), incontinence (4%), stress incontinence (1%), and severe bleeding (1%). CONCLUSIONS: Postoperative strictures of the prostatic urethra must be recognized and can be easily treated with endoscopic therapy.

Aged↗

PubMed1999

Neo-adjuvant chemotherapy and bladder preservation in locally advanced transitional cell carcinoma of the bladder.

BACKGROUND: The possibility of bladder preservation as well as the utility of neo-adjuvant chemotherapy for invasive bladder cancer are controversial issues. The purpose of this study was the evaluation of neo-adjuvant M-VAC chemotherapy and bladder preservation in patients with locally advanced transitional cell carcinoma of the bladder. PATIENTS AND METHODS: Eighty-seven consecutive evaluable patients with T2-T4aNxM0 TCC of the bladder were treated with three cycles of neo-adjuvant M-VAC chemotherapy. After three cycles of M-VAC, 42 patients had TURB alone, 13 patients underwent partial cystectomy, and 32 patients were to undergo radical cystectomy. RESULTS: Forty (51%) patients were T0 at the TURB following M-VAC. Thirty (71%) patients who had chemotherapy and TURB alone are alive; at a median follow-up of 54+ months (8(+)-109+). Twenty-four (57%) have maintained an intact bladder. Of 13 responding patients with monofocal lesions who underwent partial cystectomy, 8 patients (62%) are alive with a functioning bladder, at a median follow-up of 80+ months (16-107+ months). At a follow-up of 32 months (7-121+ months), 20 (63%) patients in the radical cystectomy group are alive. In patients who had downstaging to T0 or superficial disease, median follow-up is 55 months (10-121+ months) and five-year survival is 71%. Patients who failed to respond (T2 or greater after chemotherapy), at a median follow-up of 24 months (7-103+ months), had five-year survival of only 29%. CONCLUSIONS: Bladder sparing in selected patients on the basis of response to neo-adjuvant chemotherapy is a feasible approach which must be confirmed in prospective randomized trials.

Adult↗

PubMed1999

Comparison of the BTA stat test with voided urine cytology and bladder wash cytology in the diagnosis and monitoring of bladder cancer.

OBJECTIVE: To compare the BTA stat test (BTA stat), a new one-step immunochromatographic assay that can be performed in the urologist's office or in the laboratory, to voided urine cytology and bladder wash cytology (cytology) in the diagnosis and monitoring of cancer of the bladder (BC). METHODS: BTA stat and cytology were performed in a double-blinded, prospective, clinical study on specimens from 240 subjects (68 females; mean age of subjects: 64 years) suspected of having BC. RESULTS: In 107 subjects with final diagnoses of BC confirmed by cystoscopy or cystoscopy and biopsy, the overall sensitivities of BTA stat and cytology were 65 and 33%, respectively. For tumor grades I, II, and III, the sensitivities of BTA stat were 39, 67 and 83%, respectively. Those of cytology were 4, 20 and 69%. Nine subjects had a diagnosis of 'suspicious for bladder cancer'. The specificities of BTA stat and cytology in the 124 subjects without BC were 64 and 99%, respectively. In the subjects with a history of BC (n = 74), the specificities of BTA stat and cytology were 72 and 99%, respectively. The specificity of BTA stat was lower in subjects with benign or malignant genitourinary disease other than BC (46%) than in subjects without genitourinary disease (71%). CONCLUSIONS: The BTA stat test is considerably more sensitive than cytology in the detection of BC and can replace cytology as an adjunct to cystoscopy in the diagnosis and follow-up of patients with BC. However, due to low specificity, BTA stat should not be used without first ruling out potential interferences such as infections, renal disease and cancer, or genitourinary trauma.

Adult↗

PubMed1999

Multicenter trial of the quantitative BTA TRAK assay in the detection of bladder cancer.

BACKGROUND: Human complement factor H-related protein (hCFHrp) is produced by several bladder cancer cell lines and may be useful as a cancer marker. The aim of this study was to compare urinary hCFHrp and cytology for the detection of bladder cancer found by cystoscopy in patients with suggestive signs, symptoms, or preliminary test results. METHODS: The BTA TRAK assay, a quantitative enzyme immunoassay for the bladder tumor-associated antigen in urine, was compared with exfoliative cytology in 220 patients (155 men, 65 women; mean age, 64.2 years) presenting with signs, symptoms, or preliminary diagnostic results suggestive of this disease. Cystoscopy was the standard of detection. RESULTS: In the 100 patients found to have bladder cancer, the overall sensitivities of the BTA TRAK assay (at a previously determined decision threshold of 14 kilounits/L) and cytology were 66% (66 of 100) and 33% (33 of 100), respectively (P <0.001). The BTA TRAK assay proved to be statistically more sensitive than cytology for tumor grades I and II and for stage Ta and T1 tumors. In contrast, the overall specificity of the BTA TRAK assay in the 120 patients without cystoscopically confirmed bladder cancer was 69% (83 of 120) and that of cytology was 99% (119 of 120; P <0.001). The specificity of the BTA TRAK assay was higher in patients without benign or malignant genitourinary disease other than bladder cancer (76%; n = 89) than in patients with these conditions. When the BTA TRAK assay and cytology were used together such that a positive result in either test was scored as positive and the results compared with those of the BTA TRAK assay alone, increases in overall sensitivity and equivalent specificity were observed. CONCLUSION: Because of its relatively high sensitivity, the BTA TRAK assay could complement cytology as an adjunct to cystoscopy in the diagnosis and follow-up of most patients with bladder cancer.

Adult↗

PubMed1999

Buccal mucosa urethroplasty for the treatment of bulbar urethral strictures.

PURPOSE: We report the results of urethroplasty with a free graft of buccal mucosa as a dorsal onlay for the treatment of bulbar urethral strictures. MATERIALS AND METHODS: Since June 1994, 30 patients with bulbar urethral strictures have been treated with buccal mucosa urethroplasty. Urethroplasty was performed with a free graft of buccal mucosa using a ventral onlay in the first 7 patients and a dorsal onlay in 23. Dorsal urethrotomy was performed with a Sachse urethrotome after the bulbar urethra was separated from the corpora. The buccal mucosa onlay was sutured to the urethra and corpora cavernosa to ensure a patent urethra. RESULTS: At 20-month followup (range 3 to 50) the success rate was 96% (29 of 30 patients). Urethral stricture recurred in only 1 of 7 patients in the ventral onlay and none of 23 in the dorsal onlay group. CONCLUSIONS: Preliminary results of urethroplasty for bulbar urethral strictures with a dorsal onlay graft of buccal mucosa are excellent. Longer followup is needed to evaluate definitive results.

Adolescent↗

PubMed1999

Neoadjuvant Hormonal Therapy and Radical Prostatectomy for Locally Advanced Prostate Cancer.

The management of locally advanced prostate cancer remains controversial. Cause-specific survival rates are high for organ-confined disease, but there is a disturbingly high incidence of positive margins in radical prostatectomy specimens. Thus, there has been much interest in neoadjuvant hormonal therapy as a means of shrinking the primary tumor. Both nonrandomized and randomized trials have revealed reductions in tumor size, but the effect on tumor stage and patient survival is less clear. Because the long-term value is not clear, and because neoadjuvant hormonal therapy does have side effects and increases treatment costs, it is at present not advisable outside the clinical research setting.

Journal Article↗

PubMed1998

[Internal urethrotomy].

Urethral dilatation and urethrotomy can be effective treatments of the stricture disease in selected patients when the spongy tissue is not severely damaged. In the few reports comparing urethrotomy and dilatation, results are not significantly different. A long term followup is mandatory in assessing the outcome of treatment of urethral strictures. Characteristics of the stricture as location, length, caliber, number, and previous failed treatments allow to select the best therapeutical option. After the failure of the first instrumentation, repeated procedures are not curative.

Dilatation↗

PubMed1998

Radiotherapy with or without androgen deprivation in the treatment of localized adenocarcinoma of the prostate.

This study analyzes the results of disease relapse and survival in two series of patients treated between 1974 and 1991 with definitive irradiation, with or without early androgen deprivation, for carcinoma of the prostate localized to the pelvis. All 264 patients were irradiated to the prostate and pelvic lymph nodes with a dose of 50 to 54 Gy in 25 to 27 fractions, followed by a 16- to 20-Gy boost in 8 to 10 fractions to the prostate and periprostatic region. Ninety percent of patients received a total dose to the prostate (pelvis + boost) of 70 Gy. Ninety-nine of the 264 patients underwent early androgen deprivation. The endocrine manipulation program was initiated 0 to 9 months before the beginning of the radiotherapy course and was continued for 2 or more years or until disease progression. All patients who relapsed after radiotherapy alone received late hormonal manipulation. After a median follow-up of 100 months, no difference in the incidence of local and distant failure rate and cancer-specific mortality was detected between the two treatment groups. The local and distant failure rates were, respectively, 19% and 40% in patients who had undergone radiotherapy and early androgen deprivation and 20% and 36% in patients who received radiotherapy alone. Cancer mortality was similar, with 35% and 30% of deaths in the former and latter group, respectively. Death for intercurrent disease, however, was significantly more frequent (p = 0.03) in patients treated with radiotherapy and hormones (19%) than in those who received radiotherapy alone (8%). Actuarial analysis of both metastasis-free and disease-free survival detected no difference between the two treatment groups, with 10-year rates of 53.3% and 42.5%, respectively, in the radiation-alone group and 45.5% and 47%, respectively, in the radiation-plus-androgen deprivation group. A statistically significant difference (p = 0.03) in overall survival in favor of patients treated with radiotherapy alone was noted, with a 10-year rate of 47%, compared with 26% observed in the radiotherapy-plus-androgen deprivation group. In conclusion, results of our study confirm numerous reports based on retrospective analyses that failed to show any benefit of hormonal management adjuvant to a definitive irradiation. The disappointing finding was the significantly better overall survival in patients who underwent radiotherapy alone.

Adenocarcinoma↗

PubMed1998

[The Studer ileal bladder and the Paduan ileal bladder: comparison of 2 techniques].

Between January 1988 and December 1995 48 orthotopic detubularized and reconfigured ileal neobladder were carried out with two distinct surgical procedures in the same Hospital. 33 underwent lower urinary tract reconstruction using Studer's technique with an afferent ileal tubular isoperistaltic segment; in 15 patients the ileal substitution of the bladder was performed with Paduan ileal bladder (VIP). In any case an ileal low pressure reservoir was obtained with similar functional capacity (400 ml. at the urodynamic control), as using the same length of ileum (40 cm) for the reconstruction of the reservoir itself. In order to other functional aspects (e.g. diurnal and nocturnal continence) results were analogous if a correct rehabilitation program was observed. Significant post-voiding residual and late neobladder decompensation was prevented with adequate mictional training. Early and late complications (globally 19-24%) were evaluated: strictures of ureteroileal and ileo-urethral anastomoses were rare; an ileoureteral reflux was observed at a cystographic control in 50% of Studer group, but never clinically significant and only in 20% of VIPs. No clinically significant metabolic changes were found. Survival was satisfactory at a mean follow-up of 48 months.

Adult↗

PubMed1997

Results of Bard BTA test in monitoring patients with a history of transitional cell cancer of the bladder.

OBJECTIVES: To evaluate the sensitivity and specificity of the Bard BTA test compared with bladder washing cytology in patients with a history of transitional cell bladder cancer undergoing routine follow-up cystoscopy. METHODS: During routine follow-up for transitional cell bladder cancer, 75 patients underwent cystoscopy, bladder washing cytology, and the Bard BTA test, a latex agglutination test that qualitatively detects basement membrane complexes in voided urine. From October 1994 to October 1995, a total of 104 Bard BTA test examinations were performed. The results of the Bard BTA test were compared with those attained with cystoscopy and bladder washing cytology. RESULTS: Cystoscopy found tumors in 13 cases. The Bard BTA test was diagnostic in 7 (54%) cases; it was more sensitive than bladder washing cytology, which was positive in only 3 (23%) cases. However, the specificity of the Bard BTA was lower (9% clinically unconfirmed positive tests) than that attained with cytology. In 2 patients (2%) in whom the cystoscopy was negative, the Bard BTA test was predictive for a positive cystoscopy 3 and 5 months later. CONCLUSIONS: The Bard BTA test is a noninvasive test that may be an important addition to cystoscopy and cytology in the routine surveillance of patients with a history of transitional cell cancer of the bladder.

Adult↗

PubMed1996

Prostate-specific antigen and prostatitis in men under fifty.

OBJECTIVE: To evaluate the occurrence of increased prostate-specific antigen (PSA) serum concentration in patients with prostatitis and low incidence of benign prostatic hyperplasia and prostatic cancer, PSA was measured in a selected population. METHODS: PSA levels were evaluated in 72 patients with prostatitis under 50 years of age. RESULTS: An increased PSA (> 4 ng/ml) was found in 5/7 (71%) patients with acute prostatitis, and in 2/13 (15%) and 2/32 (6%) patients with chronic bacterial and abacterial prostatitis, respectively. No patient with prostatodynia had an increased PSA. In patients with bacterial prostatitis PSA level decreased to normal value after effective antibiotic therapy in most cases. CONCLUSION: Prostatitis must be considered when using PSA as tumor marker.

Adult↗

PubMed1996

Internal urethrotomy in the management of anterior urethral strictures: long-term followup.

PURPOSE: We evaluated the long-term results of internal urethrotomy for anterior urethral strictures. MATERIALS AND METHODS: Between 1975 and 1990, 224 patients underwent internal urethrotomy for anterior urethral strictures. Median followup was 98 months (range 60 to 216). RESULTS: The recurrence rate after 1 urethrotomy was 68% overall, and 58% for bulbar, 84% for penile and 89% for penile bulbar urethral strictures. Repeated urethrotomies did not improve the success rate. Prognostic characteristics of bulbar urethral strictures associated with good results included single or primary strictures, length shorter than 10 mm. and caliber wider than 15F. Preoperative infection and etiology of the strictures did not correlate with results. Multiple urethrotomies achieve only temporary improvement and can be compared to repeated dilations. CONCLUSIONS: Alternative treatments should be considered for penile strictures and after failure of initial urethrotomy.

Adolescent↗

PubMed1995

Prognostic impact of transurethral resection on patients irradiated for localized prostate cancer.

The prognosis for irradiated patients with localized prostatic carcinoma following transurethral resection of the prostate (TURP) has been debated. Controversy centers upon whether or not TURP has an adverse effect on the outcome. A retrospective analysis of 264 patients treated during 1974-1991 with radical external beam radiotherapy was performed. Ten patients who were irradiated postoperatively were excluded. One hundred and nine patients with urinary obstruction underwent TURP. In another 155 patients, pathological diagnosis was made by needle aspiration or tru-cut biopsies. One hundred and one patients received endocrine manipulation, 58 (40%) in the needle biopsy group, and 43 (39.5%) in the TURP group. Lymph node staging by pelvic lymphadenectomy (20 cases), lymphangiography (15 cases), and CAT and/or NMR (113 cases) was performed in 148 patients. Nodal metastases were found in 38 patients, 19 in the needle biopsy group, and 19 in the TURP group. Disease-related, disease-free and metastasis-free survivals were calculated for all stages and within each tumor stage and histological grade for both groups. Correlation of pretreatment factors with clinical outcome was evaluated by multivariate analysis. Overall, disease-related survival was significantly higher (P = 0.05) in patients undergoing needle biopsy than in those who had TURP (58% vs. 38% at 10 years). This difference was more significant in the subset of patients with well differentiated tumors (P < 0.01). However, no difference could be observed between the two groups in histological grade 2 and 3 tumors or by stage comparison.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1995

Bacillus Calmette-Guerin in the treatment of stage T1 grade 3 transitional cell carcinoma of the bladder: long-term results.

PURPOSE: We performed a retrospective long-term study to evaluate the results of immunotherapy in the treatment of high grade superficial bladder tumors. MATERIALS AND METHODS: Between 1981 and 1993, 593 patients with superficial transitional cell carcinoma of the bladder underwent transurethral resection. Of 64 patients with stage T1 grade 3 disease 50 received intravesical bacillus Calmette-Guerin after transurethral resection of all visible tumor. RESULTS: At a median followup of 42 months (range 12 to 112) 36 patients (72%) are disease-free and have not required further treatment. Superficial recurrence was noted in 8 patients (16%). Disease progressed in 6 patients (12%), including 5 with locally invasive and 1 with metastatic disease. Cystectomy was performed for progression in 4 patients and for recurrent stage T1 grade 3 disease in 1. There was 1 disease related death (2%). The overall survival rate is 94%. CONCLUSIONS: Intravesical bacillus Calmette-Guerin appears to be the most effective conservative treatment for patients with stage T1 grade 3 bladder cancer.

Adjuvants, Immunologic↗

PubMed1995

Biologic characteristics of T1 papillary bladder cancer. Flow cytometric study of paraffin-embedded material.

DNA ploidy, proliferative activity (evaluated in terms of the proliferative index [PI]) and epidermal growth factor receptors (EGF-R) expression in primary bladder cancer in 52 patients were studied by means of flow cytometry and immunohistochemistry. Forty of the 52 tumors yielded evaluable DNA histograms: 22 were diploid (55%) and 18 aneuploid (45%) (median DNA index = 1.5). Ninety-five percent of the tumors were positive for EGF-R expression. The median PI value of the entire case series, estimated with a mathematical model, was 5.4%, or 6.7% in diploid tumors and 12.1% in aneuploid ones. EGF-R expression was higher in aneuploid than diploid tumors. Most of the well-differentiated tumors were diploid, while aneuploid populations and positivity for EGF-R expression were more frequent in poorly and moderately differentiated tumors. No differences in proliferative activity were observed in relation to grade. Overexpression of EGF-R in aneuploid tumors and a relationship between it, proliferative activity and grading were observed. The disease-free survival rates were 72% and 91% for patients with aneuploid and diploid tumors, respectively.

Aneuploidy↗

PubMed1994

Treatment of a recurrent penobulbar urethral stricture after wallstent implantation with a second inner wallstent.

The wallstent has been proved to be effective for the treatment of bulbar urethral strictures. Only a few failures are reported in the literature. We present a case of a patient with a recurrent stricture after wallstent implantation. The recurrence has been managed successfully with gradual dilation and with the insertion of an inner stent inside the first one, with a twenty-nine-month follow-up.

Aged↗

PubMed1994

A modified prostatic UroLume Wallstent for healthy patients with symptomatic benign prostatic hyperplasia: a European Multicenter Study.

OBJECTIVES: This European multicenter study was aimed to assess the clinical reliability of a modified prostatic UroLume Wallstent (American Medical System, Minnetonka, MN) in the treatment of 135 healthy patients with symptomatic benign prostatic hyperplasia. METHODS: Ninety-one patients who were obstructed but still voiding spontaneously and 44 patients who had an indwelling catheter were treated by placement of a modified stent. RESULTS: A significant improvement in mean peak flow rates and residual urine volumes was maintained throughout follow-up. Both obstructive and irritative voiding symptoms were significantly improved after placement of the stent, although a greater amelioration was seen in obstructive symptoms. The rate of patients reporting erections increased after stent insertion. Eighty percent of sexually active patients reported the maintenance of antegrade ejaculation postoperatively. A greater than 80% epithelialization of the stent was seen in 28 patients (100%) examined at the 18-month follow-up. Long-term complications were seen in 51 patients (38%). Twenty-one of these patients had the stent removed due to intractable detrusor instability, stent encrustation, stent migration, or persistence of obstruction due to prominent median lobe, understenting, or severe hyperplasia of the epithelium of the prostatic urethra. In 6 of them another stent was reimplanted while the others were treated surgically. CONCLUSIONS: Although this modified stent was abandoned due to an unacceptable rate of complications, this study demonstrates that bladder outlet obstruction in healthy patients with benign prostatic hyperplasia can be successfully relieved by the placement of a UroLume Wallstent.

Aged↗

PubMed1993

Neoadjuvant M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin) for infiltrating transitional cell carcinoma of the bladder.

BACKGROUND: Based on the excellent results with combination chemotherapy such as M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin) in patients with advanced disease, neoadjuvant chemotherapy has been advocated to improve survival and in some cases to permit bladder conservation. METHODS: A Phase II study of neoadjuvant M-VAC chemotherapy was performed in patients with T2-T4N0M0 bladder tumors. After clinical staging, three cycles of M-VAC were given. After patients underwent postchemotherapy clinical restaging, pathologic restaging (partial or radical cystectomy) was planned. RESULTS: Forty-six patients are evaluable. A clinical response was attained in 78%. Six patients (13%) had stable disease, and four (9%) had progression. After chemotherapy, 17 patients underwent radical cystectomy, none of whom were pTO. In this group, 10 of the 17 (59%) are alive at a median follow-up of 37+ months (range, 8-62+ months). Eleven patients had a partial cystectomy; 7 of the 11 (64%) are alive, 6 (55%) with a preserved bladder. Eighteen patients had clinical restaging only, and did not have pathologic staging. Median follow-up for this group is 36+ months (11-65+ months). Twenty-one of the 29 (72%) patients managed with conservative surgery or transurethral resection of the bladder alone are alive with a functional bladder. Median survival for all patients has not yet been reached. Two-year survival is 82%, and 3-year survival is 70%. CONCLUSIONS: The current study is of interest in terms of bladder conservation. Assessment of the true success of any bladder-preserving treatment will require longer follow-up.

Aged↗