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Vito Pansadoro

Publications and source records attributed to Vito Pansadoro.

9 recordsLinked to original sources
PubMed2005

Retroperitoneal laparoscopic radical nephrectomy for renal cell carcinoma with infrahepatic vena caval thrombus.

PURPOSE: The retroperitoneal laparoscopic approach is utilized to treat a right renal tumor with vena caval thrombus reaching infrahepatic veins. MATERIALS AND METHODS: The patient is an 87-year-old woman with a tumor measuring 8 x 9 cm and a vena caval thrombus (7 cm), stretching as far as the subhepatic vein. The retroperitoneal laparoscopic approach is used with the patient in the lateral position and the usual 4 laparoscopy trocars. A wide incision is made through Gerota's fascia, the renal artery clipped and severed, and the vena cava is dissected to the level of the infrahepatic veins; a vessel loop is encircled twice upstream of the thrombus. Vessel loop is similarly tied below the thrombus. An 8 cm abdominal wall incision is made joining two trocars on the medial and anterior axillary side. After retrieving the vessel loops and closing the vena cava by pulling gently on the loops, thrombus is extracted through a cavotomy under direct vision, with removal of the surgical specimen, positioning of the Satinsky haemostatic forceps, and closure of the vena cava using uninterrupted Prolene 2/0 sutures. RESULTS: Blood loss was 300 cc. The patient was discharged on day 6, and a CT-scan 4 months later disclosed no signs of recurrence. CONCLUSIONS: This is an original solution that opens the way to further indications for using retroperitoneal laparoscopy to treat tumors extending into the inferior vena cava.

Aged↗
PubMed2004

The incidence of prostate cancer in men with prostate specific antigen greater than 4.0 ng/ml: a randomized study of 6 versus 12 core transperineal prostate biopsy.

PURPOSE: The prostate cancer detection rate in patients with elevated prostate specific antigen (PSA) increases with extended needle biopsy protocols. Transperineal biopsy under transrectal ultrasound guidance is rarely reported, although notable cancer diagnoses are obtained with this technique. We describe the results of 6 and 12 core transperineal biopsy. MATERIALS AND METHODS: A total of 214 patients with PSA greater than 4.0 ng/ml were prospectively randomized to undergo 6 or 12 core transperineal biopsy. Each group of 107 patients was comparable in terms of clinical characteristics. The procedure was performed on an outpatient basis using local anesthesia. Specimens were obtained with a fan technique with 2 puncture sites slightly above the rectum (1 per lobe) under transrectal ultrasound guidance. Cores were taken from all peripheral areas, including the far lateral aspect of the prostate. RESULTS: The overall cancer detection rate was 38% and 51% for 6 and 12 core biopsy, respectively. In patients with PSA between 4.1 and 10 ng/ml the cancer detection rate was 30% and 49% for 6 and 12 core biopsy, respectively. CONCLUSIONS: The 12 core transperineal prostate biopsy is superior to 6 core biopsy. The technique provides optimal prostate cancer diagnosis. About half of the patients with PSA greater than 4.0 ng/ml and a slightly lower percent with PSA between 4.1 and 10 ng/ml have prostate cancer.

Aged↗
PubMed2003

Can patient selection for bladder preservation be based on response to chemotherapy?

BACKGROUND: Neoadjuvant chemotherapy for patients with muscle-invasive bladder carcinoma is given to treat micrometastases and to preserve the bladder. The objective of this study was to evaluate the possibility of bladder preservation in patients with muscle-invasive bladder carcinoma who were treated with neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) chemotherapy. METHODS: One hundred four consecutive patients with T2-T4,N0,M0 transitional cell carcinoma of the bladder were treated with 3 cycles of neoadjuvant M-VAC chemotherapy. After clinical restaging, 52 patients underwent transurethral resection of the bladder (TURB) alone, 13 patients underwent partial cystectomy, and 39 patients underwent radical cystectomy. RESULTS: The median survival for the entire group was 7.49 years (95% confidence interval, 4.86-10.0 years). Forty-nine patients (49%) were T0 at the time of TURB after receiving M-VAC. Thirty-one of 52 patients (60%) who received chemotherapy and underwent TURB alone were alive at a median follow-up of 56 + months (range, 10-160 + months): Twenty-three patients (44%) in that TURB group maintained an intact bladder. Of 13 responding patients with monofocal lesions who underwent partial cystectomy, only 1 patient required salvage cystectomy, and survival generally was good. The 5-year survival rate for this group was 69%. With a long median follow-up of 88 + months (range, 16-158 months), 4 patients (31%) were alive with a functioning bladder. In the radical cystectomy group, the median follow-up was 45 months (range, 4-172 + months), and 15 of 39 patients (38%) patients remained alive. In 77 patients who had their tumors down-staged to T0 or superficial disease, the median follow-up was 63 months (range, 4-172 + months), and the 5-year rate survival was 69%. This is in contrast to a 5-year survival rate of only 26% in 27 patients who failed to respond and had a status >/= T2 after receiving chemotherapy (median follow-up, 31 months; range, 7-156 + months). The median survival for 27 elderly patients (age >/= 70 years; median age, 73 years; range, 70-82 years) was 90 months (7.5 years). For elderly patients who underwent TURB and partial cystectomy, the 5-year survival rate was 67% with a 109-month (9-year) median survival; 47% of patients preserved their bladders intact. The median follow-up of the living elderly patients was 61 months (range, 20-120 + months). CONCLUSIONS: Bladder sparing in selected patients on the basis of response to neoadjuvant chemotherapy is a feasible approach that should be confirmed in prospective, randomized trials. Selected elderly patients are candidates for this approach.

Adult↗
PubMed2003

Buccal mucosa urethroplasty in the treatment of bulbar urethral strictures.

OBJECTIVES: To report our 8-year experience with buccal mucosa onlay urethroplasty with the dorsal approach in the treatment of bulbar urethral strictures. The buccal mucosal graft is widely used as an effective option for urethral reconstruction. METHODS: Since June 1994, we have treated 65 patients with bulbar urethral strictures with buccal mucosa urethroplasty. A free graft of buccal mucosa was used as a ventral onlay in 9 patients and as a dorsal onlay in the remaining 56 patients. The bulbar urethra was isolated from the corpora. Endoscopic urethrotomy was performed dorsally. The graft was obtained from the lower lip and sutured to the urethra and corpora cavernosa. A transurethral grooved catheter and suprapubic drainage was maintained for 7 and 14 days, respectively. RESULTS: The median follow-up was 41 months (range 6 to 94). The overall recurrence rate was 3% (2 of 65). One recurrence occurred in a ventral onlay patient and one in a dorsal onlay patient. Minor complications occurred in 9 patients (14%). CONCLUSIONS: Buccal mucosa dorsal onlay urethroplasty is an excellent option for the treatment of bulbar urethral strictures.

Adolescent↗
PubMed2002

Long-term follow-up of G3T1 transitional cell carcinoma of the bladder treated with intravesical bacille Calmette-Guérin: 18-year experience.

OBJECTIVES: Immunotherapy with bacille Calmette-Guérin (BCG) has been proposed in the past decade as first-line treatment for high-grade superficial bladder cancer (G3T1). We report our 18-year experience in the treatment of patients with G3T1 bladder cancer. METHODS: From January 1989 to July 1997, 670 patients underwent transurethral resection for superficial bladder cancer. Eighty-one patients (12%) had G3T1 tumors. All of these patients were treated with an innovative schedule of Pasteur strain BCG followed by maintenance BCG therapy. Treatment consisted of four cycles of 6 instillations per cycle of BCG. The first cycle was administered weekly x 6, the second was given every 2 weeks x 6, the third cycle was given monthly x 6, and the fourth was given every 3 months x 6 instillations. RESULTS: Sixty-nine patients (84%) completed at least the first two cycles. At a median follow-up of 76 months (range 30 to 197), the overall recurrence rate was 33% (27 of 81). The median time to recurrence was 20 months (range 5 to 128). Of these patients, 12 (15%) had progression at a median follow-up of 16 months (range 8 to 58). Cystectomy was required in 7 patients (8%). Death from disease occurred in 5 (6%) of 81 patients. One patient died of adenocarcinoma at the ureterosigmoidostomy site. Sixty patients (74%) were alive at a median follow-up of 79+ months (range 15 to 182). Of these, 56 (69%) were alive with a functioning bladder. CONCLUSIONS: Conservative treatment with BCG is a reasonable approach for patients with primary G3T1 transitional cell carcinoma of the bladder. The long-term results of BCG therapy are good. Cystectomy may not be justified as the therapy of choice in first-line treatment of high-grade superficial carcinoma of the bladder.

Adjuvants, Immunologic↗
PubMed2002

Conservative treatment of intraperitoneal bladder perforation during transurethral resection of bladder tumor.

A new technique for conservative treatment of intraperitoneal bladder perforation during transurethral resection of bladder tumor is presented. This technique consists in the percutaneous insertion of an intraperitoneal drainage tube, using as a guide the sheath of the resectoscope, which is advanced through the bladder perforation and peritoneum up to the abdominal wall.

Abdominal Wall↗
PubMed2002

Which urethroplasty for which results?

PURPOSE OF REVIEW: Urethral surgery is rapidly changing because of developments in techniques. The aim of this paper is to provide an update and a review of the most significant surgical options and their outcomes in the treatment of urethral strictures. RECENT FINDINGS: Indications and results of anastomotic repair, pedicled flap, free graft and complex urethral reconstruction are reported. New trends such as dorsal urethroplasty and the use of buccal mucosa are reviewed. SUMMARY: Most urethral strictures can be managed successfully by urethral surgery. A wide spectrum of effective procedures is available. To obtain optimal results, adequate knowledge and experience of the most common techniques are required.

Anastomosis, Surgical↗
PubMedDate not supplied

Prostate cancer: evaluation with endorectal MR imaging and three-dimensional proton MR spectroscopic imaging.

PURPOSE: To establish the additional value of MR Spectroscopy (3D CSI MRS Three-dimensional Chemical Shift Imaging Magnetic Resonance Spectroscopy) to endorectal MR in the diagnosis and grading of prostate cancer. MATERIALS AND METHODS: MR and 3D CSI MR spectroscopy were performed in 53 patients with suspicion of prostate cancer on the basis of rectal exploration and/or transrectal ultrasound and/or the PSA levels. All the examinations were performed with a 1.5 T imager using an endorectal coil. We acquired axial and coronal T2-weighted FSE sequences, axial T1-weighted SE sequences and PRESS 3D CSI (Point Resolved Spectroscopy 3D Chemical Shift Imaging) sequences localized on the axial T2 images so as to include the prostatic gland while excluding the periprostatic fat. The MR examinations were evaluated by two radiologists unaware of the clinical data, transrectal ultrasound findings, PSA levels and histological findings. The MR and 3D CSI MRS findings were compared with the biopsy findings in 22 cases and with material obtained from laparoscopic prostatectomy in 31 cases. RESULTS: The histological examination revealed adenocarcinoma in 37 cases, prostatitis in 2 cases and no alterations in the remaining 14 cases. The morphologic MR scan showed a sensitivity of 76%, a specificity of 56%, an accuracy of 70%, a PPV of 80% and a NPV of 50%. By combining MR and 3D CSI MRS we obtained a sensitivity of 95%, a specificity of 81%, an accuracy of 91%, a PPV of 92% and a NPV of 87%. Elevated choline concentrations were found both in tumours with a low Gleason score (18 cases) and in those with a high Gleason score (19 cases); instead we found markedly reduced (n=9) or absent (n=4) citrate only in the tumours with a high Gleason score, while we found normal citrate levels in the 18 tumours with a low Gleason score. CONCLUSIONS: The 3D CSI MRS improved the reliability of endorectal MR in the diagnosis and characterisation of prostatic cancer. Moreover, the 3D CSI MRS findings demonstrated a linear correlation with tumour grade.

Adenocarcinoma↗