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Pamplona, Spain

Guimaraes G.C.,Hospital A C Camargo | Rocha R.M.,Hospital A C Camargo | Zequi S.C.,Urology Service | Cunha I.W.,Hospital A C Camargo | Soares F.A.,Hospital A C Camargo
Current Oncology Reports | Year: 2011

Penile cancer is an aggressive disease, with major psychological and social impact. The etiological factors are poor genital hygiene, the presence of phimosis, viral infection, ultraviolet radiation, smoking, balanitis xerotic obliterans, and chronic lichen. Identifying prognostic factors is important to select patients at risk for lymph node metastasis and avoid unneeded lymphadenectomy. The presence of lymph node metastasis is currently the strongest prognostic factor but its evaluation is imperfect using clinical and laboratorial methods. The treatment for invasive penile cancer is based on the treatment of primary tumor, usually with amputation and regional lymphadenectomy, treatments that have a high morbidity rate. © 2011 Springer Science+Business Media, LLC. Source

Wiedemann L.,University Paris Est Creteil | Cornu J.-N.,University Paris Est Creteil | Haab E.,University Paris Est Creteil | Peyrat L.,University Paris Est Creteil | And 4 more authors.
BJU International | Year: 2013

Objectives To describe the surgical technique of transcorporal artificial urinary sphincter (AUS) implantation. To assess the efficacy of the AUS on continence and erectile function. Patients and Methods A prospective evaluation was conducted between December 2007 and October 2012 at a tertiary referral centre of all male patients treated by transcorporal AUS (AMS800™, AmericanMedicalSystems, Minnetonka, MN, USA) implantation for stress urinary incontinence (SUI) recurrence, after failure of previous anti-incontinence surgery. Functional urinary outcomes were assessed according to daily pad use, the Urinary Symptom Profile questionnaire, and International Consultation on Incontinence Questionnaire - Short-Form. Erectile function was evaluated using the five-item International Index of Erectile Function (IIEF-5) questionnaire and patient satisfaction was assessed by Patient Global Impression of Improvement questionnaire. Data were collected by telephone interview. Results A total of 23 patients were included. Their mean (sd; range) age was 70 (7; 60-85) years. Of these, 18 patients had urethral atrophy and/or erosion after placement of AUS (11 patients), male sling (four patients) or both (three patients), and five patients had severe urethral atrophy after pelvic radiation therapy. The implantation of the AUS with transcorporal cuff placement was successful in all patients, with no peri-operative complications. Follow-up data over 1 year were available for 17 patients. After a median (sd; range) follow-up of 20 (15; 2-59) months, eight patients were perfectly dry (no pad use and no symptoms), five achieved social continence (less than one pad/day), and four still had SUI (required two or more pads/day). Among six patients who had good preoperative erectile function and were sexually active, four had no decrease in their IIEF-5 score. Conclusions Transcorporal AUS cuff placement is a useful alternative for challenging cases of male SUI after failure of previous surgical treatment, urethral atrophy or erosion. Erectile function can be maintained despite dissection of the corporal body. © 2013 BJU International. Source

Chen Y.-B.,Sloan Kettering Cancer Center | Brannon A.R.,Sloan Kettering Cancer Center | Toubaji A.,Sloan Kettering Cancer Center | Dudas M.E.,Sloan Kettering Cancer Center | And 9 more authors.
American Journal of Surgical Pathology | Year: 2014

Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome is an autosomal dominant disorder in which germline mutations of fumarate hydratase (FH) gene confer an increased risk of cutaneous and uterine leiomyomas and renal cancer. HLRCC-associated renal cancer is highly aggressive and frequently presents as a solitary mass. We reviewed the clinicopathologic features of 9 patients with renal tumors presenting as sporadic cases but who were later proven to have FH germline mutations. Histologically, all tumors showed mixed architectural patterns, with papillary as the dominant pattern in only 3 cases. Besides papillary, tubular, tubulopapillary, solid, and cystic elements, 6 of 9 tumors contained collecting duct carcinoma-like areas with infiltrating tubules, nests, or individual cells surrounded by desmoplastic stroma. Prominent tubulocystic carcinoma-like component and sarcomatoid differentiation were identified. Although all tumors exhibited the proposed hallmark of HLRCC (large eosinophilic nucleolus surrounded by a clear halo), this feature was often not uniformly present throughout the tumor. Prior studies have shown that a high level of fumarate accumulated in HLRCC tumor cells causes aberrant succination of cellular proteins by forming a stable chemical modification, S-(2-succino)-cysteine (2SC), which can be detected by immunohistochemistry. We thus explored the utility of detecting 2SC by immunohistochemistry in the differential diagnosis of HLRCC tumors and other high-grade renal tumors and investigated the correlation between 2SC staining and FH molecular alterations. All confirmed HLRCC tumors demonstrated diffuse and strong nuclear and cytoplasmic 2SC staining, whereas all clear cell (184/184, 100%), most high-grade unclassified (93/97, 96%), and the large majority of "type 2" papillary (35/45, 78%) renal cell carcinoma cases showed no 2SC immunoreactivity. A subset of papillary (22%) and rare unclassified (4%) tumors showed patchy or diffuse cytoplasmic staining without nuclear labeling, unlike the pattern seen with confirmed HLRCC tumors. Sequencing revealed no germline or somatic FH alterations in 14 tumors that either exhibited only cytoplasmic 2SC staining (n=5) or were negative for 2SC (n=9), despite their HLRCC-like morphologic features. Our results emphasize the pivotal role of pathologic examination in the diagnosis of HLRCC patients and indicate immunohistochemical detection of 2SC as a useful ancillary tool in the differentiation of HLRCC renal tumors from other high-grade renal cell carcinomas. © 2014 by Lippincott Williams and Wilkins. Source

Jackson M.A.,Hartford Hospital | Bellas N.,Hartford Hospital | Siegrist T.,Urology Service | Haddock P.,Hartford Hospital | And 3 more authors.
Urology | Year: 2016

Objective To undertake a prospective/retrospective comparison of longer-term oncologic and quality of life outcomes in open radical prostatectomy (ORP) or robotic-assisted laparoscopic radical prostatectomy (RALP) patients. Materials and Methods The clinical progression of ORP and RALP patients who underwent surgery during 2004 was followed over an extended (10 year) period. Pre- and perioperative parameters, oncologic outcomes, recurrence, mortality, and quality of life were compared between surgical modalities. Follow-up time was calculated from the time of surgery to the latest contact. Postoperative quality of life data were obtained from Expanded Prostate Cancer Index Composite survey questionnaires. Recurrence rates, times to recurrence, surgical time, length of stay, hematocrit, follow-up time, and sexual and urinary bother scores were compared between surgical groups. Multivariate analyses were used to predict positive surgical margins and biochemical recurrence. Results 63 ORP and 116 RALP patients were included (mean age of 60.4 ± 6.4 and 58.6 ± 5.8 years; P =.067), with follow-up times of 10.3 and 10.1 years (P =.191). RALP patients had longer operative times (P <.001), shorter hospital stays (P <.001), and higher discharge hematocrits (P <.001). With prostate-specific antigen, Gleason score, and T-stage as covariates, time to recurrence (P =.365) and positive margin rate (P =.230) were not statistically different between groups. Ninety-five percent of RALP patients were continent and 48.0% were potent vs 92.6% and 41.5% of ORP patients (P =.720;.497). Urinary and sexual bother were not significantly different between groups (P =.392;.985). Conclusion Our longer-term follow-up data suggest that ORP and RALP patients have comparable oncologic and quality of life outcomes. © 2016 Elsevier Inc. Source

McCammon K.,Eastern Virginia Medical School | Haab F.,Urology Service
European Urology, Supplements | Year: 2011

The AdVance ® transobturator sling, an innovative sling developed to correct postprostatectomy stress urinary incontinence, acts by repositioning the urethral sphincter complex back into the pelvis. Optimal placement of the sling on the urethral bulb is ensured by following a recommended surgical technique. Postoperative pain resolves spontaneously or is easily controlled with analgesics. Patients must comply with postoperative care instructions, that is, no strenuous exercise in the immediate postoperative period to avoid sling slippage. It is also feasible to conduct implantation of an inflatable penile prosthesis in men with erectile dysfunction at the same time as the AdVance ® sling. The subsequent placement of an artificial urinary sphincter is not compromised in men who have previously received the AdVance ® sling. The AdVance ® transobturator sling for postprostatectomy stress urinary incontinence is an innovative nonobstructive sling. Optimal placement of the sling on the urethral bulb is ensured by following a recommended surgical technique. A low rate of postoperative pain is reported. © 2011. Source

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