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PCA3: A new tool to diagnose prostate cancer (PCa) and a guidance in biopsy decisionscantigen (PSA) is an accurate predictor of prostate cancer risk inmen with serum PSA 2.5 ng/mL and lower. Cancer 2008;113:2695-703.13. Chun FK, et al. Prostate cancer gene 3 (PCA3): developmentand internal validation of a novel biopsy nomogram. Eur Urol. 2009Oct; 56(4):659-67.14. Nakanishi H, Groskopf J, Fritsche HA, et al. PCA3 molecularurine assay correlates with prostate cancer tumor volume: implicationin selecting candidates for active surveillance. J Urol 2008;179:1804-9, discussion 1809-10.15. Seitz C, et al. Prostate biopsy. Minerva Mol Nefrol 2003;55:205-18.16. Haese A, et al. Clinical utility of the PCA3 urine assay inEuropean men scheduled for repeat biopsy Eur Urol 2008 Nov;54(5):1081-8.17. Raja J, et al. Current status of transrectal ultrasound-guidedprostate biopsy in the diagnosis of prostate cancer. Clin Radiol 2006;61:142-153.18. Marks LS, et al. PCA3 molecular urine assay for prostate cancerin men undergoing repeat biopsy. Urology 2007; 69:532-5.CorrespondenceGiuseppe Sepe, MDDepartment of UrologyCasa di Cura Malzoni “Villa Platani”Via C. Errico 2 - 83100 Avellino, Italygiuseppesepe44@libero.itVito Pansadoro, MDLaparoscopic CenterCasa di Cura Pio XIVia Aurelia 559 - 00165 Roma, Italyvito@pansadoro.itRosaria Giulivo, BDLaboratorio di Biodiagnostica Montevergine MalzoniVia Nazionale 146 - 83013 Mercogliano (AV), Italyr.giulivo@laboratorio-biodiagnostica.itPaola Bruni, BDLaboratorio di Biodiagnostica Montevergine MalzoniVia Nazionale 146 - 83013 Mercogliano (AV), Italyp.bruni@laboratorio-biodiagnostica.itFabio Galasso, MDDepartment of UrologyCasa di Cura Malzoni “Villa Platani”Via C. Errico 2 - 83100 Avellino, Italyfa_gala@hotmail.comRenato Giannella, MDDepartment of UrologyCasa di Cura Malzoni “Villa Platani”Via C. Errico 2 - 83100 Avellino, Italyr.giannella@libero.itVittorino Ricci Barbini, MDUrologist Consultant, Ospedale di PoggibonsiLoc. Campostaggia - 53036 Poggibonsi (Siena), Italyriccibarbini@hotmail.comVincenzo Disanto, MDUrologist Consultant, Casa di Cura S. RitaVia G. Petroni 132/G - 70125 Bari, Italyvincenzo.disanto@tin.itRosario Leonardi, MDDepartment of Urology, Clinica BasileVia Odorico da Pordenone 5 - 95128 Catania, Italyleonardi.r@tiscali.itArchivio Italiano di Urologia e Andrologia 2010; 82, 19
ORIGINAL PAPERSurgery for renal cell carcinomain two European urologic clinics: To compare or compete?* Svetoslav Dechev Dyakov 1 , * Giuseppe Lucarelli 2 , Alexander Ivanov Hinev 1 ,Petar Kirilov Chankov 1 , Deyan Anakievski 1 , Pasquale Ditonno 2 ,Pasquale Martino 2 , Francesco Paolo Selvaggi 2 , Michele Battaglia 2* These authors equally contributed to this work;1 St. Marina University Hospital - Third Clinic of Surgery - Division of Urology - Varna, Bulgaria;2Department of Emergency and Organ Transplantation - Urology Andrology and Kidney TransplantationUnit - University of Bari, ItalySummaryObjectives: To evaluate and compare the incidence, TNM staging and the current strategyfor the surgical treatment of renal cell carcinoma (RCC) in two European urologic institutions,situated in Varna, Bulgaria and in Bari, Italy. Both clinics have sound experienceof RCC surgery, and modern laparoscopic equipment. A retrospective chart review of allpatients with RCC diagnosed and treated in the last year was conducted at the two sites.Materials and methods: In total, 88 patients (66 males and 22 females, mean age 58 years, range24-81 years) were enrolled in the study. Comparisons were made between some clinical and pathologicparameters with an established prognostic and therapeutic impact. The type of surgery performedat both sites was analyzed as well. All these comparative studies were performed in relationto the 2008 EAU guidelines on the current management of RCC. Commercially available statisticalsoftware was used for the purpose.Results: The results showed no difference between the two sites regarding the RCC incidenceand the patients’ age and gender. Significant differences (p value < 0.0001) emerged in termsof: the median size of the tumors at surgery (8.5 cm in Varna, SD ± 4.04 vs. 4.4 cm in Bari,SD ± 2.02); T-stage of the tumor (Varna T1-33%, T2-30%, T3-22%, T4-15% vs. Bari T1-64%,T2-12%, T3-24%, T4-0%); N-positive disease (24% vs. 2%); distant metastases (20% vs. 2%)and presence of necrosis in the renal masses (37% vs. 19%). Thus, 85% of Varna patients underwentopen radical nephrectomy, 11% nephron-sparing surgery and 4% explorative laparotomy,due to inoperability of the renal mass. Only 29% of Bari patients were treated by open radicalnephrectomy, 12% underwent laparoscopic nephrectomy, 57% open partial nephrectomy and 2%laparoscopic partial tumor resection.Conclusions: These numbers demonstrate more advantageous tumour features at the Italian clinicin terms of organ-sparing surgical options (open and laparoscopic), whereas in the Bulgarian clinicthe tumour features pose certain limitations to the application of modern surgical techniques.This difference is due to early diagnosis of RCC in Italy, allowing treatment of smaller volumetumors.KEY WORDS: Renal cancer; Radical nephrectomy; Nephron-sparing surgery; TNM classification;Europe; mortality.Submitted 15 June 2009; Accepted 10 December 2009INTRODUCTIONOver 200,000 new cases of kidney cancer are diagnosedyearly worldwide and the disease accounts for approximately100,000 deaths each year. The highest incidence isfound in North America, Europe, and Australia (1).Surgery of early detected renal cell carcinoma (RCC) can becurative, but 20-30% of patients present with metastases atthe time of diagnosis. In addition, 20-40% of patients withprimary localized disease develop metastases (2). Theannual incidence of RCC is approximately 2% in Europeand this figure is continuing to rise. This can largely beattributed to a greater success in detecting small renalmasses (< 4 cm), and has yielded a corresponding increasein the rate of surgical treatment of small tumors (3, 4).In 1969, Charles J. Robson et al. published a paper describingwhat was later to be regarded as the gold standard forRCC radical surgery (5).10Archivio Italiano di Urologia e Andrologia 2010; 82, 1
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Page 27 and 28: PRESENTATIONPercutaneous nephrolith
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Page 31 and 32: PCNL in ItalyTable 1.Number and hos
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Page 35 and 36: The patient position for PNL: Does
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Page 39 and 40: Tubeless percutaneous nephrolithoto
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Page 47 and 48: PRESENTATIONHigh burden stones: The
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Indications, prediction of success
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Indications, prediction of success
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Laparoscopic and open stone surgery
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