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40 7° Congresso Nazionale Associazione Italiana di Endourologia chiusura con Hem-o-lok. Il rene è stato asportato mediante incisione di servizio di 4 cm su pregresso Pfannestiel. In quinta giornata postoperatoria la paziente è stata sottoposta a cistoscopia con litotrissia laser e asportazione dei frammenti residui. È stato inoltre esplorato il moncone ureterale distale in cui alloggiava il calcolo con evacuazione di minuscoli residui litiasici. Risultati: L’esame istologico ha confermato il GENERAL INFORMATION AIMS AND SCOPE “Archivio Italiano di Urologia e Andrologia” publishes papers dealing with the urological, nephrological and andrological sciences. Original articles on both clinical and research fields, reviews, editorials, case reports, abstracts from papers published elsewhere, book rewiews, congress proceedings can be published. Papers submitted for publication and all other editorial correspondence should be addressed to: Edizioni Scripta Manent s.n.c. Via Bassini 41 20133 Milano - Italy Tel. +39 0270608091 - Fax +39 0270606917 e-mail: scriman@tin.it architurol@tin.it www.architurol.it COPYRIGHT Papers are accepted for publication with the understanding that no substantial part has been, or will be published elsewhere. By submitting a manuscript, the authors agree that the copyright is transferred to the Publisher if and when the article is accepted for publication. Archivio Italiano di Urologia e Andrologia 2007, 79, 3, Supplemento 1 quadro di pielonefrite cronica in rene idronefrotico. La paziente è stata dimessa in sesta giornata. La radiografia diretta eseguita a 1 mese dall’intervento non ha dimostrato frammenti residui. Conclusioni: La tecnica laparoscopica abbinata all’utilizzo di endoscopi flessibili è risultata efficace e versatile consentendo un approccio mini invasivo anche nel caso di una situazione insolita come quella da noi affrontata. The copyright covers the exclusive rights to reproduce and distribute the article, including reprints, photographic reproduction and translation. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without thr prior written permission of the Publisher. Registrazione: Tribunale di Milano n.289 del 21/05/2001 Direttore Responsabile: Pietro Cazzola Direzione Generale: Armando Mazzù Direzione Marketing: Antonio Di Maio Consulenza grafica: Piero Merlini Impaginazione: Clementina Pasina Stampa: Parole Nuove s.r.l. - Via Garibaldi 58 20047 Brugherio, Milano - Italy Ai sensi della legge 675/96 è possibile in qualsiasi momento opporsi all’invio della rivista comunicando per iscritto la propria decisione a: Edizioni Scripta Manent s.n.c. - Via Bassini, 41 - 20133 Milano
The role of fluorescent cystoscopy with hexaminolevulinate in the diagnosis of bladder cancer. A. Volpe, F. Porpiglia, M. Billia, R.M. Scarpa Urothelial carcinoma of the bladder is the sixth most common malignant disease in the world. In 75–85% of cases, bladder tumors are superficial at first diagnosis. However, 50–70% of patients presenting with superficial bladder cancer will develop one or several recurrences after initial treatment with transurethral resection (TUR), while 10- 20% will experience disease progression with infiltration of the bladder muscle. White light cystoscopy (WLC) and urinary cytology are the standard methods for detecting bladder cancer, but their sensitivity and specificity are not completely satisfactory, leading to a relatively frequent incomplete detection of primary or recurrent tumors (1,2). Flat urothelial lesions, such as CIS or urothelial dysplasia, are particularly difficult to visualize endoscopically with classical WLC because they are frequently located in unspecifically inflamed or normal appearing mucosa. Even the use of random biopsies does not result in a clinically relevant improvement in the diagnosis of CIS (3). This is particularly important since CIS is characterized by a higher risk of progression to muscle invasive disease. Furthermore, the risk of incomplete removal of tumour tissue during transurethral resection of bladder tumour (TURBT) is significant, either by overlooking flat dysplastic lesions extending from the resected tumour, or tiny papillary satellite tumours. Tumour remnants were found in up to over 50% of cases at a second-look resection 4-6 weeks after a first TURBT (4,5). The tumours that have been missed during the resection will account for at least part of the frequent positive cystoscopies 3-6 months after initial treatment and may be responsible for a decreased survival. To improve the sensitivity of WLC, especially for CIS, fluorescence cystoscopy (FC) has been studied extensively in the last few years (6). FC is a technique of photodynamic diagnosis (PDD). PDD is based on the interaction between a fluorochrome with a high selectivity for tumour cells and light with an appropriate wavelength, which is absorbed by the fluorochrome and reemitted with a different (longer) wavelength. Since the early 1990s, 5-aminolaevulinic acid (5-ALA) has been investigated for the fluorescent detection of urothelial cancer. ALA is a precursor in the heme biosynthesis pathway and induces an accumulation of fluorescent endogenous porphyrins, mainly protoporphyrin IX (PPIX) in tissues of epithelial origin (7). The mechanisms that lead to an increased production of fluorescent PPIX in cancerous tissue are currently not fully understood. Several theories have been proposed, including differences in the level of cellular metabolism, structur- 7° Congresso Nazionale Associazione Italiana di Endourologia Divisione Universitaria di Urologia, ASO San Luigi Gonzaga, Orbassano, Università di Torino al characteristics of diseased urothelium, inflammation with consequent increase in permeability to ALA and hyperproliferation of the urothelium, leading to a cumulative effect. There are mainly two enzymes in the biosynthesis of heme considered responsible for a tumour cell-specific accumulation of PPIX: porphobilinogen deaminase and ferrochelatase. The former is the rate limiting enzyme and has been identified in greater concentrations in tumour tissue. Clinical results with 5-ALA cystoscopy have been very encouraging. Kriegmair et al. first evaluated the significance and feasibility of the procedure, comparing endoscopic findings under white light and fluorescent cystoscopy and histology. A very high correlation was observed between biopsies taken from areas with either negative or positive fluorescence and histological findings. In particular, a sensitivity of more than 95% and a specificity of 68.5% was achieved (8). Other series have subsequently confirmed these findings (9-12). Overall, FC accounts for an increase in the tumor detection rate between 18-76% as compared to WLC. Zaak et al. have the largest experience with 5-ALA FC. In their series tumors were detected only because of positive fluorescence in 26.4% of cases. The incidence of CIS and severe dysplasia in this patient group was 26.9%. Also, in cases of suspicious cytological findings with negative WLC, FC was able to considerably increase the tumor detection rate (7). In addition to flat urothelial lesions, the high rate of residual tumor after TUR represents another reason for the high recurrence rate of bladder tumors after the first resection. A multicentre, randomized prospective trial including 165 patients was carried out in 1997-98 to investigate whether FC-guided TURBT is able to reduce the rate of overlooked tumors. The Authors compared the rate of residual tumours 10-14 days after initial resection and found that 62% of patients were tumor-free after FC-guided TURBT vs. 41% of cases after WLC-guided TURBT (p < 0.01). Therefore, the rate of residual tumor could be reduced significantly by nearly 40% under fluoroscopic guidance (13). In another study of 191 patients with superficial bladder cancer, the residual tumour rate at 5-6 weeks from the initial resection was 25.2% in the WLC arm versus 4.5% in the FC arm (p < 0.0001) (14). Some studies have been also carried out to determine whether FC-guided TUR is able to increase recurrence free survival. Initial results showed a clear trend towards lower recurrence rates in patients who had been resected under Archivio Italiano di Urologia e Andrologia 2007, 79, 3, Supplemento 1 41
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Periodico trimestrale - Spedizione
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7° Congresso Nazionale Associazion
Page 7 and 8: 16 Settembre 2007 7° Congresso Naz
Page 9 and 10: Ore 17:30-18:30 Golden video Tratta
Page 11 and 12: Aula Rossa Video Laparoscopia 1 Mod
Page 13 and 14: Quale TURP: mono o bipolare? C. Ter
Page 15 and 16: 19 settembre 2007 Ore 8:00-9:00 Aul
Page 17 and 18: Ore 9:00-13:30 AUDITORIUM 7° Congr
Page 19 and 20: ABSTRACTS Golden Communications 18
Page 21 and 22: in due casi è stata effettuata una
Page 23 and 24: Materiali e Metodi: con un doppio c
Page 25 and 26: in tutte le altre forme di neoplasi
Page 27 and 28: trissia; in 5 casi sono state utili
Page 29 and 30: manovre endourologiche per la rimoz
Page 31 and 32: matica. Non sono state registrate c
Page 33 and 34: Materiali e Metodi: Presentiamo il
Page 35 and 36: elativamente semplice, riproducibil
Page 37 and 38: Conclusioni: L’incisione laser pe
Page 39 and 40: ma è poco indicata per le fistole
Page 41 and 42: metriosi vescicale. Successivamente
Page 43 and 44: emostasi GYRUS è stata introdotta
Page 45 and 46: mento di scelta per la sua mininvas
Page 47 and 48: stent in quanto in 1 sono stati pos
Page 49 and 50: ilaterale in 3 casi, diretta e bila
Page 51 and 52: vaso di urina è stato trattato con
Page 53 and 54: endovision è piu’ sicura nell’
Page 55 and 56: Il terzo tempo è costituito dal po
Page 57: mente ricavato tra retto e vagina.
Page 61 and 62: 7° Congresso Nazionale Associazion
Page 63 and 64: RESULTS All patients are alive; for
Page 65 and 66: 7° Congresso Nazionale Associazion
Page 67 and 68: low-up. The increase in the mean Qm
Page 69 and 70: REFERENCES 1. Reich O, Gratzke C, S
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