Acta Urológica Portuguesa最新文献

Purpose

To evaluate the relationship between mean apparent diffusion coefficient (ADC) and post-surgical Gleason scores. To determine the diagnostic accuracy of multiparametric magnetic resonance imaging (mp-MRI) on a 1.5 T magnet in distinguishing low, intermediate and high-grade prostate tumors.

Material and methods

This is a retrospective institutional-review-board-approved, single-center study including 30 patients (median age, 60 years) who underwent mp-MRI before prostatectomy for prostate cancer. Using histological reports for guidance, the tumors were localized in ADC maps, and mean ADCs were measured and examined for correlation with Gleason scores. 2 patients had 2 measurable foci, so a total of 32 tumors were studied. The diagnostic accuracy of the mean ADC was assessed by using the area under the receiver operating characteristic curve (ROC).

Results

In the differentiation of tumors with a Gleason score of 6 from those with a Gleason score of at least 7, mean ADC yielded an AUC of 0.76 (95% confidence interval: 0.59, 0.93). In the differentiation of tumors with Gleason scores of 6 or 7 from those with a Gleason score of at least 8, mean ADC yielded an AUC of 0.94 (95% confidence interval: 0.86, 1.00).

Conclusion

Mean ADC values may allow a correct assessment of the patient risk using a 1.5 T magnet without ERC.

Introduction

Fibroepithelial polyps are extremely rare benign tumors arising from mesodermal tissue in the ureteral wall in children, that can cause ureteropelvic junction obstruction.

Case report

In this report, we present an 11‐year‐old boy complaining of left intermitent lumbar pain related with ipsilateral hydronephrosis. Surgical exploration revealed several endoluminal polyps located at the ureteropelvic junction, obstructing the lumen of the ureter.

Discussion

Standard treatment consists in resection of the affected ureteral segment followed by open or laparoscopic dismembered pyeloplasty. The prognosis is excellent.

Introduction

Over the past few years, the increasing use of cross‐sectional imaging, including ultrasound and computed tomography imaging, resulted in an increase incidental diagnosis of renal tumors, especially small renal masses (< 4 cm). The knowledge that 30% of these masses may be benign, including oncocytomas led to the investigation for more effective methods of diagnosis in order to avoid overtreatment situations.

Objectives

The authors decided to analyse and compare contrast enhancement patterns of oncocytomas and clear‐cell renal cell carcinoma (ccRCC) to predict histology.

Material and methods

Between 2004‐2015 we retrospectively identified 32 patients with either histological confirmation of renal oncocytoma (N = 16) or ccRCC (N = 16) who underwent percutaneous biopsy, total or partial nephrectomy. The relative attenuation of solid renal lesions and normal renal cortex was determined in the unenhanced and nephrographic phase. Statistical comparison was carried out by Mann‐Withney test.

Results

The oncocytomas and cc‐RCC average size was 3.7 cm [1.8 to 14] and 3.5 cm [1.9 to 8.4], respectively. The average attenuation in the unenhanced phase was 33 HU and 32 HU, respectively. In nephrographic phase, the average contrast enhancement was 47.5 and 47.4 H, respectively. In nephrographic phase, the attenuation difference between the oncocytomas and normal renal cortex was 43.5 HU and the attenuation difference between the cc‐RCC and normal renal cortex was 59.7 HU. These results were statistically significant (p < 0.05).

Conclusions

In the nephrographic phase, URO‐CT reveals that oncocytomas have greater isodensity to the normal renal cortex compared to cc‐RCC. This finding can help us to determine which lesions we should biopsy or not.

Aim

In the evaluation of prostate cancer, clinical nomograms are commonly used to predict the probability of lymphatic and extra‐nodal spread. Those nomograms may suggest the presence and the extension of this cancer but do not allow a clear distinction between loco‐regional and distant disease. In this study, it was intended to evaluate the usefulness of 18F‐Fluorocoline positron emission tomography/computed tomography (18F‐FCH‐PET/CT) in the workup of patients with the initial diagnosis of prostate cancer and staged by this imaging technique.

Material and methods

The medical records of 39 patients with prostate cancer who underwent 18F‐FCH PET/CT for initial staging, between November 2010 and April 2015, were reviewed. Of these, 20 patients were excluded because they had already started hormonotherapy. In the other 19 patients, the performance of 18F‐FCH PET/CT for the detection of lymph node metastasis was evaluated by calculating the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy. Six patients had performed pelvic lymphadenectomy (total of 69 lymph nodes), allowing histological confirmation. When there was no histological confirmation (total of 30 lymph nodes and 3 cases of bone metastasis), the findings of 18F‐FCH PET/CT were correlated with the values of PSA and the information from multiple imaging modalities such as CT, bone scan, magnetic resonance (MRI), 18F‐Sodium Fluoride (18F‐NaF) PET/CT of control.

Results

The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for lymph node metastasis detection were, respectively, 96.8%, 80.9%, 69.8%, 98.2% and 85.8%. In our sample, this technique also allowed the identification of nodal extra pelvic or bone metastasis in 5 patients (26.3%) with implications in the treatment. It showed uptake suggestive of bone metastasis, corroborated by other diagnostic technics or by the follow‐up, in 3 patients, those with prostate specific antigen (PSA) of 9.5 ± 2.9 ng/mL.

Conclusion

18F‐FCH PET/CT is an entire body and multi organ imaging modality that allows the identification, globally, of the sites of disease in patients with prostate cancer. In this study, 18F‐FCH PET/CT showed good results when used in the initial staging of these patients. It is highlighted the ability to detect distant disease, in particular bone metastasis, even with PSA< 20 ng/mL.

In the PSA era, the incidence of localized prostate cancer has been increasing. This reality requires new therapeutic strategies, in order to give an answer to patients, in whom active surveillance may be indicate but desire more interventionist strategy with minimal side effects and without compromising cancer control. In these cases, focal therapies that include irreversible electroporation may be effective alternative strategies. The irreversible electroporation is an emergent approach on focal treatment of localized PCa. The nonthermal mechanism that preserves the tissue architecture without damaging tissue structures, such as vessels and nerves within the target region, is the main advantage comparatively to other techniques used in focal treatment. The number of clinical studies is reduced and the results still immature.

Introduction and Objectives

Penile prosthesis implantation is a common, well‐established treatment for correcting medical refractory erectile dysfunction. Although more invasive than some of the other currently available therapies, PP surgery has the advantages of high patient satisfaction rates. The aim of this study was to evaluate the surgical results and patient satisfaction after implantation of PP in 25 patients treated at the University Hospital of Coimbra (CHUC).

Material and Methods

We evaluated 25 patients with erectile dysfunction who underwent implantation of PP, inflatable and semi‐rigid, between November 2000 and November 2013. The information was obtained from medical records and telephone interviews and encompassed clinical severity, comorbidity, etiology, PP type, surgical complications, need for reintervention and degree of patient satisfaction.

Results

88% of patients had severe ED. The main etiologies reported were: multifactorial (46.4%), atherogenic (24%) and neurologic (16%). Most devices implanted were inflatable prostheses (84%). In 80% of the cases there were no complications reported; the rate of re‐intervention was 20%. There were a high percentage of satisfied / very satisfied patients (65%).

Discussion/Conclusion

PP surgery remains an excellent alternative in restoring erectile function in patients whose medical therapies have failed. Despite its invasive nature, the implementation of PP has proven to be associated with a low rate of complications and a high degree of patient satisfaction.