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Biomedical subjects

Giorgio Guazzoni

Publications and source records attributed to Giorgio Guazzoni.

At least 19 recordsLinked to original sources
PubMed2006

Early biochemical outcomes following permanent interstitial brachytherapy as monotherapy in 1050 patients with clinical T1-T2 prostate cancer.

BACKGROUND AND PURPOSE: Five European centres (France, Finland, Italy, Spain and the UK) have pooled data to generate a large patient series involving 1175 patients treated with prostate brachytherapy. This paper reports preliminary data on PSA outcome up to 4 years. PATIENTS AND METHODS: Out of 1175 in the database, 1050 patients with localised prostate cancer who had received transperineal seed implantation as monotherapy between May 1998 and August 2003 were stage T1-T2. A total of 668 (63.6%) patients met the low-risk group definition, 297 (28.3%) as intermediate-risk definition and 66 (6.3%) the high-risk group definition. The majority of patients were Gleason score 6 or less (n=951) and disease stage was T1c in 557 patients. RESULTS: Of the 1050 patients, PSA data up to 4 years were available for 210 patients, while 364 patients with PSA values up to 36 months were evaluable by the Kaplan-Meier method for freedom from biochemical failure. The biochemical progression-free rate at 3 years was estimated to be 91%, with a 93% and 88% rate for low- and intermediate-risk groups, respectively, versus 80% for the high-risk group. PSA kinetics provide encouraging evidence of treatment efficacy. CONCLUSION: These data on 4-year PSA follow-up on patients treated with prostate brachytherapy reflect those previously reported in the literature. This patient series will be followed to provide long-term outcome in the future.

Aged↗
PubMed2006

Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up.

OBJECTIVE: Prospectively evaluate perioperative outcomes and 2-yr follow-up after holmium laser enucleation (HoLEP) and standard open prostatectomy (OP) for treating benign prostatic hyperplasia-related obstructed voiding symptoms, with prostates >70 g. METHODS: From March 2003 to December 2004, 80 consecutive patients were randomised for surgical treatment with HoLEP (n=41) or standard OP (n=39). All patients were preoperatively assessed with International Prostate Symptom Score and International Index of Erectile Function questionnaires and complete urodynamic evaluation. Intraoperative and perioperative parameters such as blood loss, catheter removal, and hospital stays were assessed. Early and late complications were recorded. Patients were evaluated at 1-, 3-, 12-, and 24-mo follow-ups with the same tests. RESULTS: Operating room time was significantly shorter for the OP group (72.09+/-21.22 min vs. 58.31+/-11.95 min, p<0.0001); catheter removal (1.5+/-1.07 d and 4.1+/-0.5 d, p<0.001) and hospital stay (2.7+/-1.1 d vs. 5.4+/-1.05 d, p<0.001) were shorter in the HoLEP group. Blood loss was less and blood transfusions fewer in the HoLEP group (p<0.001). In both groups urodynamic and uroflowmetry findings improved from baseline, were still evident at the 24-mo follow-up, and were comparable between the two groups. Late complications were also comparable. CONCLUSIONS: HoLEP is a feasible technique for treating large prostates. Functional results are similar to OP at the 2-yr follow-up. Reduced catheterisation, hospital stay, and blood loss make HoLEP an attractive option for the treatment of large prostates.

Adenocarcinoma↗
PubMed2006

Intra- and peri-operative outcomes comparing radical retropubic and laparoscopic radical prostatectomy: results from a prospective, randomised, single-surgeon study.

OBJECTIVES: To prospectively compare intra- and peri-operative outcomes of open radical retropubic prostatectomy (RRP) and laparoscopic prostatectomy (LRP) by a single surgeon. PATIENTS AND METHODS: One-hundred-twenty, consecutive, age-matched patients diagnosed with clinically localized prostate cancer were eligible for surgery. Sixty patients underwent RRP and 60, LRP. Intra- and peri-operative parameters, pathologic findings and early complications were recorded. A validated visual analogue scale was used to assess pain in the recovery room, 3 h after the operation and on post-operative days 1, 2 and 3. A cystogram was performed on post-operative day 5. RESULTS: Operating time was significantly shorter in the RRP group versus the LRP group (mean+/-SD, 170+/-34. 2 vs 235+/-49.9 min, p<0.001). Blood loss was significantly less in the LRP group versus the RRP group (mean+/-SD, 853.3+/-485 vs 257.3+/-177 ml, p<0.001), but no patient in either group underwent early re-intervention for bleeding. The RRP group showed a trend for higher use of analgesia. A watertight anastomosis was shown at cystourethrography and the catheter removed in 86% and 66% of LRP and RRP patients, respectively. The overall percentage of post-operative complications and positive margins were comparable. CONCLUSION: Laparoscopic prostatectomy is an attractive alternative to open prostatectomy, offering the advantages of reduced blood loss and safe early catheter removal. Furthermore, the laparoscopic procedure proved to be safe oncologically. Long-term follow-up is required to compare functional results in terms of continence and potency.

Aged↗
PubMed2006

Anastomotic fibrous ring as cause of stricture recurrence after bulbar onlay graft urethroplasty.

PURPOSE: We retrospectively reviewed patterns of failure after bulbar substitution urethroplasty. In particular we investigated the prevalence and location of anastomotic fibrous ring strictures occurring at the apical anastomoses between the graft and urethral plate after 3 types of onlay graft techniques. MATERIALS AND METHODS: We reviewed the records of 107 patients who underwent bulbar urethroplasty between 1994 and 2004. Mean patient age was 44 years. Patients with lichen sclerosus, failed hypospadias repair or urethroplasty and panurethral strictures were excluded. A total of 45 patients underwent dorsal onlay skin graft urethroplasty, 50 underwent buccal mucosa onlay graft urethroplasty and 12 underwent augmented end-to-end urethroplasty. The clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean followup was 74 months (range 12 to 130). RESULTS: Of 107 cases 85 (80%) were successful and 22 (20%) failed. Failure in 12 patients (11%) involved the whole grafted area and in 10 (9%) it involved the anastomotic site, which was distal and proximal in 5 each. Urethrography, urethral ultrasound and urethroscopy were fundamental for determining the difference between full-length and focal extension of re-stricture. Failures were treated with multistage urethroplasty in 12 cases, urethrotomy in 7 and 1-stage urethroplasty in 3. Of the patients 16 had a satisfactory final outcome and 6 underwent definitive perineal urinary diversion. CONCLUSIONS: The prevalence and location of anastomotic ring strictures after bulbar urethroplasty were uniformly distributed in after 3 surgical techniques using skin or buccal mucosa. Further studies are necessary to clarify the etiology of these fibrous ring strictures.

Adolescent↗
PubMed2006

Urodynamics after TURP and HoLEP in urodynamically obstructed patients: are there any differences at 1 year of follow-up?

OBJECTIVES: To compare urodynamic findings after holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) for the treatment of benign prostatic hyperplasia-related bladder outlet obstruction. METHODS: From January to October 2002, 100 consecutive patients with benign prostatic hyperplasia with obstructive lower urinary tract symptoms were randomized to surgical treatment with either HoLEP (group 1, n = 52) or TURP (group 2, n = 48). All patients were preoperatively assessed using the International Prostate Symptom Score and quality-of-life question, total serum prostate-specific antigen measurement, transrectal ultrasonography, and complete urodynamic study. The operative time, catheterization time, and overall hospital stay were also recorded for both groups. All patients were assessed at 1, 6, and 12 months postoperatively using a complete urodynamic evaluation. RESULTS: All patients were obstructed preoperatively (Schäfer grade greater than 2). Both groups were comparable in terms of age, total serum prostate-specific antigen level, International Prostate Symptom Score, and urodynamic results. At 1, 6, and 12 months of follow-up, no statistically significant differences were recorded in terms of detrussor pressure at maximal urinary flow rate, Schäfer grade (linear passive urethral resistance relation), maximal urinary flow rate, International Prostate Symptom Score, and quality-of-life score. In the HoLEP group, the catheterization time and hospital stay were significantly shorter. Transitory lower urinary tract symptoms after 3 months of follow-up and dysuria were more frequent in the HoLEP group than in the TURP group, although at 12 months of follow-up, the results were comparable. CONCLUSIONS: Both HoLEP and TURP were equally effective in relieving bladder outlet obstruction. Although associated with greater early self-resolving irritative symptoms, HoLEP can guarantee a shorter catheterization time and hospital stay with longer operative times, proposing itself as an attractive alternative to standard TURP.

Aged↗
PubMed2006

Bone metastases are infrequent in patients with newly diagnosed prostate cancer: analysis of their clinical and pathologic features.

OBJECTIVES: To investigate the clinical and pathologic characteristics of patients with bone metastases identified at the time of newly diagnosed prostate carcinoma at biopsy. METHODS: From November 2002 to May 2004, 1587 consecutive patients had a pathologic diagnosis of prostate cancer and underwent conventional technetium-99m methylene diphosphonate scintigraphy of the entire body. The clinical and pathologic features of those patients with positive bone scan findings (group 1) were compared with those of a subcohort of 372 patients with negative bone scan findings performed at the same nuclear medicine department (group 2). RESULTS: A retrospective complete data collection was available for 1242 of 1587 patients. Bone metastases were found in 31 patients (2.5%). As expected, patients with skeletal metastases had a significantly greater mean serum total prostate-specific antigen level, and a Gleason sum of 8 or 9 was significantly more frequent in the pathologic findings of these subjects. Group 1 patients had a significantly greater prevalence of previous nonprostate primary neoplasms (chi-square 12.74, df = 1, P = 0.0004) and reported a greater prevalence of current use of H2 blockers for the treatment and prevention of gastroesophageal reflux disorders (chi-square 37.52, df = 1, P < 0.0001) than did group 2 patients. CONCLUSIONS: Our data have confirmed that bone metastases are more frequent in patients with high prostate-specific antigen levels and poorly differentiated tumors at biopsy regardless of the patient's age. A history of previous nonprostate primary neoplasms and the use of H2 blockers seemed to be more prevalent in those patients with bone metastases at diagnosis.

Aged↗
PubMed2006

Cost containment in laparoscopic radical nephrectomy: feasibility and advantages over open radical nephrectomy.

PURPOSE: To highlight the impact of the laparoscopic experience of the surgical team on achievement of satisfactory results with cost containment in performing laparoscopic radical nephrectomy (LRN). PATIENTS AND METHODS: We compared the cost components of 15 consecutive uncomplicated LRNs performed in 2001 (LRN01) with 15 consecutive uncomplicated laparoscopic radical nephrectomies performed in 2003 (LRN03) and with 15 consecutive uncomplicated procedures performed at our institution by the same surgical team in the year 1999 matched for patient age, tumor size, and disease stage. The groups were comparable in demographics. RESULTS: The operative times were 250, 225, and 195 minutes in the LRN01, LRN03, and open-surgery groups, respectively, while the lengths of postoperative stay were 3.8, 3.1, and 6.5 days. Operating room costs, excluding the disposable instruments, were 11.00 /min for the open surgery and 10.00 /min for laparoscopic nephrectomy, and the cost of the postoperative stay was 300 to 310 per day. The cost of disposable instruments was 952.18 for LRN01 and 146.37 for LRN03. The overall costs were 4155.00 for the open-surgery group, 4672.00 for LRN01, and 3336.37 for LRN03. CONCLUSIONS: Cost containment in laparoscopic nephrectomy is possible. A proper team learning curve and the employment of reliable reusable instruments is the key to reducing costs, making this procedure as economically advantageous as the equivalent open procedure.

Cost Control↗
PubMed2006

Hormonal treatment for prostate cancer in Italy. Preliminary data from a survey of the QUABIOS Group.

OBJECTIVE: An observational study was planned by the QUABIOS group, to survey the hormonal modalities administered to prostate cancer patients in Italy within a time window of 12 months. We report here a summary of treatment schedules and related adverse effects, as recorded at the first visit. MATERIAL AND METHODS: Patients with diagnosis of prostate cancer and under hormonal therapy (LHRH-a and/or antiandrogen, previous orchidectomy) were eligible for this study. Adverse events were reported (graduated according to NCI-CTC v2.0, when pertaining) only in patients having received at least three months of hormonal treatment. RESULTS: 560 patients were enrolled from February to December, 2004 by 33 urological centers in Italy. A moderate to severe impairment of sexual function subsequent to the hormonal treatment was observed in 18.3% of patients treated with antiandrogen monotherapy, in 48.1% of patients treated with LHRH-a, and in 59.9% of patients treated with the combined approach. 24.7% patients referred a gastrointestinal toxicity (nausea/vomiting and diarrhea), without clear differences between treatment modalities. An asthenia subsequent to the hormonal treatment was moderate to severe in 3.5% of patients treated with antiandrogen monotherapy, as compared to 14.5% for LHRH-a and 12.9% for the combined approach, respectively. A gynecomastia / breast pain was present in 27.8% of antiandrogen monotherapy patients, as compared to 13.9% for LHRH-a and 13.8% for the combined approach, respectively. As compared to cyproterone acetate, bicalutamide had more sexual function impairment, more gastrointestinal toxicity, (slightly) more asthenia and more gynecomastia / breast pain. CONCLUSIONS: In our series antiandrogens were obviously associated with less sexual function impairment and less asthenia than LHRH-a containing schedules; on the other hand gynecomastia mainly affected patients receiving antiandrogen monotherapy. Within antiandrogens, cyproterone acetate generally appeared to be better tolerated than bicalutamide, with less severe impairment of sexual function, less gastrointestinal toxicity and negligible gynecomastia.

Aged↗
PubMed2005

Dorsal onlay graft urethroplasty using penile skin or buccal mucosa for repair of bulbar urethral stricture: results of a prospective single center study.

OBJECTIVE: To compare the outcomes of dorsal onlay graft urethroplasty using penile skin (PS) or buccal mucosa (BM) free grafts in the repair of adult bulbourethral strictures. METHODS: From January 1998 to March 2003, 30 patients with bulbar urethral strictures underwent urethral reconstruction with PS (17) or with BM free graft (13). Follow-up was done at 6, 12 and 18 months postoperatively, and every year subsequently. Success was defined as normalization of IPSS and a stable Q(max) value >20 ml/s. Any further instrumentation for stricture recurrence was considered a failure. RESULTS: Mean follow-up was 51 months (20-74). The overall success rate was 80% (85% in the BM and 76% in the PS group). Improvement of uroflowmetry, IPSS and QoL did not show a significant difference between the two groups. A significant improvement of the orgasmic function domain of the IIEF was found in patients treated with a PS graft. Post-operative complications were lip hypoesthesia (30%), retraction of the ventral skin of the penis (7%), post-voiding dribbling (8% with BM graft, and 7%, with PS graft). Six patients, 2 with BM (15%) and 4 with PS graft patch (24%) required further treatment due to stricture recurrence. CONCLUSION: Results of PS or BM graft are comparable at 18 month follow-up, although orgasmic function is significantly improved in patients receiving a PS graft. Nevertheless, with extended follow-up, the use of PS seems to be associated with a higher failure rate.

Adult↗
PubMed2005

Nerve-sparing laparoscopic cystectomy.

Laparoscopic radical cystectomy has been included among the viable options for the surgical treatment of muscle-invasive bladder cancer. Even with the minimally invasive approach, it must be considered a major surgical intervention and, even in experienced hands, it can be associated with a significant percentage of complications with a negative impact on overall quality of life, especially in terms of continence and sexual potency. According to our Medline search, only two papers are available from the literature on laparoscopic and robotic versions of nerve- and seminal-sparing cystectomy and nerve-sparing cystectomy, performed respectively on three and 17 patients, showing the feasibility and preliminary results of those surgical procedures. Therefore, data seem encouraging, but further prospective studies are mandatory to correctly assess oncologic and functional results in terms of potency and continence maintenance related to these innovative techniques.

Carcinoma, Transitional Cell↗
PubMed2005

Update of the minimally invasive therapies for benign prostatic hyperplasia.

PURPOSE OF REVIEW: The elevated impact benign prostatic hyperplasia has on patient quality of life has determined continuous research into the development of minimally invasive therapies aimed at restoring or preserving a good quality of life. The purpose of this review is to highlight recent developments in the field of minimally invasive treatment of benign prostatic hyperplasia, and to determine their possible impact on everyday clinical practice. RECENT FINDINGS: Recent publications have described some interesting new therapies and provided data concerning long-term follow up and cost-effectiveness that have been lacking up until now. The review mainly focuses on transurethral microwave thermotherapy, interstitial laser coagulation, transurethral laser ablation, laser prostatectomies (resection and enucleation), transurethral ethanol injection therapy, transurethral electrovaporization, and high-power (80-W) potassium titanyl phosphate laser vaporization. SUMMARY: Recent developments, new approaches and long-term reports of previously described minimally invasive therapies for the treatment of benign prostatic hyperplasia are presented. Cost-effectiveness studies were also carried out to complete the comparison with standard everyday procedures. Currently, transurethral microwave thermotherapy seems to offer the soundest basis for management of the condition, providing the longest term follow up and the largest numbers of studies completed to date. Among surgical alternatives, holmium laser enucleation has gained ground as an encouraging new approach, being similar to standard transurethral resection of the prostate, but reducing perioperative morbidity with the same long-term results. More randomized comparisons correctly conducted need to be undertaken before an accurate general picture is available for the urologist.

Humans↗
PubMed2005

Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique?

PURPOSE: The use of buccal mucosa graft onlay urethroplasty represents the most widespread method of bulbar urethral stricture repair. The graft may be placed on the ventral or dorsal urethral surface according to surgeon experience and preference. We investigated whether the results are affected by the surgical technique by comparing the outcome of 3 types of bulbar urethroplasty using buccal mucosa graft. MATERIAL AND METHODS: We repaired 50 bulbar urethral strictures with buccal mucosa grafts from 1997 to 2002. Mean patient age was 42 years. The etiology of stricture was ischemia in 12 cases, trauma in 6, instrumentation in 4 and unknown in 28. Patients with lichen sclerosus, failed hypospadias or urethroplasty and stricture extending into the penile urethra were not included. A total of 47 patients (94%) had undergone previous urethrotomy or dilation. The buccal mucosa graft was always harvested from the cheek using a 2 team approach. Mean graft length was 4.2 cm. The graft was placed on the ventral, dorsal and lateral bulbar urethral surface in 17, 27 and 6 cases, respectively. Clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean followup was 42 months (range 12 to 76). RESULTS: Of 50 cases 42 (84%) were successful and 8 (16%) failed. The 17 ventral grafts provided success in 14 cases (83%) and failure in 3 (17%). The 27 dorsal grafts provided success in 23 cases (85%) and failure in 4 (15%). The 6 lateral grafts provided success in 5 cases (83%) and failure in 1 (17%). No surgical complications were observed. Failures involved the anastomotic site (distal in 2 and proximal in 3) and the whole grafted area in 3 cases. They were treated with urethrotomy in 5 cases and 2-stage urethroplasty in 3. CONCLUSIONS: In our experience the placement of buccal mucosa grafts into the ventral, dorsal or lateral surface of the bulbar urethra showed the same success rates (83% to 85%) and the outcome was not affected by the surgical technique. Moreover, stricture recurrence was uniformly distributed in all patients.

Adolescent↗
PubMed2005

Laparoscopic adrenalectomy and adrenal-preserving surgery.

PURPOSE OF REVIEW: The aim of this paper is to define the current role of laparoscopy in the management of surgical adrenal diseases evaluating the surgical aspects, the indications and contraindications of laparoscopic adrenalectomy, focusing also on the most innovative tendencies in the laparoscopic adrenal-preserving surgery. RECENT FINDINGS: Recent publications have described some interesting new indications that need to be confirmed by long-term follow up. The present review mainly focuses on defining the state of the art of current adrenal laparoscopic surgery. SUMMARY: Laparoscopic adrenalectomy is becoming the 'platinum standard' for the treatment of the adrenal surgical diseases and it should be considered the treatment of choice for benign adrenal diseases. In cases of malignancy and conservative surgery, adrenalectomy appears to be very promising, although a longer follow up and further studies are still needed to accurately assess the role played by these procedures. Finally, who should do laparoscopic adrenalectomy? Every patient who requires the ablation of the adrenal should receive laparoscopic opportunity. And the surgeons? Only those with advanced laparoscopic skills and a good knowledge of adrenal anatomy and pathophysiology will obtain the same excellent results currently reported in the literature.

Adrenal Gland Diseases↗
PubMed2004

Sexual dysfunction is common in women with lower urinary tract symptoms and urinary incontinence: results of a cross-sectional study.

OBJECTIVE: The aim of this study was to determine the prevalence of sexual dysfunctions in women with urinary incontinence and/or lower urinary tract symptoms as compared to a general female population. METHODS: We extensively evaluated 227 consecutive women (mean age 52; age range 19-66) complaining of urinary incontinence (UI) and/or lower urinary tract symptoms (LUTS) with a comprehensive history (including several validated questionnaires), a complete physical examination and a urodynamic multichannel evaluation. Two hundred and sixteen patients were eligible for sexual function investigation because 11 out of 227 (5%) were not interested in dealing with questions regarding their own sexuality and were thus excluded from the final evaluation results. A group of 102 age-matched women (mean age 54; age range 19-63) assessed for a yearly routine gynaecological evaluation and not complaining of urinary symptoms were enrolled as cross-sectional controls and investigated in accordance with the Female Sexual Function Index (FSFI). RESULTS: Sexual dysfunction was diagnosed in 99 out of 216 patients (46%). Of these, 34 (34%) reported hypoactive sexual desire, 23 (23%) reported sexual arousal disorder; 11 patients (11%) complained of orgasmic deficiency, and 44 (44%) suffered from sexual pain disorder (e.g., dyspareunia or non-coital genital pain). Women reporting low sexual desire commonly suffered from stress incontinence (47%). We found that 60% of the women with sexual arousal disorders and 61% of those with sexual pain disorders also complained of recurrent bacterial cystitis. Forty-six percent of those complaining of orgasmic phase difficulties also reported a troublesome urge incontinence. The FSFI values in both groups scored as follows (patients versus controls; median value; p value): desire: 2.0 vs. 3.2 (p<0.01); arousal: 2.8 vs. 3.6 (p=n.s.); lubrication: 3.2 vs. 4.4 (p=0.01); orgasm: 4.1 vs. 4.4 (p=n.s.); sexual satisfaction: 2.7 vs. 4.0 (p<0.01); sexual pain: 1.8 vs. 4.0 (p<0.001). CONCLUSIONS: Women reporting UI or LUTS also complained of sexual dysfunctions in a significantly higher number than a general, healthy female population not complaining of urinary symptoms. Investigation of female sexuality is suggested for these patients.

Adult↗
PubMed2004

Holmium laser enucleation versus transurethral resection of the prostate. Are histological findings comparable?

PURPOSE: We investigated if an adequate histological diagnosis can be made from tissue after holmium laser enucleation of the prostate (HoLEP) and whether it is comparable to transurethral prostate resection (TURP) tissue findings in patients with benign prostatic hyperplasia. MATERIALS AND METHODS: We analyzed 40 HoLEP and 40 age matched TURP tissue specimens from patients who underwent 1 of the 2 procedures between January 2001 and August 2002. Each histological specimen was reviewed by a single pathologist. Preoperative prostate ultrasound volume, total serum prostatic specific antigen and postoperative tissue weight were evaluated. Microscopic histological diagnosis was assessed by standard histological techniques and immunohistochemical evaluation. RESULTS: Patients were comparable in terms of age and preoperative total serum prostate specific antigen. Tissue remaining following the procedure was estimated to be 36.3% of preoperative ultrasound volume after HoLEP and 52.8% after TURP (p <0.001). Incidental adenocarcinoma and high grade PIN of the prostate were diagnosed in a comparable percent of specimens in the 2 groups. Tissue thermal artifacts induced by the laser were mostly due to coagulation. Thus, the alterations were similar to those after TURP. CONCLUSIONS: Tissue quality is altered after HoLEP and TURP. General prostatic architecture was maintained in the majority of HoLEP histological specimens. A moderately higher percent of prostatic tissue obtained by the Ho laser is lost by vaporization and coagulation. Nevertheless, these differences do not seem to alter pathologist ability to detect incidental prostate cancer and PIN.

Holmium↗
PubMed2004

Laparoscopic cryoablation of solid renal masses: intermediate term followup.

PURPOSE: We report our experience with laparoscopic renal cryoablation (LRC) in select cases of small renal neoplasms. We evaluated the oncological results with the advantages of minimally invasive surgery. MATERIALS AND METHODS: Since September 2000, at our department 37 patients with a mean age of 64 years (range 29 to 89) have undergone LRC for computerized tomography or magnetic resonance imaging (MRI) documented renal masses. Mean lesion diameter was 25.7 mm (range 10 to 60). According to tumor position in 22 cases the procedure was performed transperitoneally and in 15 it was done retroperitoneoscopically. Postoperative followup included MRI on postoperative day 1, 1, 3, 6, 12, 18 and 24 months after surgery, and annually thereafter. Moreover, 6 months following the surgical procedure biopsy of the site of the treated neoplasm was performed. RESULTS: The laparoscopic procedure was successfully completed in all cases. Mean operative time was 194 minutes (range 120 to 300) and mean blood loss was 165.3 ml (range 20 to 900). Final histological evaluation revealed renal cell carcinoma in 29 cases and oncocytoma in 6, while 2 were reported as indefinite. All patients were discharged home after a mean of 3.8 days (range 3 to 7) and returned to normal social life after a mean of 7.3 days (range 5 to 9). Early and postoperative complications were evaluated. Mean diameter of the cryolesion on postoperative day 1 on MRI was 48.2 mm and it progressively decreased during followup. Of the 35 patients with at least 6 months of followup computerized tomography guided biopsy was performed in 25, who were negative for neoplasm. CONCLUSIONS: LRC for small renal masses appears to be a safe, reproducible, minimally invasive technique. Medium term followup in our series is encouraging, although further studies and prolonged followup are needed to access properly the role of this surgical technique.

Adenoma, Oxyphilic↗