A case of bladder explosion with wide rupture during transurethral resection of the prostate (TURP) is reported. Immediate cystography was performed and the patient was promptly operated; the postoperative course was uneventful. Intravesical explosion is caused by explosive gas formation and the more dangerous combination is the mixture of air and hydrogen; therefore, the introduction of air during TURP is necessary in order to produce a bladder explosion. This unusual complication of a common urological procedure is rare but serious, and should it arise always requires immediate surgical correction.

Objective: To look for the presence of colonic metaplasia (CM), the shifting from sialomucins (SIs) to sulfomucins (SUs), considered as a probably premalignant lesion in the stomach in the mucosa of the ileal neobladder (IN). Methods: 19 patients with IN were subjected to endoscopic biopsy; the samples were analyzed by means of histochemistry with high iron diamine, a test indicated to identify SIs and SUs. Results: CM was never observed earlier than 1 year after the operation, was absent in 9/19 patients (mean follow-up 14 months) and present in 10/ 19 (mean follow-up 59 months). Conclusion: Time-dependent phenotypic changes, already described in the stomach as being premalignant, take place after constant contact with urine in the mucosa of the IN. It is at present unclear whether they may be defined as only metaplastic or frankly preneoplastic; anyway, a careful follow-up remains indicated in all patients with intestinal urinary diversions.

Colonic metaplasia with shifting from sialo-to sulfomucins was observed in 10/18 patients with ileal orthotopic neobladder; their median follow-up was 59 months. There is a significant statistical relationship (p = 0.002) between Colonic Metaplasia and a follow-up longer than 14 months. Diversion Cancer is nowadays a practical problem and probably urologists will be confronted with it in the future more than at present. A modification of established attitudes as regards urinary diversion in standard situations (i.e., 60 over years old patients with invasive bladder cancer) don't seems, at present, justified, although our study confirms the suspicion that ileal neobladder could be considered theoretically at risk for cancer onset.

– A retrospective analysis was carried out to assess the prognostic significance of microvascular invasion (mV) in 48 patients with pT3aN0M0 renal cell cancer. mV is defined in this study as the definite presence of neoplastic thrombosis, more or less adhering to and/or infiltrating the walls of the small venous vessels. Taking into consideration just neoplasms with a nuclear grading of 2 and 3 (according to Fuhrman), at the time of the study 65% of deceased patients were mV+, while 74% of living patients were in mV-. The probabilities of survival, according to Kaplan Mayer, in the two groups of patients appear to be significantly influenced by the mV+ and mV- factor. It can be concluded that this factor, histologically easy to determine, is useful for selecting a sub-group of patients with a more unfavourable prognosis.

There are several diagnostic procedures that can identify patients with recurrent or primary transitional cell carcinoma (TCC) of the bladder. Cystoscopy is the best tool and the golden standard against which the other tools have to be compared. In our experience the BTA test has proved more accurate than urinary cytology, above all in diagnosing low-grade, low-stage TCC of the bladder.

BPH patients may be asymptomatic or symptomatic and the latter with or without obstruction. Symptoms may be independent of the obstruction. The endoscopic or surgical ablation of the enlarged gland has a percentage of failure in all reports. The urodynamics study including uroflowmetry, pressure flow study with application of nomogram for the obstruction provides a certain diagnosis of obstruction in the majority of cases.

— Laser treatment of benign prostatic hypertrophy (BPH) has gradually become more widespread over the last few years. In the USA it is considered an alternative to endoscopic resection as far as insurance payments are concerned. Different methods are used but the most common and suitable one for urologists is the removal and coagulation of the prostatic tissue under visual control (VLAP or ELAP). The Authors report their personal experience in this type of treatment where good results are due to: 1) combination of a powerful, stable laser source 2) durable side-emission contact fibre 3) laser resector, which also in the absence of epicystostomy maintains a good flow during the operation. However, “laser resection” should still be considered an experimental procedure to be used for randomised protocols or on selected patients (high risk of bleeding, Jehovah's witnesses, carriers of pace-maker, etc.).

We report a case of paratesticular desmoplastic small cell tumor. In accord with the literature, the patient was subjected to treatment with combined chemotherapy, but he developed progression of disease and died 13 months later.

Leydig Cell Tumours (LCT) account for 3% of all testicular tumours; 10% are malignant and are refractory to radio- and chemotherapy. The role of Retroperitoneal Lymph Node Dissection in clinical stage I LCT is therefore a particularly debated one. From March ‘83 to December ‘95, 10 patients with LCT were subjected to orchiectomy (1 of them bilaterally because of a metachronous tumour). In 10 out of 11 specimens the following pathological features – a) size larger than 50 mm, b) infiltration of spermatic cord, c) lymphatics and veins, d) capsule, e) necrosis, f) cellular pleomorphism, g) numerous mitoses, h) nuclear atypia – were absent. The only patient in which b) and d) were present was subjected to RPLND. After a follow-up ranging from 17 to 157 months all patients are disease-free. Abstention from RPLND in clinical stage I LCT therefore seems the more rational choice when the above- listed pathologic features are absent.

The Authors describe their limited but significant experience (101 cases) regarding the diagnostic and therapeutic approach to patients with multiple traumas with involvement of the urogenital tract. Approach to the renal trauma in these patients appears to be highly controversial. Experience has shown that in cases of severe renal trauma, when the urologist is called immediately to visit the patient so that a complete and correct urological diagnostic procedure can be planned, the possibilities of conservative treatment to save the kidney are greater.

Sixty-nine patients with localised prostatic cancer, who could not undergo radical prostatectomy due to loco-regional lymph node metastasis or anaesthesiological counter-indications, were subjected to a combined treatment, radiation therapy and androgen deprivation. All patients underwent pelvio-lymphadenectomy and those with cervico-urethral obstruction, endoscopic resection of the prostate. There was a progression of the disease in 33% of patients with lymph node metastasis (median time of progression 33 months) and in 27% of those without (median time of progression 22 months). Stable disease in 67% of patients (median follow-up over 3 years).

Two cases of sarcoma of the spermatic cord in adults are described: a well-differentiated liposarcoma and a high-grade leiomyosarcoma. Elective treatment for both was radical orchiectomy and adjuvant radiation therapy. As already reported in literature, the prognosis for these two patients is not unfavourable.

— We present a case of scrotal localization of “small round cell tumour”. The patient, a 28-year-old man, underwent orchifunicolectomy and antiblastic chemotherapy (platinum, adriamycin, cyclophosphamide) and died after 13 months.

— The Authors describe a new software for prostate transrectal ultrasound biopsy (TRUSB) patient management.

DNA nuclear ploidy determined by flow cytometry was evaluated from prostatic tissue in 64 patients with prostatic cancer who had undergone radical prostatectomy. DNA ploidy was compared to tumour stage, tumour grading (Gleason score), PSA. DNA ploidy pattern was diploid in 46% and aneuploid in 54% of the tumours. Tumours pathologically staged B acc. to AUS were aneuploid in 25%, those staged C in 59% and those staged D in 66.6%. Aneuploidy was found in 36% of the tumours with Gleason score between 2 and 4, in 63% between 5 and 7 and in 45% between 8 and 10. Mean preoperative seric PSA was 34.3 ng/ml in diploid tumours and 39.8 ng/ml in aneuploid neoplasms. Our results suggest no relationship between tumour stage, grade and preoperative PSA.

La ploidie nucleaire de l'ADN determinee par la cytometrie en flux a ete evaluee sur le tissu prostatique de 51 patients ayant un carcinome prostatique traite par prostatectomie radicale. Le contenu en ADN etait diploide dans 46% des cas et aneuploide dans 54% des tumeurs. La ploidie de l'ADN a ete comparee au grade histologique de la tumeur. L'aneuploidie a ete trouvee dans 0% des tumeurs avec un score de Gleason de 2 a 4; dans 62% des cas avec score de Gleason de 5 a 7 et dans 50% des cas avec score de 8 a 10. Nos resultats demontrent qu'il n'y a aucune relation entre ces deux variables

DNA nuclear ploidy determined by flow cytometry was evaluated from prostate tissue in 51 patients with prostatic cancer who had undergone radical prostatectomy. DNA ploidy pattern was diploid in 46% and aneuploid in 54% of tumors. DNA ploidy was compared to histological tumor grading. 92 Aneuploidy was found in 0% of the tumors with Gleason score between 2 and 4 in 62% between 5 and 7 and in 50% between 8 and 10. Our results suggest there is no relationship between the two parameters.