Cracco CM, Terrone C, Porpiglia F, Scarpa RM. Immune response in prostate cancer. Minerva Urol Nefrol. 2005;57(4):301-11.

A Berruti, M Tucci, A Mosca, R Tarabuzzi, G Gorzegno, C Terrone, F Vana, G Lamanna, M Tampellini, F Porpiglia, A Angeli, R M Scarpa and L Dogliotti. Predictive factors for skeletal complications in hormone-refractory prostate cancer patients with metastatic bone disease. Br J Cancer 2005;93:633-638. I.F.:3.742.

Porpiglia F, Terrone C, Cracco C, Cossu M, Grande S, Musso F, Renard J, Scarpa RM. Early ligature of renal artery during radical laparoscopic transperitoneal nephrectomy: description of standard technique and direct access. J Endourol 2005;19:623-7. I.F.: 1,552.

Porpiglia F, Terrone C, Cracco C, Renard J, Musso F, Grande S, Scarpa RM. Direct Access to the renal artery at the level of treitz ligament during left radical laparoscopic transperitoneal nephrectomy. Eur Urol 2005;48:291-5. I.F.: 2,651.

C Terrone, D Vaccino, M Tucci, A Mosca. Caso clinico di carcinoma prostatico. Urologia 2005;72(Suppl.1):36-43.

ER Bollito, D Pacchioni, C Terrone, G Casetta, M Mari, M Volante, R DePompa, S Cappia, A Lopez-Beltran, and M Papotti. Neuroendocrine differentiation in primary adenocarcinomas of the urinary bladder. Anal Quant Cytol Histol 2005 (In press) I.F.: 0,940.

Porpiglia F, Ragni F, Terrone C, Renard J, Musso F, Grande S, Cracco C, Ghignone G, Scarpa RM. Is laparoscopic unilateral sural nerve grafting during radical prostatectomy effective in retaining sexual potency? BJU Int. 2005;95(9):1267-1271. I.F.: 2,089.

Berruti A, Fara E, Tucci M, Tarabuzzi R, Mosca A, Terrone C, Gorzegno G, Fasolis G, Tampellini M, Porpiglia F, De Stefanis M, Fontana D, Bertetto O, Dogliotti L; Gruppo Onco-Urologico Piemontese, Rete Oncologica Piemontese. Oral estramustine plus oral etoposide in the treatment of hormone refractory prostate cancer patients: A phase II study with a 5-year follow-up. Urol Oncol 2005;23(1):1-7. I.F.: 1,378.

Berruti A, Mosca A, Tucci M, Terrone C, Torta M, Tarabuzzi R, Russo L, Cracco C, Bollito E, Scarpa RM, Angeli A, Dogliotti L. Independent prognostic role of circulating chromogranin A in prostate cancer patients with hormone-refractory disease. Endocr Relat Cancer 2005;12(1):109-17. I.F.: 4,597.

Porpiglia F, Fiori C, Terrone C, Bollito E, Fontana D, Scarpa RM. Assessment of surgical margins in renal cell carcinoma after nephron sparing: a comparative study: laparoscopy vs open surgery. J Urol 2005;173(4):1098-101. I.F.: 3,713.

S. Guercio, C. Terrone, R. Tarabuzzi, M. Poggio, C. Cracco, E. Bollito, R.M. Scarpa: PSA decrease after levofloxacin therapy in patients with histological prostatis. Arch It Urol Androl 2004;76:154-158.

F. Porpiglia, C. Fiori, S. Bovio, P. Destefanis, A. Alì, C. Terrone, D. Fontana, R.M. Scarpa, A. Tempia, M. Terzolo. Bilateral adrenalectomy for Cushing's syndrome: a comparison between laparoscopy and open surgery. J Endocrinol Invest 2004;27:654-8. I.F.: 1,525.

Terrone C, Cracco C, Guercio S, Bollito E, Poggio M, Scoffone C, Tarabuzzi R, Porpiglia F, Scarpa RM, Fontana D, Rocca Rossetti S. Prognostic value of the involvement of the urinary collecting system in renal cell carcinoma. Eur Urol 2004;46(4):472-6. I.F.: 2,651.

2004 Jul-Aug
Bilateral adrenalectomy for Cushing's syndrome: a comparison between laparoscopy and open surgery.
Porpiglia F, Fiori C, Bovio S, Destefanis P, Ali A, Terrone C, Fontana D, Scarpa RM, Tempia A, Terzolo M.
Division of Urology II, Department of Clinical and Surgical Sciences, San Giovanni Battista Hospital, Italy

We report our experience with bilateral adrenalectomy for treatment of Cushing's syndrome and we compare the outcome of laparoscopy with open surgery in terms of effectiveness and safety. A series of 23 patients underwent bilateral adrenalectomy for treatment of Cushing's syndrome [Cushing's disease in 16, ectopic ACTH syndrome in 2, and ACTH-independent macronodular adrenal hyperplasia (AIMAH) in 5 cases]. From 1993 to 1996, all patients were treated using an open approach (Group A), while from 1997 all patients were treated using a transperitoneal laparoscopic approach (Group B). The comparison between the 2 groups was performed considering patients characteristics, operative times, blood losses, intraoperative and post-operative complications, analgesic consumption, post-operative hospital stay and recovery. Open surgery was performed in 10 patients and laparoscopy in 13 patients. No significant difference was recorded between the two groups as to patients' characteristics and complications. Mean operative time was significantly increased in Group B, while post-operative hospital stay was significantly longer in Group A. Laparoscopic bilateral adrenalectomy can be safely and effectively employed to treat Cushing's syndrome. However, long operatives times may represent a limitation especially in high risk patients.

2004 Oct
Prognostic value of the involvement of the urinary collecting system in renal cell carcinoma.
Terrone C, Cracco C, Guercio S, Bollito E, Poggio M, Scoffone C, Tarabuzzi R, Porpiglia F, Scarpa RM, Fontana D, Rocca Rossetti S.
Urologia Universitaria, Azienda Ospedaliera S. Luigi, Orbassano, Turin, Italy.

OBJECTIVES: The prognostic role of the invasion of the urinary collecting system (UCS) by renal cell carcinoma (RCC) has not attracted a notable amount of attention. The aim of this study was to investigate incidence and prognostic value of UCS involvement in RCC.
MATERIAL AND METHODS: All pathological reports of radical nephrectomies performed in two centres of urology from November 1983 to December 1999 were reviewed in order to evaluate the invasion of the UCS (calices, renal pelvis, ureter). Patients were divided into two groups according to presence (Group 1) or absence (Group 2) of UCS invasion. The stage was determined according to the TNM 6th edition. Overall and cause-specific survival rates were evaluated. Univariate and multivariate analyses were performed.
RESULTS: The evaluable specimens were 671 from the 735 examined; in 64 cases it was not possible to ascertain or to exclude UCS involvement. Invasion of the UCS was found in 59 cases (8.8%). Median follow-up was 59.0 months (range 0-216). Tumours invading the UCS were usually symptomatic, with high nuclear grade and predominantly high stage. At univariate analysis the 5 year overall and cause-specific survival rates of tumours invading the UCS were significantly lower when compared to those without UCS invasion (42.8% versus 60.8% and 45.5% versus 64.7%, respectively). When groups were stratified, according to the pT category, the 5-year cause-specific survival rate was only significantly different for the pT2 category (33.3% versus 76.9%). At the multivariate analysis TNM staging, symptoms at diagnosis and tumour grade were the only independent prognostic factors.
CONCLUSION: The invasion of the UCS by RCC is unusual, particularly in small tumours. UCS involvement does not represent an independent prognostic factor. However, in organ-confined tumours (i.e. pT2) UCS involvement has an influence on the prognosis and should be taken into account when planning adjuvant treatments and follow-up.

 

2004 Aug
Nifedipine versus tamsulosin for the management of lower ureteral stones.
Porpiglia F, Ghignone G, Fiori C, Fontana D, Scarpa RM.
Division of Urology, Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Italy.

PURPOSE: We evaluate and compare the effectiveness of 2 different medical therapies during watchful waiting in patients with lower ureteral stones.
MATERIALS AND METHODS: A total of 86 patients with stones less than 1 cm located in the lower ureter (juxtavesical or intramural tract) were enrolled in the study and were randomly divided into 3 groups. Group 1 (30) and 2 (28) patients received daily oral treatment of 30 mg deflazacort, (maximum 10 days). In addition group 1 patients received 30 mg nifedipine slow-release (maximum 28 days) and group 2 received 1 daily oral therapy of 0.4 mg tamsulosin (maximum 28 days), Group 3 patients (28) were used as controls. Statistical analyses were performed using Student's test, ANOVA test, chi-square test and Fisher's exact test.
RESULTS: The average stone size for groups 1 to 3 was 4.7, 5.42 and 5.35 mm, respectively, which was not statistically significant. Expulsion was observed in 24 of 30 patients in group 1 (80%), 24 of 28 in group 2 (85%) and 12 of 28 in group 3 (43%). The difference in groups 1 and 2 with respect to group 3 was significant. Average expulsion time for groups 1 to 3 was 9.3, 7.7 and 12 days, respectively. A statistically significant difference was noted between groups 2 and 3. Mean sodium diclofenac dosage per patient in groups 1 to 3 was 19.5, 26, and 105 mg, respectively. A statistical significant difference was observed between groups 1 and 2 with respect to group 3.
CONCLUSIONS: Medical treatments with nifedipine and tamsulosin proved to be safe and effective as demonstrated by the increased stone expulsion rate and reduced need for analgesic therapy. Moreover medical therapy, particularly in regard to tamsulosin, reduced expulsion time.

 

2004 Oct
Myxoid adrenocortical adenoma with a pseudoglandular pattern.
Bollito ER, Papotti M, Porpiglia F, Terzolo M, Cracco CM, Cappia S, Gubetta L, Mikuz G.
Division of Pathology, San Luigi Gonzaga Hospital, Reg. Gonzole, Orbassano, Italy.

Myxoid changes rarely occur in adrenocortical adenomas and carcinomas. Only eight benign tumours with such features have been described thus far, five of which also had a prominent pseudoglandular component. We report an additional pseudoglandular myxoid adenoma of the adrenal gland detected in a 58-year-old male patient who developed mild hypertension. At surgery, a 4-cm mass was resected and found to contain cords and tubules of polygonal cells in a myxoid background. Limited areas of classical adrenocortical adenoma were detected in less than 20% of the tumour area. Lack of atypias and absence of mucin markers, together with an immunophenotype consistent with adrenal tumours (focal cytokeratin, vimentin, synaptophysin and alpha-inhibin immunoreactivities), led to a diagnosis of primary adrenocortical adenoma with an extensive pseudoglandular myxoid pattern. However, the differential diagnosis from metastatic well-differentiated adenocarcinomas, chordomas and retroperitoneal myxoid mesenchymal tumours (e.g. liposarcoma) may be difficult in the absence of a complete clinical history and a reliable immunoprofile. We strongly recommend staining of any myxoid or glandular tumour of the adrenal gland for alpha-inhibin and synaptophysin (probably the currently best characterised markers of adrenocortical origin) before considering alternative (probably more common) diagnoses of metastatic adenocarcinoma or retroperitoneal tumours localised to the adrenal gland.

 

2004 Feb;
Laparoscopic adrenalectomy in multiple endocrine tumors, in secreting and non-secreting lesions
Giraudo G, Del Genio G, Porpiglia F, Parini D, Garrone C, Morino M.
Chirurgia Generale II, Dipartimento di Discipline Medico-Chirurgiche Universita degli Studi di Torino, Torino, Italy.

AIM: Personal experience in laparoscopic adrenalectomies (LA) for secreting and non-secreting tumors is presented. METHODS: Between March 1995 and December 2001 a total of 111 LA (58 left, 49 right and 4 bilateral) were performed in 60 females and 51 males, mean age 47.5 (range 8-81) years, for: 38 Conn diseases, 24 incidentalomas, 15 pheochromocytomas, 13 Cushing diseases, 4 kysts, 3 angiomyolipomas, 1 adreno-genital syndrome, 1 hydatidosis, 1 hyperplasia, 1 ganglioneuroma, 1 oncocyte adenoma, 1 adrenal fibrous tumor, 4 cortical carcinomas and 4 metastases (from renal carcinoma, breast carcinoma, leiomyosarcoma and rabdoid sarcoma, respectively). In all cases LA was transabdominal with a lateral flank approach. RESULTS: Mean global operative time was 88.6 minutes (range 35-240).Conversion rate was 1.8% (2/111). There was low postoperative pain. Mean hospital stay was 4.3 days (range 2-13). There were 0.9% (1/111) 30-day mortality and 4.5% (5/111) morbidity. During a mean follow-up of 41 months (range 1-81), the 67 secreting patients were disease-free. Concerning 8 malignant cases, mean follow-up was 40.5 months (range 9-72) with 3 cortical carcinomas disease-free and 1 dead for stroke, 2 metastases (1 leiomyosarcoma and 1 breast carcinoma) dead for disease and 2 disease-free. There was no port-site metastases. CONCLUSIONS: LA seems safe and effective when performed in experienced Centers on endocrine surgery and laparoscopy.

 

2004 Feb
Is laparoscopic bladder diverticulectomy after transurethral resection of the prostate safe and effective? Comparison with open surgery.
Porpiglia F, Tarabuzzi R, Cossu M, Vacca F, Terrone C, Fiori C, Scarpa RM.
Divisione Universitaria di Urologia, Dipartimento di Scienze Cliniche e Biologiche, Azienda Ospedaliera S Luigi, Orbassano, Torino, Italy.

PURPOSE: In a retrospective nonrandomized study, we compared our experience with transurethral resection of the prostate (TURP) plus sequential laparoscopic bladder diverticulectomy with a series of combined open bladder diverticulectomies with transvesical prostatectomy.
PATIENTS AND METHODS: We considered 12 consecutive patients (group A) having 16 diverticula who underwent sequential TURP and transperitoneal laparoscopic bladder diverticulectomy and 13 consecutive patients (group B) having 13 diverticula who underwent open bladder diverticulectomy and transvesical prostatectomy. We evaluated the size and position of the diverticulum, adenoma volume, operative time, postoperative hemoglobin variations, analgesia requirement, complications, postoperative hospital stay, and uroflowmetry results.
RESULTS: No statistically significant differences existed between the groups in adenoma volume or diverticulum size or position. However, a significantly longer operative time was recorded in group A. The endolaparoscopic approach proved to be statistically superior to open surgery regarding blood loss, postoperative analgesia requirement, and hospital stay. No intraoperative complications were recorded. In addition, no statistically significant difference was found in uroflowmetry results.
CONCLUSIONS: In our experience, the endolaparoscopic approach has proved to be safe, effective, and minimally invasive and therefore superior to transvesical prostatectomy and open bladder diverticulectomy. Its only disadvantage is the longer operative time.

 

Sequential transurethral resection of the prostate and laparoscopic bladder diverticulectomy: comparison with open surgery.
Porpiglia F, Tarabuzzi R, Cossu M, Vacca F, Destefanis P, Fiori C, Scarpa RM.
Divisione Universitaria di Urologia, Dipartimento di Scienze Cliniche e Biologiche, Azienda Ospedaliera S. Luigi, Orbassano, Torino, Italy.

OBJECTIVES: To compare our experience with transurethral resection of the prostate and sequential laparoscopic bladder diverticulectomy with a previous series of combined open bladder diverticulectomy and transvesical prostatectomy.
METHODS: We compared the data of 10 consecutive patients (group 1) who underwent sequential transurethral resection of the prostate and transperitoneal laparoscopic bladder diverticulectomy and 13 consecutive patients (group 2) who underwent traditional combined open bladder diverticulectomy and transvesical prostatectomy. The following parameters were considered: size and position of the diverticulum, transrectal ultrasound adenoma volume, operative time, postoperative hemoglobin variations, analgesic requirement, complications, postoperative hospital stay, and urinary flowmetry.
RESULTS: No statistically significant differences existed between the two groups either for diverticulum size (6.8 versus 7.2 cm) or diverticula position. A significant difference was observed in the operative time (247 minutes for group 1 versus 136 minutes for group 2, P <0.0001), mean postoperative hemoglobin decrease (2.6 g/dL for group 1 and 3.9 g/dL for group 2, P = 0.001), analgesic requirement (1.3 ampoules of buprenorphine cloritrate for group 1 versus 1.8 ampoules for group 2, P = 0.45), and postoperative hospital stay (3 days for group 1 versus 9.6 days for group 2, P <0.0001). No statistically significant difference was recorded for control flowmetry. No intraoperative complications were recorded for the two groups.
CONCLUSIONS: In our series, sequential transurethral resection of the prostate and transperitoneal laparoscopic diverticulectomy for large diverticula proved to be a safe, effective, and minimally invasive procedure, despite the longer operative times compared with transvesical prostatectomy and open bladder diverticulectomy.

 

2004 Aug
Supra-ampullar cystectomy with preservation of sexual function and ileal orthotopic reservoir for bladder tumor: twenty years of experience.
Terrone C, Cracco C, Scarpa RM, Rossetti SR.
Clinica Urologica dell'Universita di Torino, Azienda Ospedaliera S. Luigi, Regione Gonzole 10, 10043 Orbassano, Turin, Italy.

OBJECTIVE: We describe the original surgical technique of supra-ampullar cystectomy associated with ileal neobladder, and present our results in terms of preservation of sexual potency, urinary continence and cancer control along twenty years of experience. MATERIALS AND METHODS: Twenty-eight consecutive patients with bladder tumor-27 transitional cell carcinomas (TCC) and 1 leiomyosarcoma-underwent supra-ampullar cystectomy with ileal orthotopic neobladder (2 Camey I and 26 Camey II) between May 1984 and June 1999. The median age of the patients was 51.0 years (range 23-65). Preoperatively 24 patients had superficial high-risk TCC. Involvement of prostatic urethra was excluded by means of preoperative endoscopic biopsies. The bladder, part of the prostate with the prostatic urethra and regional lymph nodes were removed, while the vas deferens with deferential ampullae, seminal vesicles, ejaculatory ducts and the peripheral portion of the prostate were maintained. Median followup was 90.5 months (range 10-228).
RESULTS: Out of 28 patients 6 died of bladder cancer (all with metastases, 2 also with local recurrence); 4 out of the 22 patients who were free of disease at followup died of other causes. Potency was preserved in 26 patients (92.8%), reporting satisfactory sexual intercourses; 15 patients (53.5%) also maintained antegrade ejaculation allowing procreation in 3 cases. In one patient the orthotopic neobladder according to Camey I was converted into an ileal conduit because of the excessive capacity of the reservoir, high post-void residual and recurrent pyelonephritis. Of the remaining 27 patients 16 showed both daytime and nighttime urinary continence (average interval between micturitions = 3 hours), 6 were continent during the day and 5 performed self-intermittent catheterization.
CONCLUSION: Supra-ampullar cystectomy with detubularized ileal orthotopic neobladder allows to preserve sexual function in nearly all the cases and to maintain urinary continence in most patients, without compromising oncological outcome. The indication must be restricted to highly selected cases, without potential risk of local recurrences and concomitant prostatic carcinoma.

 

Archivio italiano di Urologia e Andrologia
4° Congresso Nazionale Società Italiana di Endourologia
19-21 Aprile 2004

PROSTATECTOMIA LAPAROSCOPICA CON GRAFT DI NERVO SURALE: RISULTATI FUNZIONALI.
F. Porpiglia, R. Tarabuzzi, F. Ragni, G.R Ghignone, R.M. Scarpa
Divisione Universitaria di Urologia, Dipartimento di Scienze Cllniche e Biologiche, Università degli Studi di Torino, Ospedale San Luigi, Orbassano, Torino

Introduzione e Obiettivi: La prostatectomia radicale laparoscopica ha guadagnato nel corso dell'ultimo decennio sempre maggiore popolarità in seno alla comunità urologica grazie alla miniinvasività della tecnica e ai favorevoli risultati funzionali. Lo scopo di questo studio è quello di valutare i risultati funzionali, in termini di potenza sessuale, dopo prostatectomia radicale nerve sparing monolaterale e graft di nervo surale controlaterale.
Materiali e Metodi'. Sono stati presi in considerazione 29 pazienti sessualmente attivi affetti da carcinoma della prostata (stadio clinico TlcT2a, PSA < 10 ng/ml e Gleason Score < 7), afferenti alla nostra Divisione. 15 pazienti (gruppo A) sono stati sottoposti a prostatectomia radicale nerve sparing monolaterale con graft di nervo surale controlaterale, 14 pazienti (gruppo B), sono stati sottoposti a prostatectomia laparoscopica nerve sparing monolaterale. I pazienti sono stati successivamente coinvolti nel programma di riabilitazione sessuale mediante terapia iniettiva intacavernosa precoce e successiva assunzione di 5 PDL inibitori per os. La valutazione della funzione erettile è stata condotta nel pre e nel postoperatorio, successivamente a 3, 8 e 12 mesi mediante questionario IEEF 5. Le analisi statistiche sono state condotte mediante Chi quadro e test di Fisher.
Risultati: I due gruppi risultavano sovrapponibili in termini di caratteristiche cllniche (eia, stadio della malattia, numero di biopsie positive, lateralità della neoplasia IEEF 5 preoperatorio) A 12 mesi dall'intervento, per i pazienti del gruppo A risultava evidente un significativo miglioramento dello score IEEF 5 rispetto al postoperatorio (p<0.001), mentre questo miglioramento non risultava statisticamente significativo per i pazienti del gruppo B (p>0.05). Complessivamente si registrava una percentuale di erezioni valide (sufficienti per la penetrazione vaginale) pari al 41% nei pazienti del gruppo A e pari al 20% nei pazienti del gruppo B.
Conclusioni: I risultati di questo studio, pur con i limiti imposti dalla ridotta numerosità campionana, di 11 lenirai io die mediante il gralt del nervo surale è possibile ottenere un significativo miglioramento in termini di mantenimento della potenza sessuale. A nostro avviso, ulteriori esperienze appaiono necessarie per convalidare questa tecnica.

ACCESSO PREVENTIVO AL PEDUNCOLO RENALE IN CORSO DI NEFRECTOMIA RADICALE LAPAROSCOPICA SINISTRA:
VARIANTI DI TECNICA.
F. Porpiglia, R. Tarabuzzi, C. Terrone, M. Cossu, I. Morrà, M. Poggio, R.M. Scarpa
Divisione Universitaria di Urologia, Dipartimento di Scienze Cllniche e Biologiche, Università degli Studi di Torino, Ospedale San Luigi, Orbassano, Torino

Introduzione: Uno dei principi dell'asepsi oncologica nella chirurgia radicale del carcinoma renale è rappresentato dall'accesso preventivo al peduncolo. Scopo del video è dimostrare la riproducibilità di tale principio in chinirgia laparoscopica con due diversi accessi in corso di nefrectomia radicale sinistra.
Paziente 1: II primo caso si riferisce all'accesso preventivo all'arteria renale attraverso il Treitz. Introdotti quattro trocars da 12 mm. si ispeziona la cavità addominale e si reperiscono la vena mesenterica inferiore, l'aorta e la flessura duodenodigiunale. Lintervento inizia con la sezione del legamento di Treitz e lo scollamento della quarta porzione duodenale. Si espone lo spazio retroperitoneale preaortico. Lesposizione dell'aorta prosegue cranialmente sezionando una piccola arteria lombare e successivamente l'arteria gonadica sinistra. La dissezione prosegue al di sotto della vena renale fino ad individuare l'arteria renale sinistra che viene accuratamente liberata dalle strutture linfatiche, isolata alla sua emergenza con il dissettore e legata con nodo extracorporeo a sua volta fissato con nodo laparoscpoico intracorporeo. In asepsi neoplastica si procede al tempo della nefrectomia iniziando con la mobilizzazione della flessura splenica e del colon discendente.
Paziente 2: Nel secondo caso l'accesso preventivo al peduncolo renale procede attraverso l'incisione della doccia parietocolica sinistra e dei legamenti frenocolico e splenoparietale che consentono la mobilizzazione mediale della flessura splenica, della milza e della coda del pancreas, che vengono progressivamente scollate
dalla lascia di ioidi imo ad individuare il peduncolo renale che appare in intimo rapporto con la flessura duodenodigiunate. Sezionato il Treitz si espone un'arteria polare di minor calibro che viene campata all'emergenza con emolock e sezionata. Si individua l'arteria principale che viene isolata con il dissettore, campata all'emergenza con emolock e sezionata. Liberata la vena renale con dissettore si procede alla sua sezione con endogia. La dissezione procede cranialmente con l'isolamento del peduncolo surrenalico medio che viene sezionato previa apposizione di emolock. Si procede quindi alla liberazione progressiva della loggia renale dal muscolo psoas sezionando con endogia i vasi gonadici. Si isola quindi l'uretere che viene clippato e sezionato nella sua porzione lombare. La liberazione della loggia renale dai piani muscolari posteriori prosegue cranialmente fino ad esporre le fibre del diaframma.
Lintervento termina con la lifadenectomia pre e lateroaortica e con l'estrazione in endobag del rene e della sua atmosfera adiposa.
Conclusioni: Laccesso preventivo al peduncolo renale attraverso il Treitz, in corso di nefrectomia radicale laparoscopica sinistra, è possibile solo in pazienti selezionati. Negli altri casi si può comunque rispcttarr il prindpio dell'asepsi oncologica altravcr.so la mediai izzazione della flessura colica sn., ".Iella milza e della coda del pancreas, ottenendo una eccellente esposizione dell'arteria e della vena renale sn. in assenza di manipolazioni della loggia renale.

TRATTAMENTO LAPAROSCOPICO DI CARCINOMA CORTICOSURRENALICO DESTRO.
F. Porpiglia1, R. Tarabuzzi', M. Cossu', C. Fiori', A. De Lisa2, R Usai2, E. Usai2, R.M. Scarpa'
'Divisione Universitaria di Urologia, Dipartimento di Scienze Cllniche e Biologiche, Università degli Studi di Torino, Ospedale San Luigi Orbassano, Torino; ^Divisione Universitaria di Urologia, Dipartimento di Scienze Chirurgiche e Trapianti d'Organo, Università degli Studi di Cagliari, Ospedale S. S. Trinità, Cagliari, Italia

Introduzione: Nell'ultimo decennio la laparoscopia ha assunto un ruolo preminente nel trattamento di molte patologie in ambito urologico; in particolare questa tecnica è diventata il "gold standard" nella cura della più parte delle lesioni surrenalichc. Tuttavia il ruolo della laparoscopia nel trattamento di lesioni surrenaliche maligne è a tutt'oggi materia di vivace dibattito, in quanto i pochi dati disponibili in letteratura non consentono un giudizio univoco circa l'efficacia della procedura. Presentiamo un caso di surrenectomia laparoscopica destra eseguita per carcinoma corticosurrenalico (ACC).
Case Report: Si tratta di una paziente di 38 anni in buone condizioni generali con riscontro incidentale di lesione surrenalica destra del diametro di 9 cm circa. Si posiziona la paziente in decubito laterale sinistro e si introducono 4 trocar da 12 mm. Dopo aver creato lo pneumoperitoneo, si incide il peritoneo sottoepatico e si medializza la seconda porzione del duodeno. Lincisione prosegue lungo il margine posteriore del fegato, fino al legamento triangolare che viene sezionato. La superficie anteriore della lesione surrenalica viene progressivamente liberata dalla superficie inferiore del fegato. La dissezione della loggia surrenalica prosegue liberando la lesione dalla loggia renale e dalla parete muscolare posteriore.
Il margine superiore della massa viene liberato dalle aderenze con la superficie epatica e dalle connessioni diaframmatiche. Durante questa fase si identifica e si seziona un voluminoso peduncolo superiore. Dopo aver adeguatamente mobilizzato la massa, si prosegue nella dissezione lungo il margine laterale della cava fino ad isolare la vena surrenalica che viene clippata e sezionata. Infine, si completa la liberazione della loggia surrenalica dai piani muscolari posteriori. A questo punto si isola e successivamente si lega e si seziona il peduncolo arterioso mediale. La massa viene estratta mediante endobag. Si ispeziona la loggia surrenalica che dimostra la radicalità dell'intervento ed il buon controllo dell'emostasi. Lintervento è durato 120 minuti e le perdite ematiche sono risultate minime. Non sono state registrate complicanze intrapostoperatorie. La paziente è stata dimessa in III giornata postoperatoria. Lesame istologico è risultato compatibile con adenocarcinoma surrenalico a basso grado di malignità in stadio II di MacFarlane.
Conclusioni: II case report da noi presentato dimostra che la laparoscopia è una tecnica impiegabile nel trattamento dell'ACC. Ovviamente, non è ancora possibile esprimere un giudizio definitivo circa l'efficacia oncologica di tale procedura. Tuttavia, riteniamo che, se vengono rispettati i principi della chinirgia
oncologica, la surrenectomia laparoscopica per questo tipo di lesioni sia una procedura efficace al pari della tecnica "open".

CISTECTOMIA RADICALE LAPAROSCOPICA: STUDIO DI FATTIBILITÀ.
F. Porpiglia, R. Tarabuzzi, C. Terrone, C. Cracco, G.R Ghignone, M. Poggio, R.M. Scarpa
Divisione Universitaria di Urologia, Dipartimento di Scienze Cliniclie e Biologiche, Università degli Studi di Torino, Ospedale San Luigi, Orbassano, Torino

Introduzione: Lo sviluppo della laparoscopia urologica ha determinato, in alcuni centri, l'introduzione di tale approccio per l'esecuzione della cistectomla radicale. Scopo del lavoro è analizzare i risultati nei primi 10 casi da noi trattati, con particolare riferimento alla fattibilità di tale procedura.
Pazienti e Metodi: Dal novembre 2002 al gennaio 2004 abbiamo eseguito 10 cistectomle radicali con l'approccio laparoscopico transperitoneale. Letà media dei pazienti (8 maschi; 2 femmine) era di 60.7 anni (range 4278). Lindicazione all'intervento, in tutti i pazienti, è stata posta per diagnosi istologica dopo TURB di neoplasia transizionale infiltrante. Il tempo della cistectomla e della linfoadenectomia regionale sono stati eseguiti con approccio laparoscopico transperitoneale con 3 trocars da 12 mm e 2 trocars da 5 mm. Nei 4 casi sottoposti a sostituzione vescicale con neovescica ad Y, il serbatoio ileale è stato confezionato attraverso una minilaparotomia e l'intervento è poi proseguito per via intracorporea con le anastomosi tra neovescica ed uretra ed ureteroileali. Nei 6 casi sottoposti a derivazione urinaria esterna non continente con condotto ileale sec. Bricker, dopo la cistectomla e la linfoadenectomia pelvica laparoscopica l'intervento è proseguito e terminato per via minilaparotomica. Sono stati quindi valutati i tempi operatori, le perdite ematiche, le complicanze perioperatorie, il decorso postoperatorio ed i risultati istologici.
Risultati: II tempo medio relativo alla cistectomla e alla linfoadenectomia è risultato di 130 minuti (range 110150); il tempo relativo alla sostituzione vescicale con neovescica ad Y di 250 minuti (range 220260); il tempo relativo alla derivazione di Bricker di 100 minuti (range 80120). Le perdite ematiche medie sono risultate di 650 mi. (range 500800). In nessun caso il tempo della laparoscopia è stato convertito a cielo aperto. Non si sono osservate complicanze maggiori perioperatorie. Complicanze minori (febbre, linforrea prolungata, scompenso cardiaco) sono state osservate in 3 pazienti (30%). L'utilizzo di analgesici è stato limitato alla I GPO. Nei pazienti con neovescica ortotopica il tempo medio di cateterismo è risultato di 17 gg. (range 1425). Il tempo medio di ricovero, in tutti i pazienti, è risultato di 16 gg. (range 1328). Lesame istologico è risultato pTO in 2 casi, pT2 in3, pT3 in 3, pT4 in 2. Il numero medio di linfonodi asportati è risultato 19 (range 826); 2 pazienti sono risultati N^ (20%). In tutti i casi i margini di resezione sono risultati indenni da neoplasia.
Conclusioni: La cistectomla radicale laparoscopica rappresenta ancora una procedura pionieristica ad elevato grado di difficoltà, anche per urologi con adeguato training laparoscopico. Per quanto riguarda il tempo demolitivo la laparoscopia è in grado di riprodurre i principi oncologici della chinirgia "open" rispettando il concetto di mininvasività con tempi operatori accettabili. Il tempo ricostruttivo nella nostra esperienza richiede tempi lunghi e, quando eseguito con tecnica combinata, sembra ridurre i vantaggi della laparoscopia.

PUBBLICAZIONI SCIENTIFICHE SU RIVISTE INTERNAZIONALI DELL'UROLOGIA UNIVERSITARIA DELL'A.S.O. S. LUIGI European Urology Supplements (February 2004) Official Jurnal of the eau LAPAROSCOPIC RADICAL CYSTECTOMY WITH OPEN CONSTRUCTION OF AN ORTHOTOP1C ILEAL NEOBLADDER Porpiglia F.. Tarabuzzi R., Cossu M., ScofFone C., Terrone C., Guercio S., Scarpa R.M. San Luigi Hospital, Urology, Orbassano - Torino, Italy INTRODUCTION & OBJECTIVES: Thanks to technical improvements laparoscopy is nowadays extended to complicated operations such as radical cystectomy. This video illustrates our technique for radical laparoscopic cistectomy followed by open construction of an "Y" orthotopic neobladder. MATERIAL & METHODS: Five-port fan-like transperitoneal technique is employed. Deferent ducts arc identified, clipped and sectioned. Seminal vesicles are then dissected to expose Denonviller's aponcurosis, subsequently sectioned to reveal the anterior wall of the rectum. Section of the umbelical ligament and of the urachus gives access to the relropubic space. The cndopelvic fascia is exposed and incised. Section of the puboprostalic ligaments is followed by ligation of Santorini's plexus. Isolation and section of the ureter. Metal clips are applied prior to sectioning the superior vesical pedicle. The inferior pedicle is sectioned using vascular Endo-Gia. Section of the Sanlorini's plexus exposes the urethra, then incised. The catheter is drawn into the abdominal cavity. The posterior face of the prostate is freed from the anterior wall of the rectum and the superior prostalic pedicles are clipped and sectioned. Following cystectomy pelvic lymphadcnectomy is performed. A "Y" technique (modification of the C'amey II technique) is employed for the construction of a detubularised ileal orlholopic neobladder. The final 20 cm. of the ilcuin are excluded and cxleriori/ed for beginning the construction of the neobladder. The neobladder is replaced in the abdominal cavity, fully ready for anastomosis. The urethral and ureteral anastomoses on JJ are performed using intracorporeal sutures. RESULTS: The operation lasted 5 and half hour. The blood loss was about 500 cc. Oral feeding was started on the 3"' postoperative day. The catheter was removed on the 10"' postoperative day and JJs on the 20th day. CONCLUSIONS: Laparoscopic radical cystectomy with open orthotopic neobladder (Y technique) completely prepared cxtracorporeally and fully ready for laparoscopic intracorporeal anastomosis is feasible.   L'Impact Factor è un parametro impiegato per indicare l'importanza delle riviste scientifiche. Esso misura la frequenza con cui una rivista viene citata mediamente in 1 anno. Si ottiene dividendo il numero di citazioni degli articoli pubblicati nei precedenti 2 anni per il numero totale DI articoli pubblicati nello stesso periodo. (l'abstract di tali pubblicazioni è disponibile su: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed PubMed, National Library of Medecine) Guercio S., Terrone C., Scarpa R.M.: Sorveglianza clinica dopo terapia chirurgica del carcinoma prostatico. Recenti Progr Med 2003;94:110-113. Berruti A, Tucci M, Terrone C, Scarpa RM, Angeli A, Dogliotti L. Re: a randomized, placebo-controlled trial of zoledronic Acid in patients with hormone-refractory metastatic prostate carcinoma. J Natl Cancer Inst 2003;19;95(4):332-3. Impact Factor: 14,5. S. Guercio, C. Terrone, M. Cossu, M. Poggio, G. Ghignone, R.M. Scarpa: La colica renale. Urologia Pratica, 2003;3:57-67. Terrone C., Destefanis P., Fiori C., Savio D., Fontana D.: Renal cell cancer in presacral ectopic kidney: preoperative diagnostic imaging compared to surgical findings. Urol Int 2004;72(2):174-5. Impact Factor: 0,47. Porpiglia F., Tarabuzzi R., Cossu M., Vacca F., Terrone C., Fiori C., Scarpa R.M.: Is laparoscopic bladder diverticulectomy after transurethral resection of the prostate safe and effective? Comparison with open surgery. J Endourol 2004;18(1):73-6. Impact Factor: 1,03. Terrone C., Cracco C., Mario Scarpa R., Rocca Rossetti S.: Supra-ampullar cystectomy with preservation of sexual function and ileal orthotopic reservoir for bladder tumor: twenty years of experience. Eur Urol. 2004;46(2):264-70. Impact Factor: 1,79 1. Terrone C, Guercio S, De Luca S, Poggio M, Castelli E, Scoffone C, Tarabuzzi R, Scarpa RM, Fontana D, Rocca Rossetti S.: The number of lymph nodes examined and staging accuracy in renal cell carcinoma. BJU Int 2003 Jan;91(1):37-40. (Impact Factor 1.426). 2. Berruti A, Dogliotti L, Tucci M, Tarabuzzi R, Guercio S, Torta M, Tampellini M, Dovio A, Poggio M, Scarpa RM, Angeli A. Metabolic effects of single-dose pamidronate administration in prostate cancer patients with bone metastases. Int J Biol Markers 2002 Oct-Dec;17(4):244-52. (Impact Factor 1.467). 3. Porpiglia F, Tarabuzzi R, Cossu M, Vacca F, Destefanis P, Fiori C, Scarpa RM. Sequential transurethral resection of the prostate and laparoscopic bladder diverticulectomy: comparison with open surgery. Urology 2002 Dec;60(6):1045-9. (Impact Factor 2.762). 4. De Luca S, Terrone C, Crivellaro S, De Zan A, Polo P, Vigliani MC, Tizzani A. Opsoclonus-myoclonus syndrome as a paraneoplastic manifestation of renal cell carcinoma. a case report and review of the literature. Urol Int 2002;68(3):206-8. (Impact Factor 0.504). 5. Porpiglia F, Destefanis P, Fiori C, Giraudo G, Garrone C, Scarpa RM, Fontana D, Morino M.: Does adrenal mass size really affect safety and effectiveness of laparoscopic adrenalectomy?. Urology 2002 Nov;60(5):801-5. (Impact Factor 2.762). 6. Berruti A, Tucci M, Dogliotti L, Scarpa RM, Angeli A. Urinary calcium excretion in the monitoring of bone metastases from prostatic carcinoma. Cancer 2002 Sep 1;95(5):1182-3. (Impact Factor 3.909). 7. Berruti A, Dogliotti L, Tucci M, Scarpa RM, Angeli A. Hyperparathyroidism due to the so-called bone hunger syndrome in prostate cancer patients. J Clin Endocrinol Metab 2002 Apr;87(4):1910-1. (Impact Factor 5.160). 8. Porpiglia F, Destefanis P, Fiori C, Scarpa RM, Fontana D. Role of adjunctive medical therapy with nifedipine and deflazacort after extracorporeal shock wave lithotripsy of ureteral stones. Urology 2002 Jun;59(6):835-8. (Impact Factor 2.762). 9. Berruti A, Tucci M, Terrone C, Gorzegno G, Scarpa RM, Angeli A, Dogliotti L. Background to and management of treatment-related bone loss in prostate cancer. Drug Aging 2002;19(12):899-910. (Impact Factor 1.912). 10. Castelli E, Terrone C, Faraone N, Tizzani A. Renal infarction in a hyperhomocysteinemic patient. Nephron 2002;92(3):749-50. (Impact Factor 1.765). 11. 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Porru D, Pau AC, Scarpa RM, Zanolla L, Cao A, Usai E. Behcet's disease and the neuropathic bladder: urodynamic features: case report and a literature review. Spinal Cord 1996 May;34(5):305-7. (Impact Factor 0.962). 65. Scarpa RM, De Lisa A, Usai E. Diagnosis and treatment of ureteral calculi during pregnancy with rigid ureteroscopes. J Urol 1996 Mar;155(3):875-7. (Impact Factor 3.190). 66. Porru D, Pau AC, Fornasier V, Sorgia M, Delisa A, Scarpa RM, Usai E. Evaluation of bladder contractility in men undergoing transurethral resection of the prostate. Eur Urol 1996;30(1):34-9. (Impact Factor 2.304). 67. Scarpa RM, De Lisa A, Porru D, Canetto A, Usai E. Ureterolithotripsy in children. Urology 1995 Dec;46(6):859-62. (Impact Factor 2.762). 68. Porru D, Dore A, Usai M, Campus G, Delisa A, Scarpa RM, Usai E. Behaviour and urodynamic properties of orthotopic ileal bladder substitute after radical cystectomy. Urol Int 1994;53(1):30-3. (Impact Factor 0.504). 69. Porru D, Scarpa RM, Delisa A, Usai E.Urodynamic changes in benign prostatic hyperplasia patients treated by transurethral microwave thermotherapy. Eur Urol 1994;26(4):303-8. (Impact Factor 2.304). 70. Massidda B, Migliari R, Padovani A, Scarpa RM, Pellegrini P, Cortesi E, Usai E, Pellegrini A. Metastatic renal cell cancer treated with recombinant alpha 2a interferon and vinblastine. J Chemother 1991 Dec;3(6):387-9. (Impact Factor 1.256). 71. Vanni R, Scarpa RM, Nieddu M, Usai E. Cytogenetic investigation on 30 bladder carcinomas. Cancer Genet Cytogenet 1988 Jan;30(1):35-42. (Impact Factor 1.529). 72. Balzano S, Migliari R, Sica V, Scarpa RM, Pintus C, Loviselli A, Usai E, Balestrieri A. The effect of androgen blockade on pulsatile gonadotrophin release and LH response to naloxone. Clin Endocrinol (Oxf) 1987 Oct;27(4):491-9. (Impact Factor 2.465). 73. Vanni R, Peretti D, Scarpa RM, Usai E. Cytogenetics of bladder cancer: rearrangements of the short arm of chromosome 11. Cancer Detect Prev 1987;10(5-6):401-3. (Impact Factor 1.324). 74. Vanni R, Scarpa RM. Nonrandom chromosomal changes in transitional cell carcinoma of the bladder. Cancer Res 1986 Sep;46(9):48-73. (Impact Factor 8.302). 75. Vanni R, Scarpa RM, Nieddu M, Usai E. Identification of marker chromosomes in bladder tumor. Urol Int 1986;41(6):403-6. (Impact Factor 0.504). 76. Vanni R, Peretti D, Scarpa RM, Usai E. Derivative 11 marker chromosome in bladder carcinoma. Cancer Genet Cytogenet 1985 Apr 15;16(4):289-95. (Impact Factor 1.529). L'Impact Factor è un parametro impiegato per indicare l'importanza delle riviste scientifiche. Esso misura la frequenza con cui una rivista viene citata mediamente in 1 anno. Si ottiene dividendo il numero DI citazioni degli articoli pubblicati nei precedenti 2 anni per il numero totale DI articoli pubblicati nello stesso periodo. Impact Factor totale delle pubblicazioni sopra citate: 155,587