The treatment of upper urinary tract transitional cell carcinoma (UT-TCC) in single-kidney patients requires the radical removal of cancer, but also, when feasible, the preservation of the continuity of the urinary tract by various surgical techniques. In case of wide resections during ureteral surgery, a ureteral replacement could be advocated. In the literature, the cecal appendix has rarely been used as a ureteral substitute, moreover in benign pathological conditions, showing encouraging early results. The positive functional and oncological outcomes obtained after a lengthy follow-up in a single-kidney patient with UT-TCC treated by ureteral resection and appendix interposition confirm the viability of this surgical option.
In the last years transrectal ultrasound has become a very important diagnostic tool of either benign or neoplastic prostatic disease. We can easily evaluate gland morphology and prostatic size by transrectal ultrasound. Intraoperatively, we can verify the complete removal of the adenoma in real time. Ultrasound definition of histopathological characteristics of benign prostatic hypertrophy gives us new prognostic and therapeutic information. In the near future, if alternative non-surgical therapies prove their effectiveness in some histological aspects ultrasound will enable us to choose the most correct treatment modality.
Prostatic acid phosphatase (PAP) and specific prostatic antigen (PSA) in the serum of patients with prostatic carcinoma were determined and their clinical value compared. 128 patients were examined, 60 (46.9%) of whom had prostatic carcinoma (4 in stage T2, 27 in T3 and 29 in T4) and 68 with benign prostatic pathology. ROC (receiver operating characteristic) curves were plotted from resulting data and the underlying areas calculated to evaluate the clinical accuracy of the two markers. The area for PSA (0.90 +/-0.03) was significantly greater than that for PAP (0.71 +/-0.05), showing that PSA was better at detecting patients with or without prostatic carcinoma. Maximum clinical accuracy was 0.883 obtained with discriminating values of 0.8 U/L for PAP and 10 ug/L for PSA, confirming the superiority of PSA. However, PAP determination using thymolphthalein monophosphate as the specific substrate for the prostatic isoenzyme, showed greater clinical specificity (98.5%) so that association of the two markers made it possible to eliminate false positive results. In conclusion, results suggest the possibility of using PSA for diagnosing prostatic carcinoma in a selected high risk population. However, the simplicity of the method used for determining PAP and the greater clinical specificity of PAP and PSA combined, suggest determining both parameters for diagnostic purposes.
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