Introduction: Bladder mucosa is anatomically covered by urothelial epithelium. The replacement of the urothelium with stratified squamous cells is defined as squamous metaplasia which can be keratinizing or non-keratinizing. Clinically, it is also known as leukoplakia or keratinizing cystitis of the bladder. Although several etiologic factors have been proposed such as chronic inflammation, irritative stimuli and infection, its pathogenesis is not clearly understood. The natural history of squamous metaplasia and clinical treatment are controversial. Many authors consider squamous metaplasia as a premalignant lesion, so it is fundamental to find an effective treatment to reduce the risk of developing bladder squamous carcinoma. Case description: We report our management of a 58-year-old man with histological evidence of keratinizing squamous metaplasia and severe lower urinary tract symptoms. After repeated transurethral resections, the patient was treated with intravesical instillation of hyaluronic acid showing the regression of the lesion with an improvement of macroscopic appearance followed by the resolution of clinical symptoms. Conclusion: The therapeutic management of keratinizing squamous metaplasia is controversial, and currently no effective medical therapy is available for its treatment. Actually, patients undergo transurethral resections and a multidisciplinary approach is required to avoid cystectomy. Annual cystoscopy with multiple biopsies should be performed to determine the presence of dysplasia. Moreover, the therapeutic treatment with hyaluronic acid instillations could be the starting point and the gold standard in the follow-up of our patient. However, at present, further studies are required to formulate an adequate policy for therapeutic management of this unusual lesion of the bladder mucosa.
Despite its limitations, ultrasound-guided biopsy is still the "gold standard" for the diagnosis of prostate cancer (PCa). Multiparametric magnetic resonance imaging (mp-MRI) plays an increasingly important role in patients with prior negative biopsy; several studies report an improved clinically significant prostate cancer (Cs PCa) detection rate for MRI-targeted biopsy compared to the standard biopsy. There are currently three techniques for the MRI-targeted biopsy: the cognitive registration, the software-assisted fusion registration, and the in-bore biopsy. The best MRI-targeted biopsy technique is still a matter of debate in literature; however, MRI/TRUS fusion-guided biopsy is often described as the most accurate and cost-effective approach; we describe the technique and its results.
Purpose To demonstrate safety of a new internal protocol for patients and health workers adopted for elective urologic surgical activity during COVID-19 pandemic.Methods From March 9 to April 24, 2020 we have retrospectively evaluated 62 patients who underwent elective surgery in the urology department of IRCCS Policlinico San Donato which became a COVID-hospital. We identified non-deferrable patients that needed to be treated within one month. All patients followed a dedicated pathway from the day-hospital till the discharge. Clinical data, nasopharyngeal swabs, chest X-ray, type of anaesthesia, surgical procedure and days of hospitalization were collected. All patients were interviewed 14 days after surgery to check any Covid-related complications.Results The population included 48 (77.42%) men and 14 (22.58%) women, aged between 17 and 88 years old. We performed sixty-four (64) preoperative screenings and two (2) patients were excluded. 47 (75.81%) patients underwent oncological procedures while 15 (24.19%) patients underwent non-oncological surgery. The average hospitalization time was 2.39±2.21 days.After at least 14 postoperative days (25.00±10.35 days), we interviewed all patients to check their conditions. No patients showed symptoms related to COVID-19, except for 2 (3.23%) who manifested coryza, 28 and 35 days after discharge respectively. Neither patients nor hospital workers developed COVID-19 infection.Conclusion The duration of pandemic period is undefined; therefore, our protocol could be considered a good model for every type of surgery and its application could ensure a continuous treatment for non-deferrable conditions, in a safe way for both the patients and health workers.
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