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C130 RARE TESTICULAR TUMORS
C130
Rare testicular tumors
Nad Skegro S., Knezevic N., Kulis T., Bernat M.M., Bacak Kocman I., Kastelan Z. University Hospital Center Zagreb, Dept. of Urology, Zagreb, Croatia Introduction & Objectives: Testicular cancer is the most common neoplasm among males aged 15-35 years. Germ cell tumors represent 95% of all testicular cancers, and other 5% are mostly gonadal stromal tumors. The aim of our study is to report the incidence, review treatment and management of patients with rare testicular tumors in our hospital in the last 10 years. Material & Methods: From database of patients operated in our hospital we have extracted patients who were operated for testicular cancer. Retrospectively we analyzed medical records and histopathological evaluation after orchiectomy. We have selected patients with rare testicular tumors and commented on their further treatment and mangement. Results: In the period fom January 1999 to January 2011, 261 patients underwent orchiectomy for testicular cancer. We found 24 rare tumors. In 2 patients it was nonseminoma germ cell tumor (1 pure choriocarcinoma, and 1 tumor with placental site trophoblastic tumour (PSTT) component), in 11 gonadal stromal tumors, and in 11 other tumors (9 lymphomas, 1 metastasis, 1 sarcoma of unknown type). All 9 lymphomas were diffuse large cell non Hodgkin’s B-lymphoma (B-DLCL). The 1 patient with sarcoma received adjuvant chemotherapy. The 1 patient with solitary testicular metastasis of clear cell renal carcinoma, is now under regular follow up. Of 11 gonadal stromal tumors 8 were Leydig’s tumor 2 were Sertoli’s cell tumors and 1 was unclasified sex cord stromal tumor. Patients with Sertoli cell tumor did not receive adjuvant therapy, they are regulary followed up and free of disease. Among 8 patients with Leydig’s tumor, 6 underwent partial orchiectomy and in 2 patients, due to tumor size, we performed radical orchiectomy. They did not receive adjuvant therapy and they are regulary followed up without signs of desease till now. In group of nonseminomaous tumors we selected two patients with rare tumors. The first patient had pure choriocarcinoma and despite adjuvant chemotherapy he died soon. In second patient pathohistological examination reveled: mature teratoma 65% PSTT 5%. PSTT component had high proliferation activity (Ki67 index in more than 90% of PSTT component) indicating high DNA replication and proliferation. Conclusions: Germ cell testicular tumors represent example of a successful multimodal treatment and there are established treatment protocols. Given their frequency, for certain rare tumors there are no clearly defined treatment protocols and clinical management. In our group of patients with gonadal stromal tumors we did not need adjuvant therapy. In patient with PSTT component we performed laparoscopic RPLND. We believe that this could be an option in management of similar patients due to potentially variable response of PSTT component to chemotherapy.
C131
The incidence of tumors of the urogenital tract in patients after renal transplantation
Kleinbauerová Z.1, Zachoval R.1, Viklický O.2 1 Thomayer´s Teaching Hospital, Dept. of Urology, Praha, Czech Republic, 2IKEM, Dept. of Nephrology, Praha, Czech Republic Introduction & Objectives: The aim was to determine the incidence of tumors of the urogenital tract in patients after renal transplantation Material & Methods: The file consists of 3516 patients. (2221 men and 1295 women) who underwent kidney transplantation in the period from 1976 to 2008. Transplant patients were followed at six-months intervals - history, physical examination, laboratory tests (PSA and fPSA) + urine, kidney and bladder ultrasound. In patients with urogenital tumor were evaluated histological type and tumor grade, staging and time from transplantation to diagnosis. Results: Urogenital tumors were found in 78 patients (2%), 54 men and 24 women. Urogenital malignancy duplicity was found in 6 patients. Tumors were localized in 57 (73 %) and disseminated in 21 (27%) patients. Average time from transplantation to diagnosis was 78 months (1-248). Kidney tumor was diagnosed in 41 patients, 28 men (68%) and 13 women (32%). Clear cell, papillary and sarcomatoid carcinoma were found in 29 (70%), 9 (21%) and 3 (9%) patients resp. Grade G1, G2 and G3 was found in 17 (41%), 15 (37%) and 9 (22%) patients resp. Stage T1, T2, T3 and T4 was found in 30 (73%), 9 (23%), 1 (2%) and 1 (2%) patients resp.. Dissemination was observed in 9 patients. Average time from transplantation to diagnosis was 81 months (3-248). Renal pelvis tumor was diagnosed in 8 patients, 3 men (38%) and 5 women (62%). Urothelial carcinoma G1, G2 and G3 was found in 1 (12%), 1 (12%) and 6 (76%)patients resp. Stage T2 and T3 was found in 3 (37%) and 5 (63 %) patients resp. Dissemination was observed in 4 patients. Average time from transplantation to diagnosis was 57 months (1-182). Bladder tumor was diagnosed in 17 patients, 10 men (59%) and 7 women (41%). Urothelial carcinoma G1, G2 and G3 was found in 3 (18%), 3 (18%) and 11 (64%) patients resp. Stage T1, T2, T3 and T4 was found in 8 (47%), 4 (24%), 2 (12%) and 3 (17%) patients resp. Dissemination was observed in 6 patients. Average time from transplantation to diagnosis was 87 months (8-199). Prostate cancer was diagnosed in 14 men. Adenocarcinoma G1, G2 and G3 was found in 3 (21%), 6 (43%) and 5 (36%) patients resp. Stage T1c, T2c and T3a was
found in 7 (50%), 5 (36%) and 2 (14%) patients resp.. Dissemination was observed in 1 patient. Average time from transplantation to diagnosis was 75 months (11203). Poslech Fonetický přepis. Testicular tumor was diagnosed in 3 men, mixed germinal tumor stage T1 was found in all patients. Dissemination was observed in 1 patient. Average time from transplantation to diagnosis was 52 months (27-68). Conclusions: The incidence of genitourinary tumors in renal transplant patients is high and it is necessary to examine thoroughly all patients before transplantation and to follow them regularly in long term.
C132
Urological complications after renal transplantation
Sinescu I., Harza M.C., Serbanescu B., Baston C., Stefan B.I., Manu M.A., Vasile C., Haineala B., Guler Margaritis S., Codoiu C., Badescu B. Fundeni Clinical Institute, Center of Urological Surgery and Renal Transplantation, Bucharest, Romania Introduction & Objectives: Urological complications can affect the outcome of kidney transplantations by increasing the morbidity and mortality, including the lost of the graft. The aim of this study is to determine the incidence of urological complications, in our centre. Material & Methods: A series of 650 consecutive renal transplantations were performed between 1st of October 2004 and 28th of February 2011. The mean age: 26.2 years old. Renal grafts were obtained in 486 cases (74.7%) from living-related and in 164 cases (25.3%) from cadaveric donors. Results: The overall incidence of complications was 7.84% (51 cases). We recorded 21 ureteral stenosis (3.23%), 15 ureteral fistulas (2.3%), 10 lymphoceles (1.53%), two hematoma with ureteral obstruction (0.3%) and three cases of clot obstruction (0.46%). For the patients with ureteral stenosis (21 cases) the most common surgical treatment was vesicoureteral re-anastomosis 14 cases (2.15%). In seven cases (1.07%), we performed double pigtail stenting. For ureteral fistulas ureteral stenting was performed in eight cases (1.23%), six vesicoureteral reanastomosis (0.92%) and one ureteropyelostomy (0.15%). Peri-graft collection with obstruction of the ureter was diagnosed in 10 cases. Percutaneous drainage was successful in four cases (0.61%) and open surgical peritoneal fenestration was performed in the other six cases (0.92%). Two patients developed hematoma with secondary ureteral obstruction, solved by percutaneous drainage in one case (0.15%) and open surgical evacuation and drainage in the other (0.15%). For the cases of ureteral clot obstruction (3 cases), a double pigtail ureteral stent insertion after endourological clot removal was successful. Conclusions: Urological complications related to leakage or stenosis can be treated minimally invasive by ureteral stent insertion or by surgical vesicoureteral reimplantation. Early diagnosis and treatment will help maintain renal graft function. In our study, graft survival after successful treatment has been similar for all the patients.
C133
Vascular complications after renal transplantation
Zilinska Z.1, Chrastina M.1, Trebaticky B.1, Breza Jr. J.1, Breza Sr. J.1, Bujdak P.1, Madaric J.2, Vulev I.3, Klepanec A.3 1 University Hospital Bratislava, Dept. of Urology, Bratislava, Slovakia, 2National Institute of Cardiology, Dept. of Cardiology, Bratislava, Slovakia, 3National Institute of Cardiology, Dept. of Diagnostic and Interventional Radiology, Bratislava, Slovakia Introduction & Objectives: Vascular complications in renal transplant recipients are uncommon but important causes of graft dysfunction and graft lost after kidney transplantation. Objectives: To document vascular complications that occurred after kidney transplantions in order to assess the incidence of these complications at our center as well as to identify possible treatment approach. Material & Methods: 165 kidney transplantations were performed in the period from January 2008 to June 2011. All patients after kidney transplantation underwent ultrasound examination (included colour Doppler flow and duplex Doppler ultrasound) immediately after surgery – especially in condition of anuria, then regularly according to an internal schedule and always in patients with impaired graft function. Results: We detected renal vein thrombosis in 6 cases (3.6 %), artery thrombosis in 5 cases (3.0 %), oneme intrarenal pseudoaneurysm (0.6 %), three times arteriovenous fistula after renal biopsy (1.8 %) and renal artery stenosis in 13 patients (7.9 %). There was no extrarenal pseudoaneurysm in our group of patients. Conclusions: The incidence of vascular complications in our department correlates with the incidence of these complications referred in the literature. We confirmed the importance of immediate diagnosis and fast intervention if the diagnosis of vascular complication is established.
Eur Urol Suppl 2011;10(9):645
Rare testicular tumors
Nad Skegro S., Knezevic N., Kulis T., Bernat M.M., Bacak Kocman I., Kastelan Z. University Hospital Center Zagreb, Dept. of Urology, Zagreb, Croatia Introduction & Objectives: Testicular cancer is the most common neoplasm among males aged 15-35 years. Germ cell tumors represent 95% of all testicular cancers, and other 5% are mostly gonadal stromal tumors. The aim of our study is to report the incidence, review treatment and management of patients with rare testicular tumors in our hospital in the last 10 years. Material & Methods: From database of patients operated in our hospital we have extracted patients who were operated for testicular cancer. Retrospectively we analyzed medical records and histopathological evaluation after orchiectomy. We have selected patients with rare testicular tumors and commented on their further treatment and mangement. Results: In the period fom January 1999 to January 2011, 261 patients underwent orchiectomy for testicular cancer. We found 24 rare tumors. In 2 patients it was nonseminoma germ cell tumor (1 pure choriocarcinoma, and 1 tumor with placental site trophoblastic tumour (PSTT) component), in 11 gonadal stromal tumors, and in 11 other tumors (9 lymphomas, 1 metastasis, 1 sarcoma of unknown type). All 9 lymphomas were diffuse large cell non Hodgkin’s B-lymphoma (B-DLCL). The 1 patient with sarcoma received adjuvant chemotherapy. The 1 patient with solitary testicular metastasis of clear cell renal carcinoma, is now under regular follow up. Of 11 gonadal stromal tumors 8 were Leydig’s tumor 2 were Sertoli’s cell tumors and 1 was unclasified sex cord stromal tumor. Patients with Sertoli cell tumor did not receive adjuvant therapy, they are regulary followed up and free of disease. Among 8 patients with Leydig’s tumor, 6 underwent partial orchiectomy and in 2 patients, due to tumor size, we performed radical orchiectomy. They did not receive adjuvant therapy and they are regulary followed up without signs of desease till now. In group of nonseminomaous tumors we selected two patients with rare tumors. The first patient had pure choriocarcinoma and despite adjuvant chemotherapy he died soon. In second patient pathohistological examination reveled: mature teratoma 65% PSTT 5%. PSTT component had high proliferation activity (Ki67 index in more than 90% of PSTT component) indicating high DNA replication and proliferation. Conclusions: Germ cell testicular tumors represent example of a successful multimodal treatment and there are established treatment protocols. Given their frequency, for certain rare tumors there are no clearly defined treatment protocols and clinical management. In our group of patients with gonadal stromal tumors we did not need adjuvant therapy. In patient with PSTT component we performed laparoscopic RPLND. We believe that this could be an option in management of similar patients due to potentially variable response of PSTT component to chemotherapy.
C131
The incidence of tumors of the urogenital tract in patients after renal transplantation
Kleinbauerová Z.1, Zachoval R.1, Viklický O.2 1 Thomayer´s Teaching Hospital, Dept. of Urology, Praha, Czech Republic, 2IKEM, Dept. of Nephrology, Praha, Czech Republic Introduction & Objectives: The aim was to determine the incidence of tumors of the urogenital tract in patients after renal transplantation Material & Methods: The file consists of 3516 patients. (2221 men and 1295 women) who underwent kidney transplantation in the period from 1976 to 2008. Transplant patients were followed at six-months intervals - history, physical examination, laboratory tests (PSA and fPSA) + urine, kidney and bladder ultrasound. In patients with urogenital tumor were evaluated histological type and tumor grade, staging and time from transplantation to diagnosis. Results: Urogenital tumors were found in 78 patients (2%), 54 men and 24 women. Urogenital malignancy duplicity was found in 6 patients. Tumors were localized in 57 (73 %) and disseminated in 21 (27%) patients. Average time from transplantation to diagnosis was 78 months (1-248). Kidney tumor was diagnosed in 41 patients, 28 men (68%) and 13 women (32%). Clear cell, papillary and sarcomatoid carcinoma were found in 29 (70%), 9 (21%) and 3 (9%) patients resp. Grade G1, G2 and G3 was found in 17 (41%), 15 (37%) and 9 (22%) patients resp. Stage T1, T2, T3 and T4 was found in 30 (73%), 9 (23%), 1 (2%) and 1 (2%) patients resp.. Dissemination was observed in 9 patients. Average time from transplantation to diagnosis was 81 months (3-248). Renal pelvis tumor was diagnosed in 8 patients, 3 men (38%) and 5 women (62%). Urothelial carcinoma G1, G2 and G3 was found in 1 (12%), 1 (12%) and 6 (76%)patients resp. Stage T2 and T3 was found in 3 (37%) and 5 (63 %) patients resp. Dissemination was observed in 4 patients. Average time from transplantation to diagnosis was 57 months (1-182). Bladder tumor was diagnosed in 17 patients, 10 men (59%) and 7 women (41%). Urothelial carcinoma G1, G2 and G3 was found in 3 (18%), 3 (18%) and 11 (64%) patients resp. Stage T1, T2, T3 and T4 was found in 8 (47%), 4 (24%), 2 (12%) and 3 (17%) patients resp. Dissemination was observed in 6 patients. Average time from transplantation to diagnosis was 87 months (8-199). Prostate cancer was diagnosed in 14 men. Adenocarcinoma G1, G2 and G3 was found in 3 (21%), 6 (43%) and 5 (36%) patients resp. Stage T1c, T2c and T3a was
found in 7 (50%), 5 (36%) and 2 (14%) patients resp.. Dissemination was observed in 1 patient. Average time from transplantation to diagnosis was 75 months (11203). Poslech Fonetický přepis. Testicular tumor was diagnosed in 3 men, mixed germinal tumor stage T1 was found in all patients. Dissemination was observed in 1 patient. Average time from transplantation to diagnosis was 52 months (27-68). Conclusions: The incidence of genitourinary tumors in renal transplant patients is high and it is necessary to examine thoroughly all patients before transplantation and to follow them regularly in long term.
C132
Urological complications after renal transplantation
Sinescu I., Harza M.C., Serbanescu B., Baston C., Stefan B.I., Manu M.A., Vasile C., Haineala B., Guler Margaritis S., Codoiu C., Badescu B. Fundeni Clinical Institute, Center of Urological Surgery and Renal Transplantation, Bucharest, Romania Introduction & Objectives: Urological complications can affect the outcome of kidney transplantations by increasing the morbidity and mortality, including the lost of the graft. The aim of this study is to determine the incidence of urological complications, in our centre. Material & Methods: A series of 650 consecutive renal transplantations were performed between 1st of October 2004 and 28th of February 2011. The mean age: 26.2 years old. Renal grafts were obtained in 486 cases (74.7%) from living-related and in 164 cases (25.3%) from cadaveric donors. Results: The overall incidence of complications was 7.84% (51 cases). We recorded 21 ureteral stenosis (3.23%), 15 ureteral fistulas (2.3%), 10 lymphoceles (1.53%), two hematoma with ureteral obstruction (0.3%) and three cases of clot obstruction (0.46%). For the patients with ureteral stenosis (21 cases) the most common surgical treatment was vesicoureteral re-anastomosis 14 cases (2.15%). In seven cases (1.07%), we performed double pigtail stenting. For ureteral fistulas ureteral stenting was performed in eight cases (1.23%), six vesicoureteral reanastomosis (0.92%) and one ureteropyelostomy (0.15%). Peri-graft collection with obstruction of the ureter was diagnosed in 10 cases. Percutaneous drainage was successful in four cases (0.61%) and open surgical peritoneal fenestration was performed in the other six cases (0.92%). Two patients developed hematoma with secondary ureteral obstruction, solved by percutaneous drainage in one case (0.15%) and open surgical evacuation and drainage in the other (0.15%). For the cases of ureteral clot obstruction (3 cases), a double pigtail ureteral stent insertion after endourological clot removal was successful. Conclusions: Urological complications related to leakage or stenosis can be treated minimally invasive by ureteral stent insertion or by surgical vesicoureteral reimplantation. Early diagnosis and treatment will help maintain renal graft function. In our study, graft survival after successful treatment has been similar for all the patients.
C133
Vascular complications after renal transplantation
Zilinska Z.1, Chrastina M.1, Trebaticky B.1, Breza Jr. J.1, Breza Sr. J.1, Bujdak P.1, Madaric J.2, Vulev I.3, Klepanec A.3 1 University Hospital Bratislava, Dept. of Urology, Bratislava, Slovakia, 2National Institute of Cardiology, Dept. of Cardiology, Bratislava, Slovakia, 3National Institute of Cardiology, Dept. of Diagnostic and Interventional Radiology, Bratislava, Slovakia Introduction & Objectives: Vascular complications in renal transplant recipients are uncommon but important causes of graft dysfunction and graft lost after kidney transplantation. Objectives: To document vascular complications that occurred after kidney transplantions in order to assess the incidence of these complications at our center as well as to identify possible treatment approach. Material & Methods: 165 kidney transplantations were performed in the period from January 2008 to June 2011. All patients after kidney transplantation underwent ultrasound examination (included colour Doppler flow and duplex Doppler ultrasound) immediately after surgery – especially in condition of anuria, then regularly according to an internal schedule and always in patients with impaired graft function. Results: We detected renal vein thrombosis in 6 cases (3.6 %), artery thrombosis in 5 cases (3.0 %), oneme intrarenal pseudoaneurysm (0.6 %), three times arteriovenous fistula after renal biopsy (1.8 %) and renal artery stenosis in 13 patients (7.9 %). There was no extrarenal pseudoaneurysm in our group of patients. Conclusions: The incidence of vascular complications in our department correlates with the incidence of these complications referred in the literature. We confirmed the importance of immediate diagnosis and fast intervention if the diagnosis of vascular complication is established.
Eur Urol Suppl 2011;10(9):645