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The efficacy of weekly paclitaxel in androgen-independent prostate cancer and its addictive cytotoxicity with anthracycline derivatives led us to determine the safety and efficacy of a weekly schedule of paclitaxel and epirubicin. Between October 2000 and November 2002, 32 patients were enrolled in this study. Patients characteristics included a median age of 72 years (range 68-77), adequate hepatic, cardiac, renal and bone marrow functions, ECOG performance status of 1-2, and no prior chemotherapy. All patients had received hormonal manipulation and seven patients (22%) had received prior palliative radiation therapy. The regimen consisted of paclitaxel 70 mg/m2 i.v. infusion for 2 h and epirubicin 30 mg/m2 in bolus every week. Treatment was continued for 3 months or until disease progression or unacceptable toxicity were observed. During the study, prostate-specific antigen (PSA) was monitored and response was defined as a 50% reduction in PSA levels, to be confirmed 4 weeks later. Thirty-one patients were evaluable for toxicity and 21 for objective response. Seventeen patients (57%) had a decline above 50% in PSA level that lasted more than 4 weeks with a median time to PSA progression and a median duration of PSA response of approximately 5.5 months. Ten of the 21 patients with measurable disease (47%) had a confirmed objective response (one complete response and 20 partial responses). Thirteen of 25 symptomatic patients (56 %) had improvement in pain. The median time to disease progression was 7.6 months and the median survival was 12.9. The most prominent grade 3 toxicities were reversible myelosuppression and fatigue. Nausea, vomiting, diarrhea and peripheral edema were minimal. No evidence of cardiac toxicity was recorded. Alopecia was frequent, but reversible, in all patients. We conclude that despite the small sample size, this study demonstrates that the combination of weekly paclitaxel and epirubicin is a well-tolerated regimen for androgen-independent prostate cancer. The results imply that a combination of these agents in a weekly schedule may have clinical potential in prostate cancer treatment.

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We describe a case of a monolateral duplex system and a ureterocele containing a gigantic stone in a 65-year-old woman who presented with pyelonephritis without any previous history of urinary tract infections or stone disease. Stone removal and double left ureteroneocystostomy with plastic widening of a narrowed obstructive side were performed. The ureteral stone measured 10.5 cm in greatest diameter, weighed 85 g and contained calcium oxalates and phosphates. Three months after surgery, radiology (intravenous urography and cystography) showed left unobstructed upper and lower urinary tracts and the absence of vesicoureteral reflux. Urine culture was negative 3, 6 and 9 months after surgery.

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PURPOSE: Since metastatic renal cell carcinoma has a poor prognosis and treatment strategies, including hormone therapy, chemotherapy and immunotherapy, have little impact on the quality of life and global survival statistics, new interest has recently focused on the combination of immuno-chemotherapy using pyrimidine analogues, such as gemcitabine. MATERIALS AND METHODS: In a phase II study 16 patients with metastatic renal cell carcinoma were treated with 1,000 mg./m. gemcitabine intravenously on days 1, 8, 15 and 28 for 6 months, 3 MU (1 MU = 1 x 10(6) IU) interferon (IFN)-alpha intramuscularly 3 times a week and 4.5 million IU interleukin (IL)-2 subcutaneously daily for 5 days a week for 2 consecutive weeks every month for 6 months. Responding and nonprogressing cases were maintained on immunotherapy consisting of IFN-alpha and IL-2 for further 6 months. RESULTS: In 15 evaluable patients overall response rate (1 complete response plus 3 partial response) was 28% while stable disease was achieved in 7 (47%). Median survival duration was 20 months (range, 9 to 26+) and median time to tumor progression was 14 months (6 to 26+). The complete response lasted 24+ months and partial response lasted 16 months. The regimen was well tolerated with only 1 case of neutropenia (WHO grade 3), while anorexia, fatigue and flu-like symptoms were the most common toxicity problems but were never greater than grade 2. CONCLUSIONS: Despite the small sample size, this study demonstrates that gemcitabine combined with standard doses of IFN-alpha and low doses of IL-2 is effective treatment for metastatic renal cell carcinoma. This biotherapy was well tolerated and resulted in an optimum objective response and relatively long-term survival.

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Combination chemotherapy with newer, more active drugs in patients with advanced and/or metastatic bladder cancer might show improved response rate and survival. Gemcitabine (GEM) and Epidoxorubicin (EPI) have demonstrated activity in this disease. In addition, experimental studies in vitro have shown that the two agents have additive-synergistic effects when used in combination. Our prior phase I dose-finding study in previously untreated patients with advanced or metastatic bladder cancer defined recommended doses for further trials of GEM 1000 mg/m2 and EPI 25 mg/m2 on days 1, 8 and 15 every 28 days. A phase II trial at this dose level was initiated in previously untreated patients to assess efficacy and toxicity. Eligible patients had measurable disease; Karnofsky performance status (PS) of > 40; no prior chemotherapy; and adequate bone marrow reserve, cardiac, hepatic and renal function. Thirty- one patients (22 males, 9 females) with median age of 64 (range 44-75) and median PS of 80 were accrued, and all were eligible. Twelve patients had T4N1-2 M0, 8 had lymph node only metastases, while 11 had visceral metastases (liver, bone, lung). A total of 181 cycles was administered (range 3-7 per patient). Major toxicities (WHO grade > or = 3) were: neutropenia in 5 patients, thrombocytopenia in 2 patients, and anemia in 2 patients. Three patients had febrile neutropenic episodes and only 3 patients required dose reduction. Grade 1-2 non-hematological toxicities included nausea/vomiting, stomatitis and alopecia. No cardiac toxicity was observed. Of the 30 response evaluable patients, 17 (57%) demonstrated a major response (3 complete and 14 partial) (95% CI: 39%-75%), 7 had stable disease (23%) and 6 progressed (20%). These preliminary results confirm the phase I observation that the combination of GEM--EPI is highly active in the treatment of advanced and metastatic bladder cancer with a favourable toxicity profile.

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Primary sarcomas of the kidney are rare, accounting for 1-3% of all renal malignancies. We describe an unusual case of renal leiomyosarcoma in a 41-year-old white woman who presented with a large smooth mass, which was mobile to the overlying structures and which occupied the right hypochondria and flank. Radical nephrectomy was carried out and the patient is well, without symptoms of relapse, 1 year after surgery. Leiomyosarcomas of the kidney have an aggressive and rapidly progressive natural history, with 5-year survival rates of 29-36%. Size <5 cm, low histological grade, absence of lymph node metastases and radical surgical treatment are all associated with a better prognosis. Irradiation and chemotherapy do not appear to alter the clinical course.

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Intestinal metaplasia is a rare condition characterized by the presence of colonic epithelium and mucin-containing goblet cells in the bladder. According to its extension we can distinguish localized from widespread intestinal metaplasia. We describe a case of glandular cystitis intestinal-type in a 58-year-old man whose clinical history and diagnostic work-up are consistent with this proliferative abnormality. We also discuss the pathogenesis and the propensity of intestinal metaplasia to undergo neoplastic transformation.

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Cavernous hemangiomas of adrenal gland are rare. A case of adrenal hemangioma discovered by chance and removed surgically is reported. A review of the literature is also made.

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OBJECTIVE: To report the use of one-stage dorsal free-graft urethroplasty to reduce the incidence of urethrocele. PATIENTS AND METHODS: From 1990 to 1994, 20 men (age range 21-86 years) underwent a one-stage dorsal free-graft urethroplasty of bulbar urethral strictures (iatrogenic in 12, traumatic in three, inflammatory in three and unknown in two). All patients except one had been treated previously by optical urethrotomy from one to 14 times. RESULTS: Temporary fistulae were detected on post-operative urethrography in three patients with particularly long grafts, but they all resolved spontaneously. Within a mean follow-up of 46 months, only one patient had a short recurrent stricture, which was treated successfully by optical urethrotomy. Two patients complained of post-voiding dribbling, but radiographic studies never showed graft weakening and the urinary flow rate was always > 14 mL/s. CONCLUSION: Free skin grafts can be applied successfully to the dorsal aspect and by doing so the complications of urethral reconstruction can be reduced.

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Two cases of parameatal urethral cysts in the male are reported. These round cysts don't interfere with sexual function but can determinate an alteration of the urinary flow (biforcation of the flow). The aetiology of these cysts is not completely understood, while the treatment is univoque and simple: complete excision but no aspiration or marsupialization.

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A rare case of ureterouterine fistula caused by a complication of cesarean section after a normal pregnancy is reported. The patient presented with a urinous seeping into the vagina, and the fistula was diagnosed preoperatively on urography and computerized tomography. Treatment consisted of a 2-stage surgical approach, including percutaneous nephrostomy and subsequent ureteral reimplantation.

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We report a study on human papilloma virus (HPV) and p53 protein in 18 cases of urothelial carcinoma grade 1, 2 and 3. The presence of HPV has been correlated to the p53 protein expression, as this virus, once integrated in the cell nuclei, seems to cause the alteration of some genes expression, involved in the cell-cycle regulation, like p53. One case of urothelial papillary carcinoma grade 2, infiltrating the lamina propria, resulted to be positive for HPV type 31/33/51 and for p53 protein. Our data suggest that HPV type 31/33/51 may have played a role in the pathogenesis of this neoplasia causing an alteration of p53 gene.

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Oncocytoma is a neoplasm that constitutes 4-5% of tumors located in the renal parenchyma. It was studied for the first time by Zippel in 1942 and since than nearly 150 cases have been described. The association between neoplasm and horseshoe kidney is extremely rare. The horseshoe kidney is a malformation which often becomes complicated by infection, hydronephrosis and calculosis, but very rarely by a neoplasm (only 113 cases). The Authors report a case of oncocytoma in the horseshoe kidney and discuss the diagnostic, clinical and therapeutical aspects.

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The authors report 4 cases inverted papilloma of the urothelium. They describe the clinical, evolutive and pathological aspects of this rare tumor.

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A review of published series about 56 cases with unilateral nonvisualization on excretory urography after external trauma have been described: the renal injury causing the nonvisualization was contusion in 8 patients, laceration in 13, rupture in 12 and renal pedicle in 19. The acquisition of the most important methods has allowed a total view as about minimal lesions (contusion, laceration), as rupture or fragmentation of the kidney and renal pedicle. We have evaluated 32 cases of renal traumatic injuries and we have studied one case with unilateral nonvisualization stressing the diagnostic, etiopathogenetic and therapeutic problems.

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Transitional cell carcinoma is a rare neoplasm with an reported incidence of 2%. It is biologically different from adenocarcinoma in that it is not hormonally responsive and it is not associated with an elevated serum acid phosphatase. It is marked by local invasiveness and distant metastases. Transitional cell carcinoma has its origin at the level of the periurethral ducts in the area of the junction of the cylindrical and transitional epithelium. Transitional cell carcinoma can be distinguished from adenocarcinoma and carcinoma endometriode exclusively for its histological aspect. Various therapies have been used to treat transitional cell carcinoma but with poor results. Surgical treatment is still today the most efficient with a surviving average of 2 years. The Authors report 3 new cases, discussing diagnostic, clinical and therapeutical aspects of this rare neoplasm.

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Apart from presenting a specific symptomatology, cancer of the bladder in some rare cases may present with a set of symptoms that at first sight seem unrelated to the tumour and that constitute the paraneoplastic syndromes. The importance of these paraneoplastic symptoms is represented by the fact that they may constitute the first sign of malignity, or may be the expression of a recurrence. Two rare cases of paraneoplastic hypercalcemia are reported, the literature is reviewed and the aspects of this rare pathology are analysed.

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The fibroepithelial polyps is a rare benign tumor, that can rise at any level of the upper urinary tracts with a major predisposition at the pyeloureteral junction. The exact etiology is not known, even if we remember that chronic irritation, stasis and infection sometimes caused by an associated calculus are important factors in the genesis of the tumor. The authors report 3 new cases with ureteral seat, of which one is associated with a calculus. This fact underlines the importance of an exact differential diagnostic with the carcinoma as well for the conservative treatment as for the prognosis which is favourable.

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A case of sacrococcygeal chordoma is presented. We review the literature and we discuss the problems related to the etiology, the symptoms, the diagnosis and the treatment of this rare neoplasm. We present and discuss here the importance and the different possibilities of new diagnostic techniques, such as the CT and the MRI in the diagnosis and management of sacrococcygeal chordoma.

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Forty-three young men from the Italian army underwent urodynamic tests following the diagnosis of enuresis. Of these, 37 were included in an assessment trial to define the rationale for early anti-bacterial therapy following the test. The subjects were subdivided into two groups: one group received 500 mg Cinoxacin b.i.d. for 5 days, and the other group was not treated. The comparison of results revealed a high incidence of irritative disorders in both groups (78.9% of treated subjects and 88.9% of untreated subjects) but the most significant complications were observed in the untreated group (feveret in 27.7% and one case of septic fever). Early anti-bacterial therapy following standard urodynamic tests therefore seems to be a ration tool in urological practice.

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