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ABSTRACTS XIV Congresso Nazionale Società Italiana di Urologia OncologicaConclusioni: La percentuale di margini positivi ed il follow-upmedio a 11 mesi nella nostra iniziale esperienza con la tecnicalaparoscopica sono risultati sovrapponibili a quella riportati inletteratura a fronte di una bassa percentuale di complicanzeintra- e peri-operatorie.Bibliografia:1. Guillonneau B, el-Fettouh H, Baumert H, et al. Laparoscopic radicalprostatectomy: oncological evaluation after 1,000 cases a MontsourisInstitute. J Urol 2003; 169:12612. Martorana G, Manferrari F, Bertaccini A, Malizia M, Palmieri F,Severini E, Vitullo G. Laparoscopic radical prostatectomy: oncological evaluationin the early phase of the learning curve comparing to retropubicapproach. Arch It Urol Androl 2004; 76:13. Guillonneau B, Cathelineau X, Doublet JD, Vallancien G. Laparoscopicalradical prostatectomy: the leassons learned. J Endourol 2001; 15:441Poster n. 221ROTTURA SPONTANEA DI ANGIOMIOLIPOMA RENALEASSOCIATA A SEPSI: CASO CLINICOCerasoli S. 2 , Elmi F. 1 , Galassi P. 1 , Gerbino G. 1 , Palucci Q. 1 ,Pasini A. 3 , Turci A. 11Urologia Ospedale M. Bufalini; 2 Anatomia Patologica Ospedale M.Bufalini; 3 Radiologia Ospedale M. Bufalini, CesenaIntroduzione: L’angiomiolipoma renale (AML) è un tumore relativamenteraro (0,3-3% di tutte le neoplasie renali), generalmentebenigno. È clinicamente significativo l’AML di diametrosuperiore a 4 cm per la tendenza alla rottura spontanea consuccessivo sanguinamento. In letteratura sono riportate pochedecine di casi di AML emorragico. Non risulta descritto l’AMLemorragico associato a stato settico.Caso clinico: F.A., di a. 28, viene ricoverato d’urgenza per lombalgiaacuta dx associata a massa palpabile e febbre a 39,4°.All’ingresso HB 14,8, GB 16900, es. urine e urocoltura negative,creatininemia nella norma. Viene iniziata antibioticoterapiacon ciprofloxacina e.v. Dopo 12 ore l’HB è 10,9, la febbrerimane superiore a 39°. Vengono associati alla ciprofloxacinal’imipenem e la teicoplanina; sono eseguite TAC e RM chemostrano una neoformazione "ad iceberg", con una piccolaparte intrarenale e una maggior parte esofitica, di 8x 5,5 cm,dislocante il rene(che è normalmente funzionante) in sensoantero-inferiore; è presente una voluminosa raccolta ematicaperirenale e pararenale posteriore. Viene ipotizzata la diagnosidi AML renale sanguinante con ematoma retroperitoneale. Neigiorni successivi l’HB rimane stabile, mentre lo sfebbramentodel paziente risulta torpido (37,5-38°), con persistenza dellalombalgia. Gli indici laboratoristici di flogosi sono elevati.Ecograficamente la massa al centro mostra aspetti colliquativi,il tessuto renale appare ipoecogeno. Si decide di sottoporre ilpaziente ad intervento chirurgico esplorativo, nel sospetto diun ascesso perirenale. Il rene dx risulta racchiuso in una grossolanacotenna cartonacea , a tratti lignea, fortemente adesa alperitoneo all’esterno, alla capsula renale all’interno, alla ghiandolasurrenale superiormente; all’interno della cotenna materialenecrotico ed ematico di vecchia data. Al polo superioredel rene è presente una lesione crateriforme spontaneamentesanguinante. Escissa completamente la cotenna si pratica resezionecuneiforme della lesione renale. Nel post-operatoriopoliuria (fino a 8.000 cc) da decompressione renale. Le TACeseguite a distanza mostrano una ripresa pressochè completadella funzionalità renale. Es, istologico: angiomiolipoma renalecon aree necrotico-emorragiche e flogosi suppurativa.Conclusioni: L’indicazione chirurgica è scaturita dall’ipotesi diascesso, non risolvibile con la terapia antibiotica. Il peduncolovascolare dell’AML era a livello del cratere sanguinante, per cui lamassa asportata era necrotica. L’intervento chirurgico ha evacuatouna massa necrotica a contenuto settico, decompresso il parenchimarenale e asportato l’AML. Pertanto è stata risolta in brevetempo una patologia multifattoriale che avrebbe potuto determinare,a lungo andare, conseguenze d’organo e sistemiche.Bibliografia1. Farina LA. Renal angiomyolipoma: diagnostic difficulties and surgicalindications in 20 surgically treated patients. Actas Urol Esp 1994; 18:6392. Hellstrom PA. Spontaneous subcapsular or perirenal haemorrage causedby renal tumours. A urological emergency. Scand J Urol Nephrol 1999;33:173. Nelson CP. Contemporary diagnosis and management of renal angiomyolipoma.J Urol 2002; 168 (4pt 1):1315Archivio Italiano di Urologia e Andrologia 2004; 76, 3, Supplemento 183
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Vol. 76; n. 3, Supplement 1, Septem
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XIV CONGRESSO NAZIONALESOCIETA’ I
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Cari Amici e Cari Colleghi,è con g
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Venerdì, 10 dicembre 2004 - N° Cr
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Introduzione e presentazione del co
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14.45 - 16.15 Corso - Ricerca di ba
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Il follow-upRelatore: Melloni D. (M
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PROGRAMMA CORSO INFERMIERISTICOSaba
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Venerdì, 10 dicembre (totale ore E
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126 - STUDIO IMMUNOFENOTIPICO DI PA
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ore 11.30 -12.30 SALA Vulcania 1 Vi
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122 - NEOPLASIA MALIGNA DELLE CELLU
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165 - IL TRATTAMENTO DEI TUMORI DEL
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33 - SOMMINISTRAZIONE INTRAVESCICAL
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16 - ANALISI DEL PROFILO PROGNOSTIC
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168 - GRUPPI DI RISCHIO DELLA VALUT
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Modalità di iscrizione da parte di
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XIV Congresso Nazionale Società It
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ABSTRACTS XIV Congresso Nazionale S
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