ABSTRACTS <strong>XIV</strong> <strong>Congresso</strong> <strong>Nazionale</strong> <strong>Società</strong> <strong>Italiana</strong> <strong>di</strong> Urologia OncologicaConclusioni: La <strong>per</strong>centuale <strong>di</strong> margini positivi ed il follow-upme<strong>di</strong>o a 11 mesi nella nostra iniziale es<strong>per</strong>ienza con la tecnicalaparoscopica sono risultati sovrapponibili a quella riportati inletteratura a fronte <strong>di</strong> una bassa <strong>per</strong>centuale <strong>di</strong> complicanzeintra- e <strong>per</strong>i-o<strong>per</strong>atorie.Bibliografia:1. Guillonneau B, el-Fettouh H, Baumert H, et al. Laparoscopic ra<strong>di</strong>calprostatectomy: 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 ra<strong>di</strong>cal 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. Laparoscopicalra<strong>di</strong>cal 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 Ra<strong>di</strong>ologia Ospedale M. Bufalini, CesenaIntroduzione: L’angiomiolipoma renale (AML) è un tumore relativamenteraro (0,3-3% <strong>di</strong> tutte le neoplasie renali), generalmentebenigno. È clinicamente significativo l’AML <strong>di</strong> <strong>di</strong>ametrosu<strong>per</strong>iore a 4 cm <strong>per</strong> la tendenza alla rottura spontanea consuccessivo sanguinamento. In letteratura sono riportate pochedecine <strong>di</strong> casi <strong>di</strong> AML emorragico. Non risulta descritto l’AMLemorragico associato a stato settico.Caso clinico: F.A., <strong>di</strong> a. 28, viene ricoverato d’urgenza <strong>per</strong> 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 su<strong>per</strong>iore 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, <strong>di</strong> 8x 5,5 cm,<strong>di</strong>slocante il rene(che è normalmente funzionante) in sensoantero-inferiore; è presente una voluminosa raccolta ematica<strong>per</strong>irenale e pararenale posteriore. Viene ipotizzata la <strong>di</strong>agnosi<strong>di</strong> AML renale sanguinante con ematoma retro<strong>per</strong>itoneale. Neigiorni successivi l’HB rimane stabile, mentre lo sfebbramentodel paziente risulta torpido (37,5-38°), con <strong>per</strong>sistenza dellalombalgia. Gli in<strong>di</strong>ci laboratoristici <strong>di</strong> flogosi sono elevati.Ecograficamente la massa al centro mostra aspetti colliquativi,il tessuto renale appare ipoecogeno. Si decide <strong>di</strong> sottoporre ilpaziente ad intervento chirurgico esplorativo, nel sospetto <strong>di</strong>un ascesso <strong>per</strong>irenale. Il rene dx risulta racchiuso in una grossolanacotenna cartonacea , a tratti lignea, fortemente adesa al<strong>per</strong>itoneo all’esterno, alla capsula renale all’interno, alla ghiandolasurrenale su<strong>per</strong>iormente; all’interno della cotenna materialenecrotico ed ematico <strong>di</strong> vecchia data. Al polo su<strong>per</strong>ioredel rene è presente una lesione crateriforme spontaneamentesanguinante. Escissa completamente la cotenna si pratica resezionecuneiforme della lesione renale. Nel post-o<strong>per</strong>atoriopoliuria (fino a 8.000 cc) da decompressione renale. Le TACeseguite a <strong>di</strong>stanza mostrano una ripresa pressochè completadella funzionalità renale. Es, istologico: angiomiolipoma renalecon aree necrotico-emorragiche e flogosi suppurativa.Conclusioni: L’in<strong>di</strong>cazione chirurgica è scaturita dall’ipotesi <strong>di</strong>ascesso, non risolvibile con la terapia antibiotica. Il peduncolovascolare dell’AML era a livello del cratere sanguinante, <strong>per</strong> 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: <strong>di</strong>agnostic <strong>di</strong>fficulties and surgicalin<strong>di</strong>cations in 20 surgically treated patients. Actas Urol Esp 1994; 18:6392. Hellstrom PA. Spontaneous subcapsular or <strong>per</strong>irenal haemorrage causedby renal tumours. A urological emergency. Scand J Urol Nephrol 1999;33:173. Nelson CP. Contemporary <strong>di</strong>agnosis and management of renal angiomyolipoma.J Urol 2002; 168 (4pt 1):1315Archivio Italiano <strong>di</strong> Urologia e Andrologia 2004; 76, 3, Supplemento 183
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