Regular and Irregular Use and Reasons for Discontinuation of Solifenacin Therapy in Patients with Overactive Bladder Managed by Urologists

Solifenacin, a selective muscarinic receptor antagonist, is one of the best-tolerated and most effective medicines that relieve storage symptoms in patients with an overactive bladder (OAB). However, the persistence of solifenacin in daily clinical practice remains far below that reported in clinical trials. This study aimed to analyze the adherence of patients to the therapy and the reasons for solifenacin discontinuation and non-regular use in OAB patients managed by urologists. Data concerning non-compliance and the discontinuation of solifenacin, along with the reasons, were collected during two consecutive visits for 64,049 OAB outpatients. Over the two visits, 81.6% of the patients continued therapy, and 88.6% were taking solifenacin regularly. An age ≥ 75 yrs., the male sex, a rural or small-city dwelling, and a prescription of ≥10 mg predicted therapy continuation. The female sex, a higher education, a short or long duration of an OAB, and a non-idiopathic OAB predicted regular use. The persistence of nycturia and urinary incontinence during therapy predicted both discontinuation and non-regular use. Dissatisfaction with therapy was the most frequent reason for discontinuation. In conclusion, an initial prescription of solifenacin at a low dose reduces the chance of OAB symptom improvement and results in more frequent discontinuation. A high rate of discontinuation related to dissatisfaction suggests unrealistic expectations for OAB patients and insufficient education by urologists.

Mild elevation of liver function tests associated with renal cell carcinoma in a multimorbid older patient - a case of Stauffer's syndrome

We describe a case of a 74-year-old patient with recurrent fever of up-to 38.5°C, nocturnal sweating, weight loss of 4 kg, non-characteristic pain, and elevation of liver function tests (LFTs), who was diagnosed with Stauffer's syndrome. The patient successfully underwent laparoscopic heminephrectomy. The histology was clear-cell carcinoma of the right kidney (cT1a). The abnormalities in laboratory tests, such as Erythrocyte Sedimentation Rate, C-reactive protein, LFTs, α2-globulin, and most clinical symptoms abated 2 weeks post-surgery. We hypothesize that elevated LFTs in renal cell carcinoma patients could help deciding in favour of surgery in cases where the initial decision would be watchful waiting.

The Clinical Significance of Serum Free Light Chains in Bladder Cancer

This research aimed to assess the clinical usefulness of serum kappa (κ) and lambda (λ) free light chains (FLCs) in patients with bladder cancer (BC). One hundred samples were collected and analysed from healthy volunteers (C) and bladder cancer patients. Cancer patients were divided into two subgroups: low-grade (LG) and high-grade cancer (HG). Concentrations of FLCs, CEA, CA19-9, creatinine and urea were measured per manufacturers' guidelines. The concentrations of κ and λ FLCs and CEA were significantly higher in BC patients in comparison to the control group. Moreover, the concentrations of κ and λ FLCs and CEA were significantly higher in both low-grade as well as high-grade cancer in comparison to the controls. The levels of κ and λ FLCs differed between tumour grades, with patients presenting higher concentrations in high-grade compared to low-grade cancer. In the total study group, κFLC correlated with λFLC, the κ:λ ratio, CRP, CEA, CA19-9, creatinine and urea. There was also a correlation between λFLC and κFLC, CRP, CEA, creatinine and urea. The λFLC showed a higher ability (sensitivity and PPV) to detect bladder cancer in comparison to κFLC and CEA. In addition, λFLC had a higher ability to exclude BC (specificity and NPV) than κFLC and CEA. λFLC also showed the highest accuracy in the detection of bladder cancer. In conclusion, the revealed differences in the concentrations of both κ and λ FLCs suggest their potential participation in bladder cancer development. Increased concentrations of free light chains in bladder cancer patients and the association with the tumour grade suggest that κ and λ FLC measurements may be useful in the diagnosis and prognosis of bladder cancer. This is the first research that evaluates the concentration of FLCs in bladder cancer, so further studies are necessary to confirm their usefulness as tumour markers of this malignancy.

The Significance of Matrix Metalloproteinase 9 (MMP-9) and Metalloproteinase 2 (MMP-2) in Urinary Bladder Cancer

INTRODUCTION

Urinary bladder cancer is a serious oncological problem that is the cause of many deaths worldwide. The processes of metastasis and origination of local tumor invasion depend on the extracellular matrix (ECM) degradation. The cancer microenvironment, particularly the ECM, may be considered a key factor in cancer progression. Matrix metalloproteinases (MMPs) are classified as the main factors responsible for the degradation of ECM components. Therefore, the aim of the study was to evaluate the expression and activity of matrix metalloproteinase 2 and 9 (MMP-2 and MMP-9) in urinary bladder cancer according to different stages.

MATERIAL AND METHODS

Urinary bladder tissue samples were analyzed. Cancer patients were divided into two groups: low-grade tumors (LG; Group I) and high-grade tumors (HG; Group II). Control tissue was obtained from the opposite site to the tumor. MMPs content and activity (actual and specific) were evaluated using ELISA and Western blot methods, respectively.

RESULTS

Both MMPs are present in high and low molecular complexes in healthy or bladder cancer tissues. The content of MMP-9 is enhanced in comparison with MMP-2, particularly in HG cancer tissue. The actual activity of MMP-2 was highest in LG cancer tissue whereas the actual activity of MMP-9 was highest in HG cancer. Specific activity of both MMPs was highest in LG cancer, but the activity of MMP-9 was higher in comparison with MMP-2.

CONCLUSIONS

In conclusion, the content and specific activity of MMP-9 were increased in comparison with MMP-2. The revealed differences in content and activity of both MMPs demonstrate their different participation in ECM remodeling at different stages of cancer development. Moreover, it seems that MMP-9 has higher clinical utility than MMP-2 as a potential therapeutic option and a diagnostic biomarker of urinary bladder cancer.

Bipolar spectrum in prostate cancer patients and its role in stress related symptoms

BACKGROUND

Studies show significant co-occurrence of bipolar disorder and prostate cancer, as well as the presence of shared genes associated with both diseases. Our aim was to evaluate whether prostate cancer patients present bipolar spectrum symptoms and to establish their possible associations with stress related symptoms during diagnosis and the course of the cancer therapy.

METHODS

200 participants were enrolled to this study: 100 prostate cancer patients and 100 healthy males. Bipolar spectrum symptoms were measured with the use of Mood Disorder Questionnaire and Hypomania Checklist-32 (HCL-32). Stress related symptoms were rated with The Impact of Events Scale-Revised (IES-R), Perceived Stress Scale-10 (PSS-10) and Generalised Self-Efficacy Scale (GSES).

RESULTS

In comparison to healthy controls group, prostate cancer patients have shown higher HCL-32 scores. Mood Disorder Questionnaire measures were associated with more severe stress related to prostate cancer diagnosis and treatment reflected by higher scores of IES-R and its subscales (Avoidance, Intrusions and Hyperarousal). Mood Disorder Questionnaire, HCL-32, PSS-10, IES-R and GSES measures were not associated with clinical characteristics of prostate cancer severity.

LIMITATIONS

Cross-sectional study model precluded identification of causal relationship among variables. Bipolar spectrum symptoms and stress related measures were based on auto-questionnaires.

CONCLUSIONS

To our best knowledge, this is the first study evaluating bipolar spectrum symptoms in prostate cancer patients. We have shown that this clinical group presents increased bipolarity traits compared to healthy individuals. Moreover, bipolar spectrum symptoms were associated with more severe stress related to the prostate cancer diagnosis and its treatment, reflected in avoidance, hyperarousal, and intrusions.

No differences in miRNA expression in the stroma of ERG+ and ERG- prostate cancers

Prostate cancer (PC) is one of the most common cancers in males. A significant proportion of PCs bear TMPRSS2-ETS translocation and overexpress ERG transcription factor, allowing classification into ERG+ and ERG- groups, which differ in several features including the tumor microenvironment. The aim of the study was to verify whether they differ in expression of the miRNA in the microenvironment. The material consisted of 150 radical prostatectomies. Immunohistochemistry (IHC) for ERG was done using a routine method. FISH for TMPRSS2-ETS translocation was done with a ZytoLight SPEC ERG/TMPRSS2 TriCheck Probe. From each case, a representative section was selected, and tumor and non-tumor were microdissected with the LMD7000 device. RNA was isolated using the RNeasy Mini Kit system (Qiagen) and miRNA libraries were prepared with the NEBNext Multiplex Small RNA Library Prep Set for Illumina and their sequencing was performed on the NexSeq 500. Statistical analysis was done with Statistica and R software. When analyzing the expression of miRNAs some differences could be seen, but after correction for multiple comparisons was applied, these were found to be non- significant.

Not as black as it is painted? The impact of the first wave of COVID-19 pandemic on surgical treatment of urological cancer patients in Poland - a cross-country experience

INTRODUCTION

In the majority of Western European countries, the coronavirus disease (COVID-19) pandemic has led to a dramatic reduction in urooncological surgeries. Our objective was to evaluate the impact of the pandemic on volume and patterns of urooncological surgery in Poland.

MATERIAL AND METHODS

This is a retrospective analysis of 10 urologic centres in Poland. Data regarding major oncological procedures performed after the COVID-19 pandemic outbreak (March 15, 2020 - May 31, 2020) were evaluated and compared with data from the respective period in 2019.

RESULTS

Between March 15, 2020 and May 31, 2020, a total of 968 oncological procedures were performed in participating centres. When compared to the respective period in 2019 (1063 procedures) the overall number of surgeries declined by 8.9%. The reduction was observed for transurethral resection of bladder tumour (TURBT) (20.1%) and partial nephrectomies (PN) (16.5%). Surgical activity considering radical nephrectomy (RN), nephroureterectomy (NU), and radical prostatectomy (RP) remained relatively unchanged, whereas radical cystectomy (RC) burden showed a significant increase (90.9%). Characteristics of patients treated with TURBT, RC, NU, PN, and RN did not differ significantly between the compared periods, whereas RP in the COVID-19 period was performed more frequently in patients with a higher grade group (p = 0.028) and positive digital rectal examination (p = 0.007).

CONCLUSIONS

Surgical activity for urological cancers in Poland has been maintained during the first wave of the COVID-19 pandemic. The Polish strategy in the initial period of the COVID-19 crisis mirrors the scenario of hard initial lockdown followed by adaptive lockdown, during which oncological care remained undisrupted and did not require particular priority triage.

Factors Affecting the Usage of Wearable Device Technology for Healthcare among Indian Adults: A Cross-Sectional Study

BACKGROUND

Wearable device technology has recently been involved in the healthcare industry substantially. India is the world's third largest market for wearable devices and is projected to expand at a compound annual growth rate of ~26.33%. However, there is a paucity of literature analyzing the factors determining the acceptance of wearable healthcare device technology among low-middle-income countries.

METHODS

This cross-sectional, web-based survey aims to analyze the perceptions affecting the adoption and usage of wearable devices among the Indian population aged 16 years and above.

RESULTS

A total of 495 responses were obtained. In all, 50.3% were aged between 25-50 years and 51.3% belonged to the lower-income group. While 62.2% of the participants reported using wearable devices for managing their health, 29.3% were using them daily. technology and task fitness (TTF) showed a significant positive correlation with connectivity (r = 0.716), health care (r = 0.780), communication (r = 0.637), infotainment (r = 0.598), perceived usefulness (PU) (r = 0.792), and perceived ease of use (PEOU) (r = 0.800). Behavioral intention (BI) to use wearable devices positively correlated with PEOU (r = 0.644) and PU (r = 0.711). All factors affecting the use of wearable devices studied had higher mean scores among participants who were already using wearable devices. Male respondents had significantly higher mean scores for BI (p = 0.034) and PEOU (p = 0.009). Respondents older than 25 years of age had higher mean scores for BI (p = 0.027) and Infotainment (p = 0.032).

CONCLUSIONS

This study found a significant correlation with the adoption and acceptance of wearable devices for healthcare management in the Indian context.

Role of Deep Learning in Prostate Cancer Management: Past, Present and Future Based on a Comprehensive Literature Review

This review aims to present the applications of deep learning (DL) in prostate cancer diagnosis and treatment. Computer vision is becoming an increasingly large part of our daily lives due to advancements in technology. These advancements in computational power have allowed more extensive and more complex DL models to be trained on large datasets. Urologists have found these technologies help them in their work, and many such models have been developed to aid in the identification, treatment and surgical practices in prostate cancer. This review will present a systematic outline and summary of these deep learning models and technologies used for prostate cancer management. A literature search was carried out for English language articles over the last two decades from 2000–2021, and present in Scopus, MEDLINE, Clinicaltrials.gov, Science Direct, Web of Science and Google Scholar. A total of 224 articles were identified on the initial search. After screening, 64 articles were identified as related to applications in urology, from which 24 articles were identified to be solely related to the diagnosis and treatment of prostate cancer. The constant improvement in DL models should drive more research focusing on deep learning applications. The focus should be on improving models to the stage where they are ready to be implemented in clinical practice. Future research should prioritize developing models that can train on encrypted images, allowing increased data sharing and accessibility.

Comprehensive cancer-oriented biobanking resource of human samples for studies of post-zygotic genetic variation involved in cancer predisposition

The progress in translational cancer research relies on access to well-characterized samples from a representative number of patients and controls. The rationale behind our biobanking are explorations of post-zygotic pathogenic gene variants, especially in non-tumoral tissue, which might predispose to cancers. The targeted diagnoses are carcinomas of the breast (via mastectomy or breast conserving surgery), colon and rectum, prostate, and urinary bladder (via cystectomy or transurethral resection), exocrine pancreatic carcinoma as well as metastases of colorectal cancer to the liver. The choice was based on the high incidence of these cancers and/or frequent fatal outcome. We also collect age-matched normal controls. Our still ongoing collection originates from five clinical centers and after nearly 2-year cooperation reached 1711 patients and controls, yielding a total of 23226 independent samples, with an average of 74 donors and 1010 samples collected per month. The predominant diagnosis is breast carcinoma, with 933 donors, followed by colorectal carcinoma (383 donors), prostate carcinoma (221 donors), bladder carcinoma (81 donors), exocrine pancreatic carcinoma (15 donors) and metachronous colorectal cancer metastases to liver (14 donors). Forty percent of the total sample count originates from macroscopically healthy cancer-neighboring tissue, while contribution from tumors is 12%, which adds to the uniqueness of our collection for cancer predisposition studies. Moreover, we developed two program packages, enabling registration of patients, clinical data and samples at the participating hospitals as well as the central system of sample/data management at coordinating center. The approach used by us may serve as a model for dispersed biobanking from multiple satellite hospitals. Our biobanking resource ought to stimulate research into genetic mechanisms underlying the development of common cancers. It will allow all available "-omics" approaches on DNA-, RNA-, protein- and tissue levels to be applied. The collected samples can be made available to other research groups.

Treatment patterns for lower urinary tract symptoms and overactive bladder in an Eastern European country: a nationwide population-representative survey

Introduction

The aim of this study was to establish at the population level the treatment patterns for lower urinary tract symptoms (LUTS) and overactive bladder (OAB) in Poland.

Material and methods

We used data from LUTS POLAND, a survey representative of the entire Polish population classified by age, sex, and place of residence. The treatment patterns we considered were lifestyle changes, physiotherapy, non-prescription drugs, prescription drugs, and surgical treatment.

Results

We obtained 6,005 completed interviews. About one-third of respondents who reported LUTS or OAB were seeking treatment, and many of these persons received treatment. Men were more proactive in seeking treatment than women, and men more often received treatment. Management with prescription drugs was the most common treatment modality of LUTS and OAB respondents. There were some disparities in distribution of other treatment options between LUTS and OAB persons, but, disappointingly, non-invasive and low-cost management strategies were rarely reported as being used. Specialists (mainly urologists) provided most of the treatments. We did not identify differences between urban and rural areas in treatment seeking, treatment receiving, and the treatment methods that were used.

Conclusions

In Poland, the scale was low for seeking treatment for LUTS and OAB. As well, there was little reliance on non-invasive and low-cost management strategies for LUTS and OAB. Our findings underline the need for education of patients and physicians about LUTS and OAB, and for greater healthcare and financial resources for LUTS and OAB patients.

Engineering and clinical use of artificial intelligence (AI) with machine learning and data science advancements: radiology leading the way for future

Over the years, many clinical and engineering methods have been adapted for testing and screening for the presence of diseases. The most commonly used methods for diagnosis and analysis are computed tomography (CT) and X-ray imaging. Manual interpretation of these images is the current gold standard but can be subject to human error, is tedious, and is time-consuming. To improve efficiency and productivity, incorporating machine learning (ML) and deep learning (DL) algorithms could expedite the process. This article aims to review the role of artificial intelligence (AI) and its contribution to data science as well as various learning algorithms in radiology. We will analyze and explore the potential applications in image interpretation and radiological advances for AI. Furthermore, we will discuss the usage, methodology implemented, future of these concepts in radiology, and their limitations and challenges.

Attitudes and perceptions of outpatients towards adoption of telemedicine in healthcare during COVID-19 pandemic

BACKGROUND

Asia is home to a burgeoning market for telemedicine with the availability of cheaper smartphones and internet services. Due to a rise in telemedicine use by doctors and patients, it is imperative to understand the perception of patients towards the adoption of telemedicine, the availability of telemedicine to the general population, the frequency with which patients avail these services, and the motivation or apprehensions in using them, especially during the COVID-19 pandemic.

AIMS

The study is performed to understand the behavioral attitude and perceptions of the population regarding telemedicine and, in doing so, make services more user-friendly for patients.

METHODS

A total of 1170 participants were surveyed using a structured online questionnaire to assess the perceptions towards the adoption of telemedicine in healthcare delivery services. Multivariate analysis was performed to identify key variables of knowledge and attitude affecting the utilization of telemedicine.

RESULTS

Of the total respondents, 35.3% of patients never encountered telemedicine before and 26.9% did not come across telemedicine even during the COVID-19 pandemic.

CONCLUSION

Understanding the perceptions of patients, using targeted health education, positive communication, and behavioral modifications, is the key factor to be addressed to mitigate the apprehensions towards telemedicine and improve the utilization of the services.

Association between cardiovascular disease, cardiovascular drug therapy, and in-hospital outcomes in patients with COVID-19: data from a large single-center registry in Poland

BACKGROUND

COVID-19 recently became one of the leading causes of death worldwide, similar to cardiovascular disease (CVD). Coexisting CVD may influence the prognosis of patients with COVID-19.

AIMS

To analyze the impact of CVD and use of cardiovascular drugs on the in-hospital course and mortality of patients with COVID-19.

METHODS

We retrospectively studied data for consecutive patients admitted to our hospital, with COVID-19 between March 6th and October 15th, 2020.

RESULTS

1729 patients (median (Q1 - Q3) age 63 (50-75) years; women 48.8%) were included. Overall, in-hospital mortality was 12.9%. The most prevalent CVD was arterial hypertension (56.1%), followed by hyperlipidemia (27.4%), diabetes mellitus (DM) (25.7%), coronary artery disease (16.8%), heart failure (HF) (10.3%), atrial fibrillation (13.5%), and stroke (8%). Angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) were used in 25.0% of patients, β-blockers in 40.7%, statins in 15.6%, and antiplatelet therapy in 19.9%. Age over 65 years (odds ratio [OR] 6.4, 95% CI 4.3-9.6), male sex (OR 1.4, 95% CI 1.1-2.0), pre-existing DM (OR 1.5, 95% CI 1.1-2.1), and HF (OR 2.3, 95% CI 1.5-3.5) were independent predictors of in-hospital death, whereas treatment with ACEIs/ARBs (OR 0.4, 95% CI 0.3-0.6), β-blockers (OR 0.6, 95% CI 0.4-0.9), statins (OR 0.5, 95% CI 0.3-0.8), or antiplatelet therapy (OR 0.6, 95% CI 0.4-0.9) was associated with lower risk of death.

CONCLUSION

Among cardiovascular risk factors and diseases, HF and DM appeared to increase in-hospital COVID-19 mortality, whereas the use of cardiovascular drugs was associated with lower mortality.

Changes in neoadjuvant chemotherapy utilization in muscle invasive bladder cancer treatment: a tertiary center retrospective study

Introduction

The year 2015 brought a major shift in the national health care system in Poland – the diagnosis and treatment of patients with malignant diseases became a priority. Close multidisciplinary collaboration was facilitated to optimize patients’ care. The aim of this study was to investigate temporal changes in neoadjuvant chemotherapy (NAC) utilization in patients who underwent radical cystectomy (RC) due to muscle invasive bladder cancer (MIBC) in a single academic center in Poland.

Material and methods

Patients who underwent planned curative RC with bilateral pelvic lymph node dissection between January 2013 and December 2018 in a tertiary care center were included in the study. To assess the response to chemotherapy, tumor regression grades (TRGs) were included into the standard pathological examination of RC specimens.

Results

Out of 183 patients enrolled into the study, 105 (57.4%) underwent NAC before RC. Only 1 (4%) out of 25 patients underwent NAC prior to RC in 2013. The percentage of patients who received NAC in subsequent years were: 4% (1/25) in 2013, 36% (9/25) in 2014, 55.3% (21/38) in 2015, 62.9% (21/35) in 2016, 83.9% (26/31) in 2017 and 89.7% (26/29) in 2018 (p-value for trend <0.001). Thirty patients (28.6%) had complete pathological response to NAC (TRG1), 50 patients (47.6%) showed strong response (TRG2) and 25 patients (23.7%) had weak or no response (TRG3).

Conclusions

This study showed an increasing utilization of NAC amongst MIBC patients who underwent RC. Close multidisciplinary collaboration is the key to optimizing perioperative care of patients with MIBC.

Coexistence of lower urinary tract symptoms (LUTS) with depressive symptoms in patients suffering from depressive disorders

OBJECTIVES

The aim of the present study was to investigate the correlation between lower urinary tract symptoms (LUTS) and severity of depressive symptoms in patients treated for depression.

METHODS

102 patients (43 males, 59 females) aged 20-67 (M = 46.1) treated for depression were included in this cross-sectional analysis. Depressive symptoms were assessed with the 17-item Hamilton Depression Rating Scale (HDRS) and Quick Inventory of Depressive Symptomatology - Self Report (QIDS-SR). LUTS were examined with the International Prostate Symptom Score (IPSS). In order to analyze the impact of presented symptoms, both urological and psychiatric, on quality of life of analyzed individuals the 30-item General Health Questionnaire (GHQ-30) was used.

RESULTS

The average IPSS score in women was significantly higher than in men (9.59 vs. 6; p = 0.04). Patients suffering from at least moderate depression assessed with QIDS-SR had significantly higher scores in IPSS (9.76 vs. 4.1; p = 0.002). Severity of all LUTS assessed with IPSS correlated with QIDS-SR score in examined men (p < 0.05). In women, the total IPSS score correlated with the QIDS-SR score (p < 0.05) and with the total GHQ-30 score (p < 0.05). Anumber of other significant (p < 0.05) correlations were observed between the total IPSS score and certain items' scores in the GHQ-30 both in men and women.

CONCLUSIONS

LUTS are common among patients with depression. There is a correlation between severity of depressive symptoms and LUTS. LUTS affect quality of life and well-being as well as cause marked distress in depressed patients. Comorbidity of LUTS and depression should draw attention of both psychiatrists and urologists and enhance interdisciplinary treatment approach. Further prospective and cohort studies are essential to reveal more details of the correlation between LUTS and depression.

Patterns of gene expression characterize T1 and T3 clear cell renal cell carcinoma subtypes

Renal carcinoma is the 20th most common cancer worldwide. Clear cell renal cell carcinoma is the most frequent type of renal cancer. Even in patients diagnosed at an early stage, characteristics of disease progression remain heterogeneous. Up-to-date molecular classifications stratify the ccRCC samples into two clusters. We analyzed gene expression in 23 T1 or T3 ccRCC samples. Unsupervised clustering divided this group into three clusters, two of them contained pure T1 or T3 samples while one contained a mixed group. We defined a group of 36 genes that discriminate the mixed cluster. This gene set could be associated with tumor classification into a higher stage and it contained significant number of genes coding for molecular transporters, channel and transmembrane proteins. External data from TCGA used to test our findings confirmed that the expression levels of those 36 genes varied significantly between T1 and T3 tumors. In conclusion, we found a clustering pattern of gene expression, informative for heterogeneity among T1 and T3 tumors of clear cell renal cell carcinoma.

Nocturia has no impact on depression severity in patients suffering from depression but correlates with sleep quality

OBJECTIVES

In general population, the relationship between nocturia, depressive symptoms and sleep disturbance has been widely investigated. However, there is a paucity of data analyzing the significance of nocturia for depression severity and potential influence of nocturia on sleeping problems in depressed patients. To address this vacuum, we analyzed the impact of nocturia on depression severity and sleep quality in patients suffering from depression.

METHODS

We conducted a cross-sectional study of depressed patients treated in outpatient and inpatient Department of Adult Psychiatry, Jagiellonian University, Krakow. All patients met the DSM-5 and ICD-10 criteria for depression. Nocturia was assessed with the International Prostate Symptom Score (IPSS), severity of depression with the 17-item Hamilton Rating Scale for Depression (HRDS), and sleep quality with the Holland Sleep Disorders Questionnaire (HSDQ). Statistical analysis was carried out using an ANOVA test (post-hoc Tukey test).

RESULTS

Totally, 98 patients were included in our analysis. Nocturia was reported by 68 individuals. Majority of our patients (35) suffered from mild depression. The mean HSDQ score was 78.8 (range 32-146). Our analysis rejected the impact of nocturia on depression severity (p = 0.625) but revealed statistically significant correlation between nocturia and sleep quality (p = 0.037). A post-hoc test investigating the relationship between severity of nocturia and sleeping problems has demonstrated that higher number of night-time episodes of urination (at least 3 episodes) leads to significantly higher scores in the HSDQ.

CONCLUSIONS

Our analysis showed no impact of nocturia on illness severity in patients suffering from depression. However, we demonstrated correlation between nocturia and sleep quality in depressed individuals. Further studies with a larger number of patients are needed to validate the obtained results.

Urodynamics and diagnosis of urinary incontinence

The urinary incontinence diagnostic process should include a medical history focused on ailments related to it and their impact on the quality of patient’s life. The lack of proper control over the function of the lower urinary tract creates a lot of troubles for sufferers and prevents them from living an active professional, social, and family life. The patient with a suspicion of urinary incontinence is recommended to record in a voiding diary the number of mictions per day, the volume of urine, and episodes of incontinence. The invasive test called urodynamics is based on cystometry, profilometry, and uroflowmetry. A urodynamic examination performed in patients with incontinence allows for correct diagnosis and proposal of specific surgical or pharmacological treatment.

Perception of Lower Urinary Tract Symptoms by psychiatrists in mentally affected patients

OBJECTIVES

Lower urinary tract symptoms (LUTS) are highly prevalent and costly condition worldwide. Numerous studies have demonstrated their negative impact on health-related quality of life (HRQL), as well as on physical and mental health. The co-existence of LUTS and psychiatric symptoms is common and has been described by psychiatrists, urologists and gynecologists. However, data are lacking regarding the perception of urological symptoms by psychiatrists in their day-to-day clinical practice.

METHODS

31-question survey was designed to learn what is the perception of LUTS among psychiatrists. Survey link was sent by email to all psychiatrists registered to the Polish Association of Psychiatry via the association's email lists. The SurveyMonkey website was used as a platform where responses were collected and stored.

RESULTS

953 physicians completed the questionnaire. Majority of investigated psychiatrists only 'occasionally'ask their patients about voiding dysfunctions. Respondents estimated the frequency of voiding dysfunctions in their patients as 'moderately frequent'with a '10-30%' prevalence. However, discrepancies between different subgroups of psychiatrists have been noted. Furthermore, psychiatrists may not be fully aware of the effects of psychiatric treatment (psychotherapy/pharmacotherapy) on LUTS improvement, as well as possible deteriorations of voiding dysfunctions with psychiatric disorder progression.

CONCLUSIONS

This survey showed that the perception of urological symptoms by psychiatrists in their patients may be limited. Therefore, it is necessary to adequately inform and educate psychiatrists in terms of the impact of urological symptoms on patients'management, prognosis and quality of life.

Ureterorenoscopy training on cadavers embalmed by Thiel's method: simulation or a further step towards reality? Initial report

Introduction

The technique of ureterorenoscopy has a significant learning curve. Cadavers embalmed by the Thiel method have been successfully used for simulation training in a number of surgical specialties. Here we present our experience of the first use of Thiel cadavers in a formal ureteroscopy training course.

Material and methods

The inaugural ‘Masterclass in Flexible Ureterorenoscopy’ was run with participants performing ureterorenoscopy on three Thiel cadavers under expert supervision. A qualitative questionnaire was delivered to the participants and faculty. Assessed domains were tissue characteristics of the cadaveric urinary tract, anatomical features and procedural aspects. A five-point Likert score was used to assess responses. Data regarding participant experience in endourology were also collected.

Results

8 questionnaires were collected. All participants completed cadaveric ureterorenoscopy. Three-quarters reported the overall quality of tissue in the cadaveric bladder, ureters and pelvicalyceal system as high or excellent. Half reported the cadaveric bladder as being softer than in a live patient, whilst five out of eight thought that the cadaveric ureter was softer and more prone to trauma. Seven out of eight were satisfied with the overall quality of the cadaveric model. The quality of vision and irrigation in the upper urinary tracts was reported as high.

Conclusions

Thiel cadavers have been shown to have excellent tissue characteristics, as well as being durable and reusable. We have described the first use of Thiel cadavers in a designated ureterorenoscopy course, with high levels of delegate satisfaction. Further work is required to develop the role of Thiel cadavers as part of an integrated, modular urology training.

Prognostic role of N-cadherin expression in patients with non-muscle-invasive bladder cancer

PURPOSE

To assess the role of N-cadherin as a prognostic biomarker in patients with non-muscle-invasive bladder cancer (NMIBC) treated with transurethral resection with or without adjuvant intravesical therapy.

PATIENTS AND METHODS

Immunohistochemistry using monoclonal mouse antibody was used to evaluate the expression status of N-cadherin in 827 patients with NMIBC. N-cadherin was considered positive if any immunoreactivity with membranous staining was detected. Multivariable Cox regression models were performed to evaluate the prognostic effect of N-cadherin on survival outcomes.

RESULTS

N-cadherin expression was observed in 333 patients (40.3%); it was associated with pT1 stage and high tumor grade (both were P<0.001). Median follow-up was 55 months (interquartile range: 18-106). On multivariable Cox regression analyses that adjusted for the effect of the standard clinicopathologic features, N-cadherin expression remained associated with recurrence-free survival (P = 0.007) but not progression-free survival (P = 0.3), cancer-specific survival (P = 0.2), or overall survival (P = 0.9). Adding N-cadherin to a model for prediction of disease recurrence modestly improved its discrimination from 72.8% to 73.4%.

CONCLUSION

N-cadherin is expressed in approximately 2/5 patients with NMIBC. Its expression is associated with adverse pathological features and higher risk of disease recurrence but not progression. N-cadherin could be incorporated in predictive tools to assist in recurrence prediction helping thereby in patient selection regarding adjuvant therapies and follow-up planning.

Associations of selected lower urinary tract symptoms with biographical context in patients of a day hospital for neurotic disorders

OBJECTIVES

To assess the correlation of subjectively estimated biographical context and lower urinary tract symptoms reported by patients with neurotic and personality disorders.

METHODS

This was a retrospective analysis of the biographical context of co-existence of urinary frequency and urinary incontinence reported by 3,929 patients in a day hospital for treatment of neurotic disorders. The symptom checklists KO "0" were completed by patients prior to any treatment.

RESULTS

Urinary frequency reported by patients in a day hospital for treatment of neurotic disorders was associated with the difficulties from their childhood and adolescence (i.e. with perception of inferiority with regard to one's family and among siblings, parents' low education level), as well as the disparities in terms of sexual education and troubled relationships.

CONCLUSIONS

In the studied group of patients with neurotic and personality disorders, selected lower urinary tract symptoms were associated with adverse life circumstances from childhood and adolescence (which can show the tendency towards regression and protracted character to experience of family's dysfunction due to feeling of being neglected or abandoned), as well as, to a larger or a smaller degree, their consequences - dysfunctions in adulthood, relationship/marriage, functioning at work and dealing with finances. These associations indicated the probable significance of experiencing these aspects of life in patients, not only in day hospitals or psychiatric hospitals which reported "pseudo-urological complaints", but also in at least part of urological patients - going to hospitals due to neurotic disorders, particularly those occurring in a somatic form.

Concurrent bladder cancer in patients undergoing photodynamic diagnostic ureterorenoscopy: how many lesions do we miss under white light cystoscopy?

INTRODUCTION

There is an ongoing debate on panurothelial changes in the upper and lower urinary tract as multifocal presentation of urothelial cancer is well recognised. Concurrent bladder cancer impacts the outcome of the upper urinary tract urothelial cancer treatment, while its detection still relies on the white light cystoscopy.

MATERIAL AND METHODS

We retrospectively reviewed all patients who underwent photodynamic diagnostic ureterorenoscopy, choosing those who had synchronous bladder biopsies. Each patient received 20 mg/kg body weight of oral 5-Aminolevulinic acid around 3-4 hours before endoscopy. All procedures were performed by a single endourologist experienced in photodynamic diagnosis and flexible ureterorenoscopy.

RESULTS

Between July 2009 and June 2013, 69 patients underwent bladder biopsies at the time of photodynamic diagnostic endoscopic inspection of the upper urinary tract. In total, 43.5% (30/69) patients were found to have bladder lesions, of which 43.3% (13/30) were proven to be carcinoma in situ. White light inspection of the bladder missed bladder cancer in 16 (23.1%) patients, of which 12 were carcinoma in situ. There were 14 bladder cancer lesions missed under white light which were concomitant to the upper urinary tract urothelial cancer. Twelve (17.4%) patients developed minor complications relevant to the photosensitizer.

CONCLUSIONS

The study raises a concern about missing small bladder cancer/carcinoma in situ lesions on the initial diagnosis or in surveillance of the upper urinary tract urothelial cancer. Higher than previously reported, the rate of concomitant bladder cancer may suggest utilisation of photodynamic diagnosis to ensure the cancer free status of the bladder, but this needs to be ratified in a multi-institutional randomised trial.

Post-Irradiation Bladder Syndrome After Radiotherapy of Malignant Neoplasm of Small Pelvis Organs: An Observational, Non-Interventional Clinical Study Assessing VESIcare®/Solifenacin Treatment Results

Background

Radiotherapy is explicitly indicated as one of the excluding factors in diagnosing overactive bladder syndrome (OAB). Nevertheless, symptoms of OAB such as urgent episodes, incontinence, pollakiuria, and nocturia, which are consequences of irradiation, led us to test the effectiveness of VESIcare^®/Solifenacin in patients demonstrating these symptoms after radiation therapy of small pelvis organs due to malignant neoplasm.

Material/Methods

We conducted an observatory clinical study including 300 consecutive patients with symptoms of post-irradiation bladder; 271 of those patients completed the study. The observation time was 6 months and consisted of 3 consecutive visits taking place at 12-week intervals. We used VESIcare® at a dose of 5 mg a day. Every sixth patient was examined urodynamically at the beginning and at the end of the observation period, with an inflow speed of 50 ml/s.

Results

We noticed improvement and decline in the average number of episodes a day in the following parameters: number of micturitions a day (−36%, P<0.01), nocturia (−50%, P<0.01), urgent episodes (−41%, P<0.03), and episodes of incontinence (−43%, P<0.01). The patients’ quality of life improved. The average maximal cystometric volume increased by 34 ml (21%, p<0.01), average bladder volume of “first desire” increased by 42 ml (49%, P<0.01), and average detrusor muscle pressure at maximal cystometric volume diminished by 9 cmH₂O (−36%, P<0.03).

Conclusions

The substance is well-tolerated. Solifenacin administered long-term to patients with symptoms of OAB after radiotherapy of a malignant neoplasm of the small pelvis organs has a daily impact in decreasing number of urgent episodes, incontinence, pollakiuria, and nocturia.

Regenerative medicine- techniques and methods of administering autologous derived stem cells in urinary incontinence

The aim of the work is to present regenerative medicine achievement as an alternative SUI treatment and the variety of injected cells type as well as injection techniques itself with the analysis of their quality and possible the mechanism in which they reduce urinary incontinence symptoms. For over a decade numerous authors declare use of different type of autologous mesenchymal-derived stem cells (AMDC) in male and female SUI. The leakage improvement reached 80%, despite the number of injected cells as well as the injection technique. Important subject in the AMDC treatment is the precise cell material injection into the selected spot which might be possible with the use of the endoscopic assisting robot. The robotic supported system for cells procedure might bring the missing percentage in reaching the goal in SUI treatment.

Modified technique of cavoatrial tumor thrombectomy without cardiopulmonary by-pass and hypothermic circulatory arrest: a preliminary report

Introduction

Traditionally, tumor thrombi extending into the right atrium have been managed by open surgery with sternotomy, cardiopulmonary bypass circulation and hypothermic circulatory arrest, and are associated with significant morbidity and mortality rates. Here, we evaluate the results of cavoatrial thrombectomy using our own, Foley catheter assisted-technique, obviating the need for thoracotomy, extracorporeal circulation, and/or hypothermic circulatory arrest.

Material and methods

Between June 2013 and January 2015, 4 consecutive patients underwent cavoatrial thrombectomy performed with our own, Foley catheter assisted technique, via Chevron incision, with no need for extracorporeal circulation or hypothermy for renal cell carcinoma with tumor thrombus extending into the right atrium. Analyses of patients’ data from a prospectively maintained database with respect to perioperative characteristics, morbidity and mortality were performed.

Results

The total mean duration of surgery was 255 minutes. The mean time of total IVC (inferior vena cava) occlusion was 90 seconds. The average blood loss volume, timed from the beginning of cavotomy incision until its closure, was 1200 ml. The total mean intraoperative blood loss was 3,150 ml. There was no perioperative death. Postoperative complications included one transient acute kidney injury requiring one-off hemodialysis and one re-operation due to bleeding. The follow-up time ranged between 12 to 17 months. None of the patients developed disease recurrence. All patients were still alive at the time of study completion.

Conclusions

Obtained results support the validity of our own, Foley catheter assisted technique, without cardiopulmonary bypass and hypothermic circulatory arrest for the treatment of renal cell carcinoma with tumor thrombus extending into the right atrium.

The impact of nutrition in urogenital cancers

Prostate, bladder and kidney cancers remain the most common cancers of the urinary tract. Despite improved primary prevention, detection and treatment, the incidence of age-related cancers of the urinary tract is likely to rise as a result of global population ageing. An association of diet with prostate, bladder and kidney carcinogenesis is plausible since the majority of metabolites, including carcinogens, are excreted through the urinary tract. Moreover, large regional differences in incidence rates of urologic tumours exist throughout the world. These rates change when people relocate to different geographic areas, which is suggestive of a strong environmental influence. As a result of these observations, numerous studies have been conducted to assess the effects of diet and nutritional status in kidney, bladder and prostate carcinogenesis. Here, we review the literature assessing the effect of diet and nutritional status on urological cancer risk, which has attracted the most interest.

Endoscopic simple prostatectomy

INTRODUCTION

Many options exist for the surgical treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), including transurethral resection of the prostate (TURP), laser surgery, and open adenomectomy. Recently, endoscopic techniques have been used in the treatment of BPH.

MATERIAL AND METHODS

We reviewed clinical studies in PubMed describing minimally invasive endoscopic procedures for the treatment of BPH.

RESULTS

Laparoscopic adenomectomy (LA) and robotic-assisted simple prostatectomy (RASP) were introduced in the early 2000s. These operative techniques have been standardized and reproducible, with some individual modifications. Studies analyzing the outcomes of LA and RASP have reported significant improvements in urinary flow and decreases in patient International Prostate Symptom Score (IPSS). These minimally invasive approaches have resulted in a lower rate of complications, shorter hospital stays, smaller scars, faster recoveries, and an earlier return to work.

CONCLUSIONS

Minimally invasive techniques such as LA and RASP for the treatment BPH are safe, efficacious, and allow faster recovery. These procedures have a short learning curve and offer new options for the surgeon treating BPH.

Novel trends in transrectal ultrasound imaging of prostate gland carcinoma

Carcinoma of the prostate gland is the most common neoplasm in men. Its treatment depends on multiple factors among which local staging plays a significant role. The basic method is transrectal ultrasound imaging. This examination enables imaging of the prostate gland and its abnormalities, but it also allows ultrasound-guided biopsies to be conducted. A conventional gray-scale ultrasound examination enables assessment of the size, echostructure and outlines of the anatomic capsule, but in many cases, neoplastic lesions cannot be observed. For this reason, new sonographic techniques are implemented in order to facilitate detectability of cancer. The usage of contrast agents during transrectal ultrasound examination must be emphasized since, in combination with color Doppler, it facilitates detection of cancerous lesions by visualizing flow which is not observable without contrast enhancement. Elastography, in turn, is a different solution. It uses the differences in tissue elasticity between a neoplastic region and normal prostatic parenchyma that surrounds it. This technique facilitates detection of lesions irrespective of their echogenicity and thereby supplements conventional transrectal examinations. However, the size of the prostate gland and its relatively far location from the transducer may constitute limitations to the effectiveness of elastography. Moreover, the manner of conducting such an examination depends on the examiner and his or her subjective assessment. Another method, which falls within the novel, popular trend of combining imaging methods, is fusion of magnetic resonance imaging and transrectal sonography. The application of multidimensional magnetic resonance imaging, which is currently believed to be the best method for prostate cancer staging, in combination with the availability of a TRUS examination and the possibility of monitoring biopsies in real-time sonography is a promising alternative, but it is associated with higher costs and longer duration of the examination. This paper presents the most important novel trends in transrectal imaging in prostate cancer diagnosis based on the review of the articles available in the PubMed base and published after 2010.

Ureter regeneration-the proper scaffold has to be defined

The aim of this study was to compare two different acellular scaffolds: natural and synthetic, for urinary conduit construction and ureter segment reconstruction. Acellular aortic arch (AAM) and poly(L-lactide-co-caprolactone) (PLCL) were used in 24 rats for ureter reconstruction in both tested groups. Follow-up period was 4 weeks. Intravenous pyelography, histological and immunohistochemical analysis were performed. All animals survived surgical procedures. Patent uretero-conduit junction was observed only in one case using PLCL. In case of ureter segment reconstruction ureters were patent in one case using AAM and in four cases using PLCL scaffolds. Regeneration of urothelium layer and focal regeneration of smooth muscle layer was observed on both tested scaffolds. Obtained results indicates that synthetic acellular PLCL scaffolds showed better properties for ureter reconstruction than naturally derived acellular aortic arch.

α-blockade, apoptosis, and prostate shrinkage: how are they related?

Purpose

The α1–adrenoreceptor antagonists, such as terazosin and doxazosin, induce prostate programmed cell death (apoptosis) within prostate epithelial and stromal cells in vitro. This treatment should cause prostate volume decrease, However, this has never been observed in clinical conditions. The aim of this paper is to review the disconnect between these two processes.

Methods

PubMed and DOAJ were searched for papers related to prostate, apoptosis, and stem cell death. The following key words were used: prostate, benign prostate hyperplasia, programmed cell death, apoptosis, cell death, α1–adrenoreceptor antagonist, α–blockade, prostate epithelium, prostate stroma, stem cells, progenitors, and in vitro models.

Results

We have shown how discoveries related to stem cells can influence our understanding of α–blockade treatment for BPH patients. Prostate epithelial and mesenchymal compartments have stem (progenitors) and differentiating cells. These compartments are described in relation to experimental in vitro and in vivo settings.

Conclusions

Apoptosis is observed within prostate tissue, but this effect has no clinical significance and cannot lead to prostate shrinkage. In part, this is due to stem cells that are responsible for prostate tissue regeneration and are resistant to apoptosis triggered by α1–receptor antagonists.

Obesity and prostate cancer incidence and mortality: a systematic review of prospective cohort studies

BACKGROUND

There has been a large body of research on obesity and the risk of prostate cancer (PCa) that has been published recently. However, the epidemiological evidence for such an association has not been consistent. This may be attributed to the nature of case-control and retrospective studies, which generally are more prone to biases. Therefore, we conducted a systematic review of prospective cohort studies to assess the association between obesity and the risk of PCa incidence and death.

METHODS

A search of the PubMed database and references of published studies (from inception until March 2013) was conducted. Twenty-three eligible studies were identified and included in the systematic review.

RESULTS

The evidence from the prospective cohort studies linking obesity with PCa incidence has not been consistent. However, cumulative data is compelling for a strong positive association between obesity and fatal PCa.

CONCLUSIONS

Obesity is a significant diet-related risk factor for fatal PCa. Further well-constructed, large cohort studies on the potential association between obesity and PCa, as well as on underlying mechanisms, are needed.

[Laparoscopic radical cystectomy with extracorporeal ileal neobladder reconstruction]

Open radical cystectomy with orthotopic neobladder reconstruction is a complex procedure not only carrying a significant risk of peri- and postoperative complications but also a high, 3% risk of mortality to the patient. The advantages of performing cystectomy with various urinary diversion methods by the use of minimal invasive techniques include minimal surgical trauma, lower requirement for blood transfusion, swift recovery and shorter hospital stay. The aim of this paper is to describe an operative technique for neobladder urinary diversion formation via minilaparotomy, and classic laparoscopic technique with our own modification in patients who underwent laparoscopic radical cystectomy.

[Surgical management of severe Peyronie's disease]

Peyronie's disease (lat. induratio penis plastica) is a process of the fibrotic plaques oand other localized fibrotic conditions have been considered to be the result of an abnormal size, pain and improved penile curvature. At early stages intralesional injections may decrease penile curvature and decrease plaque volume although the exact mechanism of action on Peyronie disease is unknown. In serious cases surgery is recommended, based on ultrasound examination, cavernosography and cavernosometry. There are three mail surgical procedures to correct the curvature in Peyronie's disease: Nesbit plication, plaque excision followed by skin grafting, another autograft or synthetic material, and implantation of a penile prosthesis Aim of this study is to present our experience in surgical treatment of severe stadium in Peyronie's disease. Peyronie plaque was excised in 8 man, previously potent with severe satium of the disease. In every case saphenous autograft replacing excised plaque was used. In every case was not intra and postoperative complications. All patients reported satisfactory cosmetic and functional result. The satisfactory result of the treatment of severe stadium Peyronie disease is based on the surgical method. Saphenous graft is effective, safe and successful technique in our knowledge.

[Does neuroendocrine differentiation have prognostic value in prostate core needle biopsies?]

AIM

The biological behaviour of prostate cancer (PCa) varies significantly and cannot be, therefore, predicted. Better understanding of the mechanisms underpinning PCa oncogenesis and progression with its yet-to-be discovered poor prognostic factors is essential in order to optimise and tailor treatment to an individual patient. The aim of this paper was to investigate the association between the rate of focal PCa neuroendocrine activity, tumour cell proliferation index score, and the rate of PCa positive core needle biopsy results.

MATERIAL AND METHODS

92 men, with histologically confirmed PCa, which was clinically confined to the prostate and was graded with Gleason score > or =7, had their core needle biopsies under transrectal ultrasonography guidance performed. The PCa neuroendocrine activity was immunohistochemically confirmed using antibodies against Chromogranin-A and neuron specific enolase.

RESULTS

The neuroendocrine activity was detected in 14 (13%) out of 92 PCa patients participating in the study. The proliferative index was not increased in non-cancerous prostate cells. There was no relationship between PCa neuroendocrine activity, the number and percentage of PCa positive biopsies, prostate volume, serum PSA concentration, and Gleason score found.

CONCLUSIONS

No association between selected PCa prognostic factors and neuroendocrine activity could be found in patients with organ confined prostate cancer.

[Prospective evaluation of pain associated with indwelling JJ stents following ureterorenoscopic lithotripsy]

AIM

Routine placement of JJ ure teric stents, following uncomplicated endoscopic removal of a ureteral stone, still remains debatable. Indwelling JJ stents are not without any risks. They often can cause marked discomfort, or even pain. The aim of this study was to prospectively evaluate patient's perceived pain due to renal colic and indwelling JJ stent left following ure terorenoscopic lithotripsy (URSL).

MATERIAL AND METHODS

54 patients with colicky pain due to distal ureteric stone, and who underwent uncompli cated ureterorenoscopic lithotripsy, were included in the study. Follow ing URSL, patients were randomly selected to have either JJ stent left in situ (Group I), or remain without a stent (Group II). Among all study par ticipants levels of pain prior, as well as 14 days after the procedure were evalu ated with the use of a visual analogue pain scale.

RESULTS

Pain perception at the time of colic did not vary between men and women (6.30 +/- 1.33 and 6.38 +/- 1.11, respectively, p=0.293). Similarly, no differences in perceived pain were noted 14 days following URSL. Mean pain score in patients with indwelling JJ stent was 2.12 +/- 1.23 as compared to 2.15 +/- 0.67 in those without it (p=0.148).

CONCLUSIONS

No increase in pain levels due to indwelling JJ stent could be observed. Further research to allow for better assessment of discomfort and pain caused by an indwelling JJ stent on a larger cohort, and which could also discriminate patients' psy chosomatic symptoms, is needed.

Hair follicle stem cells can be driven into a urothelial-like phenotype: an experimental study

The aim of this study was to show that conditioned medium might induce transdifferentiation of hair follicle stem cells into urothelial-like cells. Several conditioned media and culture conditions (skeletal muscle cell conditioned medium, smooth muscle cell conditioned medium, fibroblast conditioned medium, transforming growth factor-conditioned medium, urothelial cell conditioned medium, and co-culture of hair follicle stem cells and urothelial cells) were used. The hair follicle stem cells phenotype from rat whisker hair follicles was checked by using flow cytometry and immunofluorescence. Cytokeratins 7, 8, 15 and 18 were used as markers. Urothelial cell conditioned medium increased the expression of urothelial markers (cytokeratin 7, cytokeratin 8, cytokeratin 18), whereas it decreased a hair follicle stem cells marker (cytokeratin 15) after 2 weeks of culture. This process depended on the time of cultivation. This medium was able to sustain the epithelial phenotype of the culture. Other media including a co-culture system failed to induce similar changes. Smooth muscle conditioned medium resulted in a loss of cells in culture. Hair follicle stem cells are capable of differentiating into urothelial-like cells in vitro when exposed to a bladder-specific microenvironment.

Clinical significance of surgical margin status in patients subjected to radical prostatectomy

The aim of this study is to evaluate the clinical value of positive surgical margins (PSM) in patients subjected to radical prostatectomy (RP).

The data of men who were subjected to RP from the 1st of January, 2001 to the 30th of May, 2010 were analyzed. Specimens with PSM were again evaluated to confirm the presence of positive margins.

PSM were found in 64 (25%) out of 255 analyzed patients. Out of all clinical features, only biopsy Gleason score and clinical stage of the disease were found to be predictive of PSM. Biochemical recurrence (BR) was found in 42 (16.5%) men, among them 17 (26.6%) had PSM and 25 (13.1%) had negative margins. The risk of BR in those with „focal” PSM (<3 mm) did not differ from the risk of BR observed in patients without PSM. In contrast, the likelihood of BR was significantly greater in cases of PSM in which maximum longitude exceeded 3 mm. Reevaluation of the PSM specimens revealed equivocal margins status in six cases.

PSM are not inevitably associated with BR. The risk of failure is influenced by their length. Reevaluation of the prostate specimen may lead to surgical margins status modification.

The intraoperative assessment of the effectiveness of computed tomography in the detection of the residual mass of the retroperitoneal space in patients with nonseminoma testicular tumors after chemotherapy

BACKGROUND

The incidence of testicular tumors in Poland accounts for 2.4 new cases per 100.000 men a year. When investigating the incidence with regard to age, we may notice three age ranges with the highest incidence rate: babyhood, 25-40 years of age, and age of about 60 years. A routine examination in patients with testicular cancer after the first course of chemotherapy is computed tomography of the retroperitoneal space which aims to exclude the presence of residual masses and to assess the effectiveness of the treatment.

AIM OF THE STUDY

The assessment of the effectiveness of computed tomography in the intraoperative investigation of patients with nonseminoma testicular tumors after chemotherapy.

MATERIAL/METHOD

This detailed retrospective analysis included 182 men with nonseminoma testicular tumor treated at the Center of Oncology in Cracow, between the yeas 1990-1999. Men with tumors in stage from IA to IIC made up 79.68% of the patients. Twenty patients after chemotherapy, with residual masses in the retroperitoneal cavity revealed in computed tomography, underwent retroperitoneal lymphadenectomy. The investigation was carried out with GE CT spiral scanner before and after intravenous contrast administration.

CONCLUSIONS

Computed tomography is a method of a satisfactory sensitivity in the assessment of residual masses in the retroperitoneal cavity in postchemotherapy patients, as concerns the location of the tumor, its size, number of foci, and the fact whether it can be operated on or not. Together with tumor markers, it allows for a precise qualification to retroperitoneal lymphadenectomy of residual masses in postchemotherapy patients.

Testosterone supplementation and prostate cancer, controversies still exist

Late onset hypogonadism is a common condition in aging males. The population of men who can be potentially treated with testosterone supplementation is growing. Controversy that surrounds testosterone replacement therapy is due to generally undefined lower limits of normal testosterone level and high prevalence of hypogonadal symptoms in elderly population and the non-specific nature of these symptoms. Incidence of prostate hyperplasia and occult prostate cancer in elderly are both high. The risk that testosterone treatment would trigger prostate cancer was not fully recognized. The aim of this mini review is to present a risk of carcinogenesis within the prostate related to testosterone treatment.

Technique of transurethral needle core biopsy to confirm invasive bladder cancer staging

INTRODUCTION

Transurethral, cystoscopically-guided needle core biopsy (TUcoreBxBT) seems to be a less invasive diagnostic method than transurethral resection (TURBT) offering a simple way to confirm cancer infiltration of the bladder. The aim of this study was to assess the technique of TUcoreBxBT in the diagnosis of bladder cancer infiltrating the detrusor muscle.

MATERIAL AND METHODS

In every 96 pts the suspicion of invasive bladder cancer (IBC) was evaluated on the basis of radiological examinations, cystoscopy and bimanual examination. TUcoreBxBT were performed using a rigid cystoscope with a direct working channel and tru-cut automatic (COOK Quick-Core(®) Biopsy-Needle) 18 G/480 mm needle or self construction tru-cut 16 G/400 mm needle, adapted to work with a standard biopsy gun. At least three cores were taken in each patient, followed by regular TURBT.

RESULTS

There were no complications of the bladder biopsy procedure. The average size of cores was 15 mm (8-17 mm). In every case TUcoreBxBT revealed muscle infiltration and was in agreement with all microscopic examinations of TURBT.

CONCLUSIONS

TUcoreBxBT in cases of clear suspicion of invasive bladder cancer is a simple, short and safe procedure which makes it possible to collect reliable material for microscopic examination. TUcoreBxBT is less invasive than standard TURBT only in diagnosis and staging of invasive tumours, and seems to be effective in selected cases to confirm malignancy before radical cystectomy.