Differential Expression of IGF-I Transcripts in Bladder Cancer.

BACKGROUND/AIM: A growing body of evidence shows that the differential expression of E domain-related insulin-like growth factor-I (IGF-I) transcripts (IFG-IEa, IGF-IEb and IGF-IEc) in normal and cancerous tissues, implicating specific biological roles for the putative Ea, Eb, and Ec peptides, beyond IGF-I. Herein, we investigated the expression profile of IGF-IEa, IGF-IEb and IGF-IEc transcripts in bladder cancer and compared them with samples from the normal adjacent bladder tissue. MATERIALS AND METHODS: Biopsies from 46 patients (39 men and 7 women), aged 73.3±10.9 years, were analyzed for the expression of IGF-I transcripts using semi-quantitative real time-PCR (qRT-PCR). RESULTS: The presence of all three IGF-I transcripts was detected in both normal urothelium and bladder carcinomas. The relative expression of the IGF-IEa and IFG-IEb was marginally increased in bladder cancer tissues compared to normal tissue (p>0.05). In contrast, the expression of the IGF-IEc was significantly decreased in bladder cancer as compared to normal adjacent urothelium (p<0.05). This specific suppression of IGF-IEc expression was evident and positively correlated with the histological and/or clinical characteristics of an advanced disease, referring to clinical stage, tumor grade and disease recurrence (p<0.05); however, in situ carcinomas exhibited an increased expression of all IGF-I transcripts. CONCLUSION: Our data confirm the differential expression of IGF-I transcripts in bladder cancer, revealing a distinct suppression of IGF-IEc. These findings suggest that IGF-IEc expression and putative Ec product may possess discrete biological role in disease progression beyond IGF-I.

Review of the current management of upper urinary tract injuries by the EAU Trauma Guidelines Panel.

CONTEXT: The most recent European Association of Urology (EAU) guidelines on urological trauma were published in 2014. OBJECTIVE: To present a summary of the 2014 version of the EAU guidelines on upper urinary tract injuries with the emphasis upon diagnosis and treatment. EVIDENCE ACQUISITION: The EAU trauma guidelines panel reviewed literature by a Medline search on upper urinary tract injuries; publication dates up to December 2013 were accepted. The focus was on newer publications and reviews, although older key references could be included. EVIDENCE SYNTHESIS: A full version of the guidelines is available in print and online. Blunt trauma is the main cause of renal injuries. The preferred diagnostic modality of renal trauma is computed tomography (CT) scan. Conservative management is the best approach in stable patients. Angiography and selective embolisation are the first-line treatments. Surgical exploration is primarily for the control of haemorrhage (which may necessitate nephrectomy) and renal salvage. Urinary extravasation is managed with endourologic or percutaneous techniques. Complications may require additional imaging or interventions. Follow-up is focused on renal function and blood pressure. Penetrating trauma is the main cause of noniatrogenic ureteral injuries. The diagnosis is often made by CT scanning or at laparotomy, and the mainstay of treatment is open repair. The type of repair depends upon the severity and location of the injury. CONCLUSIONS: Renal injuries are best managed conservatively or with minimally invasive techniques. Preservation of renal units is feasible in most cases. This review, performed by the EAU trauma guidelines panel, summarises the current management of upper urinary tract injuries. PATIENT SUMMARY: Patients with trauma benefit from being accurately diagnosed and treated appropriately, according to the nature and severity of their injury.

Evaluation of neutrophil gelatinase-associated lipocalin, interleukin-18, and cystatin C as molecular markers before and after unilateral shock wave lithotripsy.

OBJECTIVE: To investigate the impact of shock wave lithotripsy (SWL) on renal tissues using neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and interleukin 18 (IL-18) levels in serum and urine and to examine the relationship of these biomarkers with patient and calculus characteristics as well as SWL treatment parameters. MATERIALS AND METHODS: Thirty-seven patients with renal calculi were included in this study. Blood and urine samples were attained from each patient at 4 time points; immediately before SWL, 6 hours after, 3 days after, and 10 days after the SWL. A new generation lithotripter was used for all cases. Serum and urine NGAL concentrations were measured using commercially available enzyme-linked immunosorbent assay kits according to manufacture's protocol. The concentration of cystatin C was measured in serum, whereas IL-18 concentration was assessed in urine. RESULTS: There were no statistically significantly differences in the levels of NGAL in serum and urine before and after SWL. The mean levels of cystatin C in serum appeared significantly higher 3 and 10 days after SWL. No statistically significant differences were identified between levels of IL-18 before and after SWL. Patients with diabetes mellitus demonstrated significantly higher baseline cystatin C levels. There was no correlation between calculus characteristics or treatment parameters and the levels of all 3 biomarkers after SWL. CONCLUSION: The results of this study indicate that SWL is associated with minimal acute injury to renal tissues. Our findings support the safety profile of new generation lithotripters, provided orthodox indications and treatment principles are followed.

Safety of ultrasound-guided transrectal extended prostate biopsy in patients receiving low-dose aspirin.

PURPOSE: To determine whether the peri-procedural administration of low-dose aspirin increases the risk of bleeding complications for patients undergoing extended prostate biopsies. MATERIALS AND METHODS: From February 2007 to September 2008, 530 men undergoing extended needle biopsies were divided in two groups; those receiving aspirin and those not receiving aspirin. The morbidity of the procedure, with emphasis on hemorrhagic complications, was assessed prospectively using two standardized questionnaires. RESULTS: There were no significant differences between the two groups regarding the mean number of biopsy cores (12.9 +/- 1.6 vs. 13.1 +/- 1.2 cores, p = 0.09). No major biopsy-related complications were noted. Statistical analysis did not demonstrate significant differences in the rate of hematuria (64.5% vs. 60.6%, p = 0.46), rectal bleeding (33.6% vs. 25.9%, p = 0.09) or hemospermia (90.1% vs. 86.9%, p = 0.45). The mean duration of hematuria and rectal bleeding was significantly greater in the aspirin group compared to the control group (4.45 +/- 2.7 vs. 2.4 +/- 2.6, p = < 0.001 and 3.3 +/- 1.3 vs. 1.9 +/- 0.7, p < 0.001). Multivariate logistic regression analysis revealed that only younger patients (mean age 60.1 +/- 5.8 years) with a lower body mass index (< 25 kg/m2) receiving aspirin were at a higher risk (odds ratio = 3.46, p = 0.047) for developing hematuria and rectal bleeding after the procedure. CONCLUSIONS: The continuing use of low-dose aspirin in patients undergoing extended prostatic biopsy is a relatively safe option since it does not increase the morbidity of the procedure.

Safety of ultrasound-guided transrectal extended prostate biopsy in patients receiving low-dose aspirin

PURPOSE: To determine whether the peri-procedural administration of low-dose aspirin increases the risk of bleeding complications for patients undergoing extended prostate biopsies. MATERIALS AND METHODS: From February 2007 to September 2008, 530 men undergoing extended needle biopsies were divided in two groups; those receiving aspirin and those not receiving aspirin. The morbidity of the procedure, with emphasis on hemorrhagic complications, was assessed prospectively using two standardized questionnaires. RESULTS: There were no significant differences between the two groups regarding the mean number of biopsy cores (12.9 ± 1.6 vs. 13.1 ± 1.2 cores, p = 0.09). No major biopsy-related complications were noted. Statistical analysis did not demonstrate significant differences in the rate of hematuria (64.5 percent vs. 60.6 percent, p = 0.46), rectal bleeding (33.6 percent vs. 25.9 percent, p = 0.09) or hemospermia (90.1 percent vs. 86.9 percent, p = 0.45). The mean duration of hematuria and rectal bleeding was significantly greater in the aspirin group compared to the control group (4.45 ± 2.7 vs. 2.4 ± 2.6, p = < 0.001 and 3.3 ± 1.3 vs. 1.9 ± 0.7, p < 0.001). Multivariate logistic regression analysis revealed that only younger patients (mean age 60.1 ± 5.8 years) with a lower body mass index (< 25 kg/m2) receiving aspirin were at a higher risk (odds ratio = 3.46, p = 0.047) for developing hematuria and rectal bleeding after the procedure. CONCLUSIONS: The continuing use of low-dose aspirin in patients undergoing extended prostatic biopsy is a relatively safe option since it does not increase the morbidity of the procedure.

Differences in presentation characteristics of renal cell carcinoma in the last 25 years: a single center experience.

PURPOSE: The aim of this study was to examine trends in clinicopathological characteristics of renal cell carcinoma (RCC) cases at presentation in a single institution over a 25-years period. PATIENTS AND METHODS: The medical files of 505 patients with histologically confirmed primary RCC from 1981 to 2006 were retrospectively reviewed. Host and tumor characteristics at presentation were compared following stratification by hospitalization period (1981-1990, 1991-2000, and 2001-2006). RESULTS: Age at presentation did not change significantly over time. The incidentally diagnosed cases increased significantly by time (10.2, 40.5, 62.7%), in proportion to small (<4 cm) tumors (8.6, 17.3, 30.6%), while tumor diameter decreased significantly (8.5 +/- 3.8, 7.4 +/- 3.5, 5.8 +/- 2.9). The rate of organ-confined tumors increased significantly (42.1, 63.6, 68.9%), followed by a less pronounced decrease of metastatic cases (12.3, 8.9, 6.8%). CONCLUSIONS: The evolution of tumor characteristics at presentation in a single institution is apparent within the last 25 years. Major changes were noticed within organ-confined and small tumors and call for familiarization of urologists with nephron-sparing techniques and novel ablation technologies.

Prognostic significance of metallothionein expression in renal cell carcinoma.

BACKGROUND: Metallothionein (MT) protein expression deficiency has been implicated in carcinogenesis while MT over expression in tumors is indicative of tumor resistance to anti-cancer treatment. The purpose of the study was to examine the expression of MT expression in human renal cell carcinoma (RCC) and to correlate MT positivity, the pattern and extent of MT expression with tumor histologic cell type and nuclear grade, pathologic stage and patients' survival. PATIENTS AND METHODS: The immunohistochemical expression of MT was determined in 43 formalin-fixed and paraffin-embedded RCC specimens, using a mouse monoclonal antibody that reacts with both human MT-I and MT-II. Correlation was sought between immunohistochemical (MT positivity, intensity and extension of staining) and clinico-pathological data (histological cell type, tumor nuclear grade, pathologic stage and patients' survival). RESULTS: Positive MT staining was present in 21 cases (49%), being mild/moderate and intense in 8 and 13 cases, respectively. The pattern was cytoplasmic in 7 cases and was both cytoplasmic and nuclear in 14 cases. MT expression in a percentage of up to 25% of tumor cells (negative MT staining included) was observed in 31 cases, in a percentage 25-50% of tumor cells in 7 cases, and in a percentage of 50-75% of tumor cells in 5 cases. There was no significant correlation of MT intensity of staining to histological type, stage and patients' survival, while it was inversely correlated to higher tumor nuclear grade. MT extent of staining did not correlate with histological type, nuclear grade, and pathologic stage while a statistically significant association was found with patients' survival. CONCLUSIONS: The inverse correlation between MT staining intensity and tumor nuclear grade in RCC suggests a role of MT in tumor differentiation process. Since extent of MT expression is inversely correlated with survival it may be possibly used as a clinical prognostic parameter.

EAU guidelines on urological trauma.

PURPOSE: To determine the optimal evaluation and management of genitourinary (renal, ureteral, bladder, urethral and genital) injuries by review of the world's literature on the subject. METHODS: A consensus committee convened by the Health Care Office of the European Association of Urology (EAU) to summarize the literature concerning the diagnosis and treatment of genitourinary trauma. RESULTS: Findings of 350 citations are reviewed. CONCLUSIONS: The genitourinary trauma literature still relies heavily on expert opinion and single-institution retrospective series. Future prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates practitioner behavior.

The impact of body mass on management of patients with renal colic.

OBJECTIVE: To study the impact of body mass on diagnosis and initial response to medical treatment in patients presenting with renal colic. PATIENTS AND METHODS: One hundred and sixty-five consecutive patients presenting with symptoms of renal colic have been examined. Patients were divided in 3 groups according to their body mass index: normal-weight (BMI < or = 24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2) and obese (BMI > or = 30 kg/m2). Diagnosis of renal colic was based on history, clinical examination, presence of hematuria in a urine sample, appearance of a stone on a plain radiograph, and/or presence of hydronephrosis in ultrasonography. In addition, previous history of renal colic, time to seek medical advice and time to pain relief following administration of medications were examined. RESULTS: Mean body mass index did not differ between patients with a history of < or = 1, 1-5 and > or = 5 renal colics (P = 0.65). Prevalence rates of appearance of either lithiasis or hydronephrosis vs normal findings on the Kidney-Ureter-Bladder plain radiograph or ultrasonography were not different between normal-weight, overweight and obese subjects (P = 0.38 and P = 0.90 respectively). The time to seek for medical advice and the response to treatment were not different between the study groups (P = 0.24 and P = 0.53 respectively). CONCLUSION: Body mass does not have any impact on diagnosis, time to seek for medical advice or response to treatment in patients with renal colic.