Comprehensive Evaluation of Quality of Life in Penile Cancer Patients following Surgical Treatment.

BACKGROUND: Penile cancer (PC) is a highly aggressive disease, with a significant tendency for lymphatic spreading and subsequent development of distant metastases. The mutilating nature of PC surgical treatment has profound implications on the patient's body integrity and self-image, sexual life and intimacy, voiding and mental health. The aim of our study was to comprehensively evaluate PC patients' post-treatment quality of life (QoL), sexual activity, self-esteem, fatigue and fear of disease recurrence. (2) Methods: A cross-sectional study was conducted at the Clinic of Urology, University Clinical Centre of Serbia, and included 31 PC patients. Data were collected by means of a questionnaire. (3) Results: The average score on the Global health status scale was 67.2 out of 100 (ranging from 16.7 to 100), and the SD was 22.5. Hierarchical linear regression analysis showed that demographic characteristics, Hospital Anxiety and Depression scale (HADS) anxiety and depression scores, total Multidimensional Fatigue Inventory, Fear of cancer recurrence and Rosenberg scores and erectile function score explained a total of 78.2% of the variance in the global health status/QoL scale of PC patients. (4) Conclusions: Efforts should be made not only to increase the survival of PC patients after surgical treatment but also to enable the best possible level of QoL in the post-operative period.

The Role of Isoflavones in the Prevention of Breast Cancer and Prostate Cancer.

This narrative review summarizes epidemiological studies on breast cancer and prostate cancer with an overview of their global incidence distribution to investigate the relationship between these diseases and diet. The biological properties, mechanisms of action, and available data supporting the potential role of isoflavones in the prevention of breast cancer and prostate cancer are discussed. Studies evaluating the effects of isoflavones in tissue cultures of normal and malignant breast and prostate cells, as well as the current body of research regarding the effects of isoflavones attained through multiple modifications of cellular molecular signaling pathways and control of oxidative stress, are summarized. Furthermore, this review compiles literature sources reporting on the following: (1) levels of estrogen in breast and prostate tissue; (2) levels of isoflavones in the normal and malignant tissue of these organs in European and Asian populations; (3) average concentrations of isoflavones in the secretion of these organs (milk and semen). Finally, particular emphasis is placed on studies investigating the effect of isoflavones on tissues via estrogen receptors (ER).

Mechanisms of Prostate Cancer Cells Survival and Their Therapeutic Targeting.

Prostate cancer (PCa) is today the second most common cancer in the world, with almost 400,000 deaths annually. Multiple factors are involved in the etiology of PCa, such as older age, genetic mutations, ethnicity, diet, or inflammation. Modern treatment of PCa involves radical surgical treatment or radiation therapy in the stages when the tumor is limited to the prostate. When metastases develop, the standard procedure is androgen deprivation therapy, which aims to reduce the level of circulating testosterone, which is achieved by surgical or medical castration. However, when the level of testosterone decreases to the castration level, the tumor cells adapt to the new conditions through different mechanisms, which enable their unhindered growth and survival, despite the therapy. New knowledge about the biology of the so-called of castration-resistant PCa and the way it adapts to therapy will enable the development of new drugs, whose goal is to prolong the survival of patients with this stage of the disease, which will be discussed in this review.

Alteration of Lipid Metabolism in Prostate Cancer: Multifaceted Oncologic Implications.

Cancer is increasingly recognized as an extraordinarily heterogeneous disease featuring an intricate mutational landscape and vast intra- and intertumor variability on both genetic and phenotypic levels. Prostate cancer (PCa) is the second most prevalent malignant disease among men worldwide. A single metabolic program cannot epitomize the perplexing reprogramming of tumor metabolism needed to sustain the stemness of neoplastic cells and their prominent energy-consuming functional properties, such as intensive proliferation, uncontrolled growth, migration, and invasion. In cancerous tissue, lipids provide the structural integrity of biological membranes, supply energy, influence the regulation of redox homeostasis, contribute to plasticity, angiogenesis and microenvironment reshaping, mediate the modulation of the inflammatory response, and operate as signaling messengers, i.e., lipid mediators affecting myriad processes relevant for the development of the neoplasia. Comprehensive elucidation of the lipid metabolism alterations in PCa, the underlying regulatory mechanisms, and their implications in tumorigenesis and the progression of the disease are gaining growing research interest in the contemporary urologic oncology. Delineation of the unique metabolic signature of the PCa featuring major aberrant pathways including de novo lipogenesis, lipid uptake, storage and compositional reprogramming may provide novel, exciting, and promising avenues for improving diagnosis, risk stratification, and clinical management of such a complex and heterogeneous pathology.

Polyphenols as Possible Agents for Pancreatic Diseases.

Pancreatic cancer (PC) is very aggressive and it is estimated that it kills nearly 50% of patients within the first six months. The lack of symptoms specific to this disease prevents early diagnosis and treatment. Today, gemcitabine alone or in combination with other cytostatic agents such as cisplatin (Cis), 5-fluorouracil (5-FU), irinotecan, capecitabine, or oxaliplatin (Oxa) is used in conventional therapy. Outgoing literature provides data on the use of polyphenols, biologically active compounds, in the treatment of pancreatic cancer and the prevention of acute pancreatitis. Therefore, the first part of this review gives a brief overview of the state of pancreatic disease as well as the procedures for its treatment. The second part provides a detailed overview of the research regarding the anticancer effects of both pure polyphenols and their plant extracts. The results regarding the antiproliferative, antimetastatic, as well as inhibitory effects of polyphenols against PC cell lines as well as the prevention of acute pancreatitis are presented in detail. Finally, particular emphasis is given to the polyphenolic profiles of apples, berries, cherries, sour cherries, and grapes, given the fact that these fruits are rich in polyphenols and anthocyanins. Polyphenolic profiles, the content of individual polyphenols, and their relationships are discussed. Based on this, significant data can be obtained regarding the amount of fruit that should be consumed daily to achieve a therapeutic effect.

The Polyphenols as Potential Agents in Prevention and Therapy of Prostate Diseases.

In recent years, the progress of science and medicine greatly has influenced human life span and health. However, lifestyle habits, like physical activity, smoking cessation, moderate alcohol consumption, diet, and maintaining a normal body weight represent measures that greatly reduce the risk of various diseases. The type of diet is very important for disease development. Numerous epidemiological clinical data confirm that longevity is linked to predominantly plant-based diets and it is related to a long life; whereas the western diet, rich in red meat and fats, increases the risk of oxidative stress and thus the risk of developing various diseases and pre-aging. This review is focused on the bioavailability of polyphenols and the use of polyphenols for the prevention of prostate diseases. Special focus in this paper is placed on the isoflavonoids and flavan-3-ols, subgroups of polyphenols, and their protective effects against the development of prostate diseases.

The assessment of knowledge and attitudes of men in Serbia about prostate cancer and possibilities for its early detection and treatment in 2011: a cross-sectional study.

PURPOSE: To assess the knowledge and attitudes of men in Serbia about prostate cancer (PCa) and possibilities for its early detection and treatment in 2011. METHODS: This cross-sectional study included 407 men of various ages and education levels selected randomly and divided in 2 groups according to age (up to 40 and over 40 years). The assessment of knowledge and attitudes was based on a survey made up of 12 multiple choice questions conducted with direct contact with respondents from October 15th to December 15th 2011 with their voluntary consent. The results were evaluated in the total sample and between the groups. RESULTS: Patient groups significantly differed according to knowledge about PCa treatment success (p<0.001) and stage in which PCa is most frequently detected (p<0.001) as well as according to attitudes about community-based interventions for increasing the awareness of PCa (p<0.001). Sixty-one percent of respondents over 50 years hadn't done preventive prostate examination despite recommendations. Ninety percent of all respondents believed the community-based intervention should have been implemented in Serbia to increase the men's awareness of PCa. CONCLUSION: The study reported lack of men's knowledge about PCa in Serbia in 2011, while there was a common agreement among men on the necessity of spreading more information about this disease.

Testosterone and dihydrotestosterone levels in the transition zone correlate with prostate volume.

BACKGROUND: There is still no consensus regarding intraprostatic androgen levels and the accumulation of androgens in the hyperplastic prostatic tissue. The current opinion is that intraprostatic dihydrotestosterone (DHT) concentrations are maintained but not elevated in benign prostatic hyperplasia (BPH), while there is no similar data concerning intraprostatic testosterone (T). METHODS: Tissue T (tT) and tissue DHT (tDHT) concentration were determined in 93 patients scheduled for initial prostate biopsy. The criteria for biopsy were abnormal DRE and/or PSA > 4 ng/mL. Total prostate volume (TPV) was determined by transrectal ultrasound (TRUS). During TRUS- guided prostate biopsy, 10-12 samples were collected from the peripheral zone (PZ) and two additional samples were collected from the transition zone (TZ). The samples from the TZ were immediately frozen in liquid nitrogen at -70°C, and transported for tissue androgen determination, using liquid chromatography mass spectrometry (LC-MS). RESULTS: Pathological analysis revealed that prostate cancer (PCa) was present in 45 and absent in 48 patients. In the whole group, there were 42 men with small prostate (TPV < 30 mL) and 51 with enlarged prostate (TPV ≥ 31 mL). The overall average tT level was 0.79 ± 0.66 ng/g, while the average tDHT level was 10.27 ± 7.15 ng/g. There were no differences in tT and tDHT level in prostates with and without PCa. However, tT and tDHT levels were significantly higher in larger, than in smaller prostates (tT: 1.05 ± 0.75 and 0.46 ± 0.29 ng/g, and tDHT: 15.0 ± 6.09 and 4.51 ± 2.75 ng/g, respectively). There were strong correlations between tT and TPV (r = 0.71), and tDHT and TPV (r = 0.74). CONCLUSIONS: The present study confirmed that both T and DHT accumulated in the stroma of enlarged prostates; the degree of accumulation correlated with prostate volume.

Follow-Up Imaging of Inflammatory Myofibroblastic Tumor of the Uterus and Its Spontaneous Regression.

Inflammatory myofibroblastic tumor (IMT) is an aggressive benign mass that may arise from various tissues and organs with a great variability of histological and clinical appearances. Due to variable and nonspecific imaging findings, diagnosis of IMT is not obtained before surgery. The aim of this paper is to present CT and MRI findings during four-year follow-up of complete, spontaneous regression of IMT of the uterus. The diagnosis was made by histology and immunohistochemistry analysis of the open excisional biopsy specimen. At that time, the organ of origin was not specified. After analysis of the follow-up imaging findings and the mode of tumor regression, the uterus was proclaimed as the probable site of origin. IMT of the uterus is extremely rare and has been reported in ten cases up to now. The gradual, complete regression of uterine IMT documented by CT and MRI may contribute to understanding of its nature.

Neobladder "Belgrade pouch": Metabolic consideration.

Background/Aim: The ileal neobladder should be a lowpressure reservoir with acceptable volume and relatively small resorptive surface. A larger inner surface of the ileal pouch is associated with the high resorption of urine metabolites through intestinal mucosa and systemic metabolic disturbances, while a too small pouch results in a higher frequency of voiding and incontinency. The aim of this study was to investigate it is possible to create a neobladder from a shorter ileal segment compared to standard surgical techniques, and reduce metabolic complications. Methods: This prospective study included 77 male patients, scheduled for radical cystectomy and orthotopic neobladder derivation. The patients were divided into two groups: the standard pouch (SP) group of 37 patients scheduled for standard orthotopic neobladder, using a 50−70 cm long terminal ileum segment; the "Belgrade pouch" (BP) group of 40 patients scheduled for original, orthotopic urinary reservoir, using a 25−35 cm long terminal ileum segment. We measured neobladder capacity, acidosis, base excess and bicarbonate concentration in the postoperative month 3rd, 6th, 12th and 15th. Results: At the end of the study, the patients from the SP group had much higher neobladder capacity than the natural bladder − 750 mL (range 514−2,050 mL); in contrast, the patients from the BP group had average capacity of 438 mL (range 205−653 mL) (p < 0.001). At the end of the study, there were more patients with acidosis (37.8% : 2.5%), base excess (35.1% : 7.5%) and low bicarbonate level (40.5% : 20.0%) in the SP group, than in the BP group, respectively (p < 0.001). Conclusion: "Belgrade pouch", make from 25−35 cm long terminal ileum segment may obtain adequate capacity and lower rate of metabolic disturbances than standard, high capacity orthotopic neobladders.

Buccal mucosal graft interposition in the treatment of recurrent vesicovaginal fistula: A report on two cases.

OBJECTIVE: To present the use of autologous buccal mucosa graft (BMG) in the treatment of recurrent vesicovaginal fistula (VVF). CASE REPORTS: In 2011, two women, aged 45 years and 56 years, were admitted due to recurrent VVF. Both women had previously undergone abdominal hysterectomies for benign conditions and, subsequently, vaginal VVF repair due to vaginal urine leakage. On admission, the younger woman had a round fistula, with a diameter of 1.5 cm, located on the left side, supratrigonally; the other woman had an ellipsoidal fistula measuring 2.5 cm × 1.5 cm, located medially and supratrigonally. Both women underwent suturing of the VVF with the interposition of BMG. After the last treatment, both women were cured. CONCLUSION: Treatment of recurrent VVF with the interposition of BMG is a good alternative to the use of other tissue grafts. Larger series are needed to confirm the advantages of this method.

Idionathic retroneritoneal fibrosis: A Report on 15 Patients.

BACKGROUND/AIM: Retroperitoneal fibrosis (RPF) repre sents a chronic pathological process characterized by fibro sis which entraps and compresses the ureters and the grea blood vessels in the retroperitoneal space. A specific form of RPF is idiopathic RPF, an uncommon collagen vasculaj disease of unclear etiology. The series of 15 patients whicl underwent open surgical repair due to idiopathic RPF is presented herein. METHODS: From 1989 to 2012, 11 male and 4 female patients underwent surgery due to primar RPF. The ureters were entrapped unilaterally (7 patients), or bilaterally (8 patients). Major symptoms included low bacl pain due to hydronephrosis (9 patients), uremia (4 patients) and urinary tract infection (2 patients). The diagnosis was based on intravenous urography (IVU), retrograde uretero pyelography and computed tomography (CT). RESULTS: Surgical procedures included intraperitoneal ureteral dis placement (8 patients) and ureteral wrapping with omental flap (6 patients). One patient underwent bilateral uretera stenotic segments resection and oblique ureterography, followed by wrapping with omental flap. Pathological examination confirmed primary RPF in all patients. The meat operative time was 3.5 h (range 2.5-4.5 h). The average in trahospital stay was 21 days (range 16-26 days). The meat follow up was 32 months (6-46 months). During the follow up, 12 patients had improvement on IVU. CONCLUSION: Early recognition of signs and symptoms of RPF is of the utmost importance for the outcome. Surgical procedures including ureteral wrapping with omental flap, or intraperi toneal ureteral displacement, usually represent definitive treatment.

Bilateral triple renal pelvis: a case report.

INTRODUCTION: Triple renal pelvis is an extremely rare variation of the renal collecting system. To the authors' knowledge, bilateral triple renal pelvis has not yet been described in the literature. CASE REPORT: A 55-year-old man was hospitalized due to papillary bladder cancer, detected on ultrasonography. As incidental finding, intravenous urography revealed bilateral triple renal pelvis. Six weeks after transurethral resection of the bladder tumor (TURB) the patient was admitted again, for the second TURB. Computed to mography-urography confirmed the presence of bilateral triple renal pelvis. CONCLUSION: The unique case of bilateral triple renal pelvis was presented as an extremely rare variation of the renal collecting system.

Evaluation of free-to-total prostate specific antigen (F/T PSA), prostate specific antigen density (PSAD) and (F/T)/PSAD sensitivity on reduction of unnecessary prostate biopsies for patients with PSA in gray zone.

AIM: We evaluated the influence of ratio between free-to-total prostate specific antigen (F/T PSA) and prostate specific antigen density (PSAD)-(F/T)/PSAD on reduction of unnecessary prostate biopsies in grey zone (prostate specific antigen (psa) value 4.0-10.0 ng/ml). METHODS: The study included 108 patients. For all patients serum total PSA (T PSA), free PSA (F PSA), F/T PSA and PSAD were analyzed. The group was divided due to the prostate volume into: entire group (regardless the prostate VOL-Group 1) and group with prostate VOL<40 (Group 2). RESULTS: Seventy five patients were diagnosed with benign prostatic hyperplasia (BPH) and 33 with prostate cancer (CaP). F/T PSA and (F/T)/PSAD showed significantly lower values in patients with CaP versus those with BPH, while PSAD had significantly higher values. For the cutoff values of 1.12 for (F/T)/PSAD, we found sensitivity to be 67% and specificity 60%, and the (AUC) 0.701. For patients with VOL<40, statistical significance remained with AUC of 0.732 (p=0.003), cutoff was 0.82, and with sensitivity 77% and specificity 68%. CONCLUSIONS: Most significant prostate carcinoma predictors were PSAD and (F/T)/PSAD, where we proposed that patients with (F/T)/PSAD values below 1.49 ± 0.94 and PSAD values above 0.17±0.06 should be included for biopsy.

Surgical care vesicovaginal fistulas in women with malignant gynecological disease.

Vesicovaginal fistulae (VVF)represents one of the most frequent complications of various gynecological and obstetric procedures. In presence of a gynecological malignant tumor, fistula could be the outcome of surgical complications, radiotherapy or consequence of the tumor process. Reparation of these fistulae is a very complex problem. Our aim was to analyze the results of surgical care VVF-s occurred in women with malignant gynecological disease which was treated surgically or with radiotherapy. Out of the 48 surgically treated patients with primary VVF, in 28 of them fistula occurred after hysterectomy, and in 20 patients after radiotherapy. In 15 patients (31.25%) transvaginal approach was applied, and in 33 patients (68.75%) abdominal approach was applied, with the interposition of a well vascularized lobe being used in 25 patients. All the VVFs that occurred after radiotherapy were repaired by using the abdominal approach. The efficiency of surgical treatment of VVFs after hysterectomy due to a malignant disease was 78.5%, and after radiotherapy 65%. In patients that have not been subjected to radiotherapy, depending on the characteristics of the fistula, transvaginal or abdominal approach is applicable in VVF reparation, while the abdominal approach remains a golden standard in post-radiation fistula treatment, despite the fact that it has not solved the problem after the first medical treatment in as far as 35% of patients.

Sigma-rectum pouch (Mainz pouch II).

The Mainz pouch II is a well tolerated form of continent urinary diversion in terms of morbidity, protection of the upper urinary tract and continence rate, even in patients aged > 65 years. Mainz pouch II was described by Fisch and Hohenfellner in 1991. They viewed the simplicity and reproducibility of the operation as one of its major advantages. A good continence rates between 93%-100% after this procedure has been shown in previous studies. The longer follow up will show whether these high rates of continence can be maintained with increasing age. The Mainz Pouch II serves as a satisfying continent urinary diversion for both sexes in selected patients in terms of quality of life. Evaluation of overall quality of life in patients with Mainz pouch II urinary derivation has given encouraging results. Compliance and cooperation of the patients, together with preoperative tests for anal competence, are mandatory to avoid complications. The Mainz group reported that the overall complication rate was low and comparable with other techniques of continent urinary diversion. During the past years modifications of the original technique have been described. These represent an increasing interest in the procedure. Today, the techniques of low-pressure and reservoirs have completely replaced classical ureterosigmoidostomy. In this review article the main focus is aimed at history, complications, continence and quality of life of patients with Mainz pouch II.

New and experimental techniques in the treatment of benign prostatic diseases.

BACKGROUND: Benign prostatic hyperplasia (BPH) and chronic prostatitis (CP) are disorders with high prevalence and have a great impact on overall morbidity in men. The patients that do not respond to medical therapy for lower urinary tract symptoms (LUTS) related to BPH are candidates for surgery. However, the number of men with BPH/LUTS seeking for non-surgical, or for less invasive treatment is growing. AIM: To present the basic information about minimally invasive treatment modalities for BPH and CP: intraprostatic injections, urethral lift procedures, modifications of transurethral microwave thermotherapy (TUMT), prostatic artery embolization etc. CONCLUSION: The majority of these techniques is still in experimental phase and not widely accepted. However, it is very likely that new, safe and minimally invasive techniques will appear in the near future.

Genitourinary injuries associated with pelvic fractures.

INTRODUCTION: Pelvic fractures represent approximately 3% of all skeletal injuries. About 15% of patients with pelvic fractures have associated bladder or urethral injuries. The most common causes of pelvic fracture are motor vehicle accidents, motorcycle crashes, motor vehicles striking pedestrians, and falls. MATERIAL AND METHODS: Retrospective study included the patients treated in the Emergency Center, Clinical Center of Serbia, Belgrade, between 2000 and 2009. Of 7445 patients, there were 894 injuries of the urinary tract and 376 pelvic fractures; 55 patients with pelvic fractures (14.6%) had bladder or urethral injuries. There were 31 patients with bladder injuries, 22 patients with urethral injuries, and two patients with associated injuries of the posterior urethra and the bladder neck. RESULTS: The bladder injuries were treated by surgical exploration, cystostomy, suture of the bladder lesions and urethral catheterization. Urethral injuries were treated by primary cystostomy and urethral reconstruction and catheterization in 18 patients (82%), while cystofix-cystostomy was performed in four patients (18%). DISCUSSION: Genitourinary injuries increase overall mortality in patients with pelvic fracture, compared with traumas without associated GU injuries. These patients require multidisciplinary approach, preferably in tertiary institutions.

Urinary prostate-specific antigen: predictor of benign prostatic hyperplasia progression?

INTRODUCTION: Urinary prostate-specific antigen (uPSA) can be used as additional parameter of benign prostatic hyperplasia (BPH) progression. MATERIALS AND METHODS: From January 2001 to December 2011, uPSA was determined in 265 patients with benign prostate. Based on total prostate volume (TPV), the patients with benign prostate were divided in two groups: TPV < 31 mL and TPV ≥ 31 mL. Additional three groups were formed upon MTOPS study criteria: non- progressive BPH group (TPV < 31 mL, PSA < 1.6 ng/mL, age < 62 yrs), intermediate group (one, or two parameters {TPV, PSA, age} increased) and progressive BPH group (TPV ≥ 31 ml, PSA ≥ 1.6 ng/mL, age ≥ 62 yrs). RESULTS: Average uPSA values in the groups TPV < 31 mL and TPV ≥ 31 mL were 119.3 ± 124.5 and 255.5 ± 204.9 ng/mL, respectively and they were significantly different (p < 0.0001). Average uPSA values in the non- progressive BPH group, intermediate group and progressive BPH group were 86.8 ± 82.4 ng/mL, 166.6 ± 164.9 ng/mL and 274.9 ± 208.3 ng/mL, respectively and they were significantly different (p < 0.0001). The level of uPSA correlated significantly with TPV (r = 0.32, p < 0.0001). The cut off uPSA level of 150 ng/mL discriminates the patients with non-progressive BPH and progressive BPH with specificity of 0.83 and sensitivity of 0.67. CONCLUSION: The level of uPSA reflects prostatic hormonal activity and correlates with TPV, PSA and age. UPSA level ≥ 150 ng/mL can be used as additional predictive parameter of BPH progression.