[Antibiotic prophylaxis in urology]. / Antibiotická profylaxe v urologii.

Antibiotic prophylaxis is an important measure aimed at reduction of infectious complications after urologic procedures. The goal of this prospective study is assessment of the efficacy, safety and cost of short-time antibiotic prophylaxis before planned urologic surgery. Uncomplicated cystoscopy, urodynamic examination and ESWL were performed without antibiotic prophylaxis. Oral quinolones were effective in prostate biopsy. In open, laparoscopic or endoscopic surgery intravenous prophylaxis by cephalosporins had excellent efficacy. All types of prophylaxes were very safe and without adverse effects, and could be applied at low economic cost.

Determination of angiogenic factors in serum by protein array in patients with renal cell carcinoma.

Using the protein array method we determined the serum levels of a number of angiogenic factors. We identified serum levels of angiogenin, PDGF and MCP-1 (CCL2 chemokine) in serum of 32 patients with RCC, and 14 healthy volunteers by means of antibody array analysis. The patients were divided into three groups according to their disease stages (I+II, III, and IV). We found significant differences between the controls and patients with RCC both pre-operatively and post-operatively in angiogenin, PDGF and MCP-1 serum levels. The increase in angiogenin, PDGF and MCP-1 lasted in patients with RCC stages I-III even without metastases eight weeks post-operatively. The patients with stage IV RCC showed disturbed production of PDGF and MCP-1. Protein array analysis is a powerful tool for the identification of large numbers of trace proteins. Multiplex antibody array is able to provide data more precisely reflecting the nature of pathological processes.

[Monitoring of anti-tumour cell-mediated response in patients with renal cell carcinoma, disturbance of T cell proliferation]. / Sledování protinádorové bunecné imunitní odezvy u nemocných s renálním karcinomem, porucha proliferace T-lymfocytu.

INTRODUCTION: When checking tumour growth, a number of observations indicate that the immune system plays a significant role in patients with renal cell carcinoma (,,RCC"). Infiltration by lymphocytes (tumour infiltrating lymphocytes, "TILs") is more prevalent in RCC than any other tumours. T lymphocytes are the dominant population of TIL cells. Views concerning the role ofT lymphocytic subpopulations, B lymphocytes and NK cells in an anti-tumour response are not established. AIM: The aim is to determine the phenotype and activation of lymphocytic cells and to compare their representation in tumour stroma (TIL), peripheral blood (PBL) and renal vein blood in patients with RCC. PATIENTS AND METHODS: The samples of peripheral blood taken from the cubital and renal veins and tumour stroma cells were obtained from 60 patients in the course of their surgeries carried out due to primary RCC. TILs were isolated from mechanically disintegrated tumour tissue. Immunophenotype multiparametric analysis of PBL and TILs was carried out. Their surface and activation characteristics were determined by means of flow cytometer. RESULTS: CD3+ T lymphocytes (70.4%) were the main population of TILs. The number of CD3+/CD8+ T lymphocytes was significantly higher in TILs, 39.7% (p < 0.01), while CD4+ T lymphocytes were the majority population in peripheral blood, 41.35% (p < 0.001). The representation of CD3+/69+ T lymphocytes was significantly higher in TILs, 32.05%, compared to PBL (p < 0.001). On the contrary, the numbers of CD3+/CD25+, CD8+/57+ and CD4+/RA+ (naive CD4+ T lymphocytes) were higher in PBL (p < 0.001). The differences in representation of (CD3+/16+ 56+) NK cells and CD3+/DR+ T cells in TILs and PBL were not significant. CONCLUSION: The above-mentioned results prove that the characteristics and intensity of anti-tumour responses are different in compared compartments (tumour/PBL). CD3+/CD8+ T lymphocytes are the dominant lymphocytic population of TILs. The knowledge of phenotype and functions ofeffector cells, which are responsible for anti-tumour response, are the basic precondition for understanding the anti-tumour immune response and the cause of its failure.

[Percutaneous radiofrequency ablation of the renal tumors. Initial clinical experience with minimally invasive therapy]. / Perkutánní radiofrekvencní ablace renálních tumoru. První klinické zkusenosti miniinvazivní terapie.

UNLABELLED: AIM OF THE ARTICLE: To evaluate first clinical and interventional radiological features and experience with computed tomography-guided percutaneous radiofrequency ablation of the renal tumors using StarBurst instruments (RITA Medical System, Inc., Mountain View, CA). METHODS: The group of 8 patients with mean age 77.75 +/- 4.38 years underwent during a period of 12 months CT-guided RFA treatments for enhancing renal masses, with a mean size 21.78 +/- 9.81 mm, using only conscious sedation and local anaesthesia. All patients had multiple medical comorbidities that limited or completely contraindicated surgical treatment. In two cases tumors involved solitary kidney. Patients were hospitalized in urologic department of University hospital, where possible early complications were monitored. Patients were followed with clinical status and renal function studies. Also enhanced imaging (enhanced computed tomography or magnetic resonance in one case) were performed 1 month, 3, 6 and 12 months after initial procedure. Successful ablation was defined as a lack of enhancement of the renal mass eventually with a scar-like retraction of surrounding renal parenchyma. RESULTS: During a 12-months period (from February 2006 to February 2007) 10 percutaneous CT-guided RFA treatments in 8 patients were performed. In 6 patients (75%) were single treatment successful, 1 had an initial failure and underwent reablation successfully and 1 underwent second treatment for coexisting small tumor in the same kidney. All patients stayed in hospital for a 3 days, none from this group died during this period and none need not to be excluded from this study. We did not reveal any early complication. Average length of the following-up was 5.75 months. CONCLUSIONS: CT-guided percutaneous radiofrequency ablation is a promising therapeutic alternative of surgical methods (nephrectomies or nephron-sparing surgical devices) especially with small renal tumors in patients with multiple medical comorbidities, tumors in solitary kidneys and in rarer indications. The procedure were well tolerated using only conscious sedation and local anaesthesia. None early complication was observed. Other useful informations will be probably captured by following-up this group and by monitoring new patients.

[A case of an asynchronic triple tumorous disorder: a rectal adenocarcinoma, a carcinoma of the kidney and a prostatic adenocarcinoma--case report]. / Asynchronní triplicitní výskyt nádorového onemocnení: adenokarcinomu rekta, karcinomu ledviny a adenokarcinomu prostaty--kazuistika.

The authors describe occurence asynchronic tumor triplicity. In the year 1980 in 56 years old patient had histologically proven rectal adenocarcinoma and consequently was done radical Miles amputation of rectum. In December 1991 in the same patient was histologically proven well differentiated adenocarcinoma of prostate after transurethral resection of prostate. Prostate cancer was threated bilateral orchiectomy (March 1992) and consequently from April to June 1992 was done small-volume irradiation of pelvic by Betatron X-ray, box technique with dosage 70 Gy. In November 1992 there was done radical transperitoneal nephrectomy on right side for renal carcinoma. Histologically was proven moderately differentiated clear cell renal carcinoma. In August 1994 was found suspected pulmonary metastases, wich was proof on CT in the January 1995. Therapy was Imodin, Wobenzym, Vinblastin. Patient was died of generalisation renal cancer in the February 1998. The carcinoma of prostate and rectum wasn't found in the autopsy. The authors emphasize pertinence radical surgical access incuding multiplex malignant tumors and consider to carry out oncology screening in the all of patients with proven malignant tumor.

[Asynchronous occurrence of three neoplastic diseases: chronic B-cell lymphatic leukemia, renal carcinoma and prostatic adenocarcinoma]. / Asynchronní triplicitní výskyt nádorového onemocnení: chronické B lymfatické leukemie, karcinomu ledviny a adenokarcinomu prostaty.

Authors present a case of three asynchronous malignancies in man working life-long in chemical industry. Course of diseases and their treatment are described: B chronic lymphatic leukaemia (B-CLL) (age of 55), conventional clear cell renal carcinoma (CRCC) (age of 61) and adenocarcinoma of prostate (CaP) (age of 72). B-CLL treatment was chlorambucil for 2 years and follow-up subsequently. CRCC treatment was radical transperitoneal nephrectomy. Due to locally advanced CaP bilateral orchiectomy and radical external beam radiotherapy were performed. Patients is alive 30 months without any signs of any malignity. Incidence of multiple malignancies and particularly triplicities are discussed in this article. Authors point out pertinence of radical therapeutic approach also in multiple malignancies and oncological screening not only in patients with heamatological malignancy, but considering it in all tumours.

Familial and sporadic renal oncocytomas--a comparative molecular-genetic analysis.

OBJECTIVES: Genetic causes of sporadic and familial renal oncocytomas are not known. We analyzed these tumors genetically in order to detect tumor-specific chromosome alterations. METHODS: DNA from 26 sporadic and 31 familial renal oncocytomas were screened by comparative genomic hybridization according to standard protocols including degenerate oligonucleotide-primed PCR. RESULTS: Chromosome alterations were detected in 19/26 sporadic (73%) and in 4/31 familial renal oncocytomas (13%). Partial or complete losses of chromosome 1 were most frequently found in both sporadic (15/26) and familial tumors (2/4). Less frequently, loss of chromosome 14 (3/26) was detected in sporadic renal oncocytomas as well as losses of 2p, 2q, 4q, 10 and 18 and gains of 1q and 17q in individual sporadic tumors. Inter-tumor variation of chromosome aberrations was prominent in 1 patient, where 1 tumor showed gains of chromosomes 5, 6q, 7, 10p, 12 and 13q, whereas the second tumor exhibited gains of chromosomes 5 and 7 and loss of 10q. In contrast to sporadic renal oncocytomas, most familial tumors (87%) were devoid of chromosome instabilities. CONCLUSION: Our results demonstrate that partial or complete loss of chromosome 1 is the most common alteration in renal oncocytomas, sporadic and familial. However, chromosome changes are much rarer in familial than in sporadic renal oncocytomas.

Genetic alterations in metastatic renal cell carcinoma detected by comparative genomic hybridization: correlation with clinical and histological data.

In order to optimize the management of patients with renal cell carcinoma (RCC) it is important to define the genetic risk for metastatic disease. In this study we performed comparative genomic hybridization (CGH) on metastatic tumors aiming at the identification of genetic alterations associated with metastatic disease. We analyzed 46 renal tumors along with their metastases, and 15 non-metastatic renal tumors. Tumors were classified pathologically according to the Heidelberg classification of RCC, and staged according to the TNM-system. Standard CGH was performed using microdissected archival tissues and DOP-PCR. The average numbers of chromosomal aberrations per tumor were 3.0, 2.1 and 3.9 in patients without metastasis, in patients who developed metastases after a two-year latency period (late onset of metastatic disease) and in patients who developed metastases within two years after therapy of the primary tumor (early onset of metastatic disease). CGH revealed chromosomal aberrations in 91% of primary metastatic tumors. Deletions or losses of chromosomes 9 (26% vs 6%), 10 (21% vs 6%) and 18 (23% vs 0) and 17 (28% vs 7%) occurred more often in metastatic tumors than in non-metastatic tumors. Furthermore, these aberrations were more common in patients with early metastases. CGH analysis of 40 pairs of primary RCCs and their corresponding metastasis revealed similar aberrations in 70% of cases. In 30%, however, metastases showed additional chromosomal aberrations not detected in the corresponding primary tumors. In conclusion, we identified genetic alterations associated with metastatic disease in RCC which could be useful for predicting prognosis. Genetic changes leading to metastases occurred early in tumorigenesis of metastatic tumors.

[Increased incidence of renal cell carcinoma in central Europe. Does diagnostic increase reflect a true increase in incidence?]. / Inzidenzzunahme beim Nierenzellkarzinom in Mitteleuropa. Entspricht die diagnostische einer echten Inzidenzzunahme?

In the last years the incidence of renal cell carcinoma diagnosis increased about 15-20%. The main aim of this study was to analyse the reason of the increase of incidence. In the present autopsy series comprising 23,801 autopsies the percentage of patients who died of renal cell carcinoma is 1.77% in Jena and 1.55% in Königgrätz (200,000 inhabitants each). Over this time the incidence of renal cell carcinoma in autopsies has increased. In spite of the increased amount of incidentally found renal cell carcinomas since beginning widespread use of ultrasonography the percentage of clinically recognized renal cell carcinomas on the total of all found renal cell carcinomas in autopsies is nearly constant about the 12-year period in Jena and 10-year period in Königgrätz. Thus, the increased number of radical nephrectomies is not only caused by widespread use of ultrasonography. The increasing trend of the incidence of renal cell carcinoma seems to be real.

Increase of renal cell carcinoma incidence in central Europe.

OBJECTIVE: In recent years the incidence of renal cell carcinoma (RCC) diagnosis has increased about 15-20%. It remains to be established whether this increase of incidence is reality or not. The main aim of this study was to analyze the reason for the increase of incidence. METHODS: In the present study, 23, 247 autopsies performed in the years 1985-1995 in the area of Jena (Germany) (14,793 autopsies) and Hradec Králové (Czech Republic) (8,454 autopsies) were analyzed. RESULTS: In this autopsy series comprising 23,247 autopsies, the percentage of patients who died of RCC is 1.76% in Jena and 1.55% in Hradec Králové (200,000 inhabitants each). Over this time the incidence of RCC in autopsies has increased. CONCLUSION: In spite of the increased amount of incidentally found RCCs since beginning widespread use of ultrasonography, the percentage of clinically recognized RCCs in the total of all found RCCs in autopsies is nearly constant over the 11-year period in Jena and 10-year period in Hradec Králové. Thus, the increased number of radical nephrectomies is not only caused by widespread use of ultrasonography. The increasing trend of the incidence of RCC seems to be real.

[Tumor thrombosis of the inferior vena cava in renal carcinoma extending to the upper hepatic margin--surgical technique]. / Nádorová trombóza DDZ u karcinomu ledvin zasahující do výse horního okraje jater--taktika chirurgické lécby.

The authors divide the invasion of a tumourous thrombus of renal cell carcinoma into the IVC, consistent with the surgical approach of this problem into three levels. They describe in detail the approach and solution of the thrombus which reached as far as the upper hepatic margin or as far as the passage of the IVC through the diaphragm. Separation of the IVC between the liver and the path of the IVC into the right atrium from the median upper section from the xiphoid two fingers beneath the umbilicus seems the optimal and safe approach to tumourous thrombosis reaching that far. Using this approach at the Urological Clinic in Hradec four patients were operated. At present the authors consider other approaches to tumourous thrombosis of the IVC of renal cell carcinoma reaching up to the upper hepatic margin less suitable and associated with a higher risk of possible tumourous embolism of the pulmonary artery.

[Continence in the orthotopic ileal bladder. Personal experience]. / Kontinence u ortotopického ileálního mechýre. Vlastní zkusenosti.

During 1989-1996 the authors selected after radical cystoprostatectomy on account of carcinoma in 43 men continent orthotopic derivation of urine. To create a neovesica the authors used a detubulized loop of the terminal ileum shaped in different modifications. The neovesica was connected with the urethra. After a time interval of 6-12 months they assessed anamnestically the continence and made a complete urodynamic study with uroflowmetry in 25 patients. After a 6-month time interval following operation they observed a significant instability of the neovesica. After 9-12 months all patients had a high-capacity low-pressure pouch. 90% of the patients were satisfied with the state of continence. The percentage of fully continent patients was higher in daytime (80%) than during the night (46%). Incontinence of varying extent (8-10%) was resolved satisfactorily by modern aids for incontinence.

[An unusual finding of penile carcinoma: case report]. / Neobvyklý nález karcinomu penisu: kazuistika.

The authors describe the radical treatment of two locally advanced tumours of the penis without detectable generalization. Both cases were resolved by radical surgery, emasculinization. With regard to the size of the tumour which infiltrated the area of the perineum and hypogastrium the covering of the defect after removal of the tumourous mass called for skin transplantations and tubular plastic operations. The authors describe also the complications which developed during the postoperative period and their solution.

[Surgical treatment of renal carcinoma with tumor thrombus extending into the right heart atrium]. / Chirurgická lécba karcinomu ledviny s nádorovou trombózou zasahující do pravé síne srdecní.

Tumours thrombosis affecting the kidney or vena cava inferior in renal carcinoma is encountered in 4%-19% of the operated patients. Thrombosis reaching as far as the right atrium is rare. It is a very serious complication for the surgeon, but its does not imply a poorer prognosis of the disease nor shorter survival than tumours thrombosis of the inferior vena cava. Five-year survival is reported in 35-60% of the patients. Therefore radical surgery is fully indicated provided team collaboration of the urologist and cardiosurgeon is ensured. It involves removal of the tumours kidney with the tumours thrombus in an open heart and inferior vena cava, using extracorporeal circulation and arrested circulation with hypothermia. The authors present a successfully performed operation performed in a 63-year-old male [correction of female] patient.

[Conservative surgery in the treatment of tumors of the renal parenchyma. 10 years' experience and results]. / Záchovné operace pri lécení nádoru parenchymu ledvin. Desetileté zkusenosti a výsledky.

BACKGROUND: Radical surgery is considered standard treatment of renal tumours confined to the organ without detectable multiple metastases. In some circumstances, however, imperative or elective conservative surgery is indicated. The objective of the present work was, based on the authors' experience, to define more accurately indications for conservative surgery and evaluate the rate of local relapses of tumours and the patients' survival. METHODS AND RESULTS: The method of conservative surgery was used in 58 patients (34 men, 24 women, mean age 26-76 years, range 56 years). The indications for surgery were as follows: bilateral tumour (11x), tumour in solitary kidney (4x), tumour in kidney of abnormal shape (2x), and tumour defined by a capsule growing extrarenally reaching a size up to 3 cm (39x). In small tumours, less than 3 cm, 29x enucleation was performed and 10 times resection of the kidney. In patients with a bilateral tumour, with a tumour in a solitary kidney in kidneys with an abnormal shape or functionally impaired kidneys 15x resection and 4x enucleation of the tumour was performed. On histological examination 20% of the tumours were classified as benign. One to five-year survival after operation was evaluated in patients with histologically confirmed malignant tumours. On comparison with five-year survival of patients with a malignant tumour after radical nephrectomy (patients of the authors), it was revealed that after conservative surgery 85% patients survived, while after a radical operation only 57%. This difference is according to the authors due among others to a low biological activity of small tumours, their low staging and grading. CONCLUSIONS: An imperative or elective conservative operation is beneficial in particular in patients with a small tumour and low grading. This is suggested by the higher percentage of patients surviving five years after operation without evidence of a local relapse of the tumour.

[Conservative surgical treatment of kidney tumors: indications, techniques, results]. / Konzervativní chirurgická lécba nádoru ledviny: indikace, technika, výsledky.

At the Urological Department in Hradec Králové the authors operated in 1989-1993 287 patients with renal tumours, in 45 of them a conservative procedure was used (15.6%). The group comprises 29 men and 16 women, mean age 56.5 years. The contralateral kidney was normal in 29 patients (64%), in 5 patients nephrectomy was performed on account of carcinoma and in 9 patients (20%) the second kidney was hypofunctional (hydronephrosis, cysts). In two patients a conservative procedure was used on account of malignity of the blood. In 33 patients the tumour was enucleated (73.3%), in 12 the upper or lower pole of the kidney was resected. In 6 patients the tumour was in the first clinical stage, but in four already in T 3a (imperative indication). Twenty-seven tumours were evaluated by the histologist as medium differentiated, 2 of 35 as poorly differentiated. Thirty-five tumours were carcinomas (77.7%), 8 were adenomas, one was angiomyolipoma and in one instance the scar after PEC was removed which was not reliably diagnosed before surgery. The preoperative examination comprised also immunological examination which, however, was not made in two patients. The immunologist evaluated the criteria as favourable in 21 patients (60%), as risky in 12, incl. 6 were immunotherapy was administered. One patient developed a urinous fistula which healed on a stent. During the investigation period no local relapse was observed.

[Intubation in reconstructive surgery of posterior urethral strictures]. / Intubacní plastika striktury zadní uretry.

The authors operated in recent years (1989-1993) three patients with iatrogenic strictures of the posterior urethra which developed after transvesical prostatectomy. In one instance a stricture was involved which was difficult to intubate and in two instances a stricture impossible to intubate which was treated temporarily by epicystostomy. With regard to the site of the stricture which affected partly the prostatic and membranous urethra the authors selected the method of intubation plastic surgery in the modification of Michalowski-Modelski, nowadays rarely mentioned in the literature. During a period of one to two years after operation the patients were able to urinate without difficulties, the urethra was patent for intubation, in one patient mild stress incontinence persists. The authors consider intubation plastic surgery, making use of the intact urethra as a suitable alternative method of treatment of short strictures in the prostatic and membranous part of the urethra. It is a relatively simple one-stage operation with satisfactory functional results.

[Long-term results of therapy in patients with retroperitoneal fibrosis]. / Dlouhodobé výsledky lécby nemocných s retroperitoneální fibrózou.

In 1972-1991 at the urological clinic in Hradec Králové 13 patients with retroperitoneal fibrosis were treated. In six idiopathic fibrosis, primary fibrosis (morbus Ormond) was involved. By surgery only one patient with the primary disease was treated, five patients with secondary fibrosis only conservatively (by nephrostomy, by introduction of an ureteral endoprosthesis and prednisone administration 1200-1500 mg in total). Seven patients, incl. five with primary fibrosis, had combined treatment, an open operation with subsequent administration of prednisone. All remained under dispensary care of the clinic. During check-up examinations renal function and congestion in the urinary pathways was examined. In morbus Ormond treatment was successful in 83% of the patients (one patient died from myocardial infarction on the fifth day after operation); in patients with the secondary disease treatment was successful in 60%.

Conservative surgery for renal cell carcinoma--indications, technique and results.

At the Department of urology in Hradec Králové between 1989-1993 287 patients with a tumor of the kidney were operated on, in 45 of them (15.6%) conservatively. In this set there are 29 men and 16 women with the mean age 56.5 years. In 29 patients the contralateral kidney was normal (64%), 5 patients underwent nephrectomy for renal cell carcinoma, in 9 patients the opposite kidney was hypofunctionalised (hydronephrosis, cysts). In two patients the conservative approach was used for reasons of another type of malignancy (haematological). In 33 (73.3%) patients enucleation, in 12 patients resection of the lower or upper pole were done. The tumor was classified as T 1 stage in 6 patients, but in 4 patients already as T 3a (in patients with imperative indication). In 35 patients the tumor was moderately differentiated, in two ones with histologically confirmed renal cell carcinomas the tumors were poorly differentiated, in 8 patients there were histologically adenomas, in one angiomyolipoma and in another case scar after PCN (percutaneous nephrolithotomy). Preoperative examination included immunological examination, this was not done in two patients. Good results were obtained in 21 patients (60%), 12 patients were in high risk and 6 of them received immunotherapy. As an early complication one patient had urinary fistula, which resolved after introduction of stent. Relapse of malignancy in the screening period was not noticed.