The utility of De Ritis Ratio in predicting prognosis in testicular cancer.

OBJECTIVE: We aimed to investigate the possible association between testicular cancer prognosis and De Ritis ratio (AST/ALT). METHODS: The medical records of all patients who underwent radical inguinal orchiectomy at a single tertiary in Istanbul, Turkey between 2006 and 2017 were retrospectively analyzed. Investigated parameters included patients' demographics, complete blood count and blood biochemistry results, pathology results, treatment schemes, imaging results, and survival. De Ritis ratio was calculated as follows: AST/ALT. RESULTS: A total of 171 patients with a mean age of 32.6 ±â€Š10.1 years were included in the study. 73 patients had T1, 83 had T2, 13 had T3 and 2 had T4 disease. Rete testis invasion was detected in 74 patients (43.3 %) as well as lymphovascular invasion in 93 (54.4 %) and tunica albuginea invasion in 80 (46.8 %) patients. The cut-off value for AST/ALT was set at 1.35 [Area Under Curve (AUC): 0.791 with a sensitivity of 80 % and specificity of 73 %]. No statistically significance was observed between patients with and without elevated AST/ALT according to rete testis invasion, lymphovascular invasion, tunica albuginea invasion, and tunica vaginalis invasion (p = .25, p = .63, p = 1.0 and p = 1.0, respectively). 28.2 % of patients with seminoma had AST/ALT > 1.35 however 41.9 % of patients with non-seminoma pathology had AST/ALT > 1.35 (p = .078). Mean estimated survival time of patients with AST/ALT > 1.35 was higher than those with AST/ALT < 1.35, 91.8 versus 70.4 months, p < .001). As seen in Kaplan-Meier analysis elevated AST/ALT is associated with early-term mortality. CONCLUSION: De Ritis ratio was shown to be significantly associated with unfavorable prognosis. De Ritis ratio might serve as a prognostic biomarker in testicular tumor besides well-known tumor markers such as beta-human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH).

Effect of transurethral resection of prostate on prostatic resistive index.

INTRODUCTION: In the present study, we evaluated the effect of transurethral resection of the prostate (TUR-P) on prostatic resistive index (RI) in patients with benign prostatic hyperplasia(BPH). PATIENTS AND METHODS: Forty BPH patients who were candidates for prostatectomy were prospectively included in the study. Prostatic RI was measured using power Doppler imaging (PDI) before TUR-P. In the postoperative follow-up, all patients were reevaluated with PDI, International Prostate Symptom Score (IPSS) and uroflowmetry. RESULTS: Mean age, IPSS and maximal urine flow rate (Q(max)) of the patients was 65.8 +/- 7.6 years, 24.6 +/- 7.1 and 7.7 +/- 3.8 ml/s, respectively. The mean prostatic RI of the patients before TUR-P was 0.79 +/- 0.02. Prostatic RI positively correlated with total prostate volume and IPSS (r = 0.57, p = 0.0001, and r = 0.42, p = 0.008, respectively) and negatively correlated with Q(max) (r = -0.37, p = 0.029) prior to treatment. After TUR-P, mean IPSS and prostatic RI significantly decreased (6.5 +/- 4.3 and 0.68 +/- 0.03, respectively; p < 0.05), whereas mean Q(max) was increased (15.7 +/- 5.7, p < 0.05). CONCLUSIONS: Our data demonstrated that prostatic RI of the patients with BPH significantly decreased after TUR-P. We believe that prostatic RI could be a useful parameter for the follow-up of patients who underwent TUR-P.

Effect of varicocelectomy on serum inhibin B levels in infertile patients with varicocele.

OBJECTIVE: In recent years serum inhibin B level has been proposed as a major indicator for Sertoli cell function and spermatogenesis. This study evaluated the effect of varicocelectomy on serum inhibin B levels and semen parameters in infertile patients with varicocele. MATERIAL AND METHODS: Thirty consecutive patients with varicocele who were complaining of infertility with oligoasthenospermia on sperm analysis were included in the study. All the patients underwent subinguinal varicocelectomy. Spermogram, serum inhibin B levels and hormone analysis were performed at 6-month postoperative follow-up. RESULTS: The mean age of the patients was 24.06+/-3.6 years. There was no statistically significant difference between the mean serum follicle-stimulating hormone, luteinizing hormone, prolactin and testosterone levels of the patients before and after the treatment (p > 0.05). There was a statistically significant improvement in sperm concentration, forward progressive motility and serum inhibin B levels after the treatment (p < 0.05). CONCLUSION: Serum inhibin B level as an endocrine marker combined with a spermogram could provide efficient data for evaluating the effect of varicocelectomy on spermatogenesis.

Effect of finasteride treatment on suburethral prostatic microvessel density in patients with hematuria related to benign prostate hyperplasia.

INTRODUCTION: In the present study we evaluated the effect of short-term finasteride treatment on microvessel density (MVD) which is an indicator of prostatic angiogenesis in patients with hematuria secondary to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: 30 patients who were candidates for BPH surgery were prospectively included in the study. All patients had history of gross hematuria and evaluated by ultrasonography and cystoscopy. The patients were randomized two groups before surgery. The treatment group consisted of 13 patients who were given 5 mg finasteride daily for 4 weeks before surgery. The control group consisted of 17 patients who did not receive finasteride before surgery. During surgery, resected suburethral and hyperplastic prostate specimens were sent for histopathologic MVD determination separately. RESULTS: Mean MVD in the suburethral portion of prostate was significantly lower in patients treated with finasteride when compared with controls (9.08 +/- 5.6 and 13.94 +/- 5.90, respectively, p < 0.05). Mean MVD for the hyperplastic portion of prostate was similar for the finasteride and control groups (14.21 +/- 7.10 and 19.75 +/- 9.73, respectively, p > 0.05). CONCLUSION: The potential role of finasteride on hematuria related to BPH may be the suppressive effect on MVD in the suburethral tissue of prostate.

The efficacy of the addition of short-term desmopressin to alarm therapy in the treatment of primary nocturnal enuresis.

OBJECTIVE: The purpose was to evaluate the efficacy of the addition of short-term desmopressin to enuretic alarm in patients with primary monosymptomatic nocturnal enuresis (PMNE). MATERIALS AND METHODS: A total of 58 [corrected] children with PMNE were included in this study. The patients were randomized into two groups. In group 1 (n=30), the patients were given 6 weeks of additional oral desmopressin to 12 weeks of enuretic alarm therapy, as a single dose of 0.2 mg at the first 3 weeks and 0.4 mg at the following 3 weeks. In group 2 (n=28), the patients were given 12 weeks of enuretic alarm therapy alone. According to the number of wet nights after 12 weeks of treatment, the patients were defined as complete responders (dry or more than 75% reduction in wet nights), partial responders (50 to 75% reduction) and non-responders (less than 50% reduction). Relapse was defined as the reappearance of >1 wet night per week for complete responders and >50% increase in pre-treatment wetting frequency for partial responders, and all these patients were called relapsers. RESULTS: The mean number of wet nights after 3 and 6 weeks treatment was significantly lower in group 1 compared to group 2. However, there was no significant difference between the groups regarding the mean number of wet nights after 12 and 24 weeks of treatment. There was no significant difference between the groups regarding the number of responders, partial responders, non-responders and relapsers. In the group with additional desmopressin therapy given, the number of patients who abandoned therapy was lower than the alarm therapy alone group, but it was not statistically significant. CONCLUSION: Our data showed that the addition of short-term desmopressin to alarm therapy was more effective only in the period when it was given, and it did not change the response to alarm therapy in the long term.

The effect of sildenafil citrate and pentoxifylline combined treatment in the management of erectile dysfunction.

INTRODUCTION: In the present study, we evaluated the efficacy of sildenafil and pentoxifylline combined therapy in the treatment of vasculogenic erectile dysfunction. METHODS: Sixty-eight patients with various degrees and types of vasculogenic erectile dysfunction were included in the study. The patients were recommended to take oral sildenafil (minimum two 50-mg tablets/week) 1 h prior to sexual intercourse for 4 weeks. After 4 weeks of washout period, patients were recommended to take combined therapy (minimum two 50-mg tablets/week sildenafil 1 h prior to sexual intercourse and 1.2 g of pentoxifylline/day divided into three doses) for an additional 4-week period. Both treatment regimes were evaluated with the international index of erectile function (IIEF). RESULTS: Mean IIEF score was higher after sildenafil treatment when compared to pre-treatment score (14.2+/-4.3 and 8.6+/-4.2, respectively, P<0.05). Likewise after the combination treatment, mean IIEF score was higher when compared to pre-treatment score (18.1+/-5.2 and 8.6+/-3.8, respectively, P<0.05). The increase in the IIEF score was 5.62+/-2.08 in the sildenafil only group whereas increase in the IIEF score was 9.51+/-3.77 in the combination therapy group. There was a statistically significant increase in the combination group when compared to the sildenafil only group (P<0.001). CONCLUSION: Our study suggests that use of sildenafil citrate and pentoxifylline combined therapy could be effective in the management of patients with vasculogenic erectile dysfunction.

The correlation between metabolic syndrome and prostatic growth in patients with benign prostatic hyperplasia.

OBJECTIVES: To evaluate the relationship between metabolic syndrome and annual prostatic growth rates in benign prostatic hyperplasia (BPH) patients. METHODS: The 78 BPH patients with lower urinary tract symptoms included in this prospective study were divided into two groups according to whether they had a diagnosis of metabolic syndrome. This diagnosis was made according to the most recent consensus report of the National Cholesterol Education Program's Third Adult Treatment Panel. Blood pressure, body weight, body height, and waist and hip circumferences were measured. The body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. Biochemical analyses including serum glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), insulin, and prostate-specific antigen (PSA) were performed. Total prostate (TP) volume and transitional zone (TZ) volume were measured by transrectal ultrasound. Annual TP and TZ growth rates were calculated. RESULTS: BPH patients with metabolic syndrome (first group) had significantly higher median body weight, BMI, serum glucose, serum triglyceride, and PSA levels but lower serum HDL-C level, compared with BPH patients without metabolic syndrome (second group, p<0.05). Median annual TP growth rate (1.0 ml/yr) and median annual TZ growth rate (1.25 ml/yr) were significantly higher in the first group versus the second group (0.64 ml/yr and 0.93 ml/yr, respectively, p<0.05). CONCLUSIONS: The present study demonstrates a further increase in prostate growth in BPH patients with metabolic syndrome. Future studies are needed to confirm our results and to explain underlying mechanisms.

The correlation between serum prostate specific antigen levels and asymptomatic inflammatory prostatitis.

INTRODUCTION: Asymptomatic inflammatory prostatitis is a common pathological finding in patients with benign prostatic hyperplasia (BPH). In the present study, we evaluated the correlation between serum prostate specific antigen (PSA) level and extent and aggressiveness of inflammation in surgical specimens of patients who underwent to surgery for BPH without any evidence of clinical prostatitis. METHODS: Histological sections of the prostatic tissues of 52 patients were scored for the extent of inflammation and aggressiveness of inflammation, using the four point scale designed by Irani et al. Extent of inflammation is graded from 0 to 3 according to the degree of invasion of inflammatory cells in prostate tissue. Aggressiveness of inflammation is graded from 0 to 3 according to the degree of contact or disruption of prostatic glandular epithelium by inflammatory cells. The serum PSA levels in different inflammation grades were compared. RESULTS: There was a significant correlation between inflammation and aggressiveness scores (r = 0.39, P < 0.01). Median PSA levels in grades 1, 2 and 3 extent of inflammation were 2.4, 5.2 and 5.7 ng/ml, respectively. There was not any significant difference between these grades for PSA. Furthermore, median PSA levels in grades 1, 2 and 3 aggressiveness of inflammation were 4.4, 4.8 and 8.7 ng/ml, respectively. There was a significant difference between grades of aggressiveness of inflammation and PSA levels. CONCLUSION: High serum PSA levels may correlate with asymptomatic inflammatory prostatitis with high aggressiveness score in BPH patients without clinical prostatitis.

Potentiation of a dendritic cell vaccine for murine renal cell carcinoma by CpG oligonucleotides.

PURPOSE: An ideal vaccine therapy for tumors should activate both effector and memory immune responses against tumor-specific antigens. Here we investigated the effect of CpG oligodeoxynucleotides (CpG-ODN) for their ability to potentiate the activity of tumor antigen-pulsed bone marrow-derived dendritic cells (DC) in a vaccine model for the treatment of murine renal cell carcinoma (RENCA). EXPERIMENTAL DESIGN: First we evaluated the effects of a murine renal cell carcinoma (RENCA) on immune cell activity in a mouse model using in vitro assays for T-cell proliferation and natural killer cell activation. To overcome the immune suppression of the tumor, we s.c. injected groups of 10 mice with dendritic cells and tumor cells. We compared the effect of different conditioning regimens of the DCs with RENCA antigen and/or CpG-ODNs before injection by measuring tumor size twice a week. RESULTS: Tumor growth was shown to negatively affect spleen cell and T-cell proliferation, IFN-gamma production, natural killer cell activity, and NF-kappaB activation in T cells. In this model, we have shown that RENCA-pulsed CpG-ODN-treated DCs were able not only to significantly reduce tumor growth but also to prevent tumor implantation in 60% of mice. Tumor-free mice were resistant to tumor challenge and the immunity conferred by the vaccine was transferable and tumor specific. CONCLUSIONS: This data show that RENCA down-modulates the immune response, and DC vaccine therapy, in conjunction with CpG-ODN, can restore tumor-specific immunity.