[Outcomes of early endoscopic realignment of post-traumatic posterior urethral ruptures]. / Résultats du réalignement endoscopique précoce des ruptures de l'urètre postérieur post-traumatique.

INTRODUCTION: Post-traumatic rupture of the posterior urethra is a serious injury that can compromise the micturition and erectile prognosis of the often-young patient. The management of this lesion is still controversial, leaving the choice between early endoscopic realignment or suprapubic catheterization with deferred urethroplasty. The objective of this study was to report our clinical experience and outcomes with early endoscopic realignment (EER) for patients with pelvic fracture urethral injury. PATIENTS AND METHODS: We underwent a retrospective review of patients with pelvic fracture associated urethral injury who underwent EER from 2010 to 2020. Preoperative, perioperative, and postoperative outcome data were collected. Complications for the surgical procedure were analyzed, as well as postoperative stenosis, urinary incontinence and erectile dysfunction. The primary endpoint was success, defined as satisfying micturition with no urethral stricture at the time of last follow-up. RESULTS: Early endoscopic realignment was performed in 26 patients managed for complete post-traumatic posterior urethral rupture. The median age was 26 (16-39) years. The most common mechanism of urethral injury was road traffic accidents in 69.23% of cases. The most common urethral injury was grade 4 in 23 patients (88.46%). The median time to endoscopic realignment was 8 days (3-18). The median time to postoperative bladder catheterization was 22 (10-32) days. The median follow-up time was 34 (18-54) months. Ten patients developed urethral stricture during follow-up: 7 (26.92%) were treated with one or two internal cold blade urethrotomies, 3 required urethroplasty. There were no urethroplasty failures after a first endoscopic realignment. Two patients reported severe stress urinary incontinence. The median IIEF-5 score at the date of last news was 23 (17-25). CONCLUSION: Early endoscopic realignment allows some patients to avoid a heavier surgical treatment, and doesn't compromise the realization of a later urethroplasty.

[The prognostic value of preoperative neutrophil-to-lymphocyte ratio in patients with non-metastatic renal cell carcinoma]. / Signification pronostique du rapport préopératoire neutrophiles-lymphocytes dans le cancer du rein non métastatique.

INTRODUCTION: The aim of this study was to investigate the prognostic significance of the preoperative neutrophil-to-lymphocyte ratio in non-metastatic renal cell carcinoma. PATIENTS AND METHODS: We retrospectively analyzed the records of patients with non-metastatic renal cell carcinoma who were operated between 2004 and 2020 at our institution. The Kaplan-Meier method was utilized to graphically display survivor functions. Univariate and multivariate Cox's proportional hazards regression models were utilized to analyze the association between neutrophil-to-lymphocyte ratio and oncological outcomes. RESULTS: We included 202 patients. Patients with higher neutrophil-to-lymphocyte ratio had larger tumors (P=0.03), higher ASA score (P=0.014), clinical symptoms (P=0.04), sarcomatoid differentiation (P=0.03) and tumor necrosis (P=0.02). The rates of recurrence-free survival and metastasis-free survival were significantly lower in patients with a high neutrophil-to-lymphocyte ratio than in those with a low ratio (P=0.017; P=0.036 respectively). Multivariate analysis identified the neutrophil-lymphocyte ratio as an independent predictor of recurrence-free and metastasis-free survival (P=0.021; P=0.001 respectively). CONCLUSION: A higher neutrophil-to-lymphocyte ratio has been associated with a symptomatic renal cancer with a significant prognostic factor for both recurrence-free and metastasis-free survival. LEVEL OF PROOF: 3.

Prognostic Significance of Plasma Folate and Cobalamin Concentrations in Non-Muscle-Invasive Bladder Cancer: A Prospective Cohort Study.

This cohort study aimed to investigate prognostic significance of plasma folate and cobalamin in non-muscle-invasive bladder cancer (NMIBC). A total of 177 NMIBC patients were followed over a period extending to 6 years. Cox regression models were applied to estimate risks for recurrence and progression according to plasma vitamins tertiles. Compared to first tertile, third tertile of plasma folate [HR (95% CI), 10.5 (1.32-83.4); p = 0.026] was associated, and of plasma cobalamin [2.12 (0.63-7.25); p = 0.116] tended to be associated with higher risk for progression. NIMBC patients with high folate/cobalamin statuses should make the physician more alert for a likely poor outcome.

Low Plasma 25-Hydoxyvitamin D at Diagnosis Predicts Poor Outcomes in Patients with Bladder Cancer: A Prospective Cohort Study.

This study aimed to investigate whether plasma 25-hydroxyvitamin D (25-OHD) at diagnosis predicts poor outcomes in patients with urothelial bladder cancer. A total of 177 patients with non-muscle-invasive bladder cancer (NMIBC) were prospectively followed up over a period extending beyond 6 years. Data on poor outcomes (ie., recurrence, progression, and mortality) were collected. Plasma 25-OHD was measured by immunoassay. Cutoff-Finder web application was used to determine the best 25-OHD cutoff point to predict a specific poor outcome. Cox-hazard models were applied to test how plasma 25-OHD affect patients outcome while adjusting for potential confounding factors. During the follow-up period, tumor recurrence and progression occurred in 40.7% and 14.1% of patients, respectively and 11.3% of patients died. Baseline 25-OHD was lower in patients who experienced poor outcome (12.2 ± 7.44 vs. 16.7 ± 10.6 ng/mL; p < 0.001). Multi-adjusted HR (95% CI) for vitamin D deficiency (25-OHD < 12 ng/mL) was 2.09 (1.27-3.44) for recurrence, 2.63 (1.06-6.49) for progression and 2.93 (1.04-8.25) for mortality in patients with NMIBC. Low plasma 25-OHD in NMIBC patients is associated with higher risk of poor outcome. Future work is required to test whether correction of vitamin D deficiency will improve quality of life and extend survival in these patients.

Interaction Effects of Plasma Vitamins A, E, D, B9, and B12 and Tobacco Exposure in Urothelial Bladder Cancer: A Multifactor Dimensionality Reduction Analysis.

The study aimed to examine circulating vitamins A, E, D, and B12 and folate in patients with urothelial bladder cancer (UBC) and detect potential interaction effects of these micronutrients on UBC risk. A case-control study was conducted on 262 UBC patients and 254 matched controls. Vitamins A and E were assessed by ultra performance liquid chromatography, and vitamins D and B12 and folate were assessed by immunological methods. Binary logistic regression models were used to test associations of plasma vitamins tertiles with UBC risk. A multifactor dimensionality reduction method (MDR) was applied to assess interactive effects of the vitamins and tobacco on UBC risk. Higher levels in vitamins A, E, and D were associated with lower occurrence of UBC. No significant association was observed in plasma folate or vitamin B12 with UBC. There were redundancy interactions of plasma vitamin D with tobacco and with plasma vitamin A on UBC risk. Even though the study could not ascertain causality, the findings suggest that vitamins A, E, and D might be protective against UBC. Vitamins A and D interact antagonistically with each other's and with tobacco to modulate UBC risk. These interactions should be taken in consideration for the prevention of UBC.

Decreased Oleic Acid and Marine n - 3 Polyunsaturated Fatty Acids in Tunisian Patients with Urothelial Bladder Cancer.

Fatty acids (FAs) are thought to impact carcinogenesis by affecting cell signaling. A case-control study including 250 patients with urothelial bladder cancer (UBC) and 250 controls was conducted. Plasma FAs composition was assessed using capillary gas chromatography. Associations of individual and classes of FAs with UBC were controlled for the main risk factors for UBC. Plasma FAs profile was different in patients compared to controls. Higher levels (third tertile vs. first tertile) in palmitic acid (PA) [multi-adjusted OR (95% CI), 1.83 (1.14-2.92)], and n - 6:n - 3 FA ratio [4.13 (2.38-7.16)] were associated with increased risk for UBC [multi-adjusted OR (95% CI), 1.83 (1.14-2.92)]. In contrast, higher levels (third tertile vs. first tertile) in oleic [0.54 (0.34-0.86)], dihomo-γ-linolenic (DGLA) [0.47 (0.29-0.74)], eicosapentaenoic (EPA) [0.32 (0.19-0.52)], and docosahexaenoic (DHA) acids [0.33 (0.20-0.53)] were associated with lower risk for UBC. Although the study design does not allow proving causality, the findings suggest a possible protective role of oleic acid and marine n - 3 polyunsaturated FAs (PUFAs) against bladder carcinogenesis.

Haplotype-based association of Vascular Endothelial Growth Factor gene polymorphisms with urothelial bladder cancer risk in Tunisian population.

BACKGROUND/AIM: Accumulated data suggested that Vascular Endothelial Growth Factor is a major mediator in vasculogenesis, angiogenesis and recently in tumorigenesis. Therefore, we aimed to investigate for the first time the association between VEGF gene variants (-2549I/D (rs35569394), -2578C/A (rs699947), and +936C/T (rs3025039)) with urothelial bladder cancer (UBC) in Tunisian population. METHODS: A total of 218 UBC patients and 204 controls were recruited and genotyped by Polymerase Chain Reaction technique. Odds ratios (OR) and 95% confidence intervals (CIs) were used to access the association between the VEGFA gene polymorphisms and UBC. RESULTS: We found a significant decreased risk association of -2578 C/A polymorphism with UBC (OR (95% CI), 0.62 (0.41-0.94), P = .026) for CA genotype and (OR (95% CI), 0.40 (0.21-0.76), P = .005) for double homozygous mutant genotype. No associations were found in case of both polymorphic sites of VEGF, vis. -2549I/D and +936C/T, respectively. Haplotype analysis revealed a strong linkage disequilibrium between -2578C/A and -2549I/D and CIC combination is the significant haplotype associated with increased risk of UBC (OR (95% CI), 3.63 (1.47-8.97), P = .005). Regarding tumor grade/stage and family history of cancer, no associations were found for -2578C/A polymorphism. CONCLUSION: CIC haplotype of VEGF gene may be important risk factor for UBC development in Tunisia.

Association of FokI polymorphism of vitamin D receptor with urothelial bladder cancer in Tunisians: role of tobacco smoking and plasma vitamin D concentration.

The aim of the study was to test whether the VDR FokI polymorphism is associated with the risk of urothelial bladder cancer (UBC) in Tunisians. The study included 200 unrelated patients with UBC and 200 healthy controls. Genotyping of the VDR FokI polymorphism was determined by PCR-RFLP method. Plasma 25-hydroxyvitamin D concentrations were measured by immunoassay. Binary logistic regression model was applied to test how the association of VDR FokI polymorphism is independent of potential confounding factors. Genotype distribution (FF, 45 vs. 55 %; Ff, 52.1 vs. 47.9 %, and ff, 12 vs. 5.5 %, respectively) and allele frequencies (F, 66.5 vs. 74.8 % and f, 33.5 vs. 25.2 %, respectively) were significantly different between UBC patients and controls. The "ff" genotype [OR (95 % CI), 2.66 (1.24-5.73); p = 0.012] and "f" allele [1.49 (1.09-2.02); p = 0.010] were associated with increased risk of UBC. The association remained significant in multivariate analysis. Stratified analyses showed that VDR FokI polymorphism is only associated with UBC risk in ever-smokers, subjects exposed to chemical carcinogens and those with plasma 25-hydroxyvitamin D over 12 µg/L. The "f" allele of VDR FokI polymorphism is associated with a higher risk of UBC in Tunisians, especially in smokers as well as subjects with occupational exposition and subjects without vitamin D deficiency. These results should be replicated in other ethnic groups and the influence of other genetic factors and environments on this association should be investigated.

Bladder Cancer is Associated with Low Plasma 25-hydroxyvitamin D Concentrations in Tunisian Population.

Little evidence suggests an impact of vitamin D on bladder cancer risk in Caucasians. This study aimed to investigate association of plasma 25-hydroxyvitamin D (25-OHD) with urothelial bladder cancer (UBC) risk in Tunisians. A case-control study included 250 patients with UBC and 250 healthy controls. Plasma 25-OHD was assessed by a competitive chemiluminescence immunoassay. Vitamin D deficiency and insufficiency were defined as 25-OHD <30 nmol/L and 30 to 49.99 nmol/L, respectively. Logistic regression models adjusting for gender, age, smoking status, duration of smoking, occupational exposure, and season were applied. Vitamin D deficiency (50.4% vs. 34.8%; P < 0.001) and insufficiency (40.4% vs. 26.8%; P < 0.001) were more frequent in patients than controls. Multivariate analysis showed that UBC is associated with vitamin D deficiency [odd-ratio (95% confidence interval), 3.71 (1.76-7.80); P = 0.001] and vitamin D insufficiency [2.65 (1.40-5.01); P = 0.003]. Other predictors of UBC were female gender, tobacco use, smoking duration, and occupational exposure. Plasma 25-OHD concentrations are low in Tunisian patients with UBC. These findings support experimental and epidemiological evidence of protective role of vitamin D against UBC but could not ascertain causal relationship. Further prospective studies and clinical trials are warranted to check causality.

[Papillary renal cell carcinoma: clinic and pathological study about 27 cases]. / Les carcinomes tubule-papillaires du rein: Etude anatomo-clinique de 27 cas.

BACKGROUND: Papillary renal cell carcinoma (PRCC) represent 10 to 15% of renal tumours in adults. They contain more than 75% of tubule-papillary structure and are divided histologically into two subtypes. The distinction between these two sub-types is essential because of different prognosis. AIM: To describe the main clinical, radiological, therapeutic and prognostic features of these tumors. A comparative analysis between the two sub histological types was performed. METHODS: This is a retrospective study, from January 2000 to December 2010, concerning 27 patients operated for PRCC. Clinical data was taken from medical observations and radiological analysis was based on CT findings. A second analysis of blades was made in doubtful cases to clarify the histological subtype. RESULTS: PRCC represented 11.3% of renal tumors operated during this period. Mean patients' age was 62 years with a male predominance (sex ratio 3.5). All tumors were unilateral and mean tumor size was 7 cm. There was no clinical or radiological sign suggestive of this histological type. Treatment consisted of radical nephrectomy in 74% of the cases and nephron sparing surgery in 26% of the cases. We found 17 subtype 1 tumors and 10 subtype 2 tumors. The five year overall and disease-free survival rate were, respectively 86% and 90% in type 1 tumors and 57% and 54% in type tumors. CONCLUSION: PRCC is the second most common renal cancer in adults. They have no clinical or radiological specific signs suggesting their diagnosis. The distinction between these two sub histological types is essential as subtype 1 tumors have a better prognosis.

[Atypical renal cysts]. / Les kystes atypiques du rein.

BACKGROUND: Atypical renal cysts are suspicious for malignancy. It is hard in some cases to give a sharp radiological diagnosis and propose an appropriate management. AIM: To give the histological results of the operated atypical renal cysts and to establish a correlation between the radiological findings and histological features. METHODS: Between January 2001 and December 2012, 22 patients have been operated in our department for atypical renal cysts. There were 10 type III and 12 type IV Bosniak lesions. We have reported clinical, epidemiological and radiological findings. We have analyzed the histological results taking into consideration the radiological findings. RESULTS: According to histological findings, 7 among the 10 type III lesions were benign (70%). However, only one case of benign tumor was noted in type IV lesions (8.3%). There was no evident correlation between tumors size and histology. With a median follow up of 48 months, three patients died because of locally advanced tumors. CONCLUSION: Management of atypical renal cysts remains difficult. A careful computed tomography staging is essential before treatment. Type III and type IV Bosniak cysts were malign in 30% and 91% of cases, respectively. There was no correlation between tumor size and malignancy. A nephron sparing surgery should be proposed whenever possible.

PSMA-PSA clones controlled by full Akt phosphorylation (T308+,S473+) recapitulate molecular features of human prostate cancer.

BACKGROUND: (PSMA+,PSA+) and (PSMA+,PSA-) are the two most individual clones that we have previously identified during prostate cancer (PC) progression. However, molecular signatures associated with these distinct PSMA-PSA prostate clones and their specific correlation with disease outcome is yet to be defined. AIM: Since Akt is a major pathway involved in the critical activating events that leads to malignant form of the disease, we studied the involvement of full Akt activation (T308+,S473+) connected with serum PSA levels, tissue PSMA expression and angiogenic activity on the emergence of (PSMA+,PSA+) and (PSMA+,PSA-) PC clones. METHODS: The study was carried out in 6 normal prostate, 25 benign prostate hyperplasia (BPH) and 23 (PC). Immunohistochemical analysis was performed to study the expression of PSMA, PSA, pAkt(T308), pAkt(S473) and CD34 in prostate tissues. The evaluation of angiogenesis was made by CD34 immune marker. Serum levels of PSA were assayed by Immulite autoanalyser. RESULTS: The most relevant result showed that, among PC patients with pAkt (T308+,S473+) profile, patients that exhibit the (PSMA+,PSA+) clone have .higher serum PSA levels, tissue PSMA expression and angiogenic activity than those with (PSMA+,PSA-) clone. Although have the same (PSMA+,PSA+) prostate clone, BPH patients have distinct molecular-biological features compared to PC patients among pAkt (T308+,S473+) profile. In fact, among patients with maximal Akt activation, the (PSMA+,PSA+) PC clone is characterized by higher serum PSA levels, tissue PSMA production and intensive angiogenic activity than (PSMA+,PSA+) BPH clone. CONCLUSION: These findings emphasize the potential role of the full Akt activation (T308+,S473+) in expansion of several PSMA-PSA prostate clones capable of driving both human PC initiation as well as progression to a metastatic phenotype. Pinpoint patients according to PSMA-PSA clones could recapitulate the histological and molecular features of human PC and may offer a novel approach for controlling metastasis.

[Impact of alfuzosin 10 mg once daily on quality of life in Tunisian patients with lower urinary symptoms suggestive of benign prostatic hyperplasia]. / Impact de l'alfuzosine lp 10 mg sur la qualite de vie chez les patients avec troubles urinaires du bas appareil suggestifs d'une hypertrophie benigne de la prostate.

BACKGROUND: Incidence of benign prostatic hyperplasia (BPH), one of the most common conditions affecting adult men, increases dramatically after the age of 50. The various symptoms of BPH, which include lower urinary tract symptoms (LUTS), can adversely affect quality of life (QoL) and sexuality and 1-Blockers are the most frequently prescribed oral medications as first-line treatment. AIM: The objectives of this study try to evaluate QoL and sexuality in patients requiring treatment by Alfuzosin 10mg once daily according to physician decision in current practice and to identify patient's profile treated with Alfuzosin 10 mg under daily practice conditions by Tunisian urologists. METHODS: 730 patients presenting a symptomatic BPH were enrolled in this study by 40 urologists. The impact of treatment on patient's QoL and sexual dysfunction were checked at every visit before treatment and at 3 and 6 months using "International Prostate symptoms score" (IPSS) and "Male Sexual Health Questionnaire - Ejaculatory Dysfunction" (MSHQ - EJD) questionnaire. RESULTS: BPH affect Qol and near half of the patients reported sexual disorders. The treatment compliance to Alfuzosin was very good with a regular intake in 92% of the cases. Quality of life significantly improves during visits: the global IPSS score decreases from 18.8 at baseline to 9.5 at 6 months. The same favorable evolution was observed with the bother score which decreases from 4.0 at baseline to 1.6 at 6 months, and with MSHQ - EJD score which increases from 10.5 at first visit to 11.4 at 6 months. CONCLUSION: Alfuzosin 10 mg administered for 6 months provides a marked improvement in patients presenting symptomatic BPH not only on LUTS but also in QoL and sexual disorders.

PSMA/PSA ratio evaluated by immunohistochemistry may improve diagnosis of prostate cancer.

Prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA) measured in serum are not fully satisfactory as biomarkers of prostate cancer (PC). Results obtained in this article indicated that PSMA/PSA ratio evaluated by immunohistochemistry in normal prostate (NP), benign prostatic hyperplasia (BPH), and PC at the individual level could be a useful tool for diagnosis and prognosis of PC. PSMA and PSA were equally expressed in NP and the PSMA/PSA ratio was 1.22 ± 0.15. Data also indicated that PSMA/PSA ratio fluctuates in BPH and PC compared to NP. In BPH, the PSMA/PSA ratio was around 0.47 ± 0.02, whereas it's significantly increased in PC, about 4.95 ± 0.83. In parallel, the highest PSMA/PSA ratio was associated with high intratumoral angiogenesis in PC patients with (PSMA+,PSA+) profile.

Giant prostatic adenocarcinoma revealed by bilateral edema of the lower limbs.

Adenocarcinoma of the prostate affects up to 70 % of men over 80 and is the second leading cause of cancer related death in men. We reported an unusual case of a giant prostatic adenocarcinoma compressing bilaterally the 2 external and internal iliac veins that was revealed by a bilateral edema of the lower limbs after histological confirmation the patient was treated by radiotherapy and hormone therapy with a clinical amelioration.

Mucinous tubular and spindle renal cell carcinoma revealed by a trauma of the kidney: a case report.

BACKGROUND: Mucinous tubular and spindle cell carcinoma is a rare renal tumor. It has been recognized as a distinct entity in the 2004 World Health Organization tumor classification. Since then, several dozen of these tumor have been reported with additional complementary morphologic characteristics, immunohistochemical profile, and molecular genetic features that have further clarified its clinicopathologic aspects. CASE PRESENTATION: We report the case of a 52-year-old male African patient who was found to have a mucinous tubular and spindle renal cell carcinoma on a nephrectomy specimen for a severe kidney trauma. CONCLUSIONS: This tumor has a histological spectrum ranging from low to high grade, which includes sarcomatoid differentiation that can confer the tumor an aggressive clinical course.

Learning by Clinical Reasoning Versus Interactive Lecture: An Analytical and Experimental Study of Teaching Urological Emergencies.

OBJECTIVE: To scrutinize the progression of clinical reasoning and theoretical knowledge by comparing the impact of Clinical Reasoning-Based Learning (CRBL) sessions with interactive lectures (IL). METHODS: In this experimental study conducted from November 15, 2021, to May 7, 2022, we focused on second-year students in the second cycle of medical studies. Four specific urologic emergency scenarios (nephritic colic, macroscopic hematuria, acute scrotal pain, and urinary incontinence in men) were selected for interactive teaching sessions. Four groups were studied. One urology item was taught via CRBL, the rest via IL. Each item was taught once with CRBL and thrice with IL. After instruction, learners took a 10-point evaluative test with multiple-choice questions and clinical scenarios. RESULTS: Four groups of 14 learners attended our department, for a total number of 56 participants. Each student attended 4 learning sessions (1 CRBL session and 3 ILs) with a number of tests completed at 4 for each. The total number of tests taken was 224. The scoring of each test was out of 10 with theoretical scores between 0 and 10. The overall median score was 7/10. We noted better ratings after the CRBL sessions (n = 56) with a median of 8/10 [4-10] compared to the IL sessions (n = 168) whose median was 6 [3-10] with a significant difference between the 2 learning methods (P <.001). CONCLUSION: The CRBL sessions were significantly better than the ILs at developing the clinical reasoning and theoretical knowledge in urology of our medical students.

A case of liposarcoma of the spermatic cord.

Para-testicular liposarcoma develops from the fatty tissue surrounding the spermatic cord and covers the testicle and epididymis. It is an extremely rare pathological entity. We report the case of a 58-year-old african man who presented with a tumor mass developed from the right spermatic cord. Right orchidectomy with wide excision of the tumor was challenging due to the significant size of the mass. The histological examination of the surgical specimen favored a paratesticular liposarcoma.

The modified 5-item frailty index as a predictor of perioperative risk in patients undergoing percutaneous nephrolithotomy.

INTRODUCTION: The modified 5-item frailty index is a relatively new tool to assess the post-operative complication risks. In urology, there is limited literature on the impact of frailty on percutaneous nephrolithotomy (PCNL) outcomes. We aimed to compare the predictive value of the modified 5-item frailty index (mFI-5) to identify high risk patients prior to PCNL. METHODS: A database of patients undergoing PCNL, between 2015 and 2022, was analyzed. Patient frailty was assessed using the mFI-5 index. The mFI-5 index was calculated based on the presence of the five co-morbidities: congestive heart failure within 30 days prior to surgery, diabetes mellitus, chronic obstructive pulmonary disease, partially dependent or totally dependent functional health status at time of surgery, and hypertension requiring medication. Patients were grouped as not frail (mFI-5 = 0), intermediate (mFI-5 = 1), and severely frail (mFI-5 ≥ 2). Primary outcomes were 30-day postoperative complications. Secondary outcomes were hospitalization: total hospital length of stay, reoperation, and unplanned readmission. RESULTS: From a total of 320 PCNL patients included for analysis, 54.06% (n = 173) were not frail, 17.81% (n = 57) were intermediate, and 28.12% (n = 90) were severely frail. Frail patients were likely to be older (p = 0.002) and have a higher American Society of Anesthesiologists score (p = 0.001), chronic kidney disease (p < 0.001). Patients of intermediate or severe frailty were more likely to exhibit postoperative sepsis (p = 0.042), significant blood loss (p = 0.036) and require intensive care units admissions (p = 0.0015). Frail patients had a longer hospital length of stay (p < 0.001) and tended to require reoperation (p = 0.001), and unplanned readmission (p = 0.02). CONCLUSION: Frailty assessment appears useful in stratifying those at risk of extended hospitalization, septic and hemorrhagic complications, readmission, or reoperation after PCNL. Preoperative assessment of frailty phenotype may give insight into treatment decisions and assist surgeons in counselling patients on expected course and hospital stay following PCNL.

Cellular distribution and heterogeneity of Psa and Psma expression in normal, hyperplasia and human prostate cancer.

BACKGROUND: As promising targets for in vivo diagnostic,prognostic and therapeutic approaches, the distribution and staining pattern of prostate specific antigen (PSA) and prostate specific membrane antigen (PSMA) in tumors are of significant interest. AIMS: To compare the cellular distribution and heterogeneity of PSA and PSMA expression in normal prostate (NP), benign prostatic hyperplasia (BPH) and primary prostatic tumors and to analyze their relation with the angiogenic activity according to Gleason grade (low, medium and high) in primary PC. METHODS: The study was carried out in 6 NP, 44 BPH and 39 PC. Immunohistochemical analysis was performed. Monoclonal antibodies 3E6 and ER-PR8 were used to assess PSMA and PSA expression respectively. The evaluation of angiogenesis was made by CD34 immune marker. RESULTS: In our study we noticed differences in the intracellular localization of the PSMA immunostaining which seem to be related to the normal and pathological context. A significant number of primary tumors presented with apical pattern of PSMA (28/39); whereas a relevant part of NP samples and BPH samples showed cytoplasmic localization (4/6 and 30/44,respectively) in luminal epithelial cells. Compared to PSMA, PSA was preferentially localized in cytoplasmic compartment in all type of prostate. A direct correlation between histological grade, PSMA expression and angiogenic activity could be demonstrated in primary PC. CONCLUSIONS: Simultaneous stains with PSA and PSMA in individual prostate tissue will greatly improve the detection rate and identify a high risk PC that could progress to metastatic phenotype. Our findings clearly support the feasibility but also direct the potential of PSMA-targeted in vivo therapeutic approaches in PC patients rather than PSA especially those with poorly differentiated adenocarcinoma.