Urinary fluorescence analysis in diagnosis of bladder cancer.

Early diagnosis of bladder cancer is crucial for improvement of cancer specific survival and recurrence rate. We analyzed the possible role of fluorescence urine analysis in bladder cancer diagnosis. The cohort consisted of 20 healthy controls, 40 patients with hematuria and 75 patients with hematuria and histologically proven bladder tumor. Synchronous fluores- cence spectra with a 70 nm wavelength difference were recorded for (1:1-1:128) urine dilutions. Concentration matrices of synchronous spectra (CMSS) were used to classify samples into tested groups. CMSS analysis allowed us to distinguish patients with tumor from patients with hematuria with a sensitivity 55% and specificity 74.7%. This is comparable to the sensitivity and specificity of other non-invasive tests like BTA stat and nmP-22 (Bladder check®). Lower fluorescence inten- sity of Imax 280 nm and ratio of 280 nm to 450 nm was found to be associated with the presence of tumor. We have found an association of decreased fluorescence with the stage of the disease. Our data suggest that CMSS urine analysis has a potential role in the non-invasive diagnostic tests for bladder cancer, but it cannot replace the current diagnostic algorithm yet.

Growth rates are similar in potentially benign and malignant small renal masses detected incidentally.

OBJECTIVE: Generally small renal masses grow at slow rate; some of them do not exhibit any growth. Does it mean that they are less aggressive? The aim of our study was to compare the growth of enhancing, non-enhancing solid renal masses, angiomyolipomas and complex renal cystic masses < or =4 cm in diameter. MATERIALS AND METHODS: 12 patients with solid enhancing, 20 with solid non-enhancing, 8 with angiomyolipomas and 25 with Bosniak II/IIF/III and IV masses were enrolled and prospectively studied during the surveillance period. The mean diameter of the lesion at presentation was 3.5; 3.1; 3.2 and 3.9 cm, the mean period of observation was 47; 48; 35 and 48 for each group respectively. All masses were detected incidentally. Progression rates (the largest diameter was calculated) were compared among the groups. RESULTS: The range and mean growth rates among all groups after one year of observation were (0.0-0.3; 0.2 cm); (0.0-0.3; 0.2 cm); (0.0-0.4; 0.3 cm); (0.0-0.3; 0.1 cm); (0.0-0.2; 0.1 cm); (0.0-0.0; 0.0 cm) and (-0.6-0.0; -0.2 cm) for 7 groups respectively. Overall 55.4% of masses did not exhibit any growth. We did not monitor any pathological lymph node enlargement, distant metastases in any group of patients. Overall, 85% of masses that exhibited growth during the first year did so at the end of follow up. CONCLUSIONS: The vast majority of small solid and complex cystic renal masses exhibit similar slow growth rates. According to these results, urologists can not predict the biological potential of the mass based on radiographic criteria and growth rates only (Tab. 2, Ref. 12).

Critical appraisal of prognostic factors for transobturator tape implantation.

OBJECTIVES: The aim of the study was (1) to compare early results of transobturator tape (TOT) implantation in women with lower and higher Valsalva leak point pressure (VLPP) and (2) to find out significant and independent prognostic factors of TOT implantation. MATERIAL AND METHODS: 97 female patients (pts) underwent TOT implantation between March 2004 and September 2007. We observed preoperative parameters including VLPP, urine leakage (PWT1), quality of life (IQOL1), age, BMI, parity, previous anti-incontinence surgery, hysterectomy status (HYE) and symptoms of OAB. According to VLPP value, pts were divided into two groups, namely those with lower VLPP values (< or =60 cmH2O) and those with higher VLPP values (> 60 cmH2O). Two different tapes were used for TOT implantation (resorbable and non-resorbable). Six months after surgery, urine leakage (PWT2) was reassessed and pts were classed into two main categories as 'cured' (PWT2 < or =2 g), or 'not cured' (PWT2 >2 g). RESULTS: Pts with lower VLPP values had significantly lower cure rates than those with higher VLPP values (43.8% vs. 81.5%, p < 0.001, respectively). Univariate logistic regresion analysis identified VLPP, PWT1, IQOL1, age, HYE, and TOT type parameters as significant factors for cure. Of these significant parameters, the multivariate logistic regresion analysis identified PWT1 and TOT type as the only independent ones. CONCLUSIONS: Pts with lower VLPP values are at a five-fold greater risk of not being cured than those with higher VLPP values. Preoperative urine leakage and TOT type are the only independent prognostic factors for cure after TOT implantation (Tab. 5, Fig. 3, Ref. 32).

Spontaneous regression of complex cystic renal mass of bosniak class IV--a rare phenomenon.

Spontaneous remission of simple renal cyst or complex renal cyst Bosniak III or IV class is a rare phenomenon. Our report describes a spontaneous partial regression of complex renal cyst Bosniak IV during the observation of complex cystic renal masses. A 66 year old male high risk patient (ASA score 3-4) refused all surgical intervention and was suggested for active surveillance strategy. We observed spontaneous partial regression of the complex cyst in this patient. To our knowledge this is the first report of spontaneous partial regression of complex renal cyst Bosniak IV class (Fig. 3, Ref. 5). Full Text (Free, PDF) www.bmj.sk.