Altered gene expression profile after exposure to transforming growth factor ß1 in the 253J human bladder cancer cell line.

PURPOSE: Transforming growth factor ß1 (TGF-ß1) inhibits the growth of bladder cancer cells and this effect is prominent and constant in 253J bladder cancer cells. We performed a microarray analysis to search for genes that were altered after TGF-ß1 treatment to understand the growth inhibitory action of TGF-ß1. MATERIALS AND METHODS: 253J bladder cancer cells were exposed to TGF-ß1 and total RNA was extracted at 6, 24, and 48 hours after exposure. The RNA was hybridized onto a human 22K oligonucleotide microarray and the data were analyzed by using GeneSpring 7.1. RESULTS: In the microarray analysis, a total of 1,974 genes showing changes of more than 2.0 fold were selected. The selected genes were further subdivided into five highly cohesive clusters with high probability according to the time-dependent expression pattern. A total of 310 genes showing changes of more than 2.0 fold in repeated arrays were identified by use of simple t-tests. Of these genes, those having a known function were listed according to clusters. Microarray analysis showed increased expression of molecules known to be related to Smad-dependent signal transduction, such as SARA and Smad4, and also those known to be related to the mitogen-activated protein kinase (MAPK) pathway, such as MAPKK1 and MAPKK4. CONCLUSIONS: A list of genes showing significantly altered expression profiles after TGF-ß1 treatment was made according to five highly cohesive clusters. The data suggest that the growth inhibitory effect of TGF-ß1 in bladder cancer may occur through the Smad-dependent pathway, possibly via activation of the extracellular signal-related kinase 1 and Jun amino-terminal kinases Mitogen-activated protein kinase pathway.

Growth inhibition after exposure to transforming growth factor-ß1 in human bladder cancer cell lines.

PURPOSE: Transforming growth factor-ß1 (TGF-ß1) plays a dual role in apoptosis and in proapoptotic responses in the support of survival in a variety of cells. The aim of this study was to determine the function of TGF-ß1 in bladder cancer cells. MATERIALS AND METHODS: The role of TGF-ß1 in bladder cancer cells was examined by observing cell viability by using the tetrazolium dye (MTT) assay after treating the bladder cancer cell lines 253J, 5637, T24, J82, HT1197, and HT1376 with TGF-ß1. Among these cell lines, the 253J and T24 cell lines were coincubated with TGF-ß1 and the pan anti-TGF-ß antibody. Fluorescence-activated cell sorter (FACS) analysis was performed to determine the mechanism involved after TGF-ß1 treatment in 253J cells. RESULTS: All six cell lines showed inhibited cellular growth after TGF-ß1 treatment. Although the T24 and J82 cell lines also showed inhibited cellular growth, the growth inhibition was less than that observed in the other 4 cell lines. The addition of pan anti-TGF-ß antibodies to the culture media restored the growth properties that had been inhibited by TGF-ß1. FACS analysis was performed in the 253J cells and the 253J cells with TGF-ß1. There were no significant differences in the cell cycle between the two treatments. However, there were more apoptotic cells in the TGF-ß1-treated 253J cells. CONCLUSIONS: TGF-ß1 did not stimulate cellular proliferation but was a growth inhibitory factor in bladder cancer cells. However, the pattern of its effects depended on the cell line. TGF-ß1 achieved growth inhibition by enhancing the level of apoptosis.

Experience of ultrasonography-guided percutaneous core biopsy for renal masses.

PURPOSE: We evaluated the safety and accuracy of ultrasonography-guided percutaneous core biopsy collection in patients with renal masses. MATERIALS AND METHODS: From June 2008 to August 2012, 30 percutaneous core biopsies of renal masses were performed. The biopsies obtained were small tumors (<4 cm) with ambiguous radiologic findings or that met classic renal biopsy indications. The biopsy results were compared with the final pathological results after definitive surgical treatment. Ultrasonography was performed on the day after biopsy collection to rule out any complications. RESULTS: The mean age of the patients was 57.7 years, and the mean tumor size was 3.39 cm. Twelve of the lesions were in the left kidney, and 18 were in the right kidney. All but one core biopsy contained sufficient material for histopathological analysis. The biopsy results showed 17 renal cell carcinomas (56.7%), 3 angiomyolipomas (10.0%), 2 oncocytomas (6.7%), 1 adenocarcinoma (3.3%), and 7 benign lesions (23.3%). A total of 18 cases underwent surgery, and the pathological results confirmed the initial biopsy diagnosis for 17 of 18 cases (94.4%). The one (5.9%) inaccurate biopsy result was found to be a urothelial carcinoma of the kidney. No needle tract seeding was found in the pathological specimens or on follow-up imaging. A small perinephric hematoma (1-2 cm) was seen in 5 cases (16.7%), but all patients remained hemodynamically stable. CONCLUSIONS: Ultrasonography-guided renal biopsy is a safe, effective, and accurate method for evaluating small renal masses. This procedure may help in selecting treatment modalities for small renal masses.

Anterior urethral valve and diverticulum in a neonate with febrile urinary tract infection.

Anterior urethral valve is a rare congenital anomaly that can cause obstructive uropathy. Herein, we report a case of an anterior urethral valve that led to the development of febrile urinary tract infection in a neonate.

Use of cystoscopic tattooing in laparoscopic partial cystectomy.

PURPOSE: During laparoscopic partial cystectomy (LPC), lesion identification is essential to help to determine the appropriate bladder incisions required to maintain adequate resection margins. The inability to use tactile senses makes it difficult for surgeons to locate lesions during laparoscopic surgery. Endoscopic India ink marking techniques are often used in laparoscopic gastroenterological surgery. We present our experience with performing LPC with India ink during the surgical resection of various bladder lesions. MATERIALS AND METHODS: LPC with cystoscopic fine needle tattooing was performed on 10 patients at our institute. Tattooing was performed at 1- to 2-cm intervals approximately 1 cm away from the outer margin of the lesion with enough depth (the deep muscle layer) under cystoscopic guidance. LPC was performed by the transperitoneal approach. The clinical courses and pathologic results were analyzed. RESULTS: All LPC with cystoscopic tattooing cases were performed successfully. The mean patient age was 39.1 years. The mean operative time was 130.5 minutes, and the mean estimated blood loss was 93 ml. The mean hospital stay was 13.1 days, and the mean duration of indwelling Foley catheterization was 10.7 days. There were no significant intraoperative or postoperative complications except 1 case of delayed urinary leak and 1 case of delayed wound healing. The pathological diagnosis included 1 urachal cancer, 1 urachal remnant, 4 urachal cysts, 2 pheochromocytomas, and 2 inflammatory masses. All specimens showed adequate surgical margins. CONCLUSIONS: Cystoscopic tattooing in LPC is a simple and effective technique to assist in locating pathological bladder lesions intraoperatively. This technique can help to determine appropriate resection margins during LPC without incurring additional complicated procedures.

Predictors of PSA Screening Among Men Over 40 Years of Age Who Had Ever Heard about PSA.

PURPOSE: The purpose of this study was to investigate social and behavioral factors associated with prostate-specific antigen (PSA) screening in men in California, United States, who were over 40 years of age and had ever heard about PSA screening. MATERIALS AND METHODS: This survey was administered as a random-digit-dialing telephone survey to produce reliable estimates of medium-sized counties. It surveyed 42,000 households and interviewed 58,407 people randomly. It considered socioeconomic status and health behavior as affecting PSA screening. Access to health care was measured as having regular health care access. The main outcome measure was self-report of ever having undergone PSA screening at least once in the respondent's lifetime. RESULTS: Of 8,864 respondents, 82.2% were White, 7.7% were Latin, 4.2% were African American, and 5.9% were Asian. The respondents' mean age was 60.13 years. Age was the significant factor for PSA screening. Respondents aged 50-59 years were 3.5 times as likely to have undergone PSA screening as were those aged 40-49 years (OR=3.49, p

Testicular volume and masculine identity in men with unilateral cryptorchidism: results of a community-based survey in Korea.

We determined the influence of cryptorchidism on testicular volume and masculine identity in young men living in a community. Of the 27,202 men aged 20 years dwelling in the community, we randomly selected a 10% sampling fraction of whom 2,080 men (a response rate of 77.0%) agreed to participate in the study. All volunteers underwent a standard evaluation, including a detailed medical history and physical examination. For the evaluation of the influence of cryptorchidism on masculine identity, we used the Bem Sex Role Inventory (BSRI). Among participants, 38 (1.8%) had cryptorchidism or a history of surgery for cryptorchidism (right 15, left 21, bilateral 2). In total, 29 had had undergone surgery (mean age at the time of operation; 8.9+/-3.9 years, range; 2-19 years). Of 25 men who had undergone orchiopexy due to unilateral cryptorchidism, the testicular volume of the affected side was significantly smaller than that of the contralateral side. Of the 36 patients with unilateral cryptorchidism, the contralateral testicular volume of men who had undergone orchiopexy was not different with that of those who had undergone orchiectomy or had not undergone surgery. When we compared the scores for masculinity and femininity using the BSRI between men with and without testis in the scrotum, there were no differences between the two groups. Our results demonstrate that delayed orchiopexy does not improve the testicular volume of the affected side or the masculine identity in men with unilateral cryptorchidism. In addition, these findings suggest that there is a need to increase the awareness of cryptorchidism among all parties involved in the health care of children.

Minimally invasive management of ureteral injuries recognized late after obstetric and gynaecologic surgery.

We evaluated whether iatrogenic ureteral injuries recognized late after obstetric and gynaecological surgery were likely to resolve with minimally invasive strategies. We reviewed our records of 30 patients with surgical ureteral injuries diagnosed after obstetric and gynaecological operations. From collected data, the outcome of minimally invasive strategies and operative repair was evaluated and compared. Thirteen patients were treated primarily by operative repair and 17 were treated by minimally invasive strategies including percutaneous nephrostomy drainage, ureteral stent placement, or both. All patients treated by operative repair obtained primary healing. Of 17 patients treated by minimally invasive strategies, 11 had recovery of injured ureters but additional procedures were needed in six. We conclude that minimally invasive strategies are not always successful in the management of ureteral injuries recognized late after obstetric and gynaecological surgery.

Influence of age, anthropometry, and hepatic and renal function on serum prostate-specific antigen levels in healthy middle-age men.

OBJECTIVES: To test the hypothesis of a causal relationship between clinical parameters, including age, anthropometry, and hepatic or renal function tests and serum prostate-specific antigen (PSA) levels and to determine the predictors of high serum PSA concentrations in healthy middle-age men. METHODS: Between January 1999 and December 2000, 6005 healthy men 40 to 59 years old who visited our hospital for a routine health checkup were entered into the study. The association between the clinical parameters and a high serum PSA level (greater than 2.5, 3.0, 3.5, or 4.0 ng/mL) was studied in three groups: the 10% with low clinical parameters, the 10% with high clinical parameters, and the remainder as a reference group. RESULTS: The univariate logistic regression analysis indicated that high or low age, body weight, body mass index, creatinine, and creatinine clearance were significant factors in relation to serum PSA concentration compared with the reference group. In the multivariate model used, only older age was positively related to the serum PSA concentration. CONCLUSIONS: The results of anthropometry and hepatic and renal function tests do not influence the serum PSA level in this population. Our findings suggest that serum PSA may be a reliable marker in middle-age men without severe hepatic or renal disease.

Management of bulbous urethral disruption by blunt external trauma: the sooner, the better?

OBJECTIVES: To investigate whether the incidence of urethral stricture is different according to the primary mode of management, we retrospectively reviewed the record of patients with bulbous urethral disruption by external blunt trauma. METHODS: A total of 95 patients with blunt bulbous urethral injuries were included in the study. Sixty-five underwent immediate urethral realignment and 30 underwent initial suprapubic tube placement followed by delayed management. The urethral injuries were interpreted as partial or complete disruption on the basis of the retrograde urethrographic findings. RESULTS: Urethral stricture developed in 12 patients (18.5%) who underwent immediate management and in 12 patients (40.0%) who underwent delayed management (P = 0.025). Of the patients with partial disruption, no significant difference was found in the urethral stricture incidence between the two groups. However, of the patients with complete disruption, urethral stricture developed in 10 (31.3%) of 32 patients who underwent immediate management and 11 (68.8%) of 16 patients who underwent delayed management (P = 0.014). In addition, the degree of urethral stricture in the patients who underwent delayed management was more severe than in those who underwent immediate urethral realignment (P = 0.023). CONCLUSIONS: Our findings suggest that better outcomes can be obtained when immediate urethral realignment is successful in patients with bulbous urethral disruption. Additional research, including prospective randomized trials, is needed to confirm these findings.

Comparison of long-term results according to the primary mode of management and type of injury for posterior urethral injuries.

BACKGROUND: We retrospectively reviewed the records of patients with traumatic posterior urethral injuries, analyzed postoperative findings to compare the results of the primary mode of management, and evaluated whether the Colapinto and McCallum classification system was valuable for predicting the complications. METHODS: 55 patients with traumatic posterior urethral injuries were included in the study. A total of 35 patients underwent immediate realignment over a Foley catheter including direct Foley catheter insertion (group 1) and 20 underwent initial suprapubic tube placement followed by delayed urethroplasty (group 2). Urethral injuries were interpreted using the Colapinto and McCallum classification based on the retrograde urethrographies. RESULTS: 44 (80.0%) of the patients were classified to type III in both groups (group 1, 29 [82.9%]; group 2, 15 [75.0%]). Of group 1, mild, moderate and severe urethral strictures developed in 7 (20.0%), 8 (22.9%) and 6 (17.1%), respectively, and developed in 6 (30.0%), 2 (10.0%) and 5 (25.0%), respectively, of group 2. Six (17.1%) and 2 (20.0%) had decreased potency and 4 (11.5%) and 1 (5.0%) were impotent in group 1 and 2, respectively. Of group 1, incontinence developed in 3 patients but 1 did not need treatment, and developed in 2 (10.0%) but 1 (5.0%) did not need treatment of group 2. The score test for trend demonstrated that there were no significant differences of these results. CONCLUSIONS: Our findings suggest that complications in patients with posterior urethral injuries are not related to the primary mode of management. Because most injuries are type III, the evolution toward the classification system is needed.

Distribution of serum prostate-specific antigen in healthy Korean men: influence of ethnicity.

OBJECTIVES: To evaluate the normal distribution of serum prostate-specific antigen (PSA) levels in healthy Korean men. The subjects included men younger than 40 years of age, because information on serum PSA levels in younger men is scarce. METHODS: Between January 1997 and December 1998, the serum PSA levels of the subjects who visited our hospital for a routine health checkup were determined. All men who were older than 50 years with abnormal digital rectal examination findings and/or an abnormal serum PSA level (greater than 4.0 ng/mL) underwent transrectal ultrasound-guided sextant biopsy. Two men who were found to have cancer were excluded from the analysis. The detection rate of prostate cancer for men with abnormal digital rectal examination findings and/or an abnormal serum PSA level was 2.0% for men 50 to 59 years old; 0.0% for men 60 to 69 years old; and 11.1% for men 70 to 79 years old. A total of 8297 men (aged 20 to 79 years) were included in the study. RESULTS: The median serum PSA level (5th to 95th percentile range) was 0.90 ng/mL (0.33 to 2.25) for men 20 to 29 years old; 0.89 ng/mL (0.30 to 2.35) for men 30 to 39 years old; 0.89 ng/mL (0.30 to 2.36) for men 40 to 49 years old; 0.96 ng/mL (0.32 to 2.96) for men 50 to 59 years old; 1.22 ng/mL (0.33 to 3.78) for men 60 to 69 years old; and 1.25 ng/mL (0.30 to 7.49) for men 70 to 79 years old. The median and 95th percentile serum PSA levels of Korean men younger than 50 years were higher, but those for men 50 years old or older were lower than in other races. In our study cohort, the serum PSA level weakly correlated with age (r = 0.088, P <0.001). The serum PSA level weakly correlated with age in men 50 years old or older (r = 0.116, P <0.001) but in men younger than 50 years, it did not correlate (r = 0.000, P = 0.987). CONCLUSIONS: These results suggest that the distribution and cutoff value of the serum PSA level in Korean men differ from those in other races. In addition, our findings raise the question of whether lowering the PSA cutoff may enhance the detection of cancer in this population with low prostate cancer rates.

Suppression of clusterin expression enhanced cisplatin-induced cytotoxicity on renal cell carcinoma cells.

OBJECTIVES: To evaluate whether antisense transfection targeted against clusterin enhances the chemosensitivity in renal cell carcinoma. METHODS: Caki-1, a renal cell carcinoma cell line, and cisplatin were used as chemotherapeutic agents. Clusterin expression of Caki-1 cells after treatment with cisplatin was measured by Western blot analysis. After the construction of a clusterin suppression vector, clusterin expression was compared between Caki-1 cells transfected with the clusterin suppression vector (Caki-1/AS), Caki-1 cells transfected with control vector (Caki-1/VO), and parental Caki-1 cells. Tumor cell viability was measured with the MTT assay at 24 and 48 hours after cisplatin treatment. RESULTS: The expression of clusterin increased gradually in Caki-1 cells, peaking at 24 hours, and was reduced to an almost undetectable level at 48 hours after cisplatin treatment. Clusterin expression was suppressed, and the percentage of viable tumor cells decreased significantly more in the Caki-1/AS than in the Caki-1/VO or parental Caki-1 cells at 24 hours after cisplatin treatment. The change in chemosensitivity of the Caki-1/AS cells lost its significance at 48 hours after cisplatin treatment. CONCLUSIONS: Our results showed that clusterin expression increased transiently after treatment of cisplatin, and its suppression by antisense transfection enhanced the cisplatin-induced cytotoxicity of renal cell carcinoma cells. Clusterin suppression may be a useful modality in enhancing the effects of cytotoxic chemotherapy in renal cell carcinoma.

Impact of varicocele on testicular volume in young men: significance of compensatory hypertrophy of contralateral testis.

PURPOSE: We examined the impact on ipsilateral testicular volume in young men with varicocele and determined whether compensatory hypertrophy exists. MATERIALS AND METHODS: Between April and November 2001, 2,700 men who were 20 years old and dwelling in the community were randomly selected at a 10% sampling fraction after a sampling process according to census district. A total of 2,080 men (77% response rate) agreed to participate in the study. All volunteers underwent standard evaluation, including medical history and physical examination. RESULTS: Testicular volume on the affected side in men with varicocele was significantly smaller than that of the contralateral side, while testicular volume on the contralateral side was significantly larger than that of the left side in normal men. In those with unilateral varicocele testicular volume on the affected side did not depend on varicocele grade but contralateral testicular volume in men with grade I varicocele was significantly smaller than in men with higher grades of the entity. The rate of testicular atrophy increased depending on varicocele grade. CONCLUSIONS: Varicocele negatively impacts testicular volume on the affected side in young men. Our findings suggest that men with higher grades of varicocele have a hypertrophied testis on the contralateral side.