Different Effects of Quercetin Glycosides and Quercetin on Kidney Mitochondrial Function-Uncoupling, Cytochrome C Reducing and Antioxidant Activity.

Flavonols are found in plants as aglycones and as glycosides. Antioxidant activity of flavonols may occur via several mechanisms within the cell, and mitochondria as a target may play an important role. There is a lack of information about the influence of the sugar moiety on biological activity of flavonoid glycosides. The aims of study were to investigate the effects of quercetin and its glycosides on mitochondrial respiration rates at various metabolic states, and to evaluate their antioxidant potential using chemical and biological approaches. Mitochondrial function was measured using an oxygraphic method, cytochrome c reduction spectrophotometrically, H2O2 generation in mitochondria fluorimetrically, and antioxidant activity of flavonoids using an HPLC-post column system. Our data revealed that quercetin and its glycosides isoquercitrin, rutin, and hyperoside uncouple kidney mitochondrial respiration (increasing the State 2 respiration rate) and significantly reduce cytochrome c. Moreover, quercetin, and its glycosides decrease the production of mitochondrial H2O2 and possess radical scavenging and ferric reducing capacities. The highest activity was characteristic for quercetin, showing that the sugar moiety significantly diminishes its activity. In conclusion, our results show the efficient radical scavenging, ferric and cytochrome c reducing capacities, and uncoupling properties of quercetin and its glycosides, as well as the importance of the sugar residue and its structure in the regulation of kidney mitochondrial function.

Reconstruction of a Lower Polar Artery for Kidney Transplantation Using Donor Ovarian Vein: Case Report with Literature Review.

Background: In the case of complicated kidney transplantation, when the accessory artery is severed, the main task is to decide whether to restore renal blood flow and which method should be used. In this report, we present a case of kidney transplantation with vascular reconstruction using an ovarian vein as an interposition graft between a larger branch of the main renal artery and the lower polar artery which was severed during kidney explantation. Case summary: Kidney transplantation using an ovarian vein was performed for a 34-year-old woman with end-stage renal disease on 1 April 2020 in the Hospital of Lithuanian university of health sciences (LUHS) Kaunas Clinics. A lower accessory renal artery was severed during kidney explantation. As the ovarian vein of the donor remained and matched the diameter of the severed vessel, it was decided to use it as an insertion between the main renal artery and the accessory renal artery of the inferior pole. The cold ischemic time was 770 min and the warm ischemic time was 37 min. A month after transplantation, the patient's condition and daily urine output were normal and the serum creatinine level decreased rapidly. Fifteen months after the surgery, the function and structure of the transplant remained normal and there was no evidence of serious vascular complications on CT scans. This is the first case where graft function was verified after transplantation using three-dimensional CT angiography. Conclusions: If an inferior polar artery is severed, vascular reconstruction must be performed to preserve the function of the graft. Usually, the gonadal vein is available during donor nephrectomy; therefore, it can be explanted without additional difficulties or incisions. Although we have not reported any complications, further studies are recommended on the long-term outcomes of this alternative approach for the reconstruction of short renal arteries.

Short ischemia induces rat kidney mitochondria dysfunction.

Renal artery clamping itself induces renal ischemia which subsequently causes renal cell injury and can lead to renal failure. The duration of warm ischemia that would be safe for postoperative kidney function during partial nephrectomy remains under investigations. Mitochondria play an important role in pathophysiology of ischemia-reperfusion induced kidney injury, however relation between ischemia time and mitochondrial dysfunction are not fully elucidated. Thus, the effects of renal ischemia (20 min, 40 min and 60 min) on mitochondrial functions were investigated by using in vitro rat ischemia model. Thus, electronmicroscopy showed that at short (20 min) ischemia mitochondria start to swell and the damage increases with the duration of ischemia. In accordance with this, a significant decrease in mitochondrial oxidative phosphorylation capacity was observed already after 20 min of ischemia with both, complex I dependent substrate glutamate/malate (52%) and complex II dependent substrate succinate (44%) which further decreased with the prolonged time of ischemia. The diminished state 3 respiration rate was associated with the decrease in mitochondrial Complex I activity and the release of cytochrome c. Mitochondrial Ca(2+) uptake was diminished by 37-49% after 20-60 min of ischemia and caspase-3 activation increased by 1.15-2.32-fold as compared to control. LDH activity changed closely with increasing time of renal ischemia. In conclusion, even short time (20 min) of warm ischemia in vitro leads to renal mitochondrial injury which increases progressively with the duration of ischemia.

Comparative Evaluation of Diagnostic Methods for Subclinical Benign Prostatic Hyperplasia in Intact Breeding Male Dogs.

Benign prostatic hyperplasia (BPH) is an androgen-related non-neoplastic enlargement of the prostate gland that commonly affects both reproductive capabilities and the general health of intact dogs. The subclinical form of BPH can be challenging to diagnose due to a lack of clinical signs, even if rectal palpation is performed. Left untreated, this condition poses risks to the dogs' health and breeding status. This study, involving 65 male dogs, aimed to investigate subclinical BPH through rectal palpation, ultrasonography, and analysis of canine prostatic-specific esterase (CPSE). Of the participants, 35 had subclinical BPH, and 30 served as a healthy control group. Dogs suspected of subclinical BPH, as determined by examination results from ultrasonography and CPSE analysis, underwent fine needle aspiration (FNA) guided by ultrasound to enhance diagnostic precision. Findings revealed distinct differences in rectal palpation and ultrasonography between subclinical BPH and healthy dogs. This study established diagnostic thresholds based on prostatic volume and CPSE values and proposed new thresholds for subclinical BPH. Additionally, results showed that prostate gland volume depended on the weight and the age of the dog. In conclusion, early detection of this condition is possible through various examinations, such as changes in ultrasound features, CPSE levels, and rectal palpation. All together, these methods can aid practitioners in early detection of BPH and assist with scheduling screening programs for dogs, ultimately promoting their overall health and reproductive well-being. In conclusion, we advocate for routine, non-invasive prostate screenings in breeding males, underlining the effectiveness of a combination of various multiple techniques for early subclinical BPH detection.

Effect of Clinical Parameters on Risk of Death from Cancer after Radical Prostatectomy in Men with Localized and Locally Advanced Prostate Cancer.

Background: The study aimed to assess predictors and to identify patients at increased risk of prostate-cancer-specific mortality (CSM) after radical prostatectomy (RP). Methods: A total of 2421 men with localized and locally advanced PCa who underwent RP in 2001−2017 were included in the study. CSM predictors were assessed using multivariate competing risk analysis. Death from other causes was considered a competing event. Cumulative CSM and other-cause mortality (OCM) were calculated in various combinations of predictors. Results: During the median 8 years (interquartile range 4.4−11.7) follow-up, 56 (2.3%) of registered deaths were due to PCa. Cumulative 10 years CSM and OCM was 3.6% (95% CI 2.7−4.7) and 15.9% (95% CI 14.2−17.9), respectively. The strongest predictors of CSM were Grade Group 5 (GG5) (hazard ratio (HR) 19.9, p < 0.0001), lymph node invasion (HR 3.4, p = 0.001), stage pT3b-4 (HR 3.1, p = 0.009), and age (HR 1.1, p = 0.0007). In groups created regarding age, stage, and GG, cumulative 10 years CSM ranged from 0.4−84.9%, whereas OCM varied from 0−43.2%. Conclusions: CSM after RP is related to GGs, pathological stage, age, and combinations of these factors, whereas other-cause mortality is only associated with age. Created CSM and OCM plots can help clinicians identify patients with the most aggressive PCa who could benefit from more intensive or novel multimodal treatment strategies.

Caffeic Acid Phenethyl Ester Protects Kidney Mitochondria against Ischemia/Reperfusion Induced Injury in an In Vivo Rat Model.

To improve ischemia/reperfusion tolerance, a lot of attention has been focused on natural antioxidants. Caffeic acid phenethyl ester (CAPE), an active component of the resinous exudates of the buds and young leaves of Populus nigra L., Baccharis sarothroides A., etc., and of propolis, possesses unique biological activities such as anti-inflammatory, antioxidant, immunomodulating, and cardioprotective effects, among others. There is a lack of studies showing a link between the antioxidant potential of CAPE and the mechanism of protective action of CAPE at the level of mitochondria, which produces the main energy for the basic functions of the cell. In the kidney, ischemia/reperfusion injury contributes to rapid kidney dysfunction and high mortality rates, and the search for biologically active protective compounds remains very actual. Therefore, the aim of this study was to identify the antioxidant potential of CAPE and to investigate whether CAPE can protect rat kidney mitochondria from in vivo kidney ischemia/reperfusion induced injury. We found that CAPE (1) possesses antioxidant activity (the reducing properties of CAPE are more pronounced than its antiradical properties); CAPE effectively reduces cytochrome c; (2) protects glutamate/malate oxidation and Complex I activity; (3) preserves the mitochondrial outer membrane from damage and from the release of cytochrome c; (4) inhibits reactive oxygen species (ROS) generation in the Complex II (SDH) F site; (5) diminishes ischemia/reperfusion-induced LDH release and protects from necrotic cell death; and (6) has no protective effects on succinate oxidation and on Complex II +III activity, but partially protects Complex II (SDH) from ischemia/reperfusion-induced damage. In summary, our study shows that caffeic acid phenethyl ester protects kidney mitochondrial oxidative phosphorylation and decreases ROS generation at Complex II in an in vivo ischemia/reperfusion model, and shows potential as a therapeutic agent for the development of pharmaceutical preparations against oxidative stress-related diseases.

Increased Succinate Accumulation Induces ROS Generation in In Vivo Ischemia/Reperfusion-Affected Rat Kidney Mitochondria.

Mitochondria are recognized as main reactive oxygen species (ROS) producers, involving ROS generation by mitochondrial complexes I and III. Lately, the focus has been shifting to the ROS generation by complex II. Contribution of complex II (SDH) to ROS generation still remains debatable, especially in in vivo settings. Moreover, it is not completely defined at what time of ischemia the first alterations in mitochondria and the cell begin, which is especially important with renal arterial clamping in vivo during kidney surgery, as it predicts the postischemic kidney function. The aim of this study on an in vivo rat kidney ischemia/reperfusion model was to determine if there is a connection among (a) duration of kidney ischemia and mitochondrial dysfunction and (b) succinate dehydrogenase activity, succinate accumulation, and ROS generation in mitochondria at low and saturating succinate concentrations. Our results point out that (1) mitochondrial disturbances can occur even after 30 min of kidney ischemia/reperfusion in vivo and increase progressively with the prolonged time of ischemia; (2) accumulation of succinate in cytosol after ischemia/reperfusion correlated with increased H2O2 generation mediated by complex II, which was most noticeable with physiological succinate concentrations; and (3) ischemia/reperfusion induced cell necrosis, indicated by the changes in LDH activity. In conclusion, our new findings on the accumulation of succinate in cytosol and changes in SDH activity during kidney ischemia/reperfusion may be important for energy production after reperfusion, when complex I activity is suppressed. On the other hand, an increased activity of succinate dehydrogenase is associated with the increased ROS generation, especially with physiological succinate concentrations. All these observations play an important role in understanding the mechanisms which occur in the early phase of ischemia/reperfusion injury in vivo and may provide new ideas for novel therapeutic approaches or injury prevention; therefore, more detailed studies are necessary in the future.

[Importance of prostate volume for detection of prostate cancer by first sextant biopsy in high-risk patients]. / Prostatos turio reiksme nustatant prostatos vezi pirmaja sekstantine biopsija dideles rizikos pacientams.

UNLABELLED: The aim of this study was to evaluate the relevance of prostate gland volume, transitional zone volume, and transitional zone index for the detection of prostate cancer by the first sextant biopsy. MATERIAL AND METHODS: A total of 121 men with high risk of prostate cancer were included in our study (prostate-specific antigen level higher than 4 ng/mL and/or pathological digital rectal examination). We consulted the patients in Outpatient Department of Kaunas University of Medicine Hospital during 2003-2006. Total prostate volume and transition zone volume were measured, and all patients underwent transrectal ultrasound-guided sextant biopsy of the prostate. According to histological results of prostate biopsy, patients were divided into two groups: benign group (benign prostate hyperplasia and high-grade intraepithelial neoplasia) and prostate cancer group. Statistical analysis was made by SPSS (Statistical Package for Social Sciences) 12.0.1 for Windows. RESULTS: After histological examination, prostate cancer was detected in 20.7% of patients (n=25). Prostate cancer was found in 24.6% of patients with a total prostate volume of less than 60 cm3 and only in 8.2% of patients with a total prostate volume greater than 60 cm3 (P=0.026). Prostate cancer was found in 27.1% of patients with transition zone volume smaller than 30 cm3 and only in 7.5% of patients with transition zone volume greater than 30 cm3 (P=0.007). A statistically significant difference was found when patients were divided into the groups according to transition zone index: when transition zone index was lower than 0.45, prostate cancer was detected in 37.1% of patients, and when transition zone index was higher than 0.45, prostate cancer was observed in 9.1% of patients (P=0.001). The possibility to detect prostate cancer was 5.9 times higher in patients with transition zone index lower than 0.45. CONCLUSIONS: Prostate cancer detection rate by first sextant prostate biopsy in patients with elevated prostate-specific antigen level and/or pathological digital rectal examination was higher when total prostate volume was less than 60 cm3, transition zone was less than 30 cm3, and transition zone index was less than 0.45.

[Importance of repeat laterally directed sextant prostate biopsy for detection of prostate cancer in high-risk patients]. / Pakartotiniu krastiniu sekstantiniu prostatos biopsiju reiksme nustatant prostatos vezi padidejusios rizikos pacientams.

UNLABELLED: Our purpose was to evaluate the relevance of repeat laterally directed sextant prostate biopsy for detection of prostate cancer in high-risk patients. MATERIAL AND METHODS: Our study included 195 men at high risk for prostate cancer (elevated prostate-specific antigen level and/or abnormal prostate detected by digital rectal examination). We consulted the patients in outpatient department of Kaunas University of Medicine Hospital during 2003-2007. We performed transrectal ultrasound-guided laterally directed sextant prostate biopsy in every patient. For the patients with benign histological findings and increased risk of prostate cancer, laterally directed sextant biopsies were repeated. RESULTS: Prostate cancer was detected in 30.3% of patients (59/195) on the first prostate biopsy, in 13.1% (11/84) on the second prostate biopsy, in 10.3% (4/39) on the third, and in 7.7% (1/13) on the forth biopsy. After all biopsies, prostate cancer was detected in 38.5% (75/195) of patients, and it differed significantly from the percentage of prostate cancer cases detected on the first biopsy (30.3%, P=0.04). We detected 78.7% (59/75) of all prostate cancer cases by the first laterally directed sextant prostate biopsy. The rest 21.3% (16/75) of cases we detected by repeat biopsies. The second laterally directed sextant prostate biopsy revealed additional 14.6% (n=11) of prostate cancer cases and increased the detection of prostate cancer to 93.3% (70/75). At the time of the first prostate biopsy, prostate cancer was diagnosed most frequently when patients had both risk factors: elevated prostate-specific antigen level and abnormal digital prostate examination; prostate cancer was diagnosed in 45.3% of these patients. The odds ratio to detect prostate cancer by the first biopsy in patients with elevated prostate-specific antigen level and abnormal digital prostate examination was 3.7, and odds ratio to detect prostate cancer by repeat biopsies was 4.7. CONCLUSIONS: Repeat ultrasound-guided laterally directed sextant prostate biopsies reveal more cases of prostate cancer as compared to the first prostate biopsy. The majority of prostate cancer cases (93.3%) are detected by the first and second laterally directed sextant prostate biopsies. After the first negative prostate biopsy, we recommend to repeat prostate biopsy in high-risk patients.

Caffeic Acid Phenethyl Ester Reduces Ischemia-Induced Kidney Mitochondrial Injury in Rats.

During partial nephrectomy, the avoidance of ischemic renal damage is extremely important as duration of renal artery clamping (i.e., ischemia) influences postoperative kidney function. Mitochondria (main producer of ATP in the cell) are very sensitive to ischemia and undergo damage during oxidative stress. Finding of a compound which diminishes ischemic injury to kidney is of great importance. Caffeic acid phenethyl ester (CAPE), biologically active compound of propolis, might be one of the promising therapeutic agents against ischemia-caused damage. Despite wide range of biological activities of CAPE, detailed biochemical mechanisms of its action at the level of mitochondria during ischemia are poorly described and need to be investigated. We investigated if CAPE (22 mg/kg and 34 mg/kg, injected intraperitoneally) has protective effects against short (20 min) and longer time (40 min) rat kidney ischemia in an in vitro ischemia model. CAPE ameliorates in part ischemia-induced renal mitochondrial injury, improves oxidative phosphorylation with complex I-dependent substrate glutamate/malate, increases Ca2+ uptake by mitochondria, blocks ischemia-induced caspase-3 activation, and protects kidney cells from ischemia-induced necrosis. The protective effects on mitochondrial respiration rates were seen after shorter (20 min) time of ischemia whereas reduction of apotosis and necrosis and increase in Ca2+ uptake were revealed after both, shorter and longer time of ischemia.

Influence of catheter on urinary flow during urodynamic pressure-flow study in men with symptomatic benign prostatic hyperplasia.

UNLABELLED: Value of urodynamic pressure-flow studies in evaluation of bladder outlet obstruction has been recognized. Voiding during these studies is influenced by transurethral catheter, which is used for measurement of vesical pressure. We have investigated the influence of 7 F (2.3 mm) catheter on flow rate during pressure-flow study as a potential cause of misclassification. PATIENTS AND METHODS: Data of free urinary flow and pressure flow from 111 men with symptomatic benign prostatic hyperplasia were analyzed. Inclusion criteria for analysis: age over 45 years, total International Prostate Symptom Score over 8, maximum flow rate in range of 4-20 ml/s, total voided volume of 100 ml or greater. RESULTS: Of all patients, means of maximum free and pressure-flow rate were 9.8 and 9.0 ml/s (p=0.01) with mean voided volume 199 and 212 ml (p=0.03) respectively. Maximum flow rate decreased in 56.8%, increased in 41.4% and was stable in 1.8% of cases. The difference ranged from -8.5 to +10.2 ml/s ('+' is indicated when maximum rate of free flow is higher). In the group of obstructed subjects mean maximum flow rates were respectively 8.8 ml/s and 7.9 ml/s (p=0.01). There was no significant difference in maximum flow rate within the group of unobstructed/equivocal subjects. More pronounced mean 1.3 ml/s difference in maximum flow rate was observed also in subgroup of patients with prostate volumes over 60 cc (p=0.01). CONCLUSIONS: Catheter of 7 F (2.3 mm) generally slightly diminishes maximum flow rate. Overdiagnosis of obstruction is more likely if considering the effect of catheter and vesical pressure. Misclassification of subject is possible in case of mild obstruction so such cases should be interpreted with caution. In the case of big difference in maximum flow rate it is necessary to take into account the free flow.

Evaluation of LRINEC Scale Feasibility for Predicting Outcomes of Fournier Gangrene.

BACKGROUND: Fournier gangrene (FG) is a fulminant necrotizing infection of the perineal, perianal, and periurethral tissues. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scale is used for diagnosis of necrotizing fasciitis. However, data on its relevance and usefulness in FG are lacking. The aim of this study was to evaluate the utility of the LRINEC scale in predicting the outcome of FG. METHODS: This retrospective case study included 41 patents with FG treated at our institution from 2000 to 2013. The patients were divided into survivors and non-survivors. RESULTS: The mortality rate was 22%. The median age (75 vs. 62.5 y; p = 0.013), rate of co-existing diabetes mellitus (66.7% vs. 3.1%; p < 0.001), and median affected skin surface (4% vs. 1%; p < 0.001) were greater in the non-survivors. Seven of nine patients (77.8%) who did not survive (compared with 37.5% who survived) had a polymicrobial infection (p = 0.032). Of all the causative pathogens isolated, Proteus mirabilis was more common in non-survivors (55.6% vs. 6.3%; p = 0.001). The median calculated LRINEC score for survivors was 5 compared with 10 for the non-survivors (p < 0.001). Regression analysis showed that all the aforementioned variables, except for polymicrobial culture, were significant risk factors for predicting death. The area under the receiver operating characteristic curve for the LRINEC score was the highest, 0.976 (95% confidence interval 0.872-0.999; p < 0.0001), and the cut-off value was ≥9 with 93.7% specificity and 100% susceptibility for the prediction of a lethal outcome. CONCLUSIONS: The LRINEC score could be used for prediction of disease severity and outcomes. A threshold of 9 could be a high-value predictor of death during the initial evaluation of patients with FG.

Independent predictors of biochemical recurrence after radical prostatectomy: a single center experience.

INTRODUCTION: The aim of study was to establish pretreatment and postoperative factors which could predict the early biochemical recurrence after radical prostatectomy. MATERIALS AND METHOD: 754 patients had undergone radical prostatectomy since January 2002 to December 2008 in our department and were included in this prospective study. Exclusion criteria were: neoadjuvant or adjuvant treatment (radiation or hormonal treatment) and N+. Following parameters were evaluated: age, PSA at time of biopsy, time period from biopsy to operation, biopsy and postoperative Gleason score, stage, high grade intraepithelial neoplasias, perineural invasion. Biochemical recurrence was detected if PSA value after radical prostatectomy was ≥0.2 ng/ml. All factors likely to be predictive were evaluated by univariate analysis (Log-rank test). Multivariate analysis using Cox model was completed for all factors with p value <0.1 at univariate analysis. RESULTS: Final analysis was done using data of 496 patients. We detected 53 (10.7%) biochemical recurrences. Calculated actuarial biochemical recurrence free survival reached 64%. Multivariate analysis highlighted that PSA >10 ng/ml (HR 2.45, p = 0.008), pathological stage ≥pT3 (HR 2.371, p = 0.02), postoperative Gleason score ≥7 (HR 2.149, p = 0.049), positive surgical margins (HR 2.482, p = 0.014) and absence of high grade intraepithelial neoplasia in removed prostate (HR 0.358, p = 0.006) are independent factors influencing biochemical recurrence after radical prostatectomy. CONCLUSION: Patients with higher PSA, locally advanced disease, positive surgical margins, and Gleason score ≥7 are at the highest risk for biochemical recurrence.

Importance of prostate volume and urinary flow rate in prediction of bladder outlet obstruction in men with symptomatic benign prostatic hyperplasia.

OBJECTIVES: To predict bladder outlet obstruction with parameters of non-invasive investigations for patients with symptomatic benign prostatic hyperplasia. PATIENTS AND METHODS: A sample of 122 men with moderate to severe lower urinary tract symptoms suggestive of benign prostatic hyperplasia was selected. Transrectal prostate ultrasound, free flow measurement, and transabdominal ultrasound for residual urine were carried out together with digital rectal examination for all patients. All patients underwent urodynamic pressure/flow test. Two groups of obstructed (91 patient) and equivocal/unobstructed (31 patient) were analyzed. Probabilistic model based on logistic regression was developed for prediction of obstruction. RESULTS: Various parameters were compared in obstructed and non-obstructed/equivocal groups, highlighting important parameters for obstruction. Correlation analysis indicates higher obstruction dependence on average and peak flow rates and lower dependence on total prostate and transition zone volumes, transition zone index. Binary logistic regression model suggests that average flow rate combined with total prostate volume is the best predictor of obstruction (83% of correct predictions; PPV = 92%; NPV = 52%) in the analyzed sample. The analyzed model suggests that peak flow rate could also be almost equally important parameter instead of average flow rate. CONCLUSIONS: The study suggests that average/peak flow rate combined with total prostate volume can be used for prediction of obstruction. The developed probabilistic model helps to determine patients who need invasive urodynamic testing for decision on surgical treatment.

Outcome of surgery in locally advanced pT3a prostate cancer.

INTRODUCTION: The aim of this study is to present the oncologic outcomes and to determine prognostic parameters of overall (OS), cancer specific survival (CSS), disease progression free survival (DPFS) and biochemical progression free survival (BPFS) after surgery for pT3a prostate cancer (PCa). MATERIAL AND METHODS: Between 2002 and 2007, a pT3a stage after radical prostatectomy was detected in 126 patients at our institution. Kaplan-Meier analysis was used to calculate OS, CSS, DPFS and BPFS. Cox regression was used to identify predictive factors of survival. RESULTS: Five-year OS, CSS, DPFS and BPFS rates were 96%, 98.7%, 97.3% and 60%, respectively. Among patients with prostate specific antigen (PSA) <10 ng/ml and PSA >20 ng/ml the 5-year OS was 98.8% and 80%, respectively, whereas 5-year BPFS was 66% and 16.6%, respectively. Survival was different when comparing surgery Gleason score ≤7 and ≥8. 5-year OS and BPFS were 98% vs. 80%, and 62.6% vs. 27.3%, respectively. Specimen Gleason score and preoperative PSA were significant predictors of BPFS. The risk of biochemical progression increased up to 2-fold when a Gleason score ≥8 was present at final pathology. CONCLUSIONS: In locally advanced pT3 PCa, surgery can yield very good cancer control and survival rates especially in cases with PSA <10 ng/ml and Gleason score ≤7. PSA and Gleason score after surgery are the most significant predictors of outcomes after radical prostatectomy.

Prostate-specific antigen and transition zone index - powerful predictors for acute urinary retention in men with benign prostatic hyperplasia.

OBJECTIVES: To examine the efficacy of prostate-specific antigen and various parameters obtained by transrectal ultrasonography as predictors of acute urinary retention in patients with benign prostatic hyperplasia. METHODS: Eighty-nine men with symptoms of benign prostatic hyperplasia were enrolled in this study from February 2002 to June 2003. Among them, 21 patients presented with acute urinary retention. Transrectal ultrasonography was used to calculate the total prostate volume, transition zone volume and transition zone index. Sample of prostate-specific antigen was taken in outpatient clinic or in clinic before first insertion of the catheter into the bladder, because of urinary retention. If the patient presented with inserted catheter, we used latest prostate-specific antigen date from the medical notes of outpatient clinic. To compare the usefulness of the various indexes, the area under the receiver-operator characteristic curve was calculated for each index. RESULTS: There were significant differences between patients with and without acute urinary retention in the total prostate volume (58.16 cm(3) and 44.28 cm(3), p=0.0028), transition zone volume (36.62 cm(3) and 23.70 cm(3), p=0.0001), transition zone index (0.62 and 0.51, p=0.00022), prostate-specific antigen (4.96 ng/ml and 2.97 ng/ml, p=0.00069), age and quality of life score, but no significant difference in International Prostate Symptom Score. In patients with acute urinary retention, the area under the receiver-operator characteristic curve was 0.775 for transition zone index, 0.742 for prostate-specific antigen, 0.737 for transition zone volume, 0.696 for total prostate zone volume and 0.633 for International Prostate Symptom Score. CONCLUSIONS: The transition zone index and prostate-specific antigen are accurate predictors of acute urinary retention in patients with benign prostatic hyperplasia and may be useful for deciding between surgical intervention and medical treatment.

The importance of prostatic measuring by transrectal ultrasound in surgical management of patients with clinically benign prostatic hyperplasia.

OBJECTIVE: To study whether transrectal ultrasound volume determination of the whole prostate and of the transition zone alone correlates to resected or enucleated weight in patients operated upon with transurethral resection of the prostate and retropubic or suprapubic prostatectomy because of presumed benign prostatic hyperplasia. MATERIAL AND METHODS: The study comprised 120 patients with symptomatic benign prostatic hyperplasia. Ninety patients underwent transurethral resection of the prostate and 30 treated using suprapubic or retropubic prostatectomy. The weights of the specimens were correlated with the corresponding volumes of the transition zone and of the whole prostate, respectively, measured by transrectal ultrasound using prolate ellipsoid method. RESULTS: The mean weight of the resected or enucleated specimens was 36.79 g. The mean whole prostate volume in all patients was 63.14 cm(3). Difference between resected weight and prostate volume was statistically significant (p= 0.0001), whereas the mean transition zone volume was 40.14 cm(3) and difference with resected weight was not significant (p=0.483). Correlation coefficients between measured total prostate volume and weight of resected tissue as well as between measured transition zone volume and weight of resected tissue were calculated and were respectively r=0.925, p< 0.001 and r=0.958, p<0.001. CONCLUSIONS: Measurements of the transition zone of the prostate by transrectal ultrasound are more accurate than those for the whole prostate to predict enucleated or resected weight. The assessment of the transition zone volume may be sufficiently reliable to be used in the clinical management of benign prostatic hyperplasia and helpful to choose modality of the surgery.

[Abdominal aortic aneurysm and horseshoe kidney anomaly]. / Pilvo aortos aneurizma ir pasagos formos inksto anomalija.

Horseshoe kidney is a challenge for vascular surgeon performing abdominal aortic aneurysm repair. First case of successful surgical treatment and positive remote result is described in Lithuanian medical press. Literature review of world surgical treatment experience is given. Operative technique depends upon anomalous kidney vascularization. Three types of vascularization are described. Rational operative approach and necessity of isthmotomy are discussed, investigation methods and treatment algorithm is presented.