[Giant renal cystic echinococcosis: case report]. / Dev Böbrek Kistik Ekinokok Hastaligi: Olgu Sunumu.

Echinococcosis is endemic in many parts of the world. Although echinococcosis can be present in all parts of the human body, urinary tract involvement develops in only 2-4% of all cases, and isolated renal cysts are extremely rare. There are no specific clinical symptoms or signs that will reliably confirm the diagnosis of renal echinococcosis. Routine blood tests are generally normal except for eosinophilia, which is found in only 20% of the cases. Radiological studies have a more important place in the preoperative diagnosis of renal hydatic disease. However, there is no specific sign on plain urography or intravenous urography, and ultrasound or computed tomography cannot always show a echinococcosis as a specific lesion. Echinococcosis should be included in the differential diagnosis of cystic lesions in solid organs or other anatomic sites, especially in endemic countries. We presented a patient with isolated giant renal cystic echinococcosis mimicking a complicated cyst who was treated successfully with nephrectomy.

CD10 expression in urothelial bladder carcinomas: a pilot study.

OBJECTIVES: The aims of this study were to investigate the expression of CD10 in normal bladder tissue and urothelial bladder carcinomas and to clarify its association with histopathological variables. MATERIALS AND METHODS: A total of 79 urothelial bladder carcinomas were selected from routine archival material. All cases were reevaluated histopathologically and graded according to the World Health Organization (WHO) 1973, WHO/ISUP 1998, and WHO 1999 systems. The TNM system was used for their pathological staging. CD10 immunohistochemical staining was performed in selected slides. RESULTS: Tumoral cases consisted of 74 men (93.7%) and 5 women (6.3%). According to the pathological stage, 25 (31.6%), 33 (41.8%), and 21 (26.6%) cases had pTa, pT1, and pT2-3 carcinomas, respectively. 34 of 79 (43%) urothelial carcinomas and only 1 of 11 (9.1%) nontumoral cases showed positive CD10 immunostaining. It was a cytoplasmic diffuse or granular immunostaining pattern both in nontumoral and tumoral urothelia. There was no statistically significant difference between tumoral and nontumoral cases with respect to CD10 reactivity (p = 0.051), but there was a trend toward significance. In urothelial tumors, there was a significant inverse correlation between pathological stages and CD10 immunoreactivity (p = 0.036, r = -0,237). There was also a statistically significant difference between pTa and pT2-3 urothelial tumors in relation to the CD10 expression (p = 0.034). No association was detected between CD10 expression and grades according to all systems used (p > 0.05). CONCLUSIONS: According to our findings, the CD10 expression in noninvasive carcinomas showed a higher level than that in invasive carcinomas, and it is inversely correlated with the pathological stage. CD10 may play an important role in the progression of urothelial bladder carcinomas, and downregulation probably facilitates invasion, especially muscle invasion.

Free insulin-like growth factor-1 levels in bladder growth following spinal cord injury experimentally.

INTRODUCTION: To determine the levels of spinal cord injury (SCI) on free insulin-like growth factor-1 (IGF-1) content in the bladder and the possible role of free IGF-1 in growth in hypertrophic bladders in an experimental model. MATERIALS AND METHODS: The contents of free IGF-1 and protein in paraplegic and non-paraplegic rats which was induced experimentally by SCI were measured. The wet weights of the bladders were also determined. The results gained were compared. RESULTS: The mean bladder free IGF-1 level in paraplegic rats was significantly higher than the corresponding bladder free IGF-1 level in sham-operated bladder (p<0.05). Mean wet weight bladder in paraplegic rats was significantly higher than the sham-operated rats (p<0.05). Paraplegic bladder had a significantly higher mean protein content than the sham-operated bladder (p<0.05). Serum free IGF-1 levels in the two groups were not different. CONCLUSION: Our pilot study reveals that free IGF-1 may be effective in SCI.

Risk factors for the formation of a steinstrasse after shock wave lithotripsy.

INTRODUCTION: We studied the various stone, renal, and therapy factors that could affect steinstrasse formation after shock wave lithotripsy (SWL) to define their predictive value. PATIENTS AND METHODS: Between May 1999 and September 2002, 563 patients were treated with a Stonelight V3 lithotriptor. A steinstrasse was recorded in 46 patients. All patient data, stone and renal characteristics, and data of SWL were reviewed. Statistical analyses of patients, stones, and therapy characteristics in correlation with the incidence of steinstrasse formation were performed to assign factors that had a significant impact on the formation of this complication. RESULTS: The overall incidence of a steinstrasse was 8.17%. The steinstrasse was in the pelvic ureter in 84.3% of the cases, in the iliac ureter in 7.84% of them, and in pelvic and iliac ureter in 7.84% of the patients. The incidence of a steinstrasse significantly correlated with stone size and site. The incidence rates of a steinstrasse in renal stones <1 cm, 1-2 cm, and >2 cm were 4.46, 15.87, and 24.3% respectively. The incidence rates of this complication in ureteral stones <1 cm and 1-2 cm were 3.37 and 9.52%, respectively. The incidence rates of a steinstrasse in stones located in upper calices, middle calices, lower calices, and renal pelvis were 6.12, 10.52, 6.36, and 19.32%, respectively. CONCLUSIONS: Stone size and site are the significant factors predicting the formation of a steinstrasse. If a patient has a high probability of steinstrasse formation, close follow-up with early intervention or prophylactic pre-SWL ureteral stenting is indicated.

Comparison of WHO 1973, WHO/ISUP 1998, WHO 1999 grade and combined scoring systems in evaluation of bladder carcinoma.

OBJECTIVES: To compare WHO 1973, WHO/ISUP 1998 and WHO 1999 histologic grading systems, and also to evaluate the primary (most common) and secondary (second most common) patterns of cancer growth according to these three grading systems. MATERIAL AND METHODS: The study consisted of 87 bladder transurethral resections that were classified as grade 1, 2 and 3, and papillary urothelial neoplasm of low malignant potential (PUNLMP), low grade (LG) and high grade (HG) carcinoma considering WHO 1973 and WHO/ISUP, respectively. The WHO 1999 system was subdivided high grade into grades 2 and 3 (HG-2 and HG-3). For combined scoring, primary (most common) and secondary (second most common) grades according to extension were recorded for three grading systems. The number was repeated when only grade was seen in all extension of the tissue examined. A final combined score was obtained which ranged from 2 to 6 for the WHO 1973 and WHO/ISUP 1998 systems and from 2 to 8 for the WHO 1999 schema. The TNM system was used for the pathologic staging. RESULTS: When considering the pathological stage, there were statistical differences between the WHO 1973 grades (p=0.011 and p=0.000), and LG and HG carcinomas of WHO/ISUP 1998 (p=0.000) and also the WHO 1999 grades (p=0.010 and p=0.003), except PUNLMP. Regarding the combined scoring, significant differences were found between score 4 (2+2) and 5 (2+3) of WHO 1973 (p=0.014) and score 5 (LG+HG) and 6 (HG+HG) of WHO/ISUP 1998 (p=0.011). There was also a significant difference between scores 4 and 6, and 6 and 8 of the WHO 1999 combined scoring system (p=0.019 and p=0.019). WHO 1973, WHO/ISUP 1998 and WHO 1999 systems were positively correlated with the pathological stage (r(s)=0.30, r(s)=0.52 and r(s)=0.50, respectively), whereas there was weak association between the combined scoring systems and stage (r(s)=0.20, r(s)=0.18 and r(s)=0.19). Comparing these grading systems, the grade 2 of WHO 1973 was subdivided into LG and HG in WHO/ISUP 1998 and also LG-1and HG-2 in WHO 1999 systems. The group of HG carcinoma in WHO/ISUP 1998 which was subdivided into HG-2 and HG-3 in the WHO 1999 system was different statistically in relation to the stage. CONCLUSIONS: Our results revealed that the WHO 1999 system may be more useful to evaluate the bladder carcinoma histopathologically in comparison to the WHO 1973 and WHO/ISUP 1998 systems.

Association between mast cells and bladder carcinoma.

INTRODUCTION: The aim of this study was to determine whether there are quantitative variations in the numbers of mast cells (MCs) in bladder carcinoma tissue associated with the histopathological grading of tumours. MATERIALS AND METHODS: Specimens of 56 bladder carcinomas were stained with toluidine blue and histologically staged using the Mostofi system. The MC counts were assessed within tumour tissue and lamina propria of the bladder. The MCs in the adjacent 'normal bladder tissue' of 14 specimens from patients who underwent cystectomy and of 10 specimens from patients having interstitial cystitis were also determined. The results were analyzed by using the Student t test, the Wilcoxon signed-rank test, and the Spearman correlation (r(s)). RESULTS: The mean MC concentration was 0.57 within the tumour tissue and 3.36 in the lamina propria. The difference between the two MC groups was statistically significant (p < 0.0001); there were no correlations between mean MC counts in tumour tissue and histopathological tumour grade and between mean MC counts in lamina propria and histopathological tumour grade. Statistically significant differences were also observed between tumour group and interstitial cystitis group (p = 0.029) and between tumour group and normal 'adjacent' tissue group (p = 0.037). CONCLUSIONS: Our findings suggest that MCs aggregate in small numbers in the lamina propria of bladder carcinomas and that the MC count is related to tumour differentiation. The number of MCs may be a useful prognostic indicator in patients with bladder carcinoma.

Urine and serum free IGF-1 levels in patients with bladder cancer: a brief report.

Insulin-like growth factor (IGF)-1, a mitogenic and anti-apoptotic peptide, can affect the proliferation of epithelial cells, and is thought to play a role in cancer development. The free IGF-1 represents the biologically active fraction of IGF-1. We hypothesised that there is a difference in free IGF-1 levels in the urine and serum from patients with TCC and normal subjects. Urine and blood samples were collected from 30 cases of superficial TCC and an equal number control subjects without malignancy. Free IGF-1 levels were measured in duplicate by radioimmunoassay. Specimens of bladder carcinoma were staged histopathologically using the Mostoffi grading system. Statistical analyses were performed using the Mann-Whitney U-test, Pearson correlation and covariate analysis. There was no significant difference in urine and serum free IGF-1 levels between the two groups. The correlation between urine and serum free IGF-1 levels and age was not significant. There was also no significant relationship between free IGF-1 levels and histopathological grading. The results of this pilot study reveal that the free IGF-1 level does not help predict tumour marker in the patients with bladder cancer.

Tension-free vaginal tape for surgical treatment of stress urinary incontinence: two years follow-up.

BACKGROUND: The objective was to study prospectively the effectiveness of tension-free vaginal tape as an ambulatory and minimal invasive operation for the treatment of female stress incontinence. METHODS: The tension-free vaginal tape procedure was performed in 25 patients with genuine stress incontinence and they were followed for a 2-year period. All patients were diagnosed with urodynamics to have genuine stress incontinence. Pad tests, cough stress test and quality-of-life assessments were carried out in all patients, both preoperatively and postoperatively. The majority of the women were discharged the morning after the surgical procedure. RESULTS: Twenty of 25 (80%) patients were found to be cured 2 years after the operation. The vaginal tape was spontaneously dropped out from the vagina in one patient 2 weeks after the procedure. We did not see such a complication in previous studies. CONCLUSION: We conclude that the tension-free vaginal tape procedure is both a safe and effective method to cure genuine female stress incontinence. Furthermore, it can be performed as an ambulatory procedure under local anesthesia with a short operative time.

Magnetic resonance imaging for stress incontinence: evaluation of patients before and after surgical correction.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of magnetic resonance imaging (MRI) in the pre and postoperative assessment of stress urinary incontinence. METHODS: Fifteen female patients with clinical evidence of stress urinary incontinence were included in this prospective study. All the patients underwent MRI in the supine position both preoperatively and postoperatively. For imaging, we used a 1.0 T magnet, T2-weighted images were obtained in the midline sagittal plane with patients at rest. Images were evaluated for anatomical stress urinary incontinence alterations, such as the increased distance between the pubococcygeal line and the bladder base and the posterior urethro-vesical angle and the urethral inclination angle changes. Wilcoxon signed rank test allowed comparisons of pre and postoperative results. RESULTS: Compared with postoperative measurements, the bladder base was lowered significantly by an average of 9.4+/-4.0 mm (P<0.01), posterior urethro-vesical angle was significantly increased by an average of 127.8+/-11.4 degrees (P<0.01), and the urethral inclination angle was significantly increased by an average of 54.9+/-10.1 degrees (P<0.01) preoperatively. CONCLUSION: Our results suggest that MRI can play a major role in the preoperative and postoperative assessment of stress urinary incontinence. It can reliably detect anatomical urinary incontinence alterations. MRI should be considered in failed surgery, complex prolapse, and in differentiating genuine stress incontinence resulting from malposition of the bladder neck from stress incontinence due to intrinsic urethral damage.

Analysis of the trace element contents of inner nucleus and outer crust parts of urinary calculi.

In this study, the lead, cadmium, nickel, and aluminum concentrations were analyzed in inner nucleus and outer crust parts of various kinds of urinary calculi, and the results obtained were statistically compared. Significant differences were found among the element concentrations in the different stone groups. In general, higher element concentrations were found in the nuclei as compared with the crust parts. In addition, some significant intra- and intercorrelations were established among the elements analyzed. The results suggest that some trace elements, including lead, cadmium, nickel, and aluminum, together with other factors may have as yet no clarified functions in the stone precipitation process in the urinary tract.

Bone mineral content and related biochemical variables in patients with ileal bladder substitution and colonic Indiana pouch.

OBJECTIVES: To evaluate the effects of ileal bladder substitution or colonic Indiana pouch on skeletal bone density and various biochemical parameters related to bone metabolism. PATIENTS AND METHODS: In 27 patients with urinary diversion and 14 controls with benign urologic disease, bone mineral density (BMD), assessed by dual-photon absorptiometry; serum electrolyte, creatinine, alkaline phosphatase and parathyroid hormone levels were determined, and capillary blood gas analysed. BMD was measured in the lumbar spine and the femur neck. The mean time since surgery was 33.6+/-10.1 months in 17 patients with an ileal bladder substitution and 56+/-9.1 months in 10 patients with a colonic Indiana pouch (p=0.001). RESULTS: Although BMD did not change in the colonic Indiana pouch group, it was reduced in the patients with ileal bladder substitution compared to control group. The mean pH value was not statistically significant different in the both groups from the control group (p>0.2). The mean base excess value reduced in the substitution group (p<0.01). While alkaline phosphatase levels increased in both groups compared to control group (p<0.05), the mean parathyroid hormone level decreased only in the patients with ileal bladder substitution (p<0.05). The other biochemical parameters were similar in patients and control subjects. There was a statistically significant correlation between the base excess values and BMD values of the patients in both groups. CONCLUSION: Although there is decreased BMD in patients with an ileal bladder substitute, there is no change in BMD in the patients with Indiana pouch. Alkaline phosphatase levels increased in both patient groups indicating increased bone turnover.