Androgens and bladder outlet obstruction: a correlation with pressure-flow variables in a preliminary study.

OBJECTIVES: To determine the relationship between androgens, lower urinary tract symptoms (LUTS) and urodynamic variables of bladder outlet obstruction (BOO) in patients with LUTS/benign prostatic hyperplasia (BPH), as androgens are important in the pathogenesis of LUTS. PATIENTS AND METHODS: Twenty-five men with symptomatic BPH were enrolled in the study and had a complete urodynamic investigation, establishing BOO. Age, prostate-specific antigen level, prostate volume and postvoid residual volume were recorded and the International Prostate Symptom Score (IPSS) was estimated. Detrusor pressure at maximum flow (P(det)Q(max)), at urethral closure (P(det)Cl, the pressure at the end of urinary flow) and maximum detrusor pressure (P(detmax)) was recorded, while detrusor overactivity (DO) was noted when present. Blood samples were collected to measure total testosterone (T), and free T (FT) was calculated. Patients were grouped according to FT levels as low (<72 pg/mL) and normal (FT > or =72 pg/mL). RESULTS: Ten patients had a low FT level, with a mean (sd) of 54.3 (16.5) pg/mL, and 15 a normal level of FT, of 90.5 (11) pg/mL. FT was negatively correlated with P(det)Cl, and P(det)Q(max); the mean P(det)Cl and P(det)Q(max) differed significantly between patients with low and normal FT levels. Fourteen patients had DO and they had significantly lower levels of FT than those with no DO. All patients with a FT level of <60 pg/mL had DO, and the presence of instability differed significantly from the rest of the group. CONCLUSIONS: Low T levels in clinical BOO correlated negatively with P(det)Cl and P(det)Q(max), while promoting DO. Androgen seems to have an ameliorating role in lower urinary tract function.

The expression of hypoxia-inducible factor-1alpha (HIF-1alpha) and angiogenesis markers in hyperplastic and malignant prostate tissue.

BACKGROUND: The process of ingrowth of new blood vessels is stimulated by the action of vascular endothelial growth factor (VEGF), while it may be simultaneously related to the degree of tissue hypoxia. Hypoxia-inducible factor 1alpha (HIF-1alpha) is a protein of cellular response to hypoxia. The relationship between hypoxia and angiogenesis in patients with benign prostate hyperplasia (BPH) and prostate cancer (PCa) was examined. MATERIALS AND METHODS: One hundred and seventy (170) prostatic tissue samples were immunohistochemically evaluated. The microvessel density (MVD) was calculated by CD34 immunostaining; the angiogenetic profile was further assessed using a monoclonal antibody against VEGF. HIF-1alpha immunoreaction was recognized through nuclear staining of positive cells. RESULTS: CD34, VEGF and HIF-1alpha staining reactions were significantly higher in the PCa group than in the BPH group. In both groups, an interrelationship between the immunoexpression of CD34 and HIF-1alpha, VEGF and HIF-1alpha, as well as VEGF and CD34 was detected. CONCLUSION: MVD, VEGF cytoplasmic immunoreactivity and HIF-1alpha immunoreaction were more prominent in PCa than in BPH and were also significantly associated with high-grade carcinomas.

Subcutaneous emphysema of the scrotum (pneumoscrotum) due to traumatic pneumothorax: a case report.

INTRODUCTION: Subcutaneous emphysema of the scrotum due to traumatic pneumothorax is a rare medical situation and only a few cases are reported in the literature. CASE REPORT: We present the case of a 22 year old man who was admitted to the emergency department after a motorcycle accident having a painless crepitant scrotum and chest excoriations. Further evaluation revealed subcutaneous emphysema of the scrotum caused by left pneumothorax. CONCLUSION: In conclusion, subcutaneous emphysema of the scrotum (or pneumoscrotum) due to traumatic pneumothorax is not an urgent condition and assessment should be supportive with intervention directed at the etiology, e.g. the pneumothorax.

Rapture of renal angiomyolipoma during pregnancy: a case report.

INTRODUCTION: Rapture of a renal angiomyolipoma and massive retroperitoneal hemorrhage, during pregnancy is rare and occasionally fatal. The association of this complication with pregnancy has been reported sporadically in the literature. CASE PRESENTATION: We report a case of a 28 years old woman, in 33 week of her first pregnancy who came to our hospital complaining of abdominal pain in the right hemiabdomen, associated with nausea and vomiting. The ultrasound and MRI (Magnetic resonance imaging) scan showed a 7 x 7 x 5 cm mass suggestive of angiomyolipoma in the right kidney, with evidence of retroperitoneal bleeding right perirenal and intrarenal haematoma. Given the size of the tumor, presence of symptoms and hemodynamic instability of the patient right nephrectomy was performed, following emergency caesarean delivery. The histological study of the resected mass revealed the presence of angiomyolipoma. CONCLUSION: In conclusion, it seems that these tumours show a greater growth index in pregnant women. Angiomyolipoma with spontaneous bleeding during pregnancy is a dangerous condition that may cause mortality in the mother and fetus, but elective, simultaneous cesarean section and radical nephrectomy can be performed. We have also done a review of the literature focusing on its management and its relationship with pregnancy.

Adenomatoid tumor of epididymidis: A case report.

BACKGROUND: Adenomatoid tumors are regarded as distinctive benign mesothelial neoplasms of the paratesticular region, most commonly occuring at the tail of the epididymidis.Because of its rarity, the clinical and histopathological aspects are discussed. CASE PRESENTATION: We present the case of a 41-year-old patient with an adenomatoid tumour located in the tail of the left epididymis that referred to our department with gradual enlarged intrascrotal mass. The diagnosis was achieved by echography, and was confirmed by surgical excision and histological analysis. CONCLUSION: Due to its low incidence in intrascrotal pathology, we believe it is important for the physician to be aware of this interesting entity in order to make a differential diagnosis from other inflammatory processes and to adopt the proper surgical approach.