Abnormal cytokine profile in patients with obstructive sleep apnea-hypopnea syndrome and erectile dysfunction.

Patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) show a high prevalence of erectile dysfunction (ED). Although the underlying pathogenesis is still unknown, endothelial dysfunction, induced by inflammatory cytokines, chemokines, and adhesion molecules, has been proposed as a possible mechanism. The aim of this study was to assess whether OSAHS is associated with activation of the inflammatory cytokine system in patients with ED compared to the matched OSAHS patients with normal sexual function. Thirty-one patients with severe OSAHS and ED were included. Fifteen patients with severe OSAHS and without ED served as controls. Serum concentrations of high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-a), interleukin-6 (IL-6), interleukin-8 (IL-8), and adiponectin were measured after the diagnostic polysomnography. We found that hsCRP levels were significantly elevated in OSAHS patients with ED compared to controls. Similarly, TNF-a levels, IL-6, and IL-8 were elevated in OSAHS patients with ED compared to controls. Serum adiponectin levels were lower in OSAHS-ED patients, but the difference did not reach statistical significance. The presence of ED in patients with severe OSAHS is associated with elevated levels of inflammatory markers, underlining a possible involvement of endothelial dysfunction in the pathogenesis of ED.

The modified Clavien classification system: a standardized platform for reporting complications in transurethral resection of the prostate.

PURPOSE: The aim of the study was to evaluate the applicability of the modified Clavien classification system (CCS) in grading perioperative complications of transurethral resection of the prostate (TURP). METHODS: All patients with benign prostatic hyperplasia submitted to monopolar TURP from January 2006 to February 2008 at a non-academic center were evaluated for complications occurring up to the end of the first postoperative month. All complications were classified according to the modified CCS independently by two urologists, and the final decision was based on consensus. If multiple complications per patient occurred, categorization was done in more than one grade. Results were presented as complication rates per grade. RESULTS: Forty-four complications were recorded in 31 out of 198 patients (overall perioperative morbidity rate: 15.7%), and their grading was generally easy, non-time-consuming and straightforward. Most of them were classified as grade I (59.1%) and II (29.5%). Higher grade complications were scarce (grade III: 2.3% and grade IV: 6.8%, respectively) There was one death (grade V: 2.3%) due to acute myocardial infarction (overall mortality rate: 0.5%). Negative outcomes such as mild dysuria during this early postoperative period or retrograde ejaculation were considered sequelae and were not recorded. Nobody was complicated with severe dysuria. There was one re-operation due to residual adenoma (0.5%). CONCLUSIONS: The modified CCS represents a straightforward and easily applicable tool that may help urologists to classify the complications of TURP in a more objective and detailed way. It may serve as a standardized platform of communication among clinicians allowing for sound comparisons.

Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience.

PURPOSE: To compare the efficacy and safety of the electromagnetic lithotripter in the treatment of pediatric lithiasis to that of the earlier electrohydraulic model. MATERIALS AND METHODS: Two groups of children with lithiasis aged between 10 and 180 months who underwent extracorporeal shock wave lithotripsy (ESWL). In the first group (26 children), ESWL was performed by using the electrohydraulic MPL 9000X Dornier lithotripter between 1994 and 2003 while in the second group (19 children) the electromagnetic EMSE 220 F--XP Dornier lithotripter was used from April 2003 to May 2006. RESULTS: In the first group, 21/26 children (80.7%) were stone free at first ESWL session. Colic pain resolved by administration of an oral analgesic in 6 (23%), brief hematuria (<24 h) resolved with increased fluid intake in 5 (19.2%), while slightly elevated body temperature (<38°C) occurred in 4 (15.3%). Four children (15.3%) failed to respond to treatment and were treated with ureteroscopy. In the second group 18/19 children were completely stone free at first ESWL session (94.7%). Complications were infrequent and of minor importance: colic pain treated with oral analgesic occurred in 1 (5.26%), brief hematuria (<24 h), resolved with increased fluid intake in 4 (21%) and slightly elevated body temperature (<38° C) monitored for 48 hours occurred in 6 (31.5%). Statistical analysis showed that electromagnetic lithotripter is more efficacious and safer than the earlier electrohydraulic model. CONCLUSIONS: Technological development not only has increased efficacy and safety of lithotripter devices in treating pediatric lithiasis, but it also provided less painful lithotripsy by eliminating the need for general anesthesia.

The phenomenon of multifocality does not affect the biologic behavior of histologic prostate carcinoma.

BACKGROUND: The affect of multifocality on the biologic behavior of histologic prostate carcinoma is a controversial issue. The aim of this study was to determine if tumor multifocality influences the prognosis of patients with prostatic cancer. MATERIAL/METHODS: Samples consisted of 264 autopsy tissues from men older than 40 years of age and less than 98 years of age who died (between August 2002 and December 2005) of diseases other than clinically diagnosed prostate carcinoma. The entire prostate and seminal vesicles were sectioned, tinted, and fixed in acetic acid. Specimens were immersed in formalin, serial sectioned at a thickness of 4 mm, postfixed, resectioned at a thickness of 2 mm, dehydrated, cleared in xylene, and immersed in paraffin. Two expert pathologists examined the sections. RESULTS: Most latent carcinomas (61%) were multifocal and were composed of 2 or more foci. Ninety percent of distinct foci were found to originate from the peripheral zone. Multifocality was more common among larger prostates, and large tumors were almost exclusively multifocal. Half of these had a total volume less than 1 cm3 and a Gleason score of 2 to 6; there was a clear correlation between tumor volume and Gleason score. Heterogeneity of Gleason grade in multifocal tumors was proportional to the number of foci. No statistically significant difference was observed with respect to capsular penetration or perineural or vascular invasion of multifocal tumors compared to those of unifocal tumors. CONCLUSIONS: Despite relative heterogeneity, the biologic behavior of multifocal tumors is not different from that observed in unifocal histologic tumors.

Value of immediate anastomotic biopsy following biochemical failure after radical prostatectomy.

AIMS: To study the value, in diagnostic terms, of performing transrectal ultrasound (TRUS)-guided anastomotic biopsy immediately following the diagnosis of biochemical failure in patients treated by radical retropubic prostatectomy. METHODS: We report on 50 sessions of TRUS-guided biopsy obtained during post-radical retropubic prostatectomy follow-up, immediately after the diagnosis of biochemical failure. No patient had received either adjuvant or further treatment due to biochemical failure status prior to the biopsy session. In each case, tissue sampling involved cores taken by a standard protocol (random) as well as TRUS-guided biopsy to sonographically suspicious areas. Statistical analysis focused on identifying the statistical importance of various pre- and post-treatment variables in predicting biopsy outcome. RESULTS: 10/50 cases with local evidence of malignancy (1 case harboring both benign and malignant glands) were identified and in another 10/50 cases benign prostatic tissue was diagnosed. The remaining (30) cases have shown fibromuscular tissue only. Statistical analysis of various parameters has demonstrated a significant correlation between local evidence of cancer and the finding of sonographically remarkable areas. CONCLUSION: Performing TRUS-guided anastomotic biopsy close to the onset of biochemical failure can frequently identify but also may easily miss the suspected local presence of prostate tissue. We believe that, with minimal risks of morbidity, there is merit in exploring its possibilities to trace local prostatic tissue, since it may provide useful information for further treatment actions also in an earlier time.

The effects of lovastatin on conventional medical treatment of lower urinary tract symptoms with finasteride.

OBJECTIVE: To explore whether or not statins have any impact on the progression of components of benign prostatic hyperplasia (lower urinary tract symptoms severity, prostate volume and serum prostate specific antigen (PSA) when combined with other agents inhibiting growth of prostate cells. MATERIALS AND METHODS: This was a preliminary, clinical study. Eligible patients were aged > 50 yrs, with International Prostate Symptom Score (IPSS) between 9 and 19, total prostate volume (TPV) >40 mL, and serum PSA > 1.5 ng/mL. Patients were divided in two groups: those with and those without lipidemia. After selection, eligible BPH patients with lipidemia (n = 18) were prescribed lovastatin 80 mg daily and finasteride 5 mg daily, while eligible patients without lipidemia (n = 15) were prescribed only finasteride 5 mg daily. IPSS, TPV and serum PSA were evaluated at end point (4 months). RESULTS: There was no difference between the two groups on the primary end point of mean change from baseline in IPSS (p = 0.69), TPV (p = 0.90) and PSA (p = 0.16) after 4 months of treatment. CONCLUSIONS: Short-term lovastatin treatment does not seem to have any effect on IPSS, TPV and PSA in men with prostatic enlargement due to presumed BPH.

Adenocarcinomas of the prostatic duct in necropsy material.

The general consensus about prostatic duct adenocarcinomas is that they have a rather aggressive biological behavior. In addition, studies or reports of latent adenocarcinoma of the prostatic duct in necropsy material are scarce in the literature. We report here three cases of adenocarcinoma of the prostatic duct that were found incidentally among 39 cases of latent acinar prostate adenocarcinomas in necropsy material. We examined the morphologic and histological features of these prostatic duct adenocarcinomas, in order to better understand their biological behavior. We identified two cases of mixed ductal-acinar adenocarcinoma and one case of pure ductal adenocarcinoma. The pure form had a favorable histological differentiation, while the mixed forms had intermediate histological differentiation patterns. Invasiveness was related to both volume and histological differentiation. The finding of prostatic ductal adenocarcinomas among autopsy material, as well as some of their histological features, suggest that these tumors might have a similar biological potential as prostatic acinar cancer.

The effectiveness of a scientific symposium to change urologists' attitude towards treatment of LUTS/BPH.

PURPOSE: The use of interactive voting systems in continuing education helps to evaluate the alteration in the audience's views after a presentation. This study was designed to evaluate whether urologists' attitude towards management of benign prostate hyperplasia can be changed, and to estimate objectively the achievement of educational goals by using an interactive voting system. METHODS: The audience attitude was repetitively estimated by responding to questions using wireless keypads. Educational goal achievement was calculated by adding the percentage of those changing their opinion from "wrong" to "right" and that of those insisting on their initial "right" opinion. RESULTS: Giving a "wrong" answer and the probability of opinion change were independent of age and board certification. Being initially on the "wrong" side resulted in a greater probability of opinion change. The educational goals were achieved in 20.8-86.2% of cases. CONCLUSION: Satellite symposia are helpful learning environments. The use of an interactive voting system may help to evaluate objectively the achievement of educational goals.

Rapid communication: first clinical experience with Doli S 220F-XP extracorporeal lithotripter for urinary lithiasis.

PURPOSE: To assess the initial results of the Dornier Doli S 220F-XP extracorporeal lithotripter for the management of solitary urinary calculi. PATIENTS AND METHODS: We prospectively examined the outcome of shockwave lithotripsy (SWL) in the first 140 patients with solitary renal and ureteral lithiasis treated by one urologist with the new power Doli S lithotripter. Ninety-one patients (group A) had renal stones, and 49 patients (group B) had ureteral stones. Data were collected with respect to stone size, location, and fragmentation. RESULTS: In group A, clinical success was documented in 77 patients (84%) at 1 month after lithotripsy. Three months after lithotripsy, 69 patients (75.2%) were stone free and 8 (8.8%) had fragments <4 mm. In group B, 41 patients (83%) achieved clinical success 1 month after lithotripsy. Thirty-eight patients (77%) were stone free 3 months after treatment, and 3 (6%) had fragments <4 mm. Seven patients (7%) in group A and three patients (6%) in group B required re-treatment. The overall efficiency quotient was 67%. No patient developed a perinephric hematoma. Ninety-four percent of the patients reported mild pain during lithotripsy. The majority (91%) mentioned that they were satisfied with this treatment modality for urinary lithiasis (mean visual analog scale satisfaction score 8). CONCLUSIONS: The Doli S 220 F-XP is a safe and effective device for managing calculi throughout the urinary tract.

Strategic lithotripsy using the Doli S EMSE 220 F-XP for the management of staghorn renal calculi.

AIM: The presentation of our results using the Dornier lithotripter (Doli) S electromagnetic shockwave emitter (EMSE) 220 F-XP for the strategic management of staghorn renal calculi. METHODS: Sixteen patients with renal staghorn stones of more than 35 mm in maximum length on plain X-rays were treated by shock wave lithotripsy (SWL) monotherapy with the Doli S EMSE 220 F-XP. Double-J ureteral stent was inserted to all prior to the first SWL treatment. Shock wave counts varied from 2,500 to 3,600 with a shock release frequency of 70-80 pulses per minute. The number of sessions varied from 2 to 6. The interval between the SWL sessions was around 1 month. Fragmentation rate of 20-25% of the stone load per session was considered a valid criterion for progressing to further SWL sessions. RESULTS: Nine patients became stone free at the end of SWL sessions and two patients had renal stone fragments smaller than 4 mm, which were eliminated 6 months later. Two patients developed streinstrasse that was managed with ureteroscopy. Auxiliary SWL was also performed on three patients with residual ureteral calculi. The mean follow up period was 12 months. The remaining five patients underwent open surgery for incomplete stone fragmentation. No major complications developed during the follow up period. The predominant composition of stones available for analysis was struvite. CONCLUSION: Doli S EMSE 220 F-XP can be a safe and effective treatment option for renal staghorn stones on an outpatient basis.

Detection of the TNFSF members BAFF, APRIL, TWEAK and their receptors in normal kidney and renal cell carcinomas.

In advanced renal cell carcinoma (RCC), surgery combined with systemic chemotherapy and immunotherapy have had limited effectiveness. Therapeutic modalities targeting VEGF, PDGF, and c-kit using tyrosine kinase inhibitors and m-TOR using specific biologic factors are in development. Therapeutic approaches targeting TNF-alpha have shown limited efficacy, while anti-TRAIL (TNFSF10) antibodies have shown enhanced activity. The presence and potential significance of other members of the TNFSF has not been investigated. Here, we assayed the TNFSF members APRIL, BAFF, TWEAK and their receptors (BCMA, TACI, BAFFR, Fn14) in 86 conventional type clear cell RCC, using immunohistochemistry and correlated our findings with histological data and, in a limited series, follow-up of patients. We observed a differential expression of these TNFSF ligands and receptors in cancerous and non-cancerous structures. BAFF was found in all RCC; APRIL expression is associated with an aggressive phenotype, correlating negatively with patients' disease-free survival, while TWEAK and its receptor Fn14 are heterogeneously expressed, correlating negatively with the grade and survival of RCC patients. This is the first study, presenting together the TNFSF members APRIL, BAFF, TWEAK and their receptors in different areas of normal renal tissue and RCC, suggesting a potential role of these TNFSF members in renal tumor biology.

Hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: review of the evidence and recommendations.

CONTEXT: Compared with standard white-light cystoscopy, photodynamic diagnosis with blue light and the photosensitiser hexaminolevulinate has been shown to improve the visualisation of bladder tumours, reduce residual tumour rates by at least 20%, and improve recurrence-free survival. There is currently no overall European consensus outlining specifically where hexaminolevulinate is or is not indicated. OBJECTIVE: Our aim was to define specific indications for hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and management of non-muscle-invasive bladder cancer (NMIBC). EVIDENCE ACQUISITION: A European expert panel was convened to review the evidence for hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and management of NMIBC (identified through a PubMed MESH search) and available guidelines from across Europe. On the basis of this information and drawing on the extensive clinical experience of the panel, specific indications for the technique were then identified through discussion. EVIDENCE SYNTHESIS: The panel recommends that hexaminolevulinate-guided fluorescence cystoscopy be used to aid diagnosis at initial transurethral resection following suspicion of bladder cancer and in patients with positive urine cytology but negative white-light cystoscopy for the assessment of tumour recurrences in patients not previously assessed with hexaminolevulinate, in the initial follow-up of patients with carcinoma in situ (CIS) or multifocal tumours, and as a teaching tool. The panel does not currently recommend the use of hexaminolevulinate-guided fluorescence cystoscopy in patients for whom cystectomy is indicated or for use in the outpatient setting with flexible cystoscopy. CONCLUSIONS: Evidence is available to support the use of hexaminolevulinate-guided fluorescence cystoscopy in a range of indications, as endorsed by an expert panel.

Endocervicosis of the bladder: report of a case and review of the current literature.

An important variety of metaplastic lesions of the urinary bladder have been reported in the medical literature up to date. Among those of Müllerian origin, endocervicosis is the most infrequent. We report a 67 years old woman who presented with a history of left flank pain and dysuria for the past 2 months. Imaging studies revealed a solid mass in the posterior bladder wall protruding into the lumen. Transurethral resection of the lesion was performed. Both pathologic examination and immunohistochemistry confirmed the diagnosis of endocervicosis. The patient was monitored with 6 months interval follow up and remains disease free 12 months post surgery.

Does educational printed material manage to change compliance with prostate cancer screening?

BACKGROUND/AIM: The effects of printed educational material on cancer screening in women (Pap test and mammography) are well documented and confirmed by several studies. The aim of our study was to evaluate the impact of similar printed educational material on prostate cancer screening by PSA and DRE. MATERIAL AND METHODS: Thousand five hundred men aged between 50 and 86 years of age, who attended our institutions for various medical conditions except prostate-related conditions, were randomly assigned to two study groups. Men in the informed group, received an educational leaflet with simple, general information on prostate cancer screening methods given by their physician along with treatment and other regular recommendations, while men in the non-informed group, were only informed by their physician in the examination room during an interview. RESULTS: After 24 months, there was no statistically significant difference between the two groups in terms of DRE screening. The percentages of men who were actually screened by DRE were 4 and 5% in the informed and non-informed groups, respectively, while the difference in the percentages of PSA screening was of statistical significance, with 31% of men screened in the non-informed group as compared to 93% of men screened in the informational leaflet group. CONCLUSIONS: A single, one-shift distribution of printed educational material on prostate cancer screening, changed their attitude regarding prostate cancer screening only in favour of PSA testing, while did not manage to change the DRE acceptance behavior. However, since the combination of the two tests is more sensitive for diagnosis than either one alone, there is a need of introducing intervention strategies, in the efforts of ameliorating the prostate cancer screening behavior.

Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience

PURPOSE: To compare the efficacy and safety of the electromagnetic lithotripter in the treatment of pediatric lithiasis to that of the earlier electrohydraulic model. MATERIALS AND METHODS: Two groups of children with lithiasis aged between 10 and 180 months who underwent extracorporeal shock wave lithotripsy (ESWL). In the first group (26 children), ESWL was performed by using the electrohydraulic MPL 9000X Dornier lithotripter between 1994 and 2003 while in the second group (19 children) the electromagnetic EMSE 220 F-XP Dornier lithotripter was used from April 2003 to May 2006. RESULTS: In the first group, 21/26 children (80.7 percent) were stone free at first ESWL session. Colic pain resolved by administration of an oral analgesic in 6 (23 percent), brief hematuria (< 24 h) resolved with increased fluid intake in 5 (19.2 percent), while slightly elevated body temperature (< 38°C) occurred in 4 (15.3 percent). Four children (15.3 percent) failed to respond to treatment and were treated with ureteroscopy. In the second group 18/19 children were completely stone free at first ESWL session (94.7 percent). Complications were infrequent and of minor importance: colic pain treated with oral analgesic occurred in 1 (5.26 percent), brief hematuria (< 24 h), resolved with increased fluid intake in 4 (21 percent) and slightly elevated body temperature (< 38°C) monitored for 48 hours occurred in 6 (31.5 percent). Statistical analysis showed that electromagnetic lithotripter is more efficacious and safer than the earlier electrohydraulic model. CONCLUSIONS: Technological development not only has increased efficacy and safety of lithotripter devices in treating pediatric lithiasis, but it also provided less painful lithotripsy by eliminating the need for general anesthesia.