[Could robotic surgery really be a revolutionary change in the treatment of kidney cancer in Hungary?] / Valóban forradalmi változást jelenthet a robotsebészet a veserákok kezelésében Magyarországon?

Robotic-assisted partial nephrectomy (RAPN) was first described in 2004 and, since its introduction in clinical practice, has progressively gained increasing popularity. Over the years, the indications have also expanded, enabling robot-assisted surgical removal of complex kidney tumors. Important considerations for clinicians when choosing a minimally invasive technique are complete resection of the tumor, maximum protection of kidney function, and avoidance of complications. The first Da Vinci robotic surgery system was installed in Hungary at the Jahn Ferenc Dél- Pest Hospital and the National Institute of Oncology. The first robotic surgery took place at the National Institute of Oncology, and then at the Jahn Ferenc Dél-Pest hospital. In addition to open surgeries, only the laparoscopic procedure was available to perform kidney tumor surgeries in Hungary. The short one-year robotic surgery experience in our country supports the results of the international literature. Due to the introduction of robotics, a higher level of precision and freedom of movement creates new opportunities compared to open or laparoscopic kidney tumor surgeries.

[Modern surgical treatment of urothelial tumors]. / Uroteliális daganatok modern sebészi kezelése.

Urothelial cell tumors are the most common malignant urinary tract lesions, affecting the bladder in the majority of cases, however, 5% of the tumors occur in the upper urinary tract (urethra, renal pelvis). About 2,000 new diseases occur in Hungary every year and due to this tumor, almost 1,000 deaths occur in every year. The purpose of this paper is to summarize the results of radical surgery indicated in patients with non-invasive and muscle-invasive urothelial cancer, as well as its international recommendations. Based on the AUA and EAU guidelines, the latest and standard treatment options are described. Transurethral resection (TUR) is still a gold standard in the initial diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC). The indication for radical cystectomy in addition to muscle invasive tumors (T2-T4a, N0-Nx, M0) is BCG resistant in T1G3 (evidence level: 3, recommendation level: B). Risk stratification is of paramount importance for the future treatment and follow-up of patients with bladder urothelial cell tumors. Although the proportions of changes in surgical care lag behind the novelties of urooncological treatments, advances in surgical technique, urinary tract reconstruction, and multimodal therapy may continue to improve the prognosis and quality of life of patients with bladder urothelial cell tumors. Tenke P, Fábián N, Németh Z. Modern surgical treatment of urothelial tumors.

Cost of illness of medically treated benign prostatic hyperplasia in Hungary.

OBJECTIVE: To perform a cost of illness study in lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH) in Hungary. METHODS: A multicentre, cross-sectional survey was carried out in 2014. BPH patients who had never undergone prostate surgery were recruited to the study. EQ-5D and the International Prostate Symptom Score (IPSS) were used to evaluate health status and disease severity. All resource utilisations related to BPH in the past 12 months were recorded. Cost analysis was performed from societal perspective. RESULTS: Overall, 246 patients were included with mean age of 70.6 (SD 8.1) years. Mean EQ-5D and IPSS were 0.85 (SD 0.19) and 12.8 (SD 6.3). Total annual per patient cost of BPH amounted to 876 (SD 1829). Distribution of the costs between direct medical, direct non-medical and indirect cost was 46, 31 and 23 %. High costs were related to informal care (243), medications (178) and private physician visits (132). Patients missed from work on average 14 h/year and 20 h/year due to absenteeism and presenteeism. Clinical severity expressed in IPSS score was found the strongest predictor of higher total costs (r = 0.429, p < 0.001). Mean costs of mild, moderate and severe patients were 203, 754 and 2168, respectively. CONCLUSIONS: To our knowledge, this is the first study in the literature that assessed indirect costs related to presenteeism in BPH. We found that costs of reduced productivity while working exceed costs of absence from work. As the retirement age is gradually increasing, the importance of presenteeism is getting more significant, especially in pursuit of sustainable employment.

LPS-induced delayed preconditioning is mediated by Hsp90 and involves the heat shock response in mouse kidney.

INTRODUCTION: We and others demonstrated previously that preconditioning with endotoxin (LPS) protected from a subsequent lethal LPS challenge or from renal ischemia-reperfusion injury (IRI). LPS is effective in evoking the heat shock response, an ancient and essential cellular defense mechanism, which plays a role in resistance to, and recovery from diseases. Here, by using the pharmacological Hsp90 inhibitor novobiocin (NB), we investigated the role of Hsp90 and the heat shock response in LPS-induced delayed renal preconditioning. METHODS: Male C57BL/6 mice were treated with preconditioning (P: 2 mg/kg, i.p.) and subsequent lethal (L: 10 mg/kg, i.p.) doses of LPS alone or in combination with NB (100 mg/kg, i.p.). Controls received saline (C) or NB. RESULTS: Preconditioning LPS conferred protection from a subsequent lethal LPS treatment. Importantly, the protective effect of LPS preconditioning was completely abolished by a concomitant treatment with NB. LPS induced a marked heat shock protein increase as demonstrated by Western blots of Hsp70 and Hsp90. NB alone also stimulated Hsp70 and Hsp90 mRNA but not protein expression. However, Hsp70 and Hsp90 protein induction in LPS-treated mice was abolished by a concomitant NB treatment, demonstrating a NB-induced impairment of the heat shock response to LPS preconditioning. CONCLUSION: LPS-induced heat shock protein induction and tolerance to a subsequent lethal LPS treatment was prevented by the Hsp90 inhibitor, novobiocin. Our findings demonstrate a critical role of Hsp90 in LPS signaling, and a potential involvement of the heat shock response in LPS-induced preconditioning.

The Rowett rat strain is resistant to renal fibrosis.

BACKGROUND: Genetic susceptibility to renal fibrosis may determine the individual rate of progression to renal failure. We aimed to study the progression in Rowett (RO) rats, a strain we found resistant to subtotal nephrectomy (SNX), comparing to Sprague-Dawley (SD) rats, a strain with established sensitivity in a radical ablation/infarction and diet-induced SNX model. METHODS: Eight-week-old male RO (RO-SNX) and SD (SD-SNX, n = 5/group) rats underwent SNX and were kept on high protein and salt diet. Kidney function was monitored and the kidneys were evaluated by histology and immunohistochemistry 5 weeks after SNX. RESULTS: RO-SNX rats had only mild proteinuria and less glomerulosclerosis, accompanied by less fibronectin and TGF-beta staining as compared to SD-SNX rats. Glomerular nitrotyrosine staining was less intense in RO-SNX vs SD-SNX, accompanied by less podocyte damage as demonstrated by desmin staining. CONCLUSION: Our results demonstrate the importance of podocyte damage in glomerulosclerosis and that Rowett rats are protected from renal fibrosis. To our knowledge, this is the first strain of rats with unknown genetic resistance, which makes the strain attractive for studying the genetic background of renal fibrosis.

Increased renoprotection with ACE inhibitor plus aldosterone antagonist as compared to monotherapies--the effect on podocytes.

BACKGROUND: Blockade of the renin-angiotensin-aldosterone system (RAAS) does not completely prevent progression of renal disease. Mineralocorticoid receptor blockade provides additional renoprotection over ACE-inhibition monotherapy. We examined the mechanisms underlying superior renoprotection in the subtotal nephrectomy (SNX) model. METHODS: Sprague-Dawley rats were randomized into six groups: (1) sham-op, (2) SNX without treatment, (3) SNX + quinapril (Q), (4) SNX + spironolactone (S), (5) SNX + combination therapy (Q+S), (6) SNX + combination hydrochlorothiazide + reserpin + hydralazine (HRH). Albuminuria and blood pressure were monitored, and kidneys were examined by morphometric and molecular methods. RESULTS: In SNX rats, albumin excretion was significantly higher than in sham-op rats. Blood pressure reduction was not significantly different between the treatment groups. All therapies (S, Q, Q+S and HRH) reduced albuminuria; the values were lowest in animals treated with Q+S. The volume density of glomerular matrix and the number of mesangial cells were significantly increased in SNX and were lowest in SNX treated with Q+S. The number of podocytes was reduced in SNX, but was normalized in SNX treated with Q+S. Glomerular volumes and podocyte volumes were significantly higher in SNX than in sham-op. Both volumes were reduced by all interventions, but almost normalized by treatment with Q+S. Expression of collagen IV, TGF-beta(1) and desmin was increased after SNX and significantly reduced by treatment with Q and Q+S. CONCLUSIONS: In subtotally nephrectomized rats, mineralocorticoid blockade provided additional renoprotection over and above ACE inhibition. Such benefit was paralleled by major changes in podocyte number and morphology and was not blood pressure dependent.