Cell and region specificity of Aryl hydrocarbon Receptor (AhR) system in the testis and the epididymis.

Aryl hydrocarbon receptor (AhR) plays multiple important functions in adaptive responses. Exposure to AhR ligands may produce an altered metabolic activity controlled by the AhR pathways, and consequently affect drug/toxin responses, hormonal status and cellular homeostasis. This research revealed species-, cell- and region-specific pattern of the AhR system expression in the rat and human testis and epididymis, complementing the existing knowledge, especially within the epididymal segments. The study showed that AhR level in the rat and human epididymis is higher than in the testis. The downregulation of AhR expression after TCDD treatment was revealed in the spermatogenic cells at different stages and the epididymal epithelial cells, but not in the Sertoli and Leydig cells. Hence, this basic research provides information about the AhR function in the testis and epididymis, which may provide an insight into deleterious effects of drugs, hormones and environmental pollutants on male fertility.

Prostate Specific Antigen-Positive Deceased Organ Donor: A Pathologist Is Indispensable.

BACKGROUND: Due to demographic projections, and lack of an algorithm in the case of a prostate specific antigen (PSA)-positive donor, the loss of organ recovery may occur more frequently in the near future without approved procedures. In Poland in recent years it has been recommended to determine tumor markers in potential donors. In the first year of the recommendation 10% of potential deceased donors were disqualified in our transplantation center on the basis of the elevated PSA levels (high PSA >10 ng/mL). Histopathologic evaluation of prostate was implemented in a donor qualification procedure to prevent reduction of the actual organ donor pool. MATERIAL AND METHODS: In the period of January 2010-January 2014 each donor reported to a coordination center (n = 52; median age, 54 years) and underwent the routine histological evaluation of the whole prostate, regardless of the PSA level. RESULTS: Pathologist revealed in the study group of 52 male donors, 6 cases of carcinoma of the prostate (CaP; 12%). There was no correlation between PSA level and CaP (-)/CaP(+) (median 7.0 vs 3.9 ng/mL, respectively; P = .51) nor high-grade prostate intraepithelial neoplasia (HGPIN) (+)/HGPIN (-) (median 5.9 vs 4.3 ng/mL; P = .14). All of the recovered organs (12 kidneys and 3 livers) from donors with CaP were transplanted, resulting in a 15% increase in the organ donor pool. CONCLUSIONS: There is no association between PSA values and CaP occurrence in deceased organ donors. Histological verification allowed for an increase in the organ pool with maintenance of safety standards.

Low cost silicone renal replicas for surgical training - technical note.

OBJECTIVE: The aim of this brief report was to present and evaluate workflow of preparation of lowcost individual silicone replicas of kidneys for laparoscopic training and surgical simulation of difficult nephron sparing surgeries. METHODS: The work flow consists of four steps: 1.Image segmentation; 2.Casting mould designing; 3.Manufacturing of casting mould; 4.Silicone replica casting. To evaluate the cost and time required to execute the presented method, authors prepared 5 silicone models for 5 consecutive patients undergoing laparoscopic kidney tumorectomy due to renal cell cancer. RESULTS: Average times of image segmentation, casting mould design, casting mould printing and pouring of silicon replicas were 94 min, 22 min, 14 h and 30 min, respectively. Average costs of casting mould printing and casting of silicon replica were 14.4$ and 7.4$ respectively. CONCLUSION: The presented technique is simple to perform and beyond basic 3D printer it does not require any other expensive equipment. The final silicone model reproduces shape and elasticity of the living organ and has similar mechanical strength. These properties of silicone replica in combination with the presented technique can be used to prepare other artificial organs, ready for a simulation of treatment.

A personalised approach to prostate cancer screening based on genotyping of risk founder alleles.

BACKGROUND: To evaluate whether genotyping for 18 prostate cancer founder variants is helpful in identifying high-risk individuals and for determining optimal screening regimens. METHODS: A serum PSA level was measured and a digital rectal examination (DRE) was performed on 2907 unaffected men aged 40-90. Three hundred and twenty-three men with an elevated PSA (≥4 ng ml⁻¹) or an abnormal DRE underwent a prostate biopsy. All men were genotyped for three founder alleles in BRCA1 (5382insC, 4153delA and C61G), for four alleles in CHEK2 (1100delC, IVS2+1G>A, del5395 and I157T), for one allele in NBS1 (657del5), for one allele in HOXB13 (G84E), and for nine low-risk single-nucleotide polymorphisms (SNPs). RESULTS: On the basis of an elevated PSA or an abnormal DRE, prostate cancer was diagnosed in 135 of 2907 men (4.6%). In men with a CHEK2 missense mutation I157T, the cancer detection rate among men with an elevated PSA or an abnormal DRE was much higher (10.2%, P=0.0008). The cancer detection rate rose with the number of SNP risk genotypes observed from 1.2% for men with no variant to 8.6% for men who carried six or more variants (P=0.04). No single variant was helpful on its own in predicting the presence of prostate cancer, however, the combination of all rare mutations and SNPs improved predictive power (area under the curve=0.59; P=0.03). CONCLUSION: These results suggest that testing for germline CHEK2 mutations improves the ability to predict the presence of prostate cancer in screened men, however, the clinical utility of incorporating DNA variants in the screening process is marginal.

Microangiographic imaging of the prostate.

OBJECTIVE: To present the results of microangiography in visualizing prostatic microvascularization. MATERIALS AND METHODS: A contrast medium was injected into the vessels of prostate specimens obtained during surgery, to fill small vessels; nine specimens were obtained after cystoprostatectomy and two after radical prostatectomy. Branches of prostatic or seminal vesicle arteries were used for the injection, the specimens then fixed in formalin, sectioned and X-rayed. RESULTS: In five samples the quality of the images was sufficient to visualize small arteries; the remaining vessels were partially filled. The vascular map was compared with previous results from historadiographic studies. CONCLUSIONS: Microangiographic imaging of prostate specimens provides a unique view of the angioarchitecture of the prostate and correlates closely with historadiographic studies. The correlation with other imaging methods, e.g. Doppler ultrasonography, needs further evaluation.

Giant neobladder calculus.

An unusual case of a calculus in the ileal neobladder is presented. The size of the stone is exceptional in the urologic literature (940 g). Neocystolithotomy was performed, with full patient recovery.

[Results of radical cystectomy for management of invasive bladder cancer with special reference to prognostic factors and quality of life depending on the type of urinary diversion]. / Wyniki radykalnej cystektomii w leczeniu naciekajacego raka pecherza moczowego ze szczególnym uwzglednieniem czynników prognostycznych i wplywu zastosowanego rodzaju odprowadzenia moczu na jakosc zycia.

Bladder cancer is one of the main problems in urology in terms of diagnosis and treatment, due to its high incidence, high recurrence rate, and difficulties in prognosis of its natural history. According to Polish epidemiological reports, bladder cancer was the fifth cause of death due to malignant diseases in 1993 (1.2% in females and 4.0% in males). Radical cystectomy remained for over forty years the main method of treatment in cases of invasive bladder cancer. Improvements in postoperative care, surgical techniques and methods of urine diversion made cystectomy a widely performed, low mortality procedure. The analysis of prognostic factors with their influence on survival is helpful in patient qualification and prognosis of long-term outcome. The objective was to study retrospectively the results of radical cystectomy in cases of invasive bladder cancer with an emphasis on negative prognostic factors affecting survival. An evaluation of the quality of life (QL) depending on urine diversion method was performed. The material consisted of 95 patients (77 males and 8 females, mean age 59.6) who underwent cystectomy at the Department of Urology, Pomeranian Academy of Medicine, between 1989 and 1998. In 46 cases (48.4%) the Bricker's ileal conduit was performed. Ileal neobladders were created in 24 cases (25.2%) and in 25 patients (26.3%) other types of urine diversion were used. Among 37 survivals (38.6%) 20 patients were evaluated by means of physical examination, abdominal ultrasonography, laboratory parameters, blood gas analysis, urine culture, and QL questionnaires. Median follow-up time was 17.4 months. Survival curves were calculated according to the Kaplan-Meier's method. Statistical significance was established using Cox and Cox-Mantel tests. Histopathologic examination revealed transitional cell carcinoma in 97.8% of the bladders. Basing on the pathologic stage, patients were assigned to 2 groups: organ confined disease (pT2-3a, 41.3%) and perivesical or adjacent organ involvement (pT3b-4, 58.7%). The tumor was graded G1, G2 and G3 in 3.4%, 22.5%, and 74.1%, respectively. Pelvic lymph node involvement was histologically confirmed in 31 patients (35.2%). Different forms of adjuvant or neoadjuvant therapy, e.g. radiotherapy, systemic chemotherapy, intra-arterial chemotherapy, electrochemotherapy were used in 28 patients. In the postoperative period 7.3% of patients died. The negative factors with significant prognostic value were identified as non organ-confined tumors pT3b-T4 (p = 0.00002), lymph node involvement pN+ (p = 0.0001), and high grade tumors G3 (p = 0.01). All these parameters were responsible for the high death rate during 500 days postoperatively. The patient's age or preoperative hydronephrosis did not influence the overall survival. The 5-year survival for organ confined and remaining tumors was 44.1% and 11.6%, respectively (Tab. 1). Overall 5-year survival rate was 22%. The highest mortality and the highest risk of cancer-related death occurred during the first year from operation (Fig. 1 and 2). QL was evaluated basing on a specific questionnaire completed by 20 patients. The quality of life was similar in all groups of urine diversion (ileal conduit, neobladder, simple diversion), but some differences concerning general health status were revealed. Patients with Bricker's ileal conduit rated their present health status worse than the other groups. Patients with continent urinary diversion presented the best emotional status and lowest rate of disturbances in self care, professional, social and leisure activities. Surprisingly, high QL in patients with simple urine diversion (ureterocutaneostomy or nephrostomy) suggests a good adaptation to the so created difficult situation. Radical cystectomy is the best method of treatment in invasive bladder cancer, although it offers a poor chance of curing the patient. Eventually, only one-fifth of the patients survive 5 years. Half of the deaths occur during the first year from surgery. The best candidates for radical cystectomy are patients with low or medium grade organ confined tumors. In other cases this is just a palliative procedure, thereby justifying the selection of simple methods of urine diversion.

[Recording of nocturnal penile tumescence using the Rigiscan device]. / Pomiar nocnych wzwodów czlonka przy uzyciu aparatu Rigiscan.

Nocturnal spontaneous erections occur in healthy men being strictly correlated with paradoxal sleep phases with rapid eye movements (REM). There are simple methods of NPT recording like stamps test or erectiometers. Rigiscan-Plus device has 2 tensiometric loops and records all changes in tumescence and rigidity also as a response to visual or pharmacological stimulation. In this paper Rigiscan is presented and the role of rigidometry as an additional method in diagnostic of impotence is stressed.