Neutrophil-to-lymphocyte ratio as a predictor of overall survival and cancer advancement in patients undergoing radical cystectomy for bladder cancer.

Introduction: Neutrophil-to-lymphocyte ratio (NLR) has proven to be promising as a prognostic factor in many malignancies. We investigated the prognostic significance of NLR in patients undergoing radical cystectomy (RC) for bladder cancer (BC). Material and methods: We retrospectively evaluated the data of 134 consecutive patients with BC who underwent RC between 2011 and 2017 at a single center. Overall survival (OS) was assessed using the Kaplan-Meier method and compared between NLR subpopulations using the log-rank test. Univariate and multivariate Cox proportional hazard models were used to identify the variables affecting OS. Results: At a median follow-up of 2.2 years, high NLR (>2.7) correlated with worse a survival outcome (p = 0.0345 in log-rank test), higher tumor stage (p = 0.0047), and higher frequency of positive lymph nodes (p = 0.0285). The univariate model showed that a high NLR (p = 0.038528), advanced pathological tumor stage (p = 0.000763), lymph node involvement (p = 0.013384), a high grade of cancer (p = 0.015611), lymphovascular invasion (LVI) (p = 0.001530), positive margins (p = 0.000890) and ureterocutaneostomy as urinary diversion (p = 0.038854) had a negative impact on OS. Tumor extending beyond the submucosa (>pT1) (hazard ratio 2.161, confidence interval 1058-4411, p = 0.0345) and lymphatic infiltration (hazard ratio 1.599, confidence interval 1028-2482, p = 0.037) have been recognized as independent risk factors of poor prognosis in multivariate Cox regression analysis. Conclusions: In our cohort, an elevated NLR is associated with worse OS and adverse histopathological findings. Consequently, the NLR is an easily acquired biomarker, which may be useful in pretreatment patient risk stratification.

Extraperitoneal Laparoscopic Prostatectomy in a Prostate Cancer Patient Undergoing Continuous Ambulatory Peritoneal Dialysis.

Radical prostatectomy (RP) in patients on continuous ambulatory peritoneal dialysis (CAPD) is a challenging procedure. The following key points need to be considered: the peritoneal cavity integrity, adjustment of the trocar positions to the peritoneal dialysis (PD) tube location, and the oncological and functional outcomes. We present a clinical case of a patient on CAPD, incidentally diagnosed with prostate cancer (PCa) during the pre-transplant evaluation. The patient suffered from LUTS, due to bladder outlet obstruction (BOO). A transurethral bladder neck incision (TUNI), with median lobe resection, was performed. A PCa Gleason score of six (3 + 3) was found in the histopathological specimen. The primary procedure was complicated by bladder neck sclerosis and acute urinary retention (AUR), resolved by suprapubic cystostomy. After proper staging determination, the patient was qualified for laparoscopic extraperitoneal RP. The standard trocar placement was modified to align with the route of the PD tube, and Retzius' space scarring was released to allow extraperitoneal prostatectomy. There were no signs of peritoneal wall damage or dialysis tube displacement. Peritoneal dialysis was resumed after 4 weeks. Laparoscopic extraperitoneal RP should be considered as an acceptable treatment method for selected patients with localized prostate cancer, allowing CAPD resumption. To the best of our knowledge, this is the first report of retroperitoneal laparoscopic RP being used in the PD population.

Urinary Incontinence in Adulthood in a Course of Ectopic Ureter-Description of Two Clinical Cases with Review of Literature.

Urinary tract pathologies are the most common congenital abnormalities. Duplex colleting system occurs at different stages of completion and is usually asymptomatic. Ureteral ectopia is an associated anomaly which may manifest as continuous incontinence. The aim of this article is to present two patients with duplex kidney and ureteral ectopia. Both patients presented symptoms of continuous urinary incontinence and became symptomatic in the adult life.

Infiltrating Treg and Th17 Cells of the Prostate Hypertrophy Gland Associated with Propionibacterium Acnes Infection.

PURPOSE: The aim of the study was to evaluate prostate cell infiltration by CD4(+)IL-17(+) and Treg cells in BPH and PCa patients depending on P. acnes infection in the prostate gland. PATIENTS AND METHODS: Prostate fragments were collected from 54 patients with PCa and 34 patients with BPH. Rapid ID 32 was used to identify the bacteria. Cells were analyzed by flow cytometry BD FACSCanto II. Statistical analysis was performed using Statistica 7 software (TIBCO Software Inc, USA). RESULTS: P. acnes was detected in 35% of patients with PCa and 41% of individuals with BPH. The infiltration of CD4(+)IL-17(+) and Treg cells was statistically significantly higher (P = 0.001) in patients with BPH and positive for P. acnes. A statistically considerably higher (P = 0.001) infiltration of Treg cells in treated for PCa with P.acnes infection was also demonstrated. CONCLUSION: Prostatitis caused by P. acnes may contribute to the development of BPH and PCa.

Preoperative Neutrophil-lymphocyte Ratio as a Predictor of Overall Survival in Patients with Localized Renal Cell Carcinoma.

PURPOSE: The neutrophil-to-lymphocyte ratio (NLR), as an indicator of the systemic inflammatory response, predicts adverse outcomes in many malignancies. We investigated its prognostic significance in patients with non-metastatic renal cell carcinoma. MATERIALS AND METHODS: We retrospectively evaluated data of 196 consecutive non-metastatic RCC patients who underwent radical or partial nephrectomy between 2010 and 2012 at a single center. Overall survival (OS) was assessed using the Kaplan-Meier method and compared using the log-rank test. We applied univariate and multivariate Cox regression models to evaluate the prognostic value of dichotomized NLR for OS.   Results: At a median follow up of 68 months, high NLR (? 2,69) correlated with worse survival outcome (P = .006 in log-rank test) and higher tumor stage (P = .035). Univariate and multivariate analysis identified elevated NLR (P = .039), as well as age (P = .002), high Fuhrmann grade (P = .002) and high pathologic T stage (P < .001), as significantly associated with overall survival. CONCLUSION: In our cohort, an elevated neutrophil-to-lymphocyte ratio is significantly associated with worse OS on univariate and multivariate analysis. Consequently, the NLR is an easily acquired biomarker, which may be useful in pretreatment patient risk stratification.

Percutaneous nephrostomy for symptomatic hypermobile kidney: a single centre experience.

INTRODUCTION: Symptomatic hypermobile kidney is treated with nephropexy, a surgical procedure through which the floating kidney is fixed to the retroperitoneum. Although both open and endoscopic procedures have a high success rate, they can be associated with risk of complications, relatively long hospital stay and high cost. AIM: We describe our percutaneous technique for fixing a hypermobile kidney and evaluate the efficacy of the percutaneous nephrostomy insertion in management of symptomatic nephroptosis. MATERIAL AND METHODS: Between January 2005 and December 2011, 11 patients diagnosed with a symptomatic right nephroptosis of at least 1 year duration were treated with a single point percutaneous nephrostomy technique. All data were retrieved from patients' medical records and then retrospectively analysed. RESULTS: Nephropexy through a single point percutaneous nephrostomy technique was successfully accomplished in 11 women. The mean operative time was 20 min. The intraoperative estimated blood loss was minimal in all cases. No major or minor intraoperative complications were noted. The average postoperative hospital stay was 2 days. Women returned to their usual activities 14 days following the surgery. Nine women had complete resolution of their pain, and 2 patients continued to complain of discomfort in their lumbar area. One patient was re-operated upon with satisfactory subjective and objective outcomes achieved. One patient refused re-operation. CONCLUSIONS: Percutaneous nephropexy is simple, inexpensive and effective for treatment of symptomatic hypermobile kidney. It remains a valuable alternative to open, laparoscopic, and robotic methods for fixing a floating kidney.

An uncommon case of inflammatory infiltration of the urinary bladder in the long-term process of the purulent inflammation of the cervix and vaginal fornix, complicated with vesicovaginal fistula of unknown etiology.

We shall discuss the case of a female patient, aged 64 years, who was suffering from long-term purulent inflammation of the vaginal fornix that later involved the vaginal stump. This inflammatory process spread to the bladder trigone and resulted in vesicovaginal fistula (VVF) formation together with a bilateral hydronephrosis that required the placement of a temporary percutaneous nephrostomy. A non-cicatrized inflammatory reaction occurred at the right-sided insertion of the nephrostomy, which has yet to be successfully treated despite intensive dermatological and surgical approaches that included skin grafting. In the course of five-year treatment we observed a gradual regression of the inflammatory infiltration of both the trigone of the bladder and the vagina as well as a gradual closing of the VVF. The extremely long-lasting and uncommon local inflammatory reactions in the vagina, bladder, and dermal layers mandated the application of conservative treatment. The possibility of difficulties and defective healing of tissues that could result from surgical correction of the VVF are discouraging for both the patient and medical staff.

Partial cystectomy in a 76 year old patient suffering from small cell carcinoma of the urinary bladder.

Small cell carcinomas of the urinary bladder originating from the neuroendocrine cells are extremely rare. We present a case of a 76-year-old patient with small cell carcinoma of the urinary bladder. The patient had hematuria and cystoscopy revealed a tumor located in a urinary bladder diverticulum. Partial resection of the bladder wall with diverticulectomy was performed. Microscopic examination established the diagnosis of neuroendocrine carcinoma, which was confirmed by immunohistochemistry. Three-month follow-up showed no recurrent disease. Patient refused further chemotherapy and radiotherapy.

[Treatment of first incidences of urolithiasis in children]. / Leczenie pierwszych epizodów kamicy ukladu moczowego u dzieci w materiale wlasnym.

Unlike adults urolithiasis in children is a rare disease. For this reason medical treatment in this age group is still a serious therapeutic challenge. The aim of the study was to analyze the results of the applied treatment in the first incidences of urinary stones disease. A group of 143 patients aged 1.5 to 17 years was enrolled in this study. Spontaneous stone passage was obtained in case of 65 patients, which amounts to 63% of patients, who received conservative treatment. 17% were qualified to the ESWL treatment, 5.6% underwent the URS procedure, and in 2.8% of patients open surgery was performed. In 29% of cases stones were left for further observation. Conservative therapy was effective in the majority of children with small urinary stones. Preferred treatment in remaining patients were minimally invasive urological procedures.

Effect of topiramate on mechanical allodynia in neuropathic pain model in rats.

Topiramate, unlike gabapentin, lamotrigine and tiagabine, resembles phenytoin and carbamazepine since it had been used as an antinociceptive drug in empirical treatment of neuropathic pain in humans, before its systemic and planned research was conducted in animal models of pain. Chronic administration of topiramate, at the dose of 50 mg/kg/day, significantly diminished the mechanical sensitivity and shortened the period of allodynia in the Seltzer mononeuropathy model in rats.