The role of endoscopic bladder tumour assessment in the management of patients subjected to transurethral bladder tumour resection.

Despite complete resection, non-muscle invasive bladder cancers tend to recur. Therefore, their risk stratification was implemented to select adjuvant therapy. Immediate intravesical chemotherapeutic instillations were shown to decrease the risk of recurrence in those with low-risk disease. The purpose of the study was to determine the role of endoscopic assessment in the management of patients subjected to transurethral resection of the bladder tumour (TURBT). In 262 patients submitted to TURBT due to primary bladder tumour, the size and the number of the lesion(s) were noted and the stage as well as the grade of the tumour(s) were typed. The individual features were then scored according to the European Organisation of Research and Treatment of Cancer 'Bladder Calculator' and the lesions were classified into the low, intermediate and high risk of recurrence group. Clinical evaluation was then compared with pathological report and final triage. Based on the clinical data, 95 (36.25%), 105 (40.07%) and 3 (1.14%) patients were endoscopically assigned to the groups of low, intermediate and high risk of recurrence respectively. After pathological report, correct risk stratification was confirmed in 86 (90.5%), 95 (90.5%) and 3 (100%) patients respectively. Endoscopic assessment of bladder cancers allows to accurately establish the risk of recurrence and may facilitate implementation of adjuvant therapy before histological evaluation.

DNA methylation status is more reliable than gene expression at detecting cancer in prostate biopsy.

BACKGROUND: We analysed critically the potential usefulness of RNA- and DNA-based biomarkers in supporting conventional histological diagnostic tests for prostate carcinoma (PCa) detection. METHODS: Microarray profiling of gene expression and DNA methylation was performed on 16 benign prostatic hyperplasia (BPH) and 32 cancerous and non-cancerous prostate samples extracted by radical prostatectomy. The predictive value of the selected biomarkers was validated by qPCR-based methods using tissue samples extracted from the 58 prostates and, separately, using 227 prostate core biopsies. RESULTS: HOXC6, AMACR and PCA3 expression showed the best discrimination between PCa and BPH. All three genes were previously reported as the most promising mRNA-based markers for distinguishing cancerous lesions from benign prostate lesions; however, none were sufficiently sensitive and specific to meet the criteria for a PCa diagnostic biomarker. By contrast, DNA methylation levels of the APC, TACC2, RARB, DGKZ and HES5 promoter regions achieved high discriminating sensitivity and specificity, with area under the curve (AUCs) reaching 0.95-1.0. Only a small overlap was detected between the DNA methylation levels of PCa-positive and PCa-negative needle biopsies, with AUCs ranging between 0.854 and 0.899. CONCLUSIONS: DNA methylation-based biomarkers reflect the prostate malignancy and might be useful in supporting clinical decisions for suspected PCa following an initial negative prostate biopsy.

Vacuum removal of the template in MCM-41 silica studied by the positron annihilation method.

Positron annihilation lifetime spectra were measured for ordered silica before template (octadecyltrimethyl ammonium) removal. An intermediate lifetime component, well pronounced in the spectra, indicates the presence of structural defects in the template being the size of a surfactant molecule. At the temperature near 420 K a radical change of template structure occurs, consisting in appearance of disorder and the degradation of template; evaporation of the fragments begins. It seems that moderate heating (up to about 500 K only) in vacuum for several hours is an effective and simple method of template removal, leaving no pure carbon residue in the pore structure. The results are compared with the data from the liquid nitrogen adsorption/desorption method and elemental analysis, confirming the positron annihilation results.

The DIRC1 gene at chromosome 2q33 spans a familial RCC-associated t(2;3)(q33;q21) chromosome translocation.

A reciprocal, balanced, constitutional chromosome translocation, t(2;3)(q33;q21), which is associated with familial clear cell renal cancer, has been described and the genomic regions surrounding the 2q and 3q breakpoints have been characterized. Based on the genomic map of the 2q break, EST AI468595 was positioned near the 2q33 translocation and the full-length gene and cDNA were isolated. This 57-kb gene, designated the DIRC1 gene, was disrupted between exons 1 and 2 by the familial translocation. The 1.5-kb mRNA encodes an 11-kDa predicted protein of 104 amino acids. Low-level expression of DIRC1 was detected by reverse transcriptase-polymerase chain reaction amplification in adult placenta, testis, ovary, and prostate and in fetal kidney, spleen, and skeletal muscle. A GFP-Dirc1 fusion protein was expressed in vitro and a polyclonal anti-Dircl peptide serum was prepared. A panel of cancer and cancer-derived cell line DNAs was examined for DIRC1 mutations, but only a rare polymorphism was observed. Two familial tumors showed loss of the derivative 3 chromosome, as observed in a Dutch kindred with t(2;3)associated renal cancers. Mutations in the second DIRC1 allele were not detected. Further studies will be required to determine if disruption of the DIRC1 gene contributed to development of the associated familial clear cell renal cancers.

[The future of urology in Europe: a perspective from the European Urology Association]. / El futuro de la urología en Europa: una perspectiva desde la Asociación Europea de Urología.

INTRODUCTION: In order to be able to influence and monitor future developments for urologists, strategies should be promoted in advance to guarantee the future of the speciality and to accommodate the inevitable changes. Faced with this challenge, the EAU, through its Strategy Planning Office (SPO), has prepared a document which is offered, here, in abbreviated form, to the European and international urological communities for general consideration. MATERIAL AND METHODS: A group of subjects, related to the domains and internal consistency of urology as a speciality, were selected and discussed among the members of the SPO and later submitted to open consultation among distinguished members of the urological community. The topics selected for discussion included: what is urology; urology in the university; sub-specialization in urology; training in urology; does kidney transplantation belong to urology, and others. RESULTS: It is shown that urology is going through an exciting and hazardous transition period. Urology has conflicting problems in its traditional domains due to changes in health care policy, and internal identification problems due to its permanent expansion and sub-specialization options. Weaker points are its relation with primary care medicine (shared care options), the presence and role of urology in institutions such as the university, department of surgery, children's hospitals, administration, etc.; the desegregating effect of the sub-specialities; the increasing encroachment of other specialities, and the increasing outpatient effect of technological progress. CONCLUSIONS: An action plan is proposed to confront these changes without losing manpower, internal consistency or social image and improving patient care quality, excellence of training and scientific progress.

The future of urology in Europe: an overview from the European association of urology.

INTRODUCTION: In order to be able to influence and monitor future developments for urologists, strategies should be promoted in advance to guarantee the future of the speciality and to accommodate the inevitable changes. Faced with this challenge, the EAU, through its Strategy Planning Office (SPO), has prepared a document which is offered, here, in abbreviated form, to the European and international urological communities for general consideration. MATERIAL AND METHODS: A group of subjects, related to the domains and internal consistency of urology as a speciality, were selected and discussed among the members of the SPO and later submitted to open consultation among distinguished members of the urological community. The topics selected for discussion included: what is urology; urology in the university; sub-specialization in urology; training in urology; does kidney transplantation belong to urology, and others. RESULTS: It is shown that urology is going through an exciting and hazardous transition period. Urology has conflicting problems in its traditional domains due to changes in health care policy, and internal identification problems due to its permanent expansion and sub-specialization options. Weaker points are its relation with primary care medicine (shared care options), the presence and role of urology in institutions such as the university, department of surgery, children's hospitals, administration, etc.; the desegregating effect of the sub-specialities; the increasing encroachment of other specialities, and the increasing outpatient effect of technological progress. CONCLUSION: An action plan is proposed to confront these changes without loosing manpower, internal consistency or social image and improving patient care quality, excellence of training and scientific progress.

El futuro de la rología en Europa: una perspectiva desde la Asociacion Europea de Urología / The Furute of Urology in Europe: an overview from the European Assocation of Urology

INTRODUCCIÓN: Es preciso promover estrategias adelantadas que influencien el futuro del compromiso asistencial científico y académico de la Urología y los urólogos, si queremos garantizar el futuro de la especialidad y acomodarnos a los cambios inevitables y previsibles. Para atender a este reto la Asociación Europea de Urología (EAU), a través de su Oficina de Estrategia y Planificación (SPO) ha elaborado un documento que se presenta a continuación, en forma abreviada, para la consideración de las Comunidades Urológicas Europeas e Internacionales, en diferentes idiomas. MATERIAL Y MÉTODOS: Se eligieron dos grupos de temas, uno relacionado con los compromisos asistenciales de la Urología y otro con la consistencia interna de nuestra disciplina, como especialidad. Estos temas fueron discutidos entre los miembros de la SPO y las conclusiones sometidas en una consulta abierta, al criterio de distinguidos miembros de la Comunidad Urológica Internacional. Los temas seleccionados para la discusión incluyeron aspectos como; Qué es la Urología; Urología y Universidad; Subespecialización en Urología; Residencia Urológica; Urología y Trasplante Renal; y otros. RESULTADOS: Se ha concluido que la Urología está atravesando un periodo de transición excitante y arriesgado. La Urología tiene problemas conflictivos en sus tradicionales campos asistenciales debido a cambios en la política Sanitaria general, así como problemas de identificación interna debidos a su permanente expansión y subespecialización. Los puntos de mayor debilidad de nuestra disciplina están en relación con aspectos de organización sanitaria (relación con la Medicina Primaria), presencia y compromiso en Instituciones como Universidad, Departamento de Cirugía, hospitales infantiles, administración, etc. Otros puntos importantes son el efecto disgregador de la subespecialización, la progresiva competencia profesional con otras especialidades y el incremento de la actividad ambulatoria debido al progreso tecnológico. CONCLUSION: Se propone un plan de acción que permita enfrentarse a estos previsibles cambios sin perder actividad profesional, sentido de unidad y solidez de la Especialidad, mejorando la imagen pública de la Urología, la calidad de la asistencia al enfermo y la excelencia en la formación y progreso científico del urólogo (AU)

Characterization of a familial RCC-associated t(2;3)(q33;q21) chromosome translocation.

A Polish family was identified in which multifocal clear cell renal carcinoma segregated with a balanced constitutional chromosome translocation, t(2:3)(q33;q21), similar to the renal cell cancer-associated t(2;3)(q35;q21) reported in a Dutch family. Bacterial artificial chromosome (BAC) contigs encompassing the 2q and 3q breakpoints were constructed and BACs crossing the breakpoints were partially sequenced. All known regional markers, genes, and expressed sequence tags (ESTs) were mapped relative to the contigs, as well as to the breakpoint sequences. Two single ESTs mapped within the 2q breakpoint BAC, whereas the repeat-rich 3q breakpoint region was gene poor. Physical mapping suggested that the 3q break was in 3q13, possibly near the border with 3q21. Physical mapping illustrated that the 2q break was closely telomeric to the 2q31 FRA2G site, consistent with the G-band assignment. Characterization of full-length cDNAs for the ESTs near the 2q break will determine if a gene(s) is altered by this familial translocation.

The lack of effect of a prophylactic dose of enoxaparin on thrombin generation in patients subjected to nephrectomy because of kidney cancer.

It is assumed that major surgery, connected with extensive tissue dissection, brings about the release of tissue factor into circulation and subsequent activation of coagulation system. This activation results in the thrombin generation, which is supposed to be suppressed by the low-molecular-mass heparins (LMMH), administered to the surgical patients as the prophylaxis against postoperative venous thromboembolism. We have estimated the concentration of circulating thrombin-antithrombin (TAT) complex in patients subjected to transperitoneal nephrectomy and randomized into controls and who received 40-mg enoxaparin 12 h before and 12 h after the operation and then once daily for 7 days. We have observed a sharp rise of TAT concentration at the end of surgery and it corresponded to the simultaneous drop of antithrombin (AT) activity. TAT concentration gradually decreased and AT activity increased up to the end of observations on the seventh postoperative day, but there were no differences observed between the groups of patients. We have also observed a biphasic increase of plasmin-plasmin inhibitor (PPI) complex concentration in our patients. Again, there were no differences in PPI between the groups of patients. It is our conclusion that under the conditions of this study, the well-known prophylactic effect of enoxaparin against the venous thromboembolic complications was not mediated by the inhibition of intraoperative thrombin generation. The anti-inflammatory or biophysical influence of LMMH may be rather taken into account in surgical patients receiving prophylactic doses of these heparins.

Magnetic resonance urography: initial experience of a low-dose Gd-DTPA-enhanced technique.

Contrast-enhanced magnetic resonance urography (MRU) is a promising tool in the evaluation of the renal collecting system, but it can be limited by T2* effects resulting from hyperconcentrated gadolinium chelates. The aim of this study was to evaluate a low-dose dimeglumine gadopentetate (Gd-DTPA) MRU technique consisting of a dynamic fast low-angle-shot (FLASH) 2D sequence and a static fast imaging in steady state precession (FISP) 3D sequence for depicting the kidneys and urinary tract. The Gd-DTPA dose (0.01 mmol/kg) was established experimentally in a healthy volunteer study. Ninety-one patients presenting with various renal disorders were examined with a low-dose Gd-DTPA MRU and a T2-weighted turbo spin echo (TSE) MRU technique on a 1.5-T system. Image quality and diagnostic value were considered at least satisfactory in 98.9% of the FLASH 2D studies, 83.5% of the FISP 3D studies and 78.5% of the TSE T2-weighted studies. Typical enhancement patterns were established for the renal cell carcinoma and transitional cell carcinoma. The major limitations were motion artefacts and insufficient hydration of the patients. Low-dose Gd-DTPA MRU appears to be a useful technique in the evaluation of the kidneys and urinary tract, especially in cases of renal tumours.

Efficacy and acceptability of tadenan (Pygeum africanum extract) in the treatment of benign prostatic hyperplasia (BPH): a multicentre trial in central Europe.

Pygeum africanum extract is available as Tadenan in many countries, including those in central and eastern Europe, for the treatment of mild to moderate BPH. Its efficacy and acceptability have been demonstrated in numerous open and placebo-controlled studies in large populations. The present open three-centre efficacy and safety study was conducted according to common protocol at urology clinics in the Czech and Slovak Republics and in Poland, in order to confirm the therapeutic profile of Pygeum africanum in conditions of daily practice, using International Prostate Symptom Score (IPSS) and flowmetry assessments. Men aged 50-75 years and in compliance with the selection criteria (including IPSS > or = 12, quality of life (QoL) score > or = 3, and maximum urinary flow < or = 15 ml/s) were first examined then recalled after two weeks during which no treatment was provided (washout and check of stability). If still compliant, they were entered at this point into a two-month period of treatment with Pygeum africanum extract 50 mg twice daily. There followed a further one-month period without treatment, the objective being to evaluate the persistence of any effects observed during the previous two months of Pygeum africanum administration. The primary efficacy parameter investigated was IPSS; the other efficacy parameters were QoL, nocturnal frequency, maximum urinary flow, average urinary flow, post-voiding residual volume and prostatic volume, after one and two months of Pygeum africanum treatment and one month after stopping treatment. A total of 85 patients were evenly distributed between the three centres and completed the entire study. At inclusion their mean IPSS was 16.17, QoL was 3.60 and nocturia was 2.6 times per night. The changes in subjective scores, IPSS and QoL after the two-month treatment period were highly statistically significant with mean improvements of 40% and 31%, respectively. Nocturnal frequency was reduced by 32% and the mean reduction was again highly statistically significant. Mean maximum urinary flow, average urinary flow and urine volume were also statistically significantly improved, but the modest improvement in post-voiding volume did not reach statistical significance. The improvements, which exceeded those observed with placebo in earlier studies, were maintained after one month without treatment indicating an interesting persistence of clinically useful activity. Prostatic volume and quality of sexual life remained unchanged throughout. No treatment-related adverse effects were observed. In conclusion, under conditions of daily practice, Pygeum africanum extract induces significant improvement in IPSS and uroflowmetry parameters. These positive effects are accompanied by a very satisfactory safety profile with the overall result of a substantial improvement in QoL.

[Analysis of clinical symptoms of renal clear cell carcinoma]. / Analiza objawów klinicznych raka jasnokomórkowego nerki.

An analysis of the clinical symptoms has been carried out in the group of 110 patients who underwent nephrectomy for a clear-cell carcinoma. Total hematuria (47.3% of patients) has been a predominant symptom of the tumour. Pain felt in the back has been noted in 39.1% of patients. Palpable tumour has been noted in 34.5% of patients. Such symptoms have been present simultaneously (Israel's triad) in 12.3% of patients. Tumour has been diagnosed accidentally, mainly with USG, in 37.3% of patients. It has been found that classic clinical symptoms of this cancer are nowadays less frequent than before introducing ultrasound examination.

[Sigmoid-vesical fistula as a consequence of sigmoid tumor]. / Przetoka esiczo-pecherzowa w nastepstwie raka esicy.

Because of unusual rarity of neoplastic sigmoid-vesical fistula in young patients the case of 43 years old woman, in whom the fistula was the consequence of sigmoid adenocarcinoma infiltration of urinary bladder, was presented. The patient was treated radically by resection of the sigmoid and partial resection of the urinary bladder within healthy tissue. After operation the patient was exposed to radiotherapy, after which chemotherapy followed (6 courses of 5-day chemotherapy with fluorouracil and calcium folinate). 18 months after operation, 16 months after radiotherapy and 14 after chemotherapy patient's general condition was good and control laboratory tests did not indicate the relapse of the neoplasm.

Glutathione S-transferase isoenzymes and glutathione in renal cell carcinoma and kidney tissue.

Many studies have established the role of the glutathione S-transferases (GSTs) and glutathione (GSH) in the neoplastic process and the drug resistance of tumor. Using isoelectric focusing we separated different forms of GSTs in 28 renal cell carcinomas (RCCs) and in morphologically unchanged adjacent kidney. In addition we determined in RCCs and adjacent kidney the level of GSH and the activities of enzymes participating in synthesis and uptake of this thiol compound. We found higher activity of acidic GSTs and higher level of GSH in RCCs versus kidney. Therefore we suggest that both parameters may play the significant role in the well known phenomenon of intrinsic cytostatic drug resistance of RCC. We also observed the elevation of GSH synthetase activity in tumor tissues in comparison to the kidneys. It may indicate that GSH synthetase, catalysing the final step in GSH synthesis, may participate in the elevation of GSH concentration in RCCs. In this work we also compared the tested parameters in RCCs in relation to the size and local extent of primary tumor (T). We found significantly lower activity of gamma-glutamyl transpeptidase (GGT) as well as GSH synthetase in the group of T3 and T4 tumors than in T2 tumors. However, no substantial differences in GSH concentrations were observed between these distinguished groups.

Resection of the liver in a metastatic disease caused by renal carcinoma.

Two patients are presented who had their livers resected because of the metastasis of the kidney tumour. It is a contribution in the discussion on the possibility of treatment of a well-advanced cancer disease. The treatment chosen was possible because of the close co-operation between two different teams of surgeons.

[Evaluation of the effectiveness of prazosin in conservative treatment of benign prostatic hypertrophy]. / Ocena skutecznosci prazosyny w zachowawczym leczeniu lagodnego przerostu gruczolu krokowego.

Prazosin--a selective blocker of alpha 1-adrenergic receptors--was administered to 30 patients with benign prostatic hypertrophy. Twenty four patients (80%) reported an improvement in voiding and observed more potent urinary stream after the treatment. Average and maximum flow rates increased in 18 patients (60%). Therapy had to be discontinued in 2 patients because of the adverse reactions (hypotension and syncope in one and exacerbation of the coronary disease symptoms in another patient).

[Early results of endoscopic treatment of vesico-ureteral reflux in children]. / Frühergebnisse der endoskopischen Behandlung des vesikoureteralen Refluxes bei Kindern.

Endoscopic treatment of vesicoureteral reflux (VUR) is based on transurethral injection of Teflon paste or collagen gel into the submucosa of the bladder wall beneath the distal ureter, resulting in support of the intramural part. This endoscopic procedure was performed in 75 children with VUR of varying severity. Altogether 111 ureters were treated, 94 with injections of Teflon paste and 17 with collagen gel. Improvement of VUR in the early postoperative period was achieved in 91.5% of the ureters treated with Teflon and in 82.4% of the ureters treated with collagen. No complications were observed. Endoscopic treatment of VUR seems to be an worthwhile alternative to open surgery. However, since long-term follow-up has not been completed, the efficacy of the method cannot yet be finally assessed.

Calicocystostomy in the treatment of giant hydronephrosis.

Calicocystostomy or calicopyelocystostomy was performed for the treatment of hydronephrosis of ectopic or transplanted kidney into the region of the iliac fossa. To the best of our knowledge there is no description of this treatment modality for hydronephrosis in a normally situated kidney. This prompted us to present 2 such cases observed in our clinic.