Obesity and renal cancer incidence and mortality--a systematic review of prospective cohort studies.

INTRODUCTION AND OBJECTIVE: There have been many studies published recently on obesity and the risk of renal cancer; however, the epidemiological evidence for such an association has not been consistent. Therefore, a systematic review was conducted of the prospective cohort studies to assess the association between obesity and the risk of renal cancer incidence and death. MATERIALS AND METHODS: A search was conducted of the PubMed database and references to published studies from inception until May 2013. Guidelines for Assessing Quality in Prognostic Studies on the Basis of Framework for Potential Biases were followed for quality assessment of studies included in the systematic review. RESULTS: Twenty eligible studies were identified and included in the systematic review. Among the 20 selected studies, overall study quality was high. Although the evidence from the prospective cohort studies, linking obesity with renal cancer incidence, has not been entirely consistent, there is a convincing body of data for a positive relationship. Moreover, cumulative data is compelling for a strong positive association between obesity and fatal renal cancer. CONCLUSIONS: There is a relatively consistent amount of evidence that obesity increases the risk of renal cancer and fatal renal cancer. Further research is needed as better understanding of mechanisms by which obesity may influence renal cancer development and progression will aid the fostering of strategies for prevention and treatment of one of the most lethal human malignancies.

[Surgical management of severe Peyronie's disease]. / Chirurgiczne leczenie ciezkich postaci choroby Peyronie.

Peyronie's disease (lat. induratio penis plastica) is a process of the fibrotic plaques oand other localized fibrotic conditions have been considered to be the result of an abnormal size, pain and improved penile curvature. At early stages intralesional injections may decrease penile curvature and decrease plaque volume although the exact mechanism of action on Peyronie disease is unknown. In serious cases surgery is recommended, based on ultrasound examination, cavernosography and cavernosometry. There are three mail surgical procedures to correct the curvature in Peyronie's disease: Nesbit plication, plaque excision followed by skin grafting, another autograft or synthetic material, and implantation of a penile prosthesis Aim of this study is to present our experience in surgical treatment of severe stadium in Peyronie's disease. Peyronie plaque was excised in 8 man, previously potent with severe satium of the disease. In every case saphenous autograft replacing excised plaque was used. In every case was not intra and postoperative complications. All patients reported satisfactory cosmetic and functional result. The satisfactory result of the treatment of severe stadium Peyronie disease is based on the surgical method. Saphenous graft is effective, safe and successful technique in our knowledge.

Role of marker lesion when applying intravesical instillations of IL-2 for non-muscle-invasive bladder cancer comparison of the therapeutic effects in two pilot studies.

AIM: Comparison of the therapeutic effect of treatment of non-muscle invasive bladder carcinoma (NMIBC) after intravesical Interleukin-2 (IL-2) instillations in the presence and absence of a marker tumour. MATERIALS AND METHODS: Two pilot studies were performed in patients with NMIBC. The first study (10 patients) was performed in Krakow (Poland), the second (26 patients) in Vilnius (Lithuania). In Krakow the tumours were treated with incomplete transurethral resection (TUR) leaving a marker tumour of 0.5-1.0-cm followed by IL-2 instillations (3 × 10(6) IU IL-2) on five consecutive days. In Vilnius the tumours were treated with complete TUR, followed by IL-2 instillations (9 × 10(6) IU IL-2) on five consecutive days. RESULTS: During 30 months follow-up, the recurrence-free survival was 5/10 (50%) and 6/26 (23%) after incomplete and complete TUR, respectively. So, the ratio of the recurrence-free survival after incomplete/complete TUR of 50/23=2.2. The median of the recurrence-free survival is >20.5 months and 7 months after incomplete and complete TUR, respectively. So, this ratio was >20.5/7= >2.9. The hazard ratio which combines both the chance of the disease recurrence and its timing for both censored and uncensored cases was 0.53, again confirming the better outcome after incomplete TUR. CONCLUSION: A possible explanation for the better therapeutic effects after incomplete TUR compared with complete TUR is that the marker tumour has tumour-associated antigens (TAA) that could lead to an immune reaction that is stimulated by local application of IL-2. After complete TUR, no TAA are available to initiate and to stimulate an immune reaction; consequently, local IL-2 therapy is less effective after complete TUR. The results of these two pilot studies have led to the recent start of a randomised prospective clinical trial in which therapeutic effects of local IL-2 therapy after complete and incomplete TUR are compared.

[Comparison of self-estimation of disuric disorders gauged IPSS scale and qualities of lives QoL with self-estimation of sexual life gauged by IIEF-5 scale]. / Porównanie samooceny dolegliwosci dysurycznych mierzonych przy uzyciu skali IPSS i jakosci zycia QoL z samoocena zycia plciowego mierzonego skala IIEF-5.

Evaluation of men with a point scale is a simple method that can be used both in primary care and specialist in-patient treatment. Although its use is not widespread. International scoring system for evaluation of symptoms of the prostate is common in Poland (IPSS). Responses to the questionnaire are the basis of IPSS scale. Quality of life form (QoL) is in addition to the scale of IPSS. It defines subjective assessment of patient well-being in case of symptoms of lower urinary tract at the same level as at the time of the study. 5-point questionnaire IIEF-5 has been used in Poland since 1999 to assess men's sexual life. The aim of the study is to compare the assessment of disuric disorders measured using the International Prostate System Score (IPSS) and Quality of Life scale versus scale of men's sexual self-esteem IIEF-5 in men at the age of 50-70. The study included 1746 randomly selected residents of the district Cracow-Downtown, at the age of 50-70. Medical interview was carried out (including complaints of lower urinary tract symptoms (IPSS), quality of life (QoL) and sexual dysfunction (IIEF-5); physical examination with assessment of individual systems with particular emphasis on genitourinary system, physical examination of the prostate (DRE), PSA level in total and free fractions, a biopsy of the prostate under ultrasound control if necessary. For the analysis qualified 1746 men. The men were divided into groups called groups of disease: a suspicion of prostate cancer, can not rule out prostate cancer, prostate cancer confirmed, probable benign prostatic hyperplasia (BPH), no lesions. The largest was the group with probable benign prostatic hyperplasia 64.89% of the total respondents, followed by a group of men without lesions, 26.29%, a group of probable prostate cancer was 6.41% of the respondents, a group with whom you can not rule out prostate cancer was 1.89%, the smallest was the group with confirmed prostate cancer, 0.52% of all male respondents. The age groups were: 498 respondents aged 50-54 years and 391 aged 55-59, 397 aged 60-64 and 460 aged 65-70. Mean age was 59.24 years. Ppicked up data were processed and analized by STATA- 5,0. Differences between groups relative to answers for the questions of scales: IPSS, QoL and IIEEF5 questionnaire were analized by Mann-Whitney, Kruskal- Wallis, Scheffe's and chi2 tests. Homogeneity of the IPSS were analised by a Cronbach coefficient test. Accordance of each questions of the scale to whole scale were analised by correlation and line regression tests. Based on the analysis of the total scale score by IPSS and QoL scale and quality of life questionnaire IIEF-5 showed that in the process of aging in the population more frequently in older than in younger men, there are complaints from the urinary tract and deteriorating quality of life of self-esteem and quality of life of sexual self-esteem. After analyzing the result of scale: IPSS, QoL, and IIEF-5 in the disease groups, it was found that the total score of IPSS differentiates men in the group with probable benign prostatic hyperplasia, from a group of men without lesions and men with suspected prostate cancer. Statistically significant reduction in quality of life (QoL) in patients with confirmed prostate cancer and in the group with probable benign prostatic hyperplasia compared with men without lesions. The highest self-esteem sex life (IIEF-5) was found in men without lesions and the lowest in the group with known prostate cancer. The scale of quality of life (QoL) was significantly positively correlated with the results of IPSS scale, as well as with each of its questions. Deterioration in the quality of life occurred as a crescendo pain of lower respiratory tract. With the increase in the incidence and severity of each symptom on a scale IPSS worsening of self-esteem was examined using a scale IIEF-5. U of men with the deterioration of the quality of life measured by the scale of QoL, worsening their sexual self-esteem scale IIEF-5. In the process of aging are growing complaints from the lower urinary tract, self-esteem deteriorates the quality of life, including sexual life, which is especially marked in men with enlarged prostate. The scale of quality of life (QoL) is significantly positively correlated with the results of IPSS scale. With the increase in the incidence and severity of symptoms on a scale IPSS had decreased self-test using the IIEF-5 scale. The deterioration of quality of life measured with QoL was associated with decreased sexual self-esteem scale IIEF-5.

[Method of the connection HMRS and TRUS images--improvement of effectiveness transrectal core biopsy of the prostate]. / Metoda polaczenia obrazów HMRS i TRUS--poprawa skutecznosci przezodbytniczej biopsji rdzeniowej stercza.

The prostate cancer is one of the most common male neoplasm. The exact location of the tumor using imaging is essential both diagnosis and treatment of prostate cancer. MR prostate with proton spectroscopy (HMRS) turns to be the best contemporary method of prostate changes imaging. However prostate biopsy performed under sonographical control using HMRS imaging registered in DICOM format is not precise enough because the layers of HMRS prostate imaging do not respond to sonographical view of the prostate. The method (MRIUSG) was performed to increase the efficiency of prostate imaging. MRIUSG reconstructs the MR picture in the level appointed by the transrectal USG. MRIUSG is based on linear interpolation of pixels with the sonographical prostate imaging obtained in real time to localize the changes and to perform the targeted prostate biopsy. The aim of the study was to determine and compare the effectiveness of transrectal core biopsy of the prostate /TRUStru-cutBx/ in the group of men with prior proton magnetic resonance spectroscopy, in which reconstruction of images was done using the method developed by the author of this study-MRIUSG, with the group without such reconstruction and thus improve detection rate of prostate diseases, prostate cancer among them. 80 males suspicious of prostate cancer and negative result of sextant core biopsy were qualified to this study. All of them undergone, with positive result, transrectal HMRS examinaton. All of them had trans-rectal core biopsy targeted at atypical suspicious findings in HMRS. Biopsies were performed on patients randomly divided into two groups. Group I in which HMRS positive foci were localized by use of MRI image only. Group II in which HMRS positive foci were localized by use of method of MRI images reconstruction and then transfering them to TRUS image (MRIUSG). Our method of localizing and transferring HMRS images to ultrasonography by images increases prostate cancer detection 22.5%, increase praecancerosus lesions detection by 10.0%, increase inflamatory changes detection 7.5% and eliminates almost 40% of falsely negative results. The probability of detecting cancer using MRIUSG about 3 times higher than in the method without image reconstruction. Method of reconstruction of images obtained in proton magnetic resonance spectroscopy, adequately measured, with marked lesions, and their comparison on a single computer screen with USG images obtained in real-time with the aim of localizing lesions and performing prostate targeted core biopsy enabled the detection of a greater number of prostate lesions in relation to biopsies performed without image reconstruction.

[Strategy in preventing of uretero-intestinal anastomosis strictures in patients with low-pressure intestinal neobladder]. / Strategia postepowania w zapobieganiu zwezeniom zespolenia moczowodowo- jelitowego u chorych z niskocisnieniowym pecherzem jelitowym.

Ureteroileal stenoses occur in 1.2-20% patients with neobladders. They constitute a serious clinical complication since, as every obstruction of urine flow from the kidney. Ureteroileal stenoses develop usually within firs 6 to 12 months following the extended urological procedure such as radical cystectomy with the creation of ileal orthotopic neobladder. Ureteroileal stenosis belongs to the most difficult complications after creation of ileal neobladder. The experience of our clinic between 2001 and 2011 covers 3500 cases of patients with bladder cancer. 226 patients underwent cystectomy, 120 were treated with urinary diversion m. Bricker and 106 underwent low pressure ileal neobladder modo Studer. Ureters anastomosed with the intestine Michalowskis way of a flap. The authors performed 344 ureteroileal anastomoses, 212 ureteroileal anastomoses with the ileal neobladder modo Studer and 11 stenoses were detected, in 5 patients one-side, in 3 bilateral. In our practice there was altogether 11 detected stenoses which constitutes 5.18%. Based on our experience, in the course of radical removal of the bladder during the preparation of the least possible damage the blood supply ureter, ureter prior to implantation should be checked for leaks, catheter should be made of soft material. The performance of the left ureter to carry out the right side of the mesentery, be careful not without angulation. In the course of the uretero-intestinal anastomosis should not be stitched in place to destroy the vascular anastomosis of ureter to intestine anastomosis and the same should be done without tension. Protect the integrity of the anastomosis, aseptic oncology. Uretero-intestinal anastomosis performed without anti-reflux protection.

[Bladder cancer biomarkers]. / Wyznaczniki procesu nowotworowego w raku pecherza moczowego.

Bladder cancer is one of the most prevalent cancers worldwide. Non-muscle invasive bladder cancer has a 70% rate of recurrence. Its biological tendency to recur and progress mandates close follow-up for the early detection of recurrent tumors. Urine cytology is the most widely used noninvasive test to detect urothelial tumors. However, it is limited by its low sensitivity. On the other hand, cystoscopy is the gold standard procedure to follow patients with a history of bladder cancer but this test is invasive and expensive. Therefore, there is a real need to develop new tests that can be used in bladder cancer surveillance. In recent years there is a constant effort to find a better non-invasive marker for bladder cancer. Many markers for the detection of bladder cancers have been tested and almost all urinary markers reported are better than cytology with regard to sensitivity, but they score lower in specificity. Our knowledge of molecular pathways in bladder cancer is growing and new methods of marker development emerge, but the perfect marker is still to be found. Currently, there are not clinically usable molecular markers that can guide us in diagnosis or surveillance, nor guide us in lowering the frequency of urethrocystoscopy in bladder cancer. This article reports some of the more prominent urine markers in use today.