New combined approach in metallic ureteral stenting to avoid urothelial hyperplasia: study in swine model.

PURPOSE: We assessed the therapeutic value of a new treatment option for ureteral strictures that may avoid urothelial hyperplasia, which is the main cause of metallic stent failure. MATERIALS AND METHODS: We used 24 pigs in this study. An experimental model of ureteral stricture was induced in all animals. Obstruction was confirmed by ultrasound and retrograde ureteropyelogram 6 weeks after model creation. The pigs were then randomly allocated to 2 experimental groups. Therapy involved placement of a 6 × 30 mm metallic ureteral covered stent in the ureteral stricture in group 1 and subsequent endoureterotomy at the ureteral segments adjacent to the 2 ends of the stent in group 2. A double pigtail stent was then deployed for 3 weeks. Completion studies 6 months after therapy included retrograde ureteropyelogram, endoluminal ultrasound and ureteroscopy to assess urothelial hyperplasia formation. RESULTS: At the end of the study evidence of urothelial hyperplasia was seen in 50% of the pigs in group 1 and in 29% in group 2. Four and 2 cases of cranial stent migration in groups 1 and 2, respectively, were seen at 6 months. Hyperplasia and renal involvement were statistically significantly different between the groups with more damage in group 1 than in group 2. CONCLUSIONS: Hyperplasia was markedly reduced when ureteral peristalsis was inhibited by endoureterotomy at the area of interaction between the stent and the ureter.

Association of steroid and xenobiotic receptor (SXR) and multidrug resistance 1 (MDR1) gene expression with survival among patients with invasive bladder carcinoma.

UNLABELLED: What's known on the subject? and What does the study add? SXR and MDR1 are known as responsible for chemo and radiotherapy resistance in some cancers, like kidney cancer (MDR1). Invasive bladder cancer is an aggressive disease, with different behaviour upon its tumoral stage, and also within the same tumoral stage, therefore molecular markers are sought. This study shows a new molecular marker, which has shown as a predictor for bad prognosis cancers, therefore, allowing us for a better patient selection for aggressive therapies. OBJECTIVE: To investigate the prognostic value of steroid and xenobiotic receptor (SXR) and multidrug resistance 1 (MDR1) gene expression in relation to survival among patients with invasive bladder cancer. PATIENTS AND METHODS: The prospective study included 67 patients diagnosed with invasive bladder cancer and treated with radical cystectomy at one of two institutions. SXR and MDR1 gene expression was assessed by real-time quantitative polymerase chain reaction (RT-PCR) in tumoral and normal tissue from frozen surgical specimens. RESULTS: Patients were followed for a mean of 29 months; 31 patients (46%) had progression. In univariate analysis, significant predictors of overall survival (OS) were pathological stage, lymph node (LN) status, histological grade, vascular-lymphatic invasion, and SXR expression. In multivariate analysis, independent predictors of OS were LN status (odds ratio [OR], 2.96; P=0.034), vascular-lymphatic invasion (OR, 2.50; P=0.029), and SXR expression (OR, 1.05, P=0.03). Among the 51 patients with negative LNs (pN0), univariate predictors of OS were SXR expression, MDR1 expression, and pathological stage. In multivariate analysis, SXR expression (OR, 1.06; P=0.01) and MDR1 expression (OR, 3.27; P=0.03) were independently associated with survival. Within the pN0 group, patients with SXR expression had shorter progression-free survival than did those without expression (P=0.004). This association persisted in the N0 subgroup with stage pT3-pT4 disease (P=0.028). However, in the pN1 group SXR expression did not have any influence. CONCLUSIONS: For patients with invasive bladder cancer, SXR expression has value as a predictor of survival independent of the standard pathological predictors. Its maximum importance appears to be in patients with stage pT3-pT4 pN0 disease.

Ureteral double-J wire stent effectiveness after endopyelotomy: an animal model study.

OBJECTIVES: The aim of this experimental study was to assess the possibility of decreasing the size of the ureteral stents used after an endopyelotomy. To this end, an experimental study was performed which compared a ureteral double-J wire stent versus a standard 7F ureteral stent after endopyelotomy. METHODS: Twenty healthy female pigs were randomly divided into 2 groups: group I (double pigtail ureteral stent 7F) and group II (lumenless ureteral double-J wire stent, Zebrastent™, 0.035 inches in diameter). Percutaneous, endoluminal ultrasonographic and fluoroscopic studies were analyzed during the 3 different phases of the study. The first phase included premodel documentation of normal urinary tracts and laparoscopic ureteropelvic junction (UPJ) obstruction induction. During the second phase, 6 weeks later, diagnosis and endopyelotomy were carried out. Sixteen weeks after the obstruction treatment, follow-up imaging studies and postmortem evaluations of all animals were performed. RESULTS: After the sonographic and fluoroscopic assessments, we determined the success rate for each group: 80% for group I and 90% for group II. No significant statistical differences were evident in the evolution of the diameter of the UPJ between groups. Better healing of the UPJ and a lower level of retroperitoneal repercussions were seen in group II. CONCLUSIONS: The ureteral double-J wire stent (Zebrastent) has been shown to be highly effective after endopyelotomy. This means that it is possible to reduce the size of ureteral stents after endopyelotomy with the advantages that this entails. Double-J ureteral stents probably act as a scaffold rather than a mold.

[The treatment of metastasic testicular pure mature teratoma]. / Tratamiento del teratoma maduro puro de testiculo metastatizado. Qué hacer?

OBJECTIVE: Given the low frequency of testicular teratoma in relation to the rest of germ cell testicular tumors and the various treatment options for advanced stages, we report one case of advanced testicular mature teratoma with retroperitoneal adenopathy in which orchyectomy was performed after retroperitoneal lymphadenectomy, with the some pathology found in the primary tumor. METHODS: We do an update on the treatment for these stages with the possibility of beginning with chemotherapy leaving lymphadenectomy for residual masses, or the contrary, being most cases treated in a mixed way. CONCLUSIONS: Without clear evidence for guidelines in these tumors, it is recommended to individualize the treatment for each patient, accordingly to tumor characteristics, probability of relapse and follow-up.

Tratamiento del teratoma maduro puro de testículo metastatizado. ¿Qué hacer? / The treatment of metastasic testicular pure mature teratoma

OBJETIVO: Dada la escasa frecuencia de teratomas testiculares en relación con el resto de tumores testiculares germinales y las diferentes opciones de tratamiento cuando se encuentran en estadios avanzados, presentamos un caso de teratoma maduro testicular avanzado con adenopatía retroperitoneal al que se realizó tras al orquiectomía una linfadencectomía retroperitoneal con el mismo hallazgo histopatológico que el primario. METODO/RESULTADOS: Realizamos una revisión de la actualidad en el tratamiento en estos estadios con las posibilidades de comenzar con quimioterapia y dejar la linfadenectomía para los residuales o a la inversa, siendo la mayoría de casos tratados de forma mixta. CONCLUSIONES: Sin existir evidencias claras del protocolo a seguir en estos tumores, es aconsejable individualizar el tratamiento en cada paciente según características del tumor, probabilidades de recidiva y seguimento posterior

OBJECTIVE: Given the low frequency of testicular teratoma in relation to the rest of germ cell testicular tumors and the various treatment options for advanced stages, we report one case of advanced testicular mature teratoma with retroperitoneal adenopathy in which orchyectomy was performed after retroperitoneal lymphadenectomy, with the same pathology found in the primary tumor. METHODS: We do an update on the treatment for these stages with the possibility of beginning with chemotherapy leaving lymphadenectomy for residual masses, or the contrary, being most cases treated in a mixed way. CONCLUSIONS: Without clear evidence for guidelines in these tumors, it is recommended to individualize the treatment for each patient, accordingly to tumor characteristics, probability of relapse and follow-up

Epidermal naevus syndrome (Solomon's syndrome) associated with bladder cancer in a 20-year-old female.

Epidermal naevus syndrome was first described by Solomon et al. in 1968, based on a study of 12 patients. Herein we report the case of a 20-year-old female diagnosed with epidermal naevus syndrome at the age of 3 years. Subsequently she experienced several different symptoms and at the last exploration a suspicious lesion was found in her bladder. The definitive pathology diagnosis was transitional cell carcinoma of the bladder, which is extremely rare in patients aged <21 years. It seems that this neoplastic lesion was directly related to the essential pathology of the patient, namely epidermal naevus syndrome.

Malignant mesothelioma of the tunica vaginalis. Report of a case without risk factors and review of the literature.

Malignant mesothelioma of the tunica vaginalis testis is an aggressive tumour with local recurrence being distant metastases the main feature of the clinical course. Usually appears over the fourth decade, having a strong relationship with occupational exposure to asbestos and long lasting hydrocele. We introduce a case of a 78-year-old caucasian male who developed a malignant mesothelioma without personal history of hydrocele or exposure to asbestos. A revision of the current literature is performed to summarize the recent therapeutic options as well as new diagnostic tools.