Mysterious ureteral migration of a wooden toothpick from the digestive tract: case report and diagnostic considerations.

Migration of foreign bodies into the urinary tract is a rare event. In certain instances, to unravel the way that objects arrived in the urinary tract is not easy. We report the case of an accidentally swallowed wooden toothpick that migrated and was found in the left ureterovesical junction, protruding into the bladder. Even though the computed tomography scan is widely employed to evaluate the urinary tract, this resource does not have a good sensitivity for detecting foreign bodies. Our report presents an insight into the best imaging approach if wooden toothpicks are suspected. In the present case, the endoscopic treatment was possible with an uneventful outcome and a complete resolution of symptoms.

Mysterious ureteral migration of a wooden toothpick from the digestive tract: case report and diagnostic considerations

ABSTRACT Migration of foreign bodies into the urinary tract is a rare event. In certain instances, to unravel the way that objects arrived in the urinary tract is not easy. We report the case of an accidentally swallowed wooden toothpick that migrated and was found in the left ureterovesical junction, protruding into the bladder. Even though the computed tomography scan is widely employed to evaluate the urinary tract, this resource does not have a good sensitivity for detecting foreign bodies. Our report presents an insight into the best imaging approach if wooden toothpicks are suspected. In the present case, the endoscopic treatment was possible with an uneventful outcome and a complete resolution of symptoms.

Radical prostatectomy and positive surgical margins: relationship with prostate cancer outcome.

INTRODUCTION: Positive surgical margins (PSMs) are an adverse factor that may predict a worse outcome in patients submitted to radical prostatectomy (RP). However, not all of these cases will evolve to biochemical (BCR) or clinical (CR) recurrence, therefore relationship between PSMs and these recurrent events has to be correlated with other clinical and pathologic findings to indicate complementary treatment for selected patients. MATERIALS AND METHODS: Of 1250 patients submitted to open retropubic radical prostatectomy (RRP), between March 1991 and June 2008, the outcome of 161 patients with PSMs and of 67 without PSMs as a control group, comprising a total of 228 cases were retrospectively reviewed. A minimum follow-up time of 2 years after surgery was considered. BCR was determined when PSA ≥ 0.2 ng/mL. CR was determined whenever there was clinical evidence of tumor. Chi-square test was used to correlate clinical and pathologic variables with PSMs. Time interval to biochemical recurrence was analyzed by the Kaplan-Meier product limit analysis using the log-rank test for comparison between groups. Univariate and multivariate Cox stepwise logistic regression models were used to identify significant predictors of risk of shorter intervals to BCR. RESULTS: Prostate circumference margin was the most common site with 78 cases (48.44%). Regarding the outcome of 228 cases from both groups, BCR occurred in 68 patients (29.82%), and CR in 10 (4.38%). Univariate analysis showed statistically significant associations (p < 0.001) between presence of PSMs with BCR, but not with CR (p = 0.05). At follow-up of the 161 patients with PSMs, only 61(37.8%) presented BCR, while 100 (62.8%) did not. BCR correlated with pathologic stage; Gleason score; preoperative PSA; tumor volume in the specimen; capsular and perineural invasion; presence and number of PSMs. CR correlated only with angiolymphatic invasion and Gleason score. Considering univariate analysis of clinical and pathologic factors predicting progression-free survival at 5 years, prostate weight; preoperative PSA; Gleason score; pathologic stage; tumor volume; PSMs; capsular and perineural invasion were correlated with BCR. At multivariate analysis, only Gleason score and percentage of tumor volume correlated as significant independent predictors of BCR. CONCLUSION: At univariate analysis, presence, number and location of PSMs have consistent correlation with BCR after RRP, but at follow-up BCR occurred only in 37.8% of patients with PSMs. However at multivariate analysis, the significant risk factors for BCR were percentage of tumor volume (p = 0.022) and Gleason score (p < 0.005) in the surgical specimen. Angiolymphatic invasion and Gleason score were significantly correlated with CR.

Radical prostatectomy and positive surgical margins: relationship with prostate cancer outcome

Introduction Positive surgical margins (PSMs) are an adverse factor that may predict a worse outcome in patients submitted to radical prostatectomy (RP). However, not all of these cases will evolve to biochemical (BCR) or clinical (CR) recurrence, therefore relationship between PSMs and these recurrent events has to be correlated with other clinical and pathologic findings to indicate complementary treatment for selected patients. Materials and Methods Of 1250 patients submitted to open retropubic radical prostatectomy (RRP), between March 1991 and June 2008, the outcome of 161 patients with PSMs and of 67 without PSMs as a control group, comprising a total of 228 cases were retrospectively reviewed. A minimum follow-up time of 2 years after surgery was considered. BCR was determined when PSA ≥ 0.2ng/mL. CR was determined whenever there was clinical evidence of tumor. Chi-square test was used to correlate clinical and pathologic variables with PSMs. Time interval to biochemical recurrence was analyzed by the Kaplan-Meier product limit analysis using the log-rank test for comparison between groups. Univariate and multivariate Cox stepwise logistic regression models were used to identify significant predictors of risk of shorter intervals to BCR. Results Prostate circumference margin was the most common site with 78 cases (48.44%). Regarding the outcome of 228 cases from both groups, BCR occurred in 68 patients (29.82%), and CR in 10 (4.38%). Univariate analysis showed statistically significant associations (p < 0.001) between presence of PSMs with BCR, but not with CR (p = 0.05). At follow-up of the 161 patients with PSMs, only 61(37.8%) presented BCR, while 100 (62.8%) did not. BCR correlated with pathologic stage; Gleason score; preoperative PSA; tumor volume in the specimen; capsular and perineural invasion; presence and number of PSMs. CR correlated only with angiolymphatic invasion and Gleason score. Considering univariate ...

Expressão de iNOS, COX-2, GLUT1, e Nitrotirosina como biomarcadores preditivos da evolução do adenocarcinoma prostático em pacientes com margens positivas pós-prostatectomia radical / Expression of iNOS, COX-2, GLUT1, and nitrotirosina as predictive biomarkers from progression of prostatic adenocarcinoma in patients with positive surgical margins post-radical prostatectomy

Apesar dos bem estabelecidos parâmetros clínicos, cirúrgicos e anatomopatológicos utilizados na atualidade para podermos predizer a evolução para recidiva bioquímica do adenocarcinoma da próstata, após seu tratamento cirúrgico, sobretudo quando da presença de margens cirúrgicas positivas, análises imunoistoquímicas tem se revelado importantes ferramentas para apoiar a indicação de tratamentos adjuvantes precocemente ou não com base na expressão de determinados marcadores que sinalizam a agressividade do tumor. O iNOS (sintase do óxido nítrico induzível) sintetiza óxido nítrico (NO) que tem importante papel no crescimento tumoral e na angiogênese, como também influencia a citotoxicidade de macrófagos e a imunosupressão induzida pelo tumor, sendo um marcador muito encontrado em células do adenocarcinoma da próstata diferenciando este de tecido benigno. A COX-2 que tem produção estimulada pelo NO, também tem sido associada a diversas neoplasias por sua ação angiogênica e no processo da inflamação, sendo estudada como via alvo terapêutico. O GLUT1 é um ativo transportador de glicose expressado em tecidos normais e expresso em altos níveis em numerosos tumores, sendo um marcador intrínseco e mediador de hipóxia reduzindo a fosforilação oxidativa e agindo na via de sinalização oxigênio-dependente através do fator de hipóxia induzida (HIF-1). A Nitrotirosina é um produto da nitração da tirosina mediado por espécies reativas do nitrogênio, tais como o ânion peroxinitrito e o dióxido de nitrogênio, sendo detectado em condições patológicas como em neoplasias sendo considerado marcador de estresse oxidativo dependente de NO. Os objetivos deste trabalho foram avaliar as expressões desses marcadores em espécimes cirúrgicos de próstatas com adenocarcinoma e avaliar suas relações com o prognóstico pós-prostatectomia radical em pacientes com margens cirúrgicas positivas, fator este considerado na literatura como significativo para recidiva bioquímica. Foram analisados...

In spite of the well-established clinical, surgical and anatomopathological parameters currently used to allow us to predict the evolution to biochemical recurrence of adenocarcinoma of the prostate, after its surgical treatment, especially when in the presence of positive surgical margins, immunohistochemical tests have become very important tools to support the indication of adjuvant therapies, either precociously or not, based on the expression of certain markers that signalize the tumor’s aggressiveness. The iNOS (inducible nitric oxide synthase) synthesizes nitric oxide (NO) which plays an important role in the tumor’s growth and in the angiogenesis, affecting as well the macrophages cytotoxicity and the tumor-induced immunosuppression, being a marker very commonly found in prostate adenocarcinoma cells, thus differentiating this from a benign hyperplasia. The COX-2, which production is stimulated by the NO, has also been associated to various neoplasias due to its angiogenic action and to its influence on the inflammation process as well, being then studied as a therapeutic target via. The GLUT1 is an active glucose transporter expressed in normal tissues and expressed at high levels in numerous tumors, playing the role as intrinsic and mediator hypoxia marker, reducing oxidative phosphorylation and acting on the oxygen-dependent signalizing via through hypoxia inducible factor (HIF-1). Nitrotyrosine is a product of tyrosine nitration mediated by reactive nitrogen species such as peroxynitrite anion and nitrogen dioxide, being detected in pathological conditions such as in neoplasias, thus being considered a marker of NO-dependent oxidative stress. The objectives of this work were to evaluate the expressions of those markers in surgical specimens of prostates with adenocarcinoma, as well as to evaluate their relation with prognosis after radical prostatectomy in patients with positive surgical margins, factor which has been considered...

Nd-Yag laser em urologia / Nd-Yag laser in urology

Os autores apresentam uma revisao da literatura sobre o uso do Nd:Yag laser em urologia. Sao descritos os principais aspectos físicos, histológicos, experimentais e práticos deste tipo de laser, bem como as indicaçoes e os resultados obtidos frente a diferentes afecçoes urológicas.