The prognostic significance of advanced age in patients with bladder cancer treated with radical cystectomy.

OBJECTIVE: To evaluate the association of patient age with pathological and long-term oncological outcomes after radical cystectomy (RC) for bladder carcinoma, as this disease, like many others, increases in incidence with age. PATIENTS AND METHODS: We retrospectively reviewed 241 consecutive patients with invasive bladder cancer who had RC between 1990 and 2007. The age at RC was analysed both as a continuous and categorical (< or =50 years, 38 patients; 51-69, 172; or > or =70, 31) variable. Survival was also analysed. RESULTS: Increasing age, analysed as a continuous and categorical variable, was associated with advanced pathological stage (P = 0.009 and 0.006, respectively). The 5-year cancer-specific survival rates for patients according to the age groups were 78.5%, 44.9% and 28.1%, respectively, and Kaplan-Meier analysis showed an increased risk of bladder cancer-specific death with advancing age (P < 0.001). Being older at RC was an important prognostic factor for disease-specific survival in a multivariate Cox regression model. Patients aged > or =70 years had a significantly higher risk of disease than patients aged < or =50 years (P = 0.002). CONCLUSIONS: Higher age at RC is significantly associated with the risk of pathologically advanced disease and poorer cancer-specific survival. More prospective work is needed to examine the impact of age on tumour biology and cancer-specific survival.

Predictive factors and short-term fetal outcomes of breech presentation: a case-control study.

OBJECTIVE: This study evaluated the predictive factors and short-term fetal outcomes of breech presentation by comparing breech and cephalic pregnancies of >or=36 weeks gestation. MATERIALS AND METHODS: Two hundred and one breech and 149 cephalic pregnancies of >or=36 weeks gestation, with no other maternal or fetal problems, were compared with regard to placental localization, fetal heart rate variability, smoking, body mass index, maternal weight gain, placental weight, birth weight, sex, Apgar scores, and umbilical cord length. RESULTS: Maternal weight gain, body mass index at term, smoking and hemoglobin values were significantly higher in breech presentation than in cephalic pregnancies. The placenta was located in the cornu-fundal region in 63.2% of breech presentations and 26.8% of cephalic presentations (p<0.001). Placental weights were 657 g and 597 g, respectively (p<0.001). Umbilical cord length was shorter in breech than cephalic pregnancies (p<0.001). Although breech pregnancies had significantly reduced fetal heart rate variability (p<0.001), Apgar scores were much higher in breech fetuses than in cephalic fetuses. Ninety-five percent of breech pregnancies underwent cesarean sections. CONCLUSION: Cornu-fundal localization of the placenta, smoking, greater maternal weight gain, higher body mass index at term, greater placental weight, shorter umbilical cord, and lower estimated fetal weight may be predictive of persistent breech presentation. Reduced fetal heart rate variability did not have an adverse effect on Apgar scores after cesarean delivery in breech fetuses with no other problems at term.

Does lower-pole caliceal anatomy predict stone clearance after shock wave lithotripsy for primary lower-pole nephrolithiasis?

AIM: In order to have an idea about the success rates after extracorporeal shock wave lithotripsy (SWL) in patients with lower-pole stones, we reviewed the caliceal anatomy of the patients treated in our clinic. PATIENTS AND METHODS: One hundred and ninety-eight patients having at least a 3-month follow-up period, with a single stone located in the lower pole, were included. Lower infundibulopelvic angle (LIP-A), infundibular width, and infundibular length were measured from standard intravenous urograms taken before initial ESWL. RESULTS: One hundred and thirty patients (65%) were male, and 68 patients (35%) were female. We found no impact of age, sex, and affected side on the results of ESWL. The overall stone-free rate was 61.1% after 3 months of follow-up. The stone-free rates were 47.8 and 81.4% in patients with an acute (< 70 degrees) and an obtuse (> or = 70 degrees) LIP-A, respectively (p = 0.007). Taking the infundibular width into consideration, the stone-free rates were 85.4 and 43.2% for favorable and unfavorable angles and widths (p = 0.003). However, infundibular length and stone sizes were not found to have important effects on a stone-free status (p = 0.546 and p = 0.283). CONCLUSION: We conclude that LIP-A (> or = 70 degrees) has the greatest impact on the clearance of residual fragments produced by SWL.

Outcome of repeated micro-surgical testicular sperm extraction in patients with non-obstructive azoospermia.

AIM: To evaluate the outcome of repetitive micro-surgical testicular sperm extraction (mTESE) attempts in non-obstructive azoospermia (NOA) cases, in relation to patients' initial testicular histology results. METHODS: A total of 68 patients with NOA in whom mTESE had been performed in previous intracytoplasmic sperm injection (ICSI) attempts were reviewed. RESULTS: Among the 68 patients with NOA, the first mTESE yielded mature sperm for ICSI in 44 (64%) (Sp(+)), and failed in the remaining 24 (36%) (Sp(-)). Following their first trial, 24 patients decided to undergo a second mTESE. Of these 24 patients, no spermatozoa were obtained in 5 patients, and Sp(+) but no fertilization/pregnancy were achieved in 19. In these 24 cases, mTESE was successively repeated for two (n = 24), three (n = 4) and four (n = 1) times. The second attempt yielded mature sperm in 3/5 patients from the Sp- group and 16/19 patients from the Sp(+) group. At the third and fourth trials, 4/4 and 1/1 of the original Sp(+) patients were Sp(+) again, respectively. Distribution of main testicular histology included Sertoli cell-only syndrome (16%), maturation arrest (22%), hypospermatogenesis (21%) and focal spermatogenesis (41%). Overall, in repetitive mTESE, 24/29 (82%) of the attempts were finally Sp(+). CONCLUSION: Repeated mTESE in patients with NOA is a feasible option, yielding considerably high sperm recovery rate. In patients with NOA, mTESE may safely be repeated one or more times to increase sperm retrieval rate, as well as to increase the chance of retrieving fresh spermatozoa to enable ICSI.

Effect of dimensions and volume of the prostate on cancer detection rate of 12 core prostate biopsy.

PURPOSE: To evaluate if volume or any of the three dimensions of prostate influences cancer detection rate by 12-core transrectal ultrasound (TRUS) guided prostate biopsy. MATERIALS AND METHODS: We have searched our database for patients who underwent 12 core TRUS guided prostate biopsy with PSA values between 4.0 and 9.9 ng/ml, benign digital exam and no suspicious lesions at TRUS. The measurements of three dimensions and volume of the prostate of 99 patients were correlated with cancer detection rates of biopsy. RESULTS: There were no statistically significant differences between patients with prostate cancer or with benign histopathologic result for mean age, PSA and % PSA. Patients without cancer had a significantly higher mean prostate volume (58.88 cc) than patients with cancer (48.85 cc) (P = 0.038). A volume of 48.5 cc was determined as a cut-off value above which cancer detection rate decreases. Of the three dimensions, only the difference for the craniocaudal dimension between benign and malignant groups was marginally significant (P = 0.052). CONCLUSIONS: With 12 core biopsy, cancer detection rate is lower in patients with prostates larger than 48.5 cc. Further studies comparing biopsy results with prostatectomy specimens can clarify whether these results necessitates higher number of cores for such patients.

Approach to newborn priapism: a rare entity.

Priapism is a rare entity with a different aetiology in newborns than in childhood and adult life. Due to its rarity, management can be challenging. The possible consequences of improper treatment make management of this condition clinically relevant. Preservation of normal erection is the major goal. Although the majority of cases are idiopathic, prolonged erection may be associated with polycythemia. As spontaneous detumescence occurs in the majority of cases, conservative non-surgical treatment is advocated initially. We report the case of a newborn presenting with priapism on the 1st day of life. Detumescence was achieved on the 4th day of life with conservative management.