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1.
Minerva Urol Nefrol ; 69(3): 285-292, 2017 Jun.
Article in English | MEDLINE | ID: mdl-27706124

ABSTRACT

BACKGROUND: To compare baseline characteristics and outcomes of patients undergoing GreenLight laser vaporization (GL) or transurethral resection of the prostate (TURP) in a real life setting. METHODS: In this prospective observational cohort, the Clinical Research Office of the Endourological Society (CROES) collected data of consecutive GL or TURP treated patients. Treatment involved one of three GL laser powers (80 W, 120 W or 180 W) based on availability in each participating centre, or TURP. Data on baseline characteristics as well as functional measures were collected at three time points: 6-12 weeks, 6, and 12months after surgery. Functional measures included urinary flow parameters, perceived prostate function (IPSS), perceived erectile function (IIEF-5) and complications. RESULTS: Seven hundred thirteen patients underwent GL, and 234 patients underwent TURP. Overall, patients treated with GL show higher BMI, IIEF and medication use, together with lower urinary function (voided volume, incontinence, urinary retention) at baseline. After the procedure, despite higher antibiotic and antimuscarinic use and shorter hospital stay, readmission rates, PVR, PSA were higher, but Qmax, and IIEF were lower in the GL group. The rate of post-operative complications was 10.3% and 5.2% for the TURP and GL group, respectively (P=0.006). CONCLUSIONS: We were unable to categorically state which procedure is superior. This observational study confirms that treatment decision for either TURP or GL is not based on patient characteristics.


Subject(s)
Laser Therapy/methods , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate/methods , Aged , Humans , Laser Therapy/instrumentation , Male , Prospective Studies , Transurethral Resection of Prostate/instrumentation , Treatment Outcome , Urinary Incontinence/etiology
2.
Anticancer Res ; 36(9): 4787-93, 2016 09.
Article in English | MEDLINE | ID: mdl-27630329

ABSTRACT

BACKGROUND/AIM: Current research of prostate cancer (PCa) offers a promising way of identifying patients with adverse prognosis who do benefit from radical treatment that can affect quality of life as resections are associated with numerous side-effects. The aim of our study was to evaluate the relationship of TMPRSS2-ERG fusion gene status, tumor tissue prostate-specific antigen (PSA), prostate cancer antigen 3 (PCA3), miR-23b, miR-26a and miR-221 expression levels in combination with preoperative serum PSA level to the risk of PCa recurrence after radical prostatectomy. PATIENTS AND METHODS: The study group consisted of 108 patients who underwent radical prostatectomy. PSA was measured in peripheral blood collected preoperativelly. The expression of TMPRSS2-ERG transcript and the expression of miR-23b, miR-26a and miR-221 in formalin-fixed, paraffin-embedded (FFPE) tumor tissues was analyzed by reverse transcription (RT) real-time polymerase chain reaction (PCR). RESULTS: Significantly shorter time to recurrence was observed in patients with high expression of TMPRSS2-ERG (p=0.0020). High levels of preoperative PSA (>10.0 ng/ml) proved to be marker of shorter time to recurrence (p=0.0153). The most promising marker of the risk of recurrence after radical prostatectomy was a combination of high level of preoperative serum PSA and high expression of TMPRSS2-ERG fusion transcript in tumor tissue (p=0.0001). CONCLUSION: A combination of high preoperative serum PSA and high expression of TMPRSS2-ERG could be promising in distinguishing those tumors that are aggressive and life-threatening.


Subject(s)
Biomarkers, Tumor/genetics , Neoplasm Recurrence, Local/genetics , Oncogene Proteins, Fusion/genetics , Prostate-Specific Antigen/blood , Prostatic Neoplasms/genetics , Adult , Aged , Antigens, Neoplasm/biosynthesis , Antigens, Neoplasm/genetics , Biomarkers, Tumor/biosynthesis , Biomarkers, Tumor/blood , Gene Expression Regulation, Neoplastic , Humans , Male , MicroRNAs/biosynthesis , MicroRNAs/genetics , Middle Aged , Neoplasm Recurrence, Local/blood , Neoplasm Recurrence, Local/pathology , Paraffin Embedding , Predictive Value of Tests , Prognosis , Proportional Hazards Models , Prostate/pathology , Prostatectomy , Prostatic Neoplasms/blood , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Risk Factors
3.
Article in English | MEDLINE | ID: mdl-23073536

ABSTRACT

BACKGROUND: Radiofrequency thermal ablation (RFA) is a minimally invasive, image guided technique for destroying tumour cells without damage to adjacent healthy tissue. It is used for partial or complete ablation of non resectable lung cancers and cancers of metastases to lung, providing an effective, relatively safe option for patients ineligible for surgery. We describe our experience with it. METHODS: In 2005 and 2006, we performed radiofrequency ablation of 7 lung lesions in 6 patients. RFA was done percutaneously under image guided CT scan in 5 patients and in one patient during thoracotomy when we found a radically unresectable tumor necessitating debulking. CT lung screening was performed after 6 months and PET/CT was done within 12 months. RESULTS: In the course of the screening, we diagnosed regression in 2 patients, a stationary state in 2 cases and local tumor progression in 2 patients, using computed tomography within 6 months after RFA. Using PET/CT within 12 months, we diagnosed non-ablation and liver metastases (there were none before) in one of the two patients with a stationary state diagnosed by means of CT before and recurrence of primary tumor in another patient. In one case of diagnosed regression, we diagnosed tumor progression. The patients survived an average of 30 months (range 9 to 60 months). CONCLUSION: RFA of lung tumors is an easy method with little patient discomfort. It can be performed percutaneously using guided CT under general anaesthesia. RFA of lung tumors possibly alone or in combination with oncology treatment can prolong patient life.


Subject(s)
Catheter Ablation/methods , Lung Neoplasms/surgery , Adult , Aged , Female , Humans , Lung Neoplasms/pathology , Male , Middle Aged , Tomography, X-Ray Computed , Treatment Outcome
4.
Wideochir Inne Tech Maloinwazyjne ; 8(1): 49-54, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23630554

ABSTRACT

INTRODUCTION: Urine leakage following laparoscopic radical prostatectomy (LRP) is a possible complication that may herald chronic urine incontinence. Intraoperative measures aiming to prevent this is not standardised. AIM: Presentation of experience with active suction of the prevesical space in managing postoperative urine leakage. MATERIAL AND METHODS: At the Department of Urology, where laparoscopy of the upper abdomen and open RP were performed, a protocol for extraperitoneal LRP was established in 8/2008. Until 5/2011, 154 LRPs have been performed. Urine leakage from a suction drain appeared in 9 cases (5.8%). Permanent active suction (with a machine for Büllae thoracic drainage) of the prevesical space with negative pressure of 7-12 cm of H2O was started immediately. RESULTS: Urine leakage started after a mean of 0.9 (0-2) days postoperatively and stopped after a mean of 8.1 (15-42) days. Leakage stopped with only suctioning in 7 cases. In one case, open re-anastomosis was performed on the 7(th) postoperative day (POD). In another case, ineffective active suction was replaced on the 10(th) POD by needle vented suction without effect and the leakage stopped following gradual shortening of the drain up to the 15(th) POD. CONCLUSIONS: Active suction of the prevesical space seems to be an effective intervention to stop postoperative urine leakage after laparoscopic radical prostatectomy.

5.
Eur Urol ; 63(2): 296-305, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23195283

ABSTRACT

BACKGROUND: Despite several antimuscarinic treatment options for overactive bladder (OAB), there is still a need for distinct treatment approaches to manage this condition. Mirabegron, a ß(3)-adrenoceptor agonist, has demonstrated efficacy and tolerability for up to 12 wk in phase 3 trials. OBJECTIVE: To assess the 12-mo safety and efficacy of mirabegron. DESIGN, SETTING, AND PARTICIPANTS: Patients ≥ 18 yr of age with OAB symptoms for ≥ 3 mo. INTERVENTIONS: After a 2-wk single-blind placebo run-in, patients with eight or more micturitions per 24h and three or more urgency episodes in a 3-d micturition diary were randomized 1:1:1 to once-daily mirabegron 50mg, mirabegron 100mg, or tolterodine extended release (ER) 4 mg for 12 mo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary variable: incidence and severity of treatment-emergent AEs (TEAEs). Secondary variables: change from baseline at months 1, 3, 6, 9, and 12 in key OAB symptoms. RESULTS AND LIMITATIONS: A total of 812, 820, and 812 patients received mirabegron 50mg, mirabegron 100mg, and tolterodine ER 4 mg, respectively. Baseline demographic and OAB characteristics were similar across groups. TEAEs were reported in 59.7%, 61.3%, and 62.6% of patients, respectively; most were mild or moderate. Serious TEAEs were reported in 5.2%, 6.2%, and 5.4% of patients, respectively. The most common TEAEs were similar across groups. Dry mouth was reported by 2.8%, 2.3%, and 8.6% of patients, respectively. Adjusted mean changes from baseline to final visit in morning systolic blood pressure were 0.2, 0.4, and -0.5mm Hg for mirabegron 50mg, 100mg, and tolterodine ER 4 mg, respectively. Mirabegron and the active control, tolterodine, improved key OAB symptoms from the first measured time point of 4 wk, and efficacy was maintained throughout the 12-mo treatment period. The study was not placebo controlled, which was a limitation. CONCLUSIONS: The safety and tolerability of mirabegron was established over 1 yr, with sustained efficacy observed over this treatment period. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00688688.


Subject(s)
Acetanilides/therapeutic use , Adrenergic beta-3 Receptor Agonists/therapeutic use , Benzhydryl Compounds/therapeutic use , Cresols/therapeutic use , Muscarinic Antagonists/therapeutic use , Phenylpropanolamine/therapeutic use , Thiazoles/therapeutic use , Urinary Bladder, Overactive/drug therapy , Aged , Constipation/chemically induced , Delayed-Action Preparations/therapeutic use , Double-Blind Method , Female , Headache/chemically induced , Humans , Hypertension/chemically induced , Male , Middle Aged , Single-Blind Method , Tolterodine Tartrate , Treatment Outcome , Urinary Bladder, Overactive/complications , Urinary Incontinence, Urge/drug therapy , Urinary Incontinence, Urge/etiology , Urinary Retention/chemically induced , Xerostomia/chemically induced
6.
Cent European J Urol ; 65(2): 75-9, 2012.
Article in English | MEDLINE | ID: mdl-24578933

ABSTRACT

INTRODUCTION: We present a cohort of patients with low-stage pelviureteric neoplastic disease who underwent complete laparoscopic nephroureterectomy (CLNUE) with intravesical lockable clip (IVLC). Due to the absence of a standard technique of NUE, the study was not randomized. MATERIALS: From 1/2010 to 1/2012, 21 patients were subjected to CLNUE-IVLC. The first step was transurethral excision of the ureterovesical junction with Collin's knife deep into the paravesical adipose tissue. The ureter was grasped with biopsy forceps and the distal end of the ureter was occluded with lockable clip. The applicator was introduced through a 5 mm port inserted as an epicystostomy. The patients were rotated to flank position and CLNUE followed. The endoscopically introduced clip on the distal ureter is proof of completion of the total ureterectomy. RESULTS: The mean operation time was 161 (115-200) min. In four (19.0%), the application of the clip failed and CLNUE was completed with non-occluded ureter. In three cases, subsequent laparoscopic nephrectomy was converted to open surgery. In two cases, the distal ureterectomy was completed with pluck technique through a lower abdominal incision that was also used for extraction of the specimen. There were four complications (Clavien II 2x, IIIb, V). Follow-up was available for all - mean 10.6 (range: 0-25) months. One died of disease generalization within 11 months. CONCLUSION: CLNUE-IVLC is fast and safe. If needed, the endoscopic phase can be switched to open NUE. Disadvantages include: the need to change the position of the patient, the risk of inability to apply the clip on the distal ureter, and the risk of an unclosed defect of the urinary bladder.

7.
World J Urol ; 29(3): 349-54, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21107846

ABSTRACT

INTRODUCTION: Tubulocystic renal carcinoma (TCRC) is a recently described neoplastic entity. To date, clinicopathological features on less than hundred cases of these rare tumours have been characterized exclusively in the pathological literature. Herein, we present five additional cases emphasizing clinical aspects on these rare renal neoplasms. MATERIAL AND METHOD: Cases diagnosed as TCRC were retrieved and reviewed from the routine and consultation files of the Pilsen tumour registry comprising over 20,000 cases of renal tumours. RESULTS: All patients were men, mean age 56 years (range 29-70). Features on computed tomography (CT) were in two cases Bosniak III, one IV and two were solid tumours. In four patients, nephrectomy was performed, and one patient underwent resection. At the time of surgery, two patients had metastases. In one case, both primary tumour and metastases were active on FDG positron emission tomography (PET)/CT. Both patients with metastatic disease were treated with sunitinib with partial response. One patient died 26 months postoperatively and the other patient is alive 5 months after surgery. Three patients with localized tumours are without evidence of disease 31, 28 and 7 months after surgery. In one case, the resected tumour was histologically combined with a papillary renal cell carcinoma (PRCC). CONCLUSION: TCRC occurs predominantly in men with a wide age range. TCRC frequently displays a cystic component which may render a radiological classification of Bosniak III or IV. FDG PET/CT is helpful in the detection of metastases. TCRC has definitive malignant potential. Our findings support a possible relationship to PRCC. The tyrosine kinase inhibitor sunitinib may be used a therapeutical agent with partial response and temporary effect.


Subject(s)
Carcinoma, Renal Cell/classification , Carcinoma, Renal Cell/pathology , Kidney Neoplasms/classification , Kidney Neoplasms/pathology , Adult , Aged , Antineoplastic Agents/therapeutic use , Carcinoma, Renal Cell/therapy , Combined Modality Therapy , Humans , Indoles/therapeutic use , Kidney Neoplasms/therapy , Male , Middle Aged , Nephrectomy/methods , Pyrroles/therapeutic use , Sunitinib , Treatment Outcome
8.
Urol Int ; 83(3): 264-70, 2009.
Article in English | MEDLINE | ID: mdl-19829022

ABSTRACT

INTRODUCTION: We describe another variant of nephroureterectomy - antegrade mini-invasive nephroureterectomy (AMNUE). METHODS: AMNUE starts with a laparoscopic nephrectomy in the flank position. The specimen is enclosed in a bag without dividing the ureter, and the patient is positioned to the lithotomy position. Then the ureterovesical junction is excised transurethrally with a Collins knife. Finally, the specimen is removed and the ureter is plucked out through a short lower abdomen incision. PATIENTS: From March 2005 to November 2008, 35 patients underwent nephroureterectomy: 7 as an open procedure, 8 as a laparoscopic nephrectomy with open ureterectomy, 8 as a complete laparoscopic nephroureterectomy, and 12 were admitted into the AMNUE group (7 men and 5 women, mean age 71 +/- 7 years, range 54-81 years). RESULTS: Tumors were found 6 times on both sides. The mean operation time was 165 +/- 32 min (105-210 min), and the mean blood loss was 150 +/- 91 ml (50-400 ml). Histology revealed 11 urothelial cancers and 1 papillary renal cell carcinoma. There was only 1 hematoma of the abdominal wall. CONCLUSION: AMNUE is a fast, safe and easily reproducible technique. It eliminates the risk of spillage of tumorous cells into the urine, which is possible in techniques where the ureter is excised with a Collins knife as the first procedure. The disadvantages of this approach are the necessary repositioning of the patient and that the long-term oncological results are currently unknown. AMNUE can be used when a complete laparoscopic nephroureterectomy is not technically feasible due to problems in the pelvis.


Subject(s)
Kidney Neoplasms/surgery , Laparoscopy , Nephrectomy/methods , Ureter/surgery , Ureteral Neoplasms/surgery , Urinary Bladder/surgery , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Urethra
9.
Int Urol Nephrol ; 41(3): 553-7, 2009.
Article in English | MEDLINE | ID: mdl-18998233

ABSTRACT

OBJECTIVE: Recently, a novel renal carcinoma with specific clinical and histological characteristics and translocation t(6;11)(p21.1;q12 or q13) has been identified. We have found 11 cases in the literature, and we are adding another 3 cases. MATERIALS AND METHODS: Three cases were found in the Plzen pathological register with approximately 15,000 cases of kidney tumors. There were two females and 1 male, aged 22, 24, and 39 years. RESULTS: The sizes of the tumors were 40, 136, and 10 mm. Two tumors were found incidentally; the biggest one was self-palpated by a 24-year-old pregnant patient. Patients are without any signs of disease 42, 20, and 17 months after surgery. CONCLUSION: This tumor is a distinctive and rare translocation carcinoma of the kidney [t(6;11), HMB45 positive]. All cases with known clinical data arose in younger people. The malignant potential is probably low.


Subject(s)
Carcinoma, Renal Cell/genetics , Kidney Neoplasms/genetics , Pregnancy Complications, Neoplastic/genetics , Translocation, Genetic , Adult , Antigens, Neoplasm/analysis , Carcinoma, Renal Cell/chemistry , Female , Humans , Kidney Neoplasms/chemistry , Male , Melanoma-Specific Antigens , Neoplasm Proteins/analysis , Pregnancy , Young Adult
10.
Urology ; 73(5): 1115-8, 2009 May.
Article in English | MEDLINE | ID: mdl-18502479

ABSTRACT

OBJECTIVES: To assess the feasibility of partial nephrectomy (PN) without renal hilar clamping using the 80-W GreenLight (532 nm) laser with opening of the collecting system followed by its suture in a porcine model. METHODS: We performed 12 open laser PNs in 6 farm pigs. We used the technique of incisional laser ablation of the lower pole of the right kidney. The pigs were kept alive, and 2 weeks later, underwent the same technique on the left kidney, followed by immediate killing. We recorded the acute and chronic outcomes. Renal parenchyma resection was achieved solely with the laser. The collecting system was opened with the laser in each procedure. All renal specimens underwent retrograde pyelography and histologic examination. RESULTS: All procedures were completed without renal hilar clamping. The mean operative and laser time was 67.1 +/- 20.6 minutes (range 35-95) and 17.8 +/- 6.4 minutes (range 10-30), respectively. The mean resected kidney mass was 17% +/- 0.5% (range 10%-27%) of the total kidney mass. The mean blood loss was 142.5 +/- 88.9 mL (range 50-350). No evidence of urinary extravasation was seen after the acute procedures, but proven urinomas with decayed suture were found after all chronic procedures. CONCLUSIONS: PN using the GreenLight laser is a feasible method for renal parenchyma incisional ablation. The laser hemostatic effect of interlobar vessel bleeding is safe and sufficient. The sutured collecting system after laser PN cannot heal in the thermically damaged tissue. The method is applicable to peripherally located lesions, without entering the collecting system. More prospective animal studies are necessary before application in humans.


Subject(s)
Kidney Tubules, Collecting/surgery , Laser Therapy/methods , Nephrectomy/methods , Suture Techniques , Animals , Biopsy, Needle , Blood Loss, Surgical/prevention & control , Constriction , Disease Models, Animal , Feasibility Studies , Hemostatic Techniques , Immunohistochemistry , Kidney Function Tests , Kidney Pelvis/physiology , Kidney Pelvis/surgery , Kidney Tubules, Collecting/pathology , Lasers , Nephrectomy/instrumentation , Recovery of Function , Risk Assessment , Sensitivity and Specificity , Sus scrofa , Swine , Treatment Outcome
11.
Int Urol Nephrol ; 37(4): 743-50, 2005.
Article in English | MEDLINE | ID: mdl-16362592

ABSTRACT

OBJECTIVE(S): To give an algorithm for resolution of extensively cystic renal neoplasms, preoperatively classified in the Bosniak classification as a category II and III. METHODS: From 1991 to 6/2004, 701 patients with 727 renal tumours were surgically treated at our hospital. Extensively cystic tumours were found in 10 cases. Extensively cystic tumours were defined as multicystic tumours without any solid nodules visible neither on CT, nor grossly in the specimen at operation (the Bosniak classification type II or III). RESULTS: Seven multilocular cystic renal cell carcinomas, three mixed epithelial and stromal tumour of the kidney and one cystic nephroma were diagnosed on histology. CONCLUSION(S): Extensively cystic renal tumours classified as the Bosniak type II or III correspond histologically to the entities mentioned above (multilocular cystic renal cell carcinoma, cystic nephroma, mixed epithelial and stromal tumour of the kidney). These entities cannot be distinguished one from another on preoperative imaging studies. A preoperative biopsy and intra-operative frozen-section analysis do not lead to a correct diagnosis in many cases. Fortunately, the operative strategy is the same for all these tumours. In such cases, the nephron sparing surgery is indicated, whenever technically feasible, as almost all extensively cystic renal tumours have a good prognosis.


Subject(s)
Carcinoma, Renal Cell/pathology , Kidney Neoplasms/pathology , Adult , Carcinoma, Renal Cell/classification , Carcinoma, Renal Cell/surgery , Humans , Kidney Neoplasms/classification , Kidney Neoplasms/surgery , Male , Middle Aged , Nephrectomy , Retrospective Studies , Wilms Tumor/pathology
13.
Scand J Urol Nephrol ; 38(6): 481-4, 2004.
Article in English | MEDLINE | ID: mdl-15841782

ABSTRACT

OBJECTIVE: Typical signs of papillary renal cell carcinoma (PRCC) are extensive necroses of the tumorous mass, which can modify the clinical appearance of PRCC. These necroses can imitate cysts on radiological examinations (ultrasonography and CT). The tumours are fragile and vulnerable to spontaneous rupture or rupture following minimal trauma (i.e. they act as a locus minoris resistentiae). MATERIAL AND METHODS: A total of 650 patients with a total of 671 renal tumours were surgically treated at our hospital between January 1991 and December 2003. RESULTS: In 16 cases bilateral tumours were found (in all cases RCC) and in five cases two types of tumour were identified in one kidney [all were a combination of conventional RCC (CRCC) and PRCC]. Altogether, 621 tumours (92.5%) were diagnosed as RCCs. Of these, CRCC was found in 563 cases (90.7%), PRCC in 36 (5.8%), chromophobe RCC in 14 (2.3%) and unclassified RCC in 7 (1.1%). All cases of ruptured PRCC were included in our study. Interestingly, only PRCCs ruptured in this series. Rupture was described in three cases of PRCC (8.3%): it was spontaneous in two cases and resulted from a traffic accident in the third. CONCLUSIONS: The extensive necrosis regularly found in PRCC can cause rupture of the tumour followed by retroperitoneal bleeding. Rupture affected <10% of our cases of PRCC. CT findings are usually not characteristic and can mimic a simple haematoma of unknown origin. Similarly, the perioperative finding is unclear in most cases. The final correct diagnosis of the renal tumour is frequently established only by the pathologist.


Subject(s)
Carcinoma, Papillary/etiology , Carcinoma, Renal Cell/etiology , Kidney Neoplasms/etiology , Kidney/injuries , Abdominal Injuries/complications , Abdominal Injuries/diagnosis , Abdominal Injuries/surgery , Accidents, Traffic , Adolescent , Aged , Carcinoma, Papillary/diagnosis , Carcinoma, Papillary/surgery , Carcinoma, Renal Cell/diagnosis , Carcinoma, Renal Cell/surgery , Diagnosis, Differential , Female , Hemoperitoneum/diagnosis , Hemoperitoneum/etiology , Hemoperitoneum/surgery , Humans , Kidney Neoplasms/diagnosis , Kidney Neoplasms/surgery , Male , Retrospective Studies , Rupture , Rupture, Spontaneous , Tomography, X-Ray Computed
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