Validated instruments in the evaluation and treatment outcomes of stress urinary incontinence in women.

Urinary incontinence is a highly prevalent condition. Although there are commonly used tools for the evaluation of urinary incontinence and measurement of treatment outcomes, there is no universally accepted standard. However, there are several validated instruments currently available and in use for assessment of patient-reported outcomes. Such an emphasis on patient-reported outcomes is key because there can be discrepancies between a physician's and a patient's perception of symptom severity and outcome.

Non-clamped partial nephrectomy: techniques and surgical outcomes.

OBJECTIVE: • To describe our technique of partial nephrectomy (PN) without vascular clamping with perioperative and short-term data to determine the safety, impact on renal function and oncological efficacy of this approach. PATIENTS AND METHODS: • We performed a retrospective review of 952 PNs done at our institution between 1987 and 2009. Patients undergoing ex vivo PN with auto-transplantation, patients with Von Hippel-Lindau disease and patients with incomplete follow-up information were excluded from the analysis. • The four-variable modification of diet in renal disease equation was used to calculate estimated glomerular filtration rate (eGFR). • The percentage change in eGFR at 1 year was compared between the two groups. RESULTS: • The analysed cohort comprised 116 PNs done with renal vascular clamping (group A) and 192 PNs done without clamping (group B). The median tumour size was slightly larger in group B than in group A (3.0 vs 2.8 cm, P = 0.002). • There was no difference in preoperative eGFR (P = 0.304) or the prevalence of solitary kidney (P = 0.69). • Median estimated blood loss was 300 mL higher in the unclamped group (P < 0.001) and was associated with a higher rate of transfusion (P = 0.001). There was no difference the positive margin rate or rate of recurrence (P = 0.60). • The median percentage change in eGFR was a 12.3% decrease for group A and a 9.8% decrease for group B at 1 year (P= 0.037). In the subset of patients with solitary kidneys, the median change in eGFR was a 21% decrease in group A and a 4.4% decrease in group B at 1 year (P = 0.027). • The rate of complications was similar in groups A and B (11.2 vs 9.9%, P = 0.72). There were no perioperative deaths. CONCLUSIONS: • Partial nephrectomy can be safely performed without vascular clamping in appropriately selected patients. • Although PN without vascular clamping is associated with higher estimated blood loss, it is also associated with better preservation of renal function without compromising oncological efficacy, as evidenced by the solitary kidney cohort.

P-cadherin as a prognostic indicator and a modulator of migratory behaviour in bladder carcinoma cells.

OBJECTIVE: To identify changes associated with P-cadherin expression in bladder cancer and evaluate the potential role of such events in determining the clinical outcome and cell behaviour, as the function of P-cadherin in normal epithelium is unknown, as is its potential role in neoplastic progression in different cancers. MATERIALS AND METHODS: In all, 536 bladder tumour specimens from 408 patients were assembled in seven tissue microarrays. Paraffin sections from each array were processed for immunohistochemistry to assess the expression of P-cadherin. The expression of P-cadherin was forced using lipofectin, followed by an assessment of migration and invasion potential using standard in vitro assays. RESULTS: The absence of P-cadherin staining was associated with muscle-invasive disease, grade 3 (P < 0.001) and nodal disease (P = 0.009). Similar results were obtained when considering cytoplasmic and unrestricted localization of P-cadherin (P < 0.001), except for nodal involvement. The group with cytoplasmic location of P-cadherin showed a shorter cancer-specific survival than the group with membrane location of P-cadherin (P = 0.03). Forced expression of P-cadherin in EJ and UM-UC-3 cells, that constitutively lack P-cadherin expression, resulted in modulation of catenin expression and enhanced migration of EJ and UM-UC-3/P-cadherin transfectants (>200%). CONCLUSIONS: These results showed that loss of expression, cytoplasmic relocation or unrestricted tissue location of P-cadherin was associated with a poor clinical outcome and prognosis in bladder cancer. From the in vitro work it is evident that P-cadherin plays a role in regulating the migration potential of bladder carcinoma cells.

Prognostic significance of altered p120 ctn expression in bladder cancer.

OBJECTIVE: To identify the frequency of change in the expression and localization of p120(ctn) in bladder tumours and its association with clinical outcomes, and to investigate the potential role of p120(ctn) in the migratory and invasive behaviour of bladder carcinoma cells. MATERIALS AND METHODS: In all, 425 superficial tumour specimens (Ta, Tis and T1) and 305 invasive (T2-T4) tumour specimens from 534 patients were assembled in 10 tissue microarrays. P120(ctn) immunostaining was scored for intensity and cellular localization and correlated with clinical variables and survival analysis. Knockdown of p120(ctn) was achieved using small-interference RNA (siRNA) followed by the assessment of migration and invasion behaviour in standard in vitro assays. RESULTS: The expression levels of p120 catenin inversely correlated with pathological tumour stage (P < 0.001), histological grade (P < 0.001), presence of lymphovascular invasion (P = 0.02) but not lymph node (LN) involvement (P = 0.17). Non-membranous localization of p120(ctn) correlated with stage (P < 0.001), grade (P < 0.001), lymphovascular invasion (P = 0.04) and LN-positive disease (P = 0.02). A low expression level of p120(ctn) was linked to a poor outcome in cancer-specific survival analysis. Knockdown of p120(ctn) using siRNA resulted in a significant reduction in the migration and invasive potential of bladder carcinoma cells. CONCLUSIONS: Our findings suggest that p120(ctn) acts as a prognostic factor in bladder tumours and has a primary role to play in the migratory and invasive behaviour of bladder carcinoma cells.