The determination of stage in nonmuscle urothelial carcinoma: Staining pattern of caspase-8.

CONTEXT: Urothelial carcinoma (UC) is one of the most frequent epithelial tumors worldwide. AIMS: We aimed to investigate the protein expressions of caspase-8, p53, murine double minute 2 (mdm2), and p14ARF in nonmuscle UCs and to correlate the findings with clinicopathological characteristics. SETTINGS AND DESIGN:: A total of 50 patients who had pTa and pT1 tumors were analyzed. SUBJECTS AND METHODS: The protein expressions of caspase-8, p53, mdm2, and p14ARF were analyzed by immunohistochemistry. STATISTICAL ANALYSIS USED: Chi-square test was done using SPSS version 16.0 (SPSS, Inc., Chicago, IL, USA). RESULTS: Cytoplasmic caspase-8 expression was significantly higher in pT1 UCs while nuclear caspase-8 expression was significantly higher in pTa UCs (P = 0.005 and P = 0.011, respectively). Cytoplasmic caspase-8 expression was also higher in high-grade UCs (P = 0.035). The expression of p53, mdm2, and p14ARF was not also related with pathological stage or grade (P > 0.05 for all). The p14ARF expression was related with nuclear caspase-8 expression in most of the patients. Complete agreement among nonmuscle UCs for immunohistochemical expression of p14 and nuclear caspase-8 was seen in 41 cases, and the pairwise kappa agreement value was substantial (κ =0.614). The patients who had recurrence were positive for both p53 and mdm2 or either p53 or mdm2 (P = 0.025). CONCLUSIONS: These results suggested that the staining pattern of caspase-8 might be helpful for determining of the stages in nonmuscle UC. It was also showed that the expression status of p53 and mdm2 were related with the recurrence.

Human TLR gene family members are differentially expressed in patients with urothelial carcinoma of the bladder.

PURPOSE: Toll-like receptors (TLRs) have an important role in the activation of both innate and adaptive immunity in response to pathogens and endogenous danger signals from damaged or dying cells. The aim of this study was to determine the relationship between urothelial carcinoma (UC) and TLR expression. BASIC PROCEDURES: Real-time polymerase chain reaction evaluation was made of the messenger RNA expression of TLRs 1-10 in 24 UC samples and 46 nontumoral bladder tissue samples. The levels of proinflammatory cytokines (IL-1ß, IL-6, and IL-8) in the urine samples were also determined with enzyme-linked immunosorbent assay. MAIN FINDINGS: TLR2-7 and TLR10 expressions were significantly higher in UC than in the control group (P<0.05 for all comparisons). No concordance was found between matched tumor tissue and urine samples in terms of TLR expression. IL-1ß, IL-6, and IL-8 levels were significantly higher in urine specimens of patients with UC (P = 0.033, P = 0.001, and P = 0.008, respectively). PRINCIPAL CONCLUSIONS: The results of this study demonstrated that the TLR gene expression profiles reflect the heterogeneity within UC. These results might also prompt further investigation to better understand the role of the TLR gene family expression in the tumor progression of UC.

Primary malignant melanoma of the penis: a case report.

We present the case of a patient with malignant melanoma of the glans penis and urethral meatus, which was found in a 60-year-old man with non-healing ulcerative penile lesion and bilateral clinically palpable inguinal lymphadenopathies at diagnosis. A diagnostic biopsy showed the characteristics of a malignant melanoma. Incisional biopsies from the cutaneous lesions on his glans penis and urethra were performed. Histopathological examination of both specimens showed generally ulceronecrotic surface and numerous atypical melanocytic cells. The diagnosis of giant cell melanoma was made. Two months later, bilateral inguinal lymph nodes dissection was performed. Histopathological examination of both specimens demonstrated malignant melanoma metastasis. Three months after the diagnosis, the patient underwent partial penectomy. High-dose interferon-alpha-2b treatment was started. Early diagnosis is of paramount importance, as the prognosis becomes very poor with an advanced tumor stage.

Elevation of serum and urinary carbohydrate antigen 19-9 in benign hydronephrosis.

OBJECTIVE: The aim of this study was to find out the predictive role of serum and urinary carbohydrate antigen 19-9 levels in benign hydronephrosis and whether these levels are helpful for differentiation of complete or partial urinary obstruction. MATERIALS AND METHODS: Fifty-four patients with, and 23 without, benign hydronephrosis were enrolled in this study. Serum and urinary carbohydrate antigen 19-9 were determined by the chemiluminescence enzyme immunometric assay method and these levels were correlated with clinical factors. RESULTS: The mean serum (P < 0.0001) and urinary (P < 0.0001) carbohydrate antigen 19-9 and serum creatinine (P < 0.008) levels were significantly higher in the hydronephrosis group than the control group. There was significant correlation between serum and urinary carbohydrate antigen 19-9 levels in the hydronephrosis group (r = 0.639, P < 0.0001). In the hydronephrosis group, there were no significant differences between the serum creatinine, serum or urinary carbohydrate antigen 19-9 levels and the clinical features except symptom duration. The best cut-off value for the serum and urinary carbohydrate antigen 19-9 were found to be 4.84 U/mL and 29.35 U/mL, respectively. CONCLUSION: Serum and urinary carbohydrate antigen 19-9 levels correlated with each other, were significantly elevated in patients with hydronephrosis and did not predict complete urinary obstruction. Benign hydronephrosis should be considered in the differential diagnosis of carbohydrate antigen 19-9 increments, as this is what is of most importance in clinical practice.

Does two episodes of acute urinary retention lead to additional ischemia-reperfusion injury in rat bladder?

AIM: To determine whether two episodes of acute urinary retention lead to additional ischemia-reperfusion injury due to decompression of the bladder, or not. MATERIALS AND METHODS: Sham, retention and recurrent retention groups consisting of 5, 8 and 8 Wistar Albino male rats were randomized, respectively. After the bladders of rats were emptied with 3F catheter, penile urethras were clamped with aneurism clamp and waited for 30 min after diuresis was forced. At the end of this period, penile clamps were removed and the bladder was again decompressed with 3F catheter and after 30 min removed for examination. In the recurrent retention group, the same process was repeated after an interval of one week. Malonedialdehyde (MDA) levels, indicator of lipid peroxidation and myeloperoxidase (MPO) levels, indicator of leukocyte activation, were examined biochemically in the tissues of the removed bladders. RESULTS: In the retention and recurrent retention groups, the average increase in bladder MDA and MPO values was higher than the values of sham group (P < 0.05), however, no significant difference was determined between retention and recurrent retention groups (P > 0.05). CONCLUSION: In the bladder tissue, due to acute urinary retention and following decompression process, ischemia-reperfusion injury occurs. Two episodes of acute urinary retention do not lead to additional the ischemia-reperfusion injury that develops in the bladder.

Does digital rectal examination affect uroflowmetry measurements?

AIMS: To determine whether digital rectal examination (DRE) would affect uroflowmetry parameters and whether these findings were not due to the circaidan changes. METHODS: A total of 79 male patients (59 in study and 20 in control group) were included in this study. First uroflowmetry was done at 10:00 am just before the genitourinary physical examination in the study group. Second and third uroflowmetry was performed at the 6th and 24th hour after the first uroflowmetry. The same uroflowmetry tests were done in a control group without DRE. Voided volume and maximum and average flow rate parameters of uroflowmetry were interpreted in our study. The relationship among first, second, and third uroflowmetry parameters were determined in the study and control groups. RESULTS: There were statistically no difference between the mean first, or 6th- or 24th-hour uroflowmetry parameters of the study and control groups (P > 0.05). CONCLUSIONS: We could not find any effect of DRE on uroflowmetry parameters. Studies in a larger patient series would be appropriate for recommending DRE before or after uroflowmetry test.