Immediate post-operative intravesical instillation of a single dose chemotherapy is not superior to continuous saline irrigation.

INTRODUCTION AND OBJECTIVES: To evaluate whether there is any difference between immediate postoperative instillation of intravesical chemotherapy (IPOIC) and continuous saline bladder irrigation (CSBI) in terms of bladder cancer (BC) recurrence in patients with primary low- or intermediate-risk non-muscle-invasive BC (NMIBC). MATERIALS AND METHODS: Medical records of 1482 patients who underwent transurethral resection of bladder tumor between March 1994 and August 2020 were reviewed retrospectively. Patients were divided into two groups according to IPOIC and/or CSBI administration status [Group-1 = CSBI alone; Group-2 = CSBI following IPOIC]. Low- and intermediate-risk NMIBC patients were also divided into subgroups according to IPOIC and/or CSBI administration status. RESULTS: A total of 594 patients with primary NMIBC were included. Of the patients, 86 (14.5%) were female and 508 (85.5%) were male with a median age of 69 (60-78) years. The frequency of patients in Group-1 and Group-2 were 361 (60.8%) and 233 (39.2%), respectively. Recurrent disease was observed in 213 (35.9%) patients. There was no difference between the groups when they were compared for recurrent disease frequency, median time to first recurrence and frequency of recurrence within first 12 months (P = .064, P = .671, and P = .145, respectively). Disease recurrence rates in low-risk NMIBC patients was lower when they were treated with "CSBI following IPOIC" when compared to "CSBI alone" (P = .042). However, no difference was observed in low-risk NMIBC subgroups when they were compared for pathological features of recurrent tumors such as number, size, grade, stage, and presence of carcinoma in situ (P > .05, for each). CONCLUSIONS: "CSBI following IPOIC" combination was not superior to "CSBI alone" for preventing adverse pathological outcomes in recurrent low- and intermediate-risk NMIBC.

Should Targeted Biopsy be Performed in Patients Who Have Only Pi-rads 3 Lesions?

Objective: To determine whether clinical or radiological parameters can predict clinically significant prostate cancer (csPC) in patients with the Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions. Patients and Methods: Data were obtained from 247 patients with PI-RADS 3 lesions on mpMRI and who had received a software guided transperineal/transrectal MRI/transrectal ultrasonography (MRI/TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy following mpMRI in the prostate cancer and prostate biopsy database of Turkish Urooncology Association, between 2016 and 2020. The cut-off values of clinical parameters were determined using receiver operating characteristic (ROC) curve analysis. Simple and multiple logistic regression analyses were performed to determine the clinical parameters in predicting csPC. Results: A total of 56 patients (22.6%) had prostate cancer, 23 (9.3%) of whom had csPC. In the lesion- based analysis, cancer detection rates (CDRs) of each lesion in targeted biopsy were found to be 6% and 5% for ISUP GG 1 and ISUP GG ≥ 2, respectively. In the patient-based analysis, clinically insignificant CDRs were significantly higher in systematic biopsy compared with targeted biopsy, whereas no significant difference was found in terms of clinically significant CDRs (p = 0.020 and p=0.422, respectively). The cut-off values were determined as 48.3 mL (AUC [95% CI] = 0.68 [0.53–0.82]) for prostate volume, and 0.213 ng/mL/mL (AUC [95% CI] = 0.64 (0.51–0.77]) for PSAD in predicting csPC. In the multiple logistic regression analysis, only PSAD was found to be an independent risk factor in predicting csPC (OR [95% CI]: 3.56 [1.15–10.91], p = 0.024). Conclusion: Since PSAD > 0.20 ng/mL/mL was found to be positive independent risk factor in predicting csPC, in the absence of advanced radiological parameters, PSAD could be used for the biopsy decision in patients with PI-RADS 3 lesions (AU)

The association between perineural invasion in mpMRI-targeted and/or systematic prostate biopsy and adverse pathological outcomes in robot-assisted radical prostatectomy.

INTRODUCTION AND OBJECTIVES: This study aims to investigate the relationship between perineural invasion (PNI) in targeted (TBx) and/or systematic (SBx) prostate needle biopsy and adverse pathological features of prostate cancer (PCa) in prostatectomy specimens. MATERIALS AND METHODS: A total of 95 male patients who underwent transperineal TBx and/or concomitant SBx subsequently treated with robot-assisted radical prostatectomy for PCa between October 2015 and June 2020 were included. The performance of PNI as a classification test (sensitivity, specificity, positive and negative predictive values) and its correlation with clinically significant PCa, surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy were computed. RESULTS: The median age of the patients was 65 (60-70) years. TBx and concomitant SBx were performed in 78 (82.1%) patients, while 16 (16.8%) patients underwent SBx alone and one (1.1%) patient underwent TBx alone. The frequency of PNI in TBx and SBx was 17 (21.5%) and 32 (34.0%), respectively. The specificity/negative predictive values of PNI for surgical margin positivity, extraprostatic extension, and seminal vesicle invasion were 79.7/88.7%, 92.5/79.0%, and 83.3/96.8%, in TBx, and 71.1/87.1%, 80.7/74.2%, and 69.5/91.9%, in SBx, respectively. There was also a statistically significant correlation between PNI in biopsy and surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy as well as the ISUP grade group and pT stage. CONCLUSIONS: The absence of PNI in prostate needle biopsy may predict localized PCa with a pT stage ≤ 2c and negative surgical margins in contrast to its presence which appears to be an indicator of unfavorable factors in final pathology.

Quimioterapia basada en docetaxel en el tratamiento de pacientes con cáncer de prostata resistente a la castración / Docetaxel based chemotherapy in the treatment of patients with castration resistant prostate cancer

Introducción: El docetaxel administrado cada 3 semanas es el tratamiento estandar del cáncer de próstata resistente a la castración (CPRC), pero se asocia con toxicidades limitantes de dosis. Se analizó la eficacia y la tolerabilidad de docetaxel 3 veces a la semana y una vez a la semana en una cohorte turca de pacientes con CPRC, con un énfasis especial en los pacientes de edad avanzada. Materiales y métodos: Se realizó un análisis retrospectivo de 45 pacientes que recibieron docetaxel 3 veces a la semana o una vez a la semana en una única clínica de oncología urológica. Se evaluaron las tasas de respuesta al tratamiento, toxicidad y supervivencia global. Resultados: La edad media de los pacientes fue de 70,0 (± 8,8) años. Se obtuvo respuesta completa o parcial de PSA en el 45% de los pacientes. La mediana de supervivencia global fue de 20,0 meses (SE: 6,46; IC 95%: 7,3-32,6). La ausencia de metástasis, tiempo hasta CPRC > 10 meses, 75 mg/m2 de DP una vez cada 3 semanas y PSA < 50% al final del tercer ciclo se asociaron con una mejor supervivencia global. No hubo diferencia significativa en la supervivencia entre los pacientes de 75 años o más en comparación con los más jóvenes. La toxicidad hematológica más frecuente fue la leucopenia, que fue limitante de la dosis en un solo paciente. Conclusión: La administración de docetaxel estándar 3 veces a la semana está bien tolerada en esta relativamente antigua cohorte de pacientes turcos con CPRC, y la administración semanal puede ser una alternativa razonable en pacientes frágiles, no solo para prolongar la supervivencia, sino también para aliviar los síntomas de la enfermedad

Introduction: Docetaxel administered every 3-weeks is the standard treatment of castration resistant prostate cancer (CRPC) but it is associated with dose limiting toxicities. We analyzed the efficacy and tolerability of 3-weekly and weekly docetaxel in a Turkish cohort of CRPC patients with a special emphasis on the elderly patients. Materials and methods: A retrospective analysis of 45 patients who received either 3-weekly or weekly docetaxel in a single urologic oncology clinic was performed. Response to therapy, toxicity and overall survival rates were evaluated. Results: The mean age of patients was 70.0 (± 8.8) years. Complete or partial PSA response was obtained in 45% of patients. The median overall survival was 20.0 months (SE 6.46; 95% CI 7.3-32.6). Absence of metastasis, time to CRPC >10 months, DP 75 mg/m2 once every 3 weeks and PSA <50% at the end of the third cycle were associated with better overall survival. There was no significant survival difference between the patients aged 75 or older versus younger ones. The most common hematological toxicity was leukopenia which was dose limiting in only one patient. Conclusion: Administration of standard 3-weekly docetaxel is well tolerated in this relatively old cohort of Turkish CRPC patients and weekly administration can be a reasonable alternative in frail patients not only to prolong survival but also to palliate disease symptoms

Docetaxel based chemotherapy in the treatment of patients with castration resistant prostate cancer.

INTRODUCTION: Docetaxel administered every 3- weeks is the standart treatment of castration resistant prostate cancer (CRPC) but it is associated with dose limiting toxicities. We analyzed the efficacy and tolerability of 3- weekly and weekly docetaxel in a Turkish cohort of CRPC patients with a special emphasis on the elderly patients. MATERIALS AND METHODS: A retrospective analyses of 45 patients who received either 3- weekly or weekly docetaxel in a single urologic oncology clinic was performed. Response to therapy, toxicity and overall survival rates were evaluated. RESULTS: The mean age of patients was 70.0 (±8.8) years. Complete or partial PSA response was obtained in 45% of patients. The median overall survival was 20,0 months (SE 6.46; 95% CI 7,3-32,6). Absence of metastasis, time to CRPC>10 months, DP 75mg/m2 once every three weeks and PSA<50% at the end of the third cycle were associated with better overall survival. There was no significant survival difference between the patients aged 75 or older versus younger ones. The most common hematological toxicity was leukopenia which was dose limiting in only one patient. CONCLUSION: Administration of standart 3-weekly docetaxel is well tolerated in this relatively old cohort of Turkish CRPC patients and weekly administration can be a reasonable alternative in frail patients not only to prolong survival but also to palliate disease symptoms.

Concurrent chemoradiotherapy with low dose weekly gemcitabine in medically inoperable muscle-invasive bladder cancer patients

PURPOSE: We aimed to determine the efficacy and the toxicity of low dose weekly gemcitabine with radiation therapy in medically unfit muscle-invasive bladder cancer patients. METHODS: Twenty-six patients were included into the retrospective analysis. Weekly gemcitabine was administered 75 mg/m(2) with a median dose of 63 Gy radiation therapy. Clinical target volume was defined as the urinary bladder only in conformal treatment planning. RESULTS: Median follow-up was 51 months (range 14-118 months). Complete response rate was 62.5 %. The 5-year local progression-free survival, disease-specific survival and overall survival rates were 40.6, 59.5 and 58.5 %, respectively. Concurrent chemotherapy was continued in 80.7 % of patients without any interruption. Gemcitabine was stopped due to grade 3 thrombocytopenia (n = 1), cardiac angina (n = 1), chronic obstructive pulmonary disease exacerbation (n = 1) or patients' reluctance (n = 2). CONCLUSIONS: Low dose weekly gemcitabine with concurrent radiotherapy is a tolerable regimen and have comparable outcomes with platinum-based combined treatments in muscle-invasive bladder cancer. Prospective randomized trials can help in understanding the safety and efficacy of this treatment specially in medically unfit patients (AU)

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Concurrent chemoradiotherapy with low dose weekly gemcitabine in medically inoperable muscle-invasive bladder cancer patients.

PURPOSE: We aimed to determine the efficacy and the toxicity of low dose weekly gemcitabine with radiation therapy in medically unfit muscle-invasive bladder cancer patients. METHODS: Twenty-six patients were included into the retrospective analysis. Weekly gemcitabine was administered 75 mg/m(2) with a median dose of 63 Gy radiation therapy. Clinical target volume was defined as the urinary bladder only in conformal treatment planning. RESULTS: Median follow-up was 51 months (range 14-118 months). Complete response rate was 62.5 %. The 5-year local progression-free survival, disease-specific survival and overall survival rates were 40.6, 59.5 and 58.5 %, respectively. Concurrent chemotherapy was continued in 80.7 % of patients without any interruption. Gemcitabine was stopped due to grade 3 thrombocytopenia (n = 1), cardiac angina (n = 1), chronic obstructive pulmonary disease exacerbation (n = 1) or patients' reluctance (n = 2). CONCLUSIONS: Low dose weekly gemcitabine with concurrent radiotherapy is a tolerable regimen and have comparable outcomes with platinum-based combined treatments in muscle-invasive bladder cancer. Prospective randomized trials can help in understanding the safety and efficacy of this treatment specially in medically unfit patients.

Nephrogenic adenoma of the ureter: case report.

Nephrogenic adenoma is a rare metaplastic benign lesion of urothelium in response to genitourinary tract procedures, chronic infection, trauma, urinary calculi and immunosuppressive therapy after renal transplantation. It has been reported to occur throughout the urinary tract especially, in the urinary bladder. We report a case of nephrogenic adenoma arising from the lower end of the right ureter with clinical and radiological features suspicious of carcinoma.

A giant adrenal pseudocyst: case report and review of the literature.

A 45-year-old woman whose MR images revealed a lobulated, complicated cyst with septations on the superior pole of left kidney underwent retroperitoneoscopic cyst marsupialization. In pathologic examination beneath the atrophic adrenal gland, hyalinized, calcification foci cyst wall without any surrounding epithelium was seen microscopically. It was reported to be "adrenal pseudocyst".

[Urinary tract injuries in polytraumatized patients]. / Verletzungen der ableitenden Harnwege bei polytraumatisierten Patienten.

BACKGROUND: Within the S3 Guideline Project of the European Association of Urology (EAU) an expert committee was set up to develop guidelines for the appropriate management of genitourinary trauma. These European guidelines were accepted in principle as national guidelines by the German Urological Society. Therefore, they also became the basis of the contribution of the German Urological Society to the S3 Guideline Project "Polytrauma" of the German Society for Trauma Surgery. METHOD: For the guideline "management of genitourinary trauma" all the requirements for classification as S3 guidelines were full-filled. The guideline itself was developed in accordance with the principles of "evidence-based medicine". A systematic analysis of literature published between 1966 and 2004 was carried out. The articles retrieved were assessed in respect of study design and clinical relevance and classified following the scheme of the Centre for Evidence-Based Medicine in Oxford. CONCLUSION: In suspected renal injuries the hemodynamic situation of the patient is the benchmark for the diagnostic and therapeutic algorithm. The diagnostic gold standard for the assessment of haemodynamically stable patients is CT scanning. Uncontrolled haemodynamic instability is an indication for immediate explorative laparotomy. Partial ureteral tears are managed by stenting; complete tears by immediate surgical repair. Pelvic fractures are often associated with bladder ruptures. Extraperitoneal bladder ruptures, identified by retrograde cystography, are in most cases safely managed by simple catheter drainage. Intraperitoneal ruptures require surgical intervention. Blood at the meatus may suggest a urethral lesion-blind urethral catheterization should not be attempted. Suprapubic cystostomy and delayed urethroplasty are recommended.

Is the positive biopsy core percent really predictive of non-organ confined prostate carcinoma?

OBJECTIVES: In this study, we investigated the association of positive biopsy core percent (PBCP), as well as other preoperative factors, with prostate cancer outcomes in a cohort of consecutive patients with clinically localized prostate cancer who underwent RRP. METHODS: Data from 203 patients who underwent RRP from March 1993 to May 2004 for clinically organ confined prostate cancer was analysed. The correlation of preoperative serum prostate specific antigen (PSA) level, biopsy Gleason score, total number of positive biopsies and PBCP with the extent of disease at final pathology and biochemical progression were analyzed. RESULTS: The mean PBCP was 29.8+/-21.1 (median 25). Histopathological examination of the RRP specimens revealed ECE in 66 (32.5 %), SVI in 43 (21.2 %), LNI in 8 (4 %), and positive SM in 59 (29.1 %). Overall, only 9% of patients ( 18 of 203) had biochemical progression at a median postoperative follow-up of 22 months. Univariate analysis revealed serum PSA, biopsy Gleason Score, the number of positive cores and PBCP as predictive factors for extra-prostatic disease in RRP specimens. However, multivariate analysis revealed that biopsy Gleason score and serum PSA were the strongest independent predictive factors for extra-prostatic disease while percent positive biopsy cores carried significance in the prediction of ECE and SM positivity. The number of positive cores was not a predictor of non-organ confined disease. Preoperative serum PSA was the only prognostic factor for determination of biochemical failure. CONCLUSION: Gleason score is the most important and independent predictive factor for extra-prostatic disease. The percentage of cores positive for cancer has significance only in the prediction of ECE and SM positivity. Further studies are needed before routine use of PBCP as one of the important preoperative prognostic factors.

¿Es el porcentaje de afectación de los cilindros de la biopsia realmente predictivo de cáncer de próstata no órgano confinado? / Is the positive biopsy core percent really predictive of non organ confined prostate carcinoma?

OBJETIVOS: Investigamos la asociación entre el porcentaje de afectación de los cilindros de biopsia y los parámetros clínicos preoperatorios, y la evolución del cáncer de próstata en una cohorte de pacientes con cáncer de próstata localizado intervenidos mediante prostatectomía radical retropúbica (PRR) de forma consecutiva. METODOS: Análisis retrospectivo de los datos de 203 pacientes con cáncer de próstata clínicamente órganoconfinado intervenidos de PRR entre Marzo de 1993 y Mayo del 2004. Se analiza la correlación del PSA preoperatorio, el Gleason en la biopsia, el número total de biopsias positivas y el porcentaje de afectación en la biopsia con la extensión de la enfermedad en el estudio anatomopatológico final y la progresión bioquímica. RESULTADOS: El porcentaje medio de afectación de los cilindros fue de 29,8 ± 21,1 (mediana 25). El análisis anatomopatológico de los especimenes quirúrgicos reveló extensión extracapsular en 66 casos (32,5%), invasión de las vesículas seminales en 43 (21,2%), afectación ganglionar en 8 (4%) y márgenes quirúrgicos positivos en 59 (29,1%). Globalmente, sólo el 9% de los pacientes (18 de 203) presentaron progresión bioquímica con un tiempo medio de seguimiento de 22 meses. El análisis univariante reveló que el Gleason en la biopsia, el número de cilindros afectos y el porcentaje de afectación eran factores predictivos de enfermedad extraprostática en el espécimen de la PRR. Sin embargo, en el análisis multivariante el Gleason y el PSA sérico eran los factores predictivos independientes más potentes de enfermedad extraprostática, mientras que el porcentaje de afectación de las biopsias tenia significación en la predicción de extensión extracapsular y márgenes positivos. El número de cilindros no fue predictivo de enfermedad extraprostática. El PSA preoperatorio fue el único factor pronóstico para la determinación de progresión bioquímica. CONCLUSIONES: La puntuación de Gleason es el factor independiente más importante en la predicción de enfermedad extraprostática. El porcentaje de los cilindros positivo para cáncer sólo tiene significación en la predicción de extensión extracapsular y márgenes quirúrgicos positivos. Son necesarios más estudios antes de utilizar rutinariamente el porcentaje de afectación de los cilindros como uno de los factores pronósticos preoperatorios importantes

OBJECTIVES: In this study, we investigated the association of positive biopsy core percent (PBCP), as well as other preoperative factors, with prostate cancer outcomes in a cohort of consecutive patients with clinically localized prostate cancer who underwent RRP. METHODS: Data from 203 patients who underwent RRP from March 1993 to May 2004 for clinically organ confined prostate cancer was analysed. The correlation of preoperative serum prostate specific antigen (PSA) level, biopsy Gleason score, total number of positive biopsies and PBCP with the extent of disease at final pathology and biochemical progression were analyzed. RESULTS: The mean PBCP was 29.8+/-21.1 (median 25). Histopathological examination of the RRP specimens revealed ECE in 66 (32.5 %), SVI in 43 (21.2 %), LNI in 8 (4 %), and positive SM in 59 (29.1 %). Overall, only 9% of patients ( 18 of 203) had biochemical progression at a median postoperative follow-up of 22 months. Univariate analysis revealed serum PSA, biopsy Gleason Score, the number of positive cores and PBCP as predictive factors for extra-prostatic disease in RRP specimens. However, multivariate analysis revealed that biopsy Gleason score and serum PSA were the strongest independent predictive factors for extra-prostatic disease while percent positive biopsy cores carried significance in the prediction of ECE and SM positivity. The number of positive cores was not a predictor of non-organ confined disease. Preoperative serum PSA was the only prognostic factor for determination of biochemical failure. CONCLUSION: Gleason score is the most important and independent predictive factor for extra-prostatic disease. The percentage of cores positive for cancer has significance only in the prediction of ECE and SM positivity. Further studies are needed before routine use of PBCP as one of the important preoperative prognostic factors

Important preoperative prognostic factors for extracapsular extension, seminal vesicle invasion and lymph node involvement in cases with radical retropubic prostatectomy.

INTRODUCTION: Initial diagnostic evaluation may provide information about the extent of disease after radical retropubic prostatectomy (RRP). The aim of this study was to investigate the predictive value of preoperative serum prostate specific antigen (PSA) level, local disease extension identified by transrectal ultrasound (TRUS), total number of positive biopsies and percentage of positive cores for cancer, as well as TRUS Biopsy Gleason score in determining the extent of disease in radical retropubic prostatectomy specimens. MATERIALS AND METHODS: A retrospective analysis was performed on 171 patients who underwent RRP from March 1993 to February 2003 for organ confined prostate cancer and whose follow-up data was accessible. The correlation of preoperative serum PSA level, local disease extension in TRUS, the total number of positive sextant biopsies and the percent of cores positive for cancer and Gleason score at TRUS biopsy specimen with the extent of disease at final pathology (Extra-capsular extension (ECE), seminal vesicle invasion (SVI), lymph node involvement (LNI) and surgical margin (SM) status on RRP specimens) were analyzed. RESULTS: The median age of the patients was 65 years. The mean preoperative serum PSA level of all patients was 11.6+/-1.2 (median 8.6) ng/ml. Histopathological evaluation of RRP specimens revealed 60 (35%) patients with ECE, 38 (22.2%) with SVI, 7 (0.04%) with LNI, and 58 (33.9%) had positive SM. Comparing the preoperative TRUS findings and postoperative evaluation of RRP specimens, the sensitivity of TRUS in predicting the ECE was 11.8% and specificity was 96%. Sensitivity of TRUS in predicting SVI was 9.8% and its specificity was 99%. With univariate analysis (sample t-test), Gleason score, percent of cores positive for cancer, and DRE were found to be predictive factors for extra-prostatic disease in RRP specimens. But with multivariate analysis (logistic regression test) Gleason score appears to be the most important and independent predictive factor for extra-prostatic disease in RRP specimens. Serum PSA levels and percentages of cores positive for cancer were also significant predictors of non organ-confined disease found at final pathology. CONCLUSION: Gleason score is the most important and independent predictive factor for extra-prostatic disease. Serum PSA levels and percentages of cores positive for cancer are the other important but non-independent predictive factors.

Paratesticular pleomorphic rhabdomyosarcoma in an adult.

Rhabdomyosarcoma (RMS) is the commonest variety of soft tissue sarcoma in children and young adults. It represents 6.5% of all malignant tumours in paediatrics with an annual incidence of 4 to 7 cases/million children. The primary paratesticular site is considered to have a good prognosis in comparison with other rhabdomyosarcomas, despite the frequency of retroperitoneal lymph node invasion. This superficial site allows rapid diagnosis and consequently often complete resection of the tumor. The multi-disciplinary treatment of paratesticular RMS has improved control of the disease with a 2-year survival of 80%. We herein report a case with paratesticular pleomorphic RMS, a rare and prognostically unfavorable variant of RMS, who is disease free for 60 months after management with multidisciplinary approach.

The efficacy of neoadjuvant chemotherapy in invasive bladder cancer.

Radical cystectomy is the gold standard in the treatment of invasive bladder cancer. However, five-year disease-free survival is low most probably due to micrometastatic disease at the time of surgery. The neoadjuvant chemotherapy may be performed as the first line management for invasive bladder tumors in order to treat micrometastases found at the diagnosis and improve resectability of larger neoplasms. A total of 43 patients diagnosed with invasive bladder tumors and 11 patients received neoadjuvant chemotherapy. The mean age of patients was 64 (43-74) years, and mean follow-up period was 52 months (12-114). Neoadjuvant chemotherapy protocol consisted of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) or cisplatin, methotrexate, and cisplatin (CMV). All patients in neoadjuvant chemotherapy group underwent radical cystectomy. There was no significant difference between the groups with respect to disease-free survival time and overall survival time. In patients who received neoadjuvant chemotherapy, the respective disease-free and overall survival times were 31 months and 36 months versus 30 months and 35 months in patients who were treated with surgery only (p > 0.05). Five-year survival rates were 36% and 31% in the chemotherapy and no-chemotherapy groups, respectively. In the present study, 5-year survival rate was not affected by neoadjuvant chemotherapy in invasive bladder tumor. Complete pathological remission (stage p0) was found in 28% and pathological downstaging (stage < T2) was seen in 9% of patients in the neoadjuvant chemotherapy group. Five-year survival rates were 75% and 14.2% in patients who responded to chemotherapy, and in patients with no response, respectively (p < 0.05). The most favorable prognostic factor in this study was the response to neoadjuvant chemotherapy revealed as complete remission or pathological downstaging. The most important issue remains the prediction of patients who would respond and benefit from neoadjuvant chemotherapy.

Apoptotic regression of prostatic tissue induced by short-term doxazosin treatment in benign prostatic hyperplasia.

OBJECTIVES: Benign enlargement of the prostate comprises both hypertrophy and in particular hyperplasia of prostatic stromal and glandular compartments. Alpha adrenergic blockade has been shown to be effective in the management of BPH. Recent investigations have shown that this effect may in part be due to apoptosis. METHODS: A total of 29 patients who were symptomatic due to BPH were enrolled into this prospective placebo controlled, double-blind randomized study and underwent prostatectomy at the end of the 4th week. Clinical efficacy was evaluated by a set of detailed investigations. Surgical specimens were analyzed by immunohistochemistry and tissue components of stroma, smooth muscle and glandular epithelium were calculated by a software on a computer after representative areas were scanned and captured as high resolution images. Apoptosis in each tissue specimen was analyzed by Terminal Deoxynucleotidyl Transferase End Labelling (TUNEL) method utilizing Biotin-16-dUTP. RESULTS: Both groups were similar in terms of baseline evaluation in all aspects. There was a steady decline in patients' urinary complaints as evidenced by International Prostate Symptom Score System (IPSS) in the doxazosin group compared to placebo. Uroflowmetric investigations on patients revealed that maximum flow rates in the active drug group increased throughout the study. Mean PSA levels decreased by 14% at the end of the study in the doxazosin group, while it increased by 11% in the placebo group. Average stroma to epithelial ratio in the doxazosin group was 2:1 in comparison to a value of 1:1 in the placebo group. The rate of apoptosis was 2.2% and 3.2% for the epithelial and stromal compartments, respectively, in the doxazosin group, and 1.2% and 2.7% for the placebo arm. CONCLUSIONS: These data suggest apoptosis as the possible underlying molecular mechanism partly responsible for the clinical efficacy and morphological changes induced by doxazosin treatment in BPH.

Early cystic relapse of embryonal carcinoma of testis in obturator fossa.

OBJECTIVE: We report a case of embryonal carcinoma stage IIB arising from the right testis that subsequently underwent chemotherapy and retroperitoneal lymph node dissection and presented with an early cystic recurrence in the obturator fossa. METHODS: This case is reanalyzed retrospectively and literature is reevaluated for the early recurrences of testicular tumors at atypical locations. We discuss the rarity of obturator fossa as a location for early recurrences of testis tumors. RESULTS: Only one case of recurrence in obturator fossa has been reported. CONCLUSIONS: This case provides an example of the possibility of recurrence in an unpredictable short interval subsequent to proper therapies and underscores the importance of close follow-up.

Effect of urinary stone disease and extracorporeal shockwave lithotripsy on excretion of glycosaminoglycans.

BACKGROUND AND PURPOSE: The effect of glycosaminoglycans (GAGs) in urinary crystal inhibition has been shown in vitro, but their inhibitor role in vivo has not been precisely determined in stone-forming patients. The aim of this study was to compare the levels of total GAGs and their components in primary stone-forming patients and a healthy control group and to investigate the impact of shockwave lithotripsy (SWL). PATIENTS AND METHODS: Thirty-eight patients with primary kidney stones and 31 healthy controls were included in this prospective study. Total urinary GAG concentrations were determined by the dimethylene blue assay (DMB), and GAG fractions (chondroitin sulfate, heparan sulfate, and dermatan sulfate) were studied by cellulose acetate electrophoresis. Analysis was repeated after SWL in the stone patients. RESULTS: Chondroitin sulfate was the major component secreted in the urine of the control subjects. Heparan sulfate was the major component in the urine of the stone patients with less chondroitin sulfate and dermatan sulfate (48%, 35%, 16.5%, respectively). Our study showed a significant increase in total urinary GAGs (4.75 v. 7.43 microg/mg of creatinine; P<0.0001) after SWL. Dermatan sulfate was the main component in this group (P<0.0001). The total urinary GAG concentrations remained high for at least 2 days after SWL. CONCLUSION: The elevation in total GAGs after SWL indicates the presence of tissue injury, which also renders dermatan sulfate the principal excreted component. Studies with longer follow-up periods are needed to determine whether these changes in the excretion of GAG components persist.