Role of oestrogen receptor-α and -ß in bladder tissue of patients with a clinical diagnosis of benign prostatic hyperplasia.

OBJECTIVES: To study the differential expression of oestrogen receptor (ER) subtypes in human urinary bladder tissue using immunohistochemistry (IHC) methods and to explore their correlation with various measures of lower urinary tract symptoms (LUTS). METHODS: In this prospective case-control study, the case group comprised 34 patients with bothersome LUTS who underwent transurethral resection of prostate (TURP), while the control group comprised 19 age-matched, otherwise healthy patients who underwent cystoscopy to investigate microscopic haematuria. Cystoscopy and bladder biopsy were performed in both groups. IHC evaluation of biopsy specimens was carried out for ER subtypes (ER-α and ER-ß) and for Ki 67 in semi-quantitative fashion. Correlations of receptors with various measures of benign prostatic hyperplasia (BPH)/LUTS were also assessed. RESULTS: Expression of ER-α (in both epithelial and stromas cells) was statistically significantly greater in the case group than in the control group, but ER-ß expression was not significantly different between the groups. Ki 67 expression was also significantly greater in the case group. Comparison of clinical variables according to receptor status showed that International Prostate Symptom Score (IPSS), post-void residual urine volume (PVR) and prostate volume were significantly associated with epithelial and stromal ER-α; however, ER-ß was associated only with PVR. CONCLUSION: We found significant correlation between bladder ER levels (specifically ER-α) and various clinical measures of BPH. We conclude that ER-α is the key mediator that could be responsible for various clinical measures of BPH/LUTS.

Immunohistochemical analysis of estrogen receptors in prostate and clinical correlation in men with benign prostatic hyperplasia.

PURPOSE: Estrogens act through interaction with 2 receptor subtypes, ER alpha (ERα) and ER beta (ERß), in human prostate. The aim of the present study was to semiquantitatively assess the differential expression of ER subtypes in human benign prostatic hyperplasia (BPH) by use of immunocytochemistry (IHC) methods and to explore their relationship with various measures of BPH. MATERIALS AND METHODS: A total of 45 patients with BPH undergoing transurethral resection of the prostate and 22 patients with bladder cancer with normal prostate undergoing surveillance cystoscopy were studied as cases and controls, respectively. Quantitative immunolabeling of ER subtypes was scored by use of a semiquantitative scale. Also, correlations were assessed between ER levels in prostate and various measures of BPH. RESULTS: Overall, we found strong immunostaining for ERα in stroma and for ERß in epithelium, respectively. The IHC score for ERα differed significantly between BPH patients and controls in both stroma (p≤0.001) and epithelium (p=0.008), respectively. The ERß IHC score was also significantly higher in the epithelium of BPH patients (p=0.01). Also, we found a significant correlation between prostatic ER levels and various clinical measures of BPH. CONCLUSIONS: ERs may play an important role in the pathogenesis of BPH.

Long-term Functional, Urodynamic, and Metabolic Outcome of a Modified Orthotopic Neobladder Created With a Short Ileal Segment: Our 5-year Experience.

OBJECTIVE: To assess the long-term functional, urodynamic, and metabolic outcomes of our modified neobladder. MATERIALS AND METHODS: In this prospective study from January 2010 to October 2014, 42 consecutive male patients with bladder tumor underwent radical cystectomy and orthotopic urinary diversion with modified ileal neobladder using 25 cm ileal segment. During follow-up, functional outcome, urodynamic studies, metabolic parameters, and renal parameters were assessed at regular intervals. Complications were graded as early (<3 months) or late (>3 months). RESULTS: There were no perioperative deaths. At a mean follow-up of 27.2 months, good or satisfactory daytime and nighttime continence were achieved in 100% and 93.8% of patients, respectively. Mean maximal bladder capacity was 588 mL at 3 years. Mean resting pressure and voiding pressures were 20.1 cm H2O and 34.6 cm H2O at 3 years, respectively. Good bladder compliance was achieved in all patients by 1 year. Mean maximum urine flow rate (Qmax) was 18.5 mL at 3 years. Postvoid residual volume was insignificant in all the patients and none of the patients were on clean intermittent self-catheterization. None of the patients developed severe metabolic acidosis. Vitamin B12 levels were within normal range in all patients. Early complications were seen in 12 patients (28.6%), whereas late complications were observed in 5 patients (12%). CONCLUSION: Our results demonstrate that our modified technique of using a short ileal segment to create a near-spherical, compliant, low-pressure reservoir provides an acceptable, safe, and functional alternative to the standard Hautmann neobladder.

Pneumatic cystolithotripsy versus holmium:yag laser cystolithotripsy in the treatment of pediatric bladder stones: a prospective randomized study.

PURPOSE: Holmium:yttrium-aluminum-garnet (Ho:YAG) laser and Pneumatic cystolithotripsy (CL) are the most widely practiced transurethral procedures for treatment of pediatric bladder stones. The aim of our study was to compare the safety and efficacy of Ho:YAG laser CL and pneumatic CL in the treatment of pediatric bladder stones. METHODS: In this prospective randomized study from January 2012 to April 2015, 25 male children with bladder stones <3 cm were consecutively randomized into two treatment groups: group A (pneumatic CL) consisted of 13 patients and group B (Ho:YAG CL) consisted of 12 patients. Operative time, duration of stay and complications were recorded. Patients were followed up prospectively. RESULTS: The mean operative time was significantly lower in group B (25.6 vs. 31.6 min) for stones <1.5 cm (p = 0.040). However, for stones between 1.5 and 3 cm in size, the mean operating times were similar in both the groups (49.4 min in Ho:YAG vs. 44.6 min in pneumatic, p = 0.40). There was no difference in complication rates and hospital stay in both the groups. No major complications were seen in both the groups. CONCLUSIONS: We found that Ho:YAG CL was more effective than pneumatic CL for treating bladder stones smaller than 1.5 cm.

A single oral dose of Silodosin and Diclofenac sodium is effective in reducing pain after ureteric stent removal: a prospective, randomized, double blind placebo-controlled study.

A prospective double-blinded placebo controlled randomized study was conducted in our institute to compare the efficacy of oral Silodosin, an alpha 1 selective antagonist and Diclofenac in relieving pain after stent removal. All patients with unilateral stent placement following renal and ureteric stone endoscopic surgery were randomized into four groups: group A (Placebo), group B (Diclofenac), group C (Silodosin) and group D (combination of Diclofenac and Silodosin). Visual analogue score (VAS score) and other relevant parameters were assessed during OPD visit. Patients were handed over randomized drug envelope and asked to take the medications one hour before the stent removal. Patients were contacted 24 h after stent removal and relevant parameters were recorded. The mean VAS scores were significantly decreased in Diclofenac (2.9), Silodosin (3.08) and combination group (2.85) when compared to placebo (4.20) (p < 0.001). However there was no statistically significant difference in VAS scores between the treatment groups, i.e., group B, C and D (p > 0.5). Analgesics requirement and severe pain rates were not significantly reduced (p = 0.07, 0.35) in the three treatment groups when compared to placebo. Thus Silodosin and Diclofenac, both are effective in preventing pain after stent removal.

Large Genital Cavernous Hemangioma: A Rare Surgically Correctable Entity.

We report a case of 24-year-old male presenting with painless penoscrotal swelling for 3 years. On examination, a large soft bag of worm-like, superficial, nonpulsatile swelling was present in scrotum and penis. Color Doppler showed dilated tortuous vessels and on angiography no connections to corpora or vessels were seen. So a diagnosis of hemangioma was made and a surgical excision was carried out by circumcoronal and scrotal incisions. Postop course was uneventful. At 6 months of follow-up, no recurrence was seen and wound had healed with excellent cosmetic appearance.

Megalourethra with Y-Type Duplication of Urethra Presented as Perianal Fistula: A Rare Case Report.

Megalourethra with Y-type duplication is an extremely rare anomaly. We report here one such case, diagnosed with retrograde urethrogram, which was done from both penile meatus and perianal opening simultaneously. Patient was successfully treated by laser optical internal urethrotomy (OIU), excision of duplicated urethra, and reduction urethroplasty in a single stage.

A Randomized Controlled Trial to Compare the Safety and Efficacy of Tadalafil and Tamsulosin in Relieving Double J Stent Related Symptoms.

Objectives. To evaluate the safety and efficacy of Tadalafil and Tamsulosin in treating Double J stent related symptoms. Methods. In a prospective study, 161 patients with DJ related symptoms were randomized into 3 groups: Group A patients (54), Group B patients (53), and Group C patients (54). They were given Tadalafil, Tamsulosin, and placebo, respectively, at 1st week till removal of DJ stent at 3rd week. All patients completed Ureteral Stent Symptom Questionnaire (USSQ) at 1st week and at 3rd week. The statistical significant difference among groups was determined by the t-test, Kruskal-Wallis test and multivariate analysis were used to assess association of the variables within the three groups, and the level of significance was set at P < 0.05. Results. Tadalafil and Tamsulosin were comparable in relieving urinary symptoms, general health, and work performance (OR = 0.65, 1.8, and 0.92). But Tadalafil was more effective in relieving body pain, sexual problems, and additional problems than Tamsulosin (OR = 5.95, 19.25, and 2.69) and was statistically significant as P < 0.05. Conclusion. Tadalafil was as effective as Tamsulosin in relieving urinary symptom but more effective in relieving sexual symptoms and body pain.