[Biologic characteristics of invasive bladder cancer: is there a difference between primary and progressive tumours?]. / Biologická povaha invazívnych nádorov mocového mechúra: existuje rozdiel medzi primárnymi a progresívnymi nádormi?

OBJECTIVE: In most muscle-invasive bladder cancer muscle invasion is present at the time of first diagnosis (primary tumours), in the rest of the patients muscle invasion is caused by progression of superficial tumours (progressive tumours). The aim of study is to determine whether a difference in natural history is between primary and progressive tumours. MATERIAL AND METHODS: In 1997-2001 we treated 278 patients with bladder cancer, 167 (60.1%) patients had superficial tumours and 111 patients had invasive tumours. At the time of diagnosis muscle invasion of the bladder was present in 90 (81.1%) patients, in 21 (18.9%) invasion was formed by progression of superficial tumours. The retrospective study evaluated and compared characteristics of patients (incl. survival) and tumours. Statistical significance was calculated by the chi2 test. RESULTS: A mean age of patients with primary tumours was 65.2 +/- 10.5 years, compared with mean age of 61.7 +/- 12.6 years of patients with progressive tumours. Gender--male:female ratio was 3.1:1 in primary tumours, as opposed to 4.2:1 in progressive. Progression of superficial tumours was noted on average within 35.4 months (range of 7-115). Within one year died 46 out of 90 (51.1%) patients with primary tumours and 11 out of 21 (52.4%) patients with progressive tumours. Three years survived 14 out of 61 (23%) patients with primary tumours and two out of 13 (15.4%) with progressive tumours. CONCLUSIONS: Prognosis of patients with progressive tumours is worse than prognosis of patients with primary invasive tumours. It is vital to detect superficial tumours in their pre-invasive stage, when they can be treated successfully.

Current issues of BPH treatment.

BPS is a disease with a negative impact on patient's quality not the quantity of life. Surgical treatment is still considered a gold standard, however, conservative treatment is an efficient and safe alternative with a positive impact on the quality of life.

[Effect of drug therapy on lower urinary tract symptoms indicating the presence of benign prostatic hyperplasia in transurethral resection of the prostate]. / Vplyv medikamentóznej liecby príznakov dolných mocových ciest naznacujúcich prítomnost' benígnej prostatickej hyperplázie na transuretrálnu resekciu prostaty.

OBJECTIVE: Medical therapy of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) has fundamentally changed. The aim of the study is to verify the suggestion that the medical therapy delayed the need of operative treatment and led to changes in characteristics of patients in need of surgery, or whether it had possibly caused deterioration of the results of surgery. MATERIAL AND METHODS: A group of 137 patients treated by TURP in 1991 (before medical therapy was introduced in Slovakia) was compared with a group of 122 patients treated by TURP in 2001 when medical therapy was offered as the primary initial therapy. We evaluated the patient's age, co-morbidity, type and length of medical therapy of LUTS, indications for operation, the weight of the resected tissue, the length of urinary bladder drainage after the operation and the period of hospitalisation. RESULTS: Patients in 2001 were on average 3.1 years older (p = 0.007), co-morbidity was present in 68.6% patients in 1991 compared to 85.2% in 2001 (not significant), and TURP for objective indications was done in 58.4% of patients in 1991 and in 50% in 2001. In 2001 71 out of 122 (58.2%) patients received medical therapy and 30 of them (24.6%) were operated on for objective indications. The weight of the resected tissue was 20.2 +/- 13.2 grams in 1991 and 24.6 +/- 15.4 grams in 2001 (p = 0.027). In 1991 the catheter was removed 4.5 +/- 1.8 days after the operation compared to 3.1 +/- 2.2 days in 2001 (p = 0.0001). The duration hospitalisation in 1991 was 7.7 +/- 5.7 days compared to 5.2 +/- 3.2 in 2001 (p = 0.0001). CONCLUSIONS: Patients receiving medical therapy have surgery at a higher age. The higher age of patients was not related to co-morbidity or the increased number of operations for objective indications, nor did the complications during surgery increase. On average more of the prostatic tissue was removed and the period of hospitalisation was shorter.

[Transurethral resection of the prostate in the treatment of benign prostatic hyperplasia]. / Transuretrálna resekcia prostaty v liecbe benígnej prostatickej hyperplázie.

BACKGROUND AND OBJECTIVES: Transurethral resection of the prostate (TURP) represents a method of choice in surgical treatment of benign prostatic hyperplasia (BPH). The objective of this prospective study was to evaluate TURP mortality and morbidity rates. PATIENTS AND METHODS: In 1998 184 patients with lower urinary tract symptoms (LUTS) indicating the presence of BPH underwent one of the following surgeries: TURP 149 (81%), transurethral incision of the prostate 19 (10.3%), and open surgery (suprapubic transvesical prostatectomy) 16 (8.7%). From the group of 149 patients treated by TURP the following patients were withdrawn from the study: 7 (4.7%) patients with a finding of incidental carcinoma of the prostate and 14 (9.4%) patients who did not attend the postoperative follow-ups. RESULTS: 64 (50%) patients were treated for LUTS syndrome before TURP. TURP was applied in 69 (53.9%) cases for absolute indications. During the surgery and within one year after it, no mortality was recorded. Complications during the surgery were present in 13 (10.2%) patients, and within 24 h after the surgery in 38 (29.7%) patients. Early postoperative complications (up to 4 postoperative weeks) were recorded in 49 (38.3%) patients. Late postoperative complications within 3 month after the surgery occurred in 16 (12.5%) patients, within 6 months in 17 (13.3%) patients, and after 12 months in 17 (13.3%) patients. CONCLUSIONS: Although complications occur almost in 58% of patients, TURP still represents the standard treatment of LUTS indicating the presence of BPH. (Tab. 5, Fig. 2, Ref. 15.).

[Incidental renal carcinoma]. / Incidentálny karcinóm oblicky.

BACKGROUND: The increasing use of progressive noninvasive diagnostic imaging techniques, has substantially increased the detection of incidentally detected renal cell carcinoma (RCC). OBJECTIVES: To determine the manner of presentation of RCC and the frequency of incidentally detected RCC. The natural history of RCC of incidentally discovered RCC was compared with that of symptomatic RCC, the reasons for examination and the methods of diagnosis in patients with incidental tumours were analysed. PATIENTS AND METHODS: In a retrospective study, 463 patients with RCC treated between 1981 and 1995 were reviewed. The patients were divided into four groups according to the fact as to whether the tumours were diagnosed on the basis of urologic symptoms, with paraneoplastic syndromes, with symptoms of metastatic disease, or whether they were detected incidentally. The records of 180 patients with RCC treated between 1991 and 1995 were grouped according to the fact as to whether the tumour was detected incidentally (n = 85), or whether it was discovered with symptoms related to the neoplastic renal disease (n = 95). The groups were compared regarding patient's age, sex, tumour size, grade of malignancy, stage and survival using univariate analyses. RESULTS: The number of RCC detected incidentally has increased from 9.3% (1981-1985) to 47.2% (1991-1995). There were significant differences between groups in the distribution of clinical stages, T1 + T2 stages were more frequently detected in incidental tumours (p < or = 0.005). No significant difference was observed between the survival of incidental and symptomatic patients. Abdominal ultrasonography was the most useful method for the detection of incidental RCC (88.2%). CONCLUSIONS: The results of this study suggest that the incidentally detected RCC occur in lower stages than the symptomatic tumours.

[The antiandrogen withdrawal syndrome: decrease in prostate specific antigen serum levels after withdrawal of antiandrogens]. / Syndróm vysadenia antiandrogénov: pokles sérových hladín prostatického specifického antigénu po vysazení antiandrogénov.

Combined androgen blockade using surgical or medical (luteinizing hormone-releasing hormone agonist) castration in association with anti-androgen has become the primary therapy in patients with metastatic prostate cancer. Patients undergoing combined androgen blockade will progress within 18-30 months after initial hormonal therapy. When progression occurs following combined androgen blockade, the non-steroid anti-androgen should be subsequently withdrawn. Several recent reports have been published on the paradoxical effect of anti-androgen withdrawal. Eight (22.9%) of 35 patients showed a decline in PSA levels following flutamide withdrawal. The mean time to progression following combined androgen blockade was 26 month and the mean duration of response to flutamide withdrawal was 4.1 months.

Fear of rape: its perceived seriousness and likelihood among young Greek women.

PIP: This paper examines the magnitude and prevalence of fear of crime as a function of seriousness and probability of occurrence among Greek female university students aged 17-29 years. The findings show that rape is the most fear producing of all offenses in young Greek women. Fear of rape is even greater than fear of murder, robbery, threat with a dangerous object, and other serious crimes. Consequently, Greek women distance themselves from possible sources of danger; thus, most of them are deprived of some of their basic freedoms. This finding is interpreted in light of rape's reported likelihood in conjunction with its reported seriousness. The findings are similar to those reported in other countries and in line with the feminist claim regarding the universality of the fear of rape in the daily life of young women. Explanations of high fear in terms of physical and social vulnerability and as a possible reflection of hidden violence against Greek women are also included in the discussion.^ieng

Transformation of the Bricker to a continent urinary reservoir to eliminate severe complications of uretero-ileostomy performed in eight patients among 200 Bricker.

Between 1969 and 1994 urinary diversion via the ileal loop (Bricker's operation) was performed in 200 patients. After introduction of methods of continent urinary diversion into clinical practice, some of young patients operated in childhood for congenital lower urinary tract malformations demanded the conversion of the primary diversion. The decision was influenced, however, not only by subjective complaints but also by severe complications having relation to the long-lasting presence of stoma. A modified Mainz pouch I, with a catheterizable stoma was constructed in 6 patients with primary uretero-ileostomy made 7 to 22 years prior to conversion because of exstrophy of the urinary bladder or a neurogenic bladder with total urine incontinence. The ileal loop used for uretero-ileostomy was detubularized or combined with additional segments of ileum and colon. The ileal stoma was connected to the umbilicus. In other two patients suffering from a neurogenic bladder the uretero-ileostomy was converted to an orthotopic ileal pouch. The authors present long-term results (1.5 to 7 years) of follow-up with urodynamic and radiological evaluation. The results both compensate the urologist's efforts and enhance the patient's quality of life.

[Prostate-specific antigen in patients with benign prostatic hyperplasia]. / Prostatický specifický antigén u pacientov s benígnou prostatickou hyperpláziou.

The authors examined 119 patients with the histological finding of benign prostatic hyperplasia (BPH). Before the planned operation of the prostate (transurethral resection or open prostatectomy) the authors examined in all patients the level of the prostate specific antigen (PSA) and the prostate volume by sonography. Of 119 patients 70 (58.8%) had elevated serum levels of PSA and in 35 (29.4%) the PSA level was higher than 10 ng/ml. The authors demonstrated a highly significant (p < 0.0001) linear relationship of the PSA serum level and volume of prostate in patients with BPH. Based on the results of simple regression analysis they elaborate an equation for the prostate volume: PSA ng/ml = (3.26 + 0.12 x volume of prostate (ml) +/- 8.44). By adding the value of the standard deviation of PSA the authors created an interval in which are most of the patients with BPH. The authors recommend supplementary examinations (transrectal sonography and biopsy of the prostate) in patients where there is a disproportion between the PSA level and the prostate volume.

[Rectosigmoid reservoirs (pouch)]. / Rektosigmoidálny rezervoár (pouch).

A low pressure and high capacity rectosigmoid reservoir for urine is formed without the need for colostomy, augmentation or extensive bowel surgery. Reservoir is created by antimesenterial detubularization of the rectosigmoid and subsequent suturing. The authors describe the operation technique and analyses the results in 20 patients who were followed up 1-25 (average 14) months after operation. All patients are continent during the day time and at night. Two patients had at the sites of implantation ureteral stricture, which in one necessitated reoperation and undiversion and in the other endoscopic dilation of the stricture.

Chronic ischaemia of the ileal neobladder: clinical manifestations and management.

Recently, bladder replacement with intestinal reservoir is becoming more common as urinary diversion in a selected group of patients after radical cystectomy. Complications occurred in two patients, 2 and 7 months, respectively, after successful radical cystoprostatectomy and reconstruction of the ileal neobladder, due to chronic ischaemic changes of the latter. Their clinical manifestations and management are discussed. Some of the possible potential mechanisms responsible for ischaemic changes of the reservoir are reviewed.

Systemic chemotherapy for muscle invasive bladder cancer.

A total of 60 patients with muscle invasive transitional cell carcinoma of the bladder were entered into the nonrandomized study. The 1st group consisted of 30 patients treated by M-VAC neo-adjuvant chemotherapy followed by radical cystectomy when a residual tumor had been detected by biopsy made after the treatment. The overall clinical response was 70%. Fifteen (50%) out of 30 patients achieved clinical complete response (cCR). Objective pathologic response was attained in 6 (66.7%) of 9 evaluable patients who underwent radical cystectomy, pathologic complete response (pCR) was observed in two (22.2%) patients. Ten (33.3%) patients are still alive at a median follow-up of 22+ months. There were three (10%) drug-related deaths. The 2nd group consisted of 30 patients treated by CMV (with carboplatin) neo-adjuvant chemotherapy followed by radical pathologic response was attained in 9 (47.4%) of 19 evaluable patients, with pCR in 6 (31.6%) patients. Twenty four (80%) patients are still alive at a median follow-up of 13+ months. There was one (3.3%) drug-related death. The authors recommend immediate radical cystectomy following neo-adjuvant chemotherapy in all patients if their total status it allows.

[Radical cystectomy in the therapy of bladder tumors]. / Radikálna cystektómia v liecbe nádorov mocového mechúra.

Between January 1970 and December 1992, 100 patients (95 males and 5 females) underwent radical cystectomy for bladder cancer. Their mean age was 54.9 years (range, 34-74 years). Indications for radical surgery were multiple superficial tumors (pTa, pT1) in 24 patients and muscle invasive bladder cancer (pT2, pT3b) in 76 patients. Patients with invasive bladder cancer had received elective pre-operative radiotherapy (40 Gy in 20 pts, 20 Gy in 18 pts). Seven patients had undergone salvage cystectomy after full-dose irradiation (60 Gy); 20 pts received pre-operative (neo-adjuvant) chemotherapy (M-VAC or CMV combination) and 11 pts had had no therapy before cystectomy. In 5 pts urinary diversion was performed in advance; in 95 pts cystectomy and urinary diversion were done at the same time. The following methods of urinary diversion were used: ureteroileostomy (Wallace's modification) in 80 pts, Mainz pouch I (ileal conduit with intermittent catheterization) in 6 pts, Mainz pouch with ileourethral anastomosis in 3 pts, ureterosigmoidostomy in 5 pts and Mainz pouch II (continent rectosigmoidal reservoir) in 6 pts. Post-cystectomy mortality was 8.0%. Long-term survival (Kaplan-Meier) following cystectomy was 15-20% of pts with invasive bladder cancer and 30-40% of pts with superficial bladder cancer.

[Urinary diversion by means of uretero-ileostomy. Long-term results]. / Derivácia mocu ureteroileostómiou. Dlhodobé výsledky.

The authors analyze a group of 187 patients where in 1969-1991 a ureteroileostomy was performed on account of malignant tumours (89.8%) or other diseases (10.2%). Ureteroileostomy was indicated along with cystectomy in 77 patients with tumours of the urinary bladder (63 times), with gynaecological carcinoma (21 times) and in tumours of the urethra and rectum (7 times). Indications in non-tumours diseases comprised a neurogenic bladder (10 times) exstrophy of the urinary bladder (6 times), post-traumatic incontinence of urine in women (twice) and iatrogenic injuries of the ureters (once). In all patients an anastomosis between the ureter and excluded loop, as described by Wallace, was used. The surgical mortality was 5.3%. During the immediate postoperative period 96 complications developed in 91 (51.3%) patients. As to late complications, most frequently complications of the stoma of the excluded loop were involved. Ureteroileostomy gives satisfactory results in the majority of patients, however, the number of complications is not negligible. The authors discuss the selection of derivation methods under our conditions.

[Comparison of urography and ultrasonography findings in patients prior to prostatectomy]. / Porovnanie nálezov na urografii s nálezmi na ultrasonografii u pacientov pred prostatektómiou.

In order to evaluate the assess of ultrasonographic examinations in patients before prostatectomy the authors correlated preoperative findings obtained by urography with ultrasonographic findings. Urography of the upper urinary pathways revealed 12 (18.8%) pathological findings, ultrasonographic examination 26 findings (40.6%) in a group of 64 patients. While in 14 patients a pathological finding on ultrasonography was not revealed by urography, only in one patient with a positive urographic finding ultrasonography was negative. Ultrasonographic examination proved to be more valuable in assessing the post-miction residue, as compared with urography. Moreover, ultrasonography is useful for assessing the volume of tissue of benign prostatic hyperplasia. Correlation of the calculated volume of prostatic tissue by means of ultrasonography with the weight of removed tissue revealed a close linear correlation. Ultrasonographic examination of patients before prostatectomy replaced urography which proved to be unnecessary diagnostic procedure.

Design relationships for acousto-optic scanning systems.

We develop the general scanning relationships of an acousto-optic system by using both a purely geometric-optics and a physical-optics approach; each approach provides useful insights into the scanning relationships. The diffraction approach reveals that there are four basic scanning configurations: a long or short chirp scanner, either aperture or repetition-rate limited. The throughput rate for a scanner is always maximized if we use the short-chirp-scanning, repetition-rate-limited mode of operation. The maximum rate may be achieved with other configurations, but at the expense of a decrease in some of the other performance parameters. Examples are given of how these design relationships are used.

Relationship between the Kaufman Test of Educational Achievement--Brief Form and the Wide Range Achievement Test--Revised Level 2 with incarcerated juvenile delinquents.

The Kaufman Test of Educational Achievement--Brief Form and the Wide Range Achievement Test--Revised Level 2 were administered in counterbalanced order to 50 male incarcerated juvenile delinquents. The analyses showed the similar subtests on the two tests, i.e., Kaufman Reading test and WRAT-R Reading, were highly correlated. The mean standard scores of th e similar subtests were not significantly different from each other. These results contrast with the significantly lower WRAT-R scores found when scores on the WRAT-R Level 1 are compared with those on the Kaufman test.

Flow cytometry (FCM) analysis of endometrial hyperplasia and carcinoma.

In a series of 52 biopsy specimens (31 endometrial carcinomas, 10 atypical endometrial hyperplasias, and 11 cases of normal endometrium), DNA ploidy and S-phase cell fraction were estimated in paraffin-embedded material. DNA aneuploidy was detected in 2 of the 10 atypical endometrial hyperplasias and 7 of the 31 endometrial carcinomas. The majority of aneuploidy was found to be connected with the loss of tumor differentiation. No ploidy disturbances were found in normal endometrium. The S-phase cell fraction value of normal endometrium was significantly lower when compared with that of endometrial carcinoma. The broad variation in S-phase cell fraction values of the endometrial carcinomas and atypical endometrial hyperplasias was in contrast with the low variability of S-phase cell values of normal endometrium. Very low incidence of aneuploidy in the group of well differentiated endometrial carcinomas (Grade I) enables the suggestion that the presence of aneuploidy predicts a more aggressive disease and that the detection of an aneuploid stemline in atypical endometrial hyperplasia may already indicate the neoplastic transformation.