Involvement of interleukin-1ß mediated nuclear factor κB signalling pathways to down-regulate prostate-specific antigen and cell proliferation in LNCaP prostate cancer cells.

Involvement of NF-κB (nuclear factor κB) mediated by IL-1ß (interleukin-1ß) on cell proliferation and PSA (prostate-specific antigen) production of LNCaP prostate cell lines and the possible cross-talk with Akt (also known as protein kinase B) signalling pathway has been investigated. NF-κB and Akt were analysed by Western blotting from LNCaP cells treated by IL-1ß before proliferation and PSA production were measured. IL-1ß inhibited proliferation and decreased PSA production. The Akt pathway was not sensitive, whereas NF-κB phosphorylation occurred as a result of treatment. PSA production and proliferation of LNCaP cells were down-regulated by NF-κB mediated by IL-1ß promoting anti-apoptotic signalling and co-suppressor factors of PSA expression. IL-1ß through NF-κB activation provides a rationale for therapeutic approaches in the anticancer treatment of prostate.

[Oncological and functional results of 50 consecutive radical prostatectomies]. / Résultats carcinologiques et fonctionnels de 50 prostatectomies radicales consécutives.

AIM: To evaluate the Oncological and functional results and to clear risk factors of biochemical recurrence in patients with prostate cancer treated by retropubic prostatectomy. METHODS: Retrospective analysis of 50 consecutive retropubic radical prostatectomies performed between January 1999 and january 2008. Biochemical recurrence was defined by PSA > 0.2 ng/ml. Univariate analysis of prognostic factors of biochemical recurrence was performed. The study of the urinary continence and the sexuality is essentially based on a meticulous interrogatory. RESULTS: The biochemical recurrence-free survival was 68%. Significant risk factors on univariate analysis were: number of positive biopsy, the percentage of positive biopsy, perineural invasion, Gleason score, clinical stage, pathological stage, and tumour volume. On the functional plan, only one patient is totally incontinent. The return to a normal sexuality appears uncertain, the sexual potency was satisfactory among 5 patients (10% of the patients operated and 55,5% of the patients having had a nervesparing techniques) CONCLUSION: Our oncological results is acceptable and are quite comparable to literature. This while guaranteeing the satisfactory functional results essentially basing on an acquirement of a continence quasi-perfect.

[Renal colic in pregnancy and lactation: diagnostic and therapeutic approaches]. / La colique néphrétique chez la femme enceinte ou allaitante: problèmes diagnostiques et thérapeutiques.

BACKGROUND: Renal colics due to urinary stones are also common in women of childbearing age whether pregnant or not. AIM: Through a review of literature, we evaluated diagnostic and therapeutic approaches in renal colic in pregnancy and lactation. METHODS: Review of literature. RESULTS: The clinical diagnosis is sometimes difficult requiring additional medical imaging based on ultrasound. Other radiological investigations using X-rays are formally forbidden. The prescription of analgesic treatment during pregnancy and lactation must take into account mainly the teratogenic risk in addition to maternal risk by altering drug pharmacokinetics during pregnancy. CONCLUSION: During pregnancy, NSAIDs are prohibited because of their teratogenicity effect. Salicylates and opiates should be used with care, especially in cases of threat of confinement. Paracetamol remains the treatment of choice. Salicylates and corticosteroids should be used with caution during lactation.

[Sclerotherapy of idiopatic hydrocele with polidocanol: a study about 190 cases]. / La sclérothérapie au polidocanol dans le traitement des hydrocèles vaginales idiopathiques : Etude à propos de 190 cas.

AIM: To evaluate the efficacy and side-effects of Polidocanol used as sclerosing agent for testicular hydrocele. METHODS: One hundred and ninety men, with a median age of 55,9 years (40-89), treated for idiopatic hydrocele were assessed. After puncture and aspiration, the empty sac was instilled with 3% Polidocanol. We recorded recurrence, complications and associated pain on a visual analogue scale. RESULTS: With a median follow-up of 19 months, The cure rate of hydroceles after one sclerotherapy session was 62,1%, and the overall cure rate using the procedure was 82,6%. Re-instillation was done for recurrences in 41% of patients. Polidocanol therapy was almost pain-free. A low rate of complications was observed. CONCLUSION: Polidocanol is a useful sclerosing agent for treating testicular hydrocele. Due to its ease of administration, low frequency of complications, high rate of effectiveness, and excellent tolerability; we recommend sclerotherapy with polidocanol as the primary treatment for hydroceles.

[Eosinophilic cystitis: review of nine cases]. / La cystite à éosinophiles pseudo-tumorale: a propos de neuf nouvelles observations.

BACKGROUND: Eosinophilic cystitis is a rare inflammatory pathology. It remains a poorly understood entity. AIM: To report a series of adult cases of eosinophilic cystitis mimicking a bladder tumor. METHODS: Retrospective study of cases of eosinophilic cystitis collected in an urology department. RESULTS: Diagnosis was established on a spontaneous bladder perforation in one case and on hematuria in the eight other cases. Histopatholgy studies confirmed the diagnosis. Eight patients underwent an endoscopic resection of bladder lesions followed by medical therapy with nonsteroidal anti-inflammatory drugs and cortimoxazole. An ileal bladder enlargement was performed in one case. Regular follow-up didn't reveal any recurrence. CONCLUSION: Eosinophilic cystitis is a rare disease simulating a tumor of bladder. Its clinical presentation is not specific and final diagnosis is based on pathology. Endoscopic resection will help to pathologic diagnosis. Associated to corticoids and antihistaminic drug endoscopic resection constitute the treatment of choice.

[Overview of premature and retarded ejaculation]. / Éjaculation prématurée et retardée.

Frequently met in clinical sexology as in general medicine, ejaculatory troubles had a multifactorial etiopathogeny and are subjects to controversies. Their therapies remain difficult despite different possible approaches.

Co-expression and impact of prostate specific membrane antigen and prostate specific antigen in prostatic pathologies.

BACKGROUND: The present study was undertaken to relate the co-expression of prostate-associated antigens, PSMA and PSA, with the degree of vascularization in normal and pathologic (hyperplasia and cancer) prostate tissues to elucidate their possible role in tumor progression. METHODS: The study was carried out in 6 normal, 44 benign prostatic hyperplastic and 39 cancerous human prostates. Immunohistochemical analysis were performed using the monoclonal antibody CD34 to determine the angiogenic activity, and the monoclonal antibodies 3E6 and ER-PR8 to assess PSMA and PSA expression, respectively. RESULTS: In our study we found that in normal prostate tissue, PSMA and PSA were equally expressed (3.7 ± 0.18 and 3.07 ± 0.11). A significant difference in their expression was see in hyperplastic and neoplastic prostates tissues (16.14 ± 0.17 and 30.72 ± 0.85, respectively) for PSMA and (34.39 ± 0.53 and 17.85 ± 1.21, respectively) for PSA. Study of prostate tumor profiles showed that the profile (PSA+, PSMA-) expression levels decreased between normal prostate, benign prostatic tissue and primary prostate cancer. In the other hand, the profile (PSA-, PSMA+) expression levels increased from normal to prostate tumor tissues. PSMA overexpression was associated with high intratumoral angiogenesis activity. By contrast, high PSA expression was associated with low angiogenesis activity. CONCLUSION: These data suggest that these markers are regulated differentially and the difference in their expression showed a correlation with malignant transformation. With regard to the duality PSMA-PSA, this implies the significance of their investigation together in normal and pathologic prostate tissues.

The 20-core prostate biopsy as an initial strategy: impact on the detection of prostatic cancer.

INTRODUCTION: To increase the detection rate of prostate cancer in recent years, we examined the increase in the number of cores taken at initial prostate biopsy. We hypothesized that an increasing number of cores may undermine the accuracy of models predicting the presence of prostate cancer at initial biopsy in patients submitted to 20-core initial biopsy. METHODS: A total of 232 consecutive patients with prostate-specific antigen (PSA) between 4 and 20 ng/mL and/or abnormal digital rectal examination (DRE) underwent 12-core prostate biopsy protocol (group 1) or 20-core prostate biopsy protocol (group 2). The patients were divided into subgroups according to the results of their serum PSA and prostate volume. We evaluated the cancer detection rate overall and in each subgroup. Clinical data were analyzed using chi-square analysis and the unpaired t-test or 1-way ANOVA with significance considered at 0.05. RESULTS: The 2 groups of patients were not significantly different with regard to parameters (age, abnormal DRE and serum PSA), although median prostate volume in group 1 (57.76 +/- 26.94 cc) were slighter greater than in group 2. Cancer detection rate for patients submitted to 20 prostate biopsy was higher than patients submitted to 12 prostate biopsy (35.2% vs. 25%, p = 0.095). Breakdown to PSA level showed a benefit to 20 prostate biopsy for PSA <6 ng/mL (37.1% vs. 12.9%, p = 0.005). Stratifying results by prostate volume, we found that the improvement of cancer detection rate with 20 prostate biopsy was significant in patients with a prostate volume greater than 60 cc (55% in 20 prostate biopsy vs. 11.3% p < 0.05). Morbidity rates were identical in groups 1 and 2 with no statistically significant difference. There appeared to be no greater risk of infection and bleeding with 20 prostate biopsy protocol. CONCLUSION: The 20-core biopsy protocol was more efficient than the 12-core biopsy protocol, especially in patients with prostate specific antigen <6 ng/mL and prostate volume greater than 60 cc.

The profile of prostate epithelial cytokines and its impact on sera prostate specific antigen levels.

The aim of this study was determined the expression of pro inflammatory cytokines in prostate epithelial cells. Furthermore, we analysed the relation between these cytokines and sera PSA levels according the three groups: 0-4, 4-20 and >20 ng/mL. The study was carried out in five normal prostate (NP), 27 benign prostate hyperplastic (BPH) and 18 prostate cancer (PC). Immunohistochemical and Western blot analysis was performed. Serum levels of PSA were assayed by Immulite autoanalyser. The western Blotting analysis revealed an immunoexpression of IL-1alpha, IL-6 and TNFalpha in BPH and PC. IL-1alpha, was absent in NP. Immunohistochemical analysis showed significant high optical density to IL-1alpha and IL-6 in cancer epithelial cells (19.45 +/- 3.25 and 26.2 +/- 3.19) compared to normal cells (1.73 +/- 1.51 and 4.83 +/- 2.65). While, TNFalpha optical densities were not significant in NP (12.03 +/- 2.9), BPH (9.87 +/- 3.85) and PC (13.34 +/- 2.34). The different profiles of cytokines according sera PSA levels showed a high immunoexpression of the profile (IL-6+, IL-1alpha+) in BPH patients with PSA between 0-4 and 4-20 ng/mL. However, PC patients with sera PSA between 4 and 20 ng/mL, showed a significant high immunoexpression of the profile (IL-6+, IL-1alpha-). This data demonstrate a locally production of pro-inflammatory cytokines by prostate epithelial cells and a cross talk between PSA and these cytokines in prostate pathologies.

Multiple unusual locations of hydatid cysts including bladder, psoas muscle and liver.

Our case concerns 66-year-old female with a multiple unusual locations of hydatid cysts including bladder, psoas muscle and liver. Coexistence of hydatid cysts in these localizations has not been previously reported. The diagnosis of vesical hydatid cyst was facilitated by the coexistence of other echinococcosis locations. Treatment consists of the excision of the cysts in the same session without any postoperative anthelmintic drugs. In a two-year follow-up no recurrence has occurred.

Spinal anesthesia for endoscopic urological surgery--low dose vs. varying doses of hyperbaric bupivacaine.

BACKGROUND AND OBJECTIVE: The aim of this study is to compare the efficiency of low dose vs. varying doses of hyperbaric bupivacaine in spinal anesthesia for endoscopic urological procedures. METHODS: Sixty consecutive patients were studied in a randomized prospective manner. They received either of 5 (Gr I), 7.5 (Gr II) or 10 mg (Gr III) of hyperbaric bupivacaine 0.5% combined with 25 microg of fentanyl, through a 25-gauge W hitacre spinal needle placed in the L3-L4 interspace. Characteristics of sensory and motor block, dose of ephedrine required, secondary effects, the patients, and the surgeons satisfaction, were noted. RESULTS: The maximum number of blocked segments was 14 +/- 1 (Gr I), 15 +/- 2 (Gr II) and 16 +/- 2 (Gr III). Time to T12 regression was significantly shorter for Gr I (53 +/- 13 min) than for Gr II (69 +/- 20 min) or Gr III (94 +/- 14 min). Bromage 3 block was not found in Gr I compared to 4 patients in Gr II and 15 patients in Gr III. The duration of motor block was shorter in Gr 1(51 +/- 18 min) than in Gr II (86 +/- 19 min) and in Gr III (138 +/- 21 min). Ephedrine was used for 16 patients in Gr III (9.8 +/- 12.2 mg), 5 patients in Gr II (3.7 +/- 7.8 mg) and 2 patients in Gr I (0.5 +/- 1.5 mg). The difference is statistically significant between Gr III and the other groups. CONCLUSIONS: These results suggest that the use of a low dose of bupivacaine (5 mg) added to fentanyl (25 microg) for endoscopic urological surgery, resulted in short-acting sensory block, without motor block and a lower incidence of cardiovascular side effects, as compared to either of 7.5 or 10 mg bupivacaine with 25 microg fentanyl.

Recurrent obstructions after resonance stent placement in the treatment of ureteral compression from malignant disease.

BACKGROUND: The Resonance ureteral stent is a newly developed all-metallic double-pigtail ureteral stent allowing a palliative diversion on a patient with malignant ureteral obstruction. AIM: To define selection criteria of good candidates for Resonance stent. CASE: A 62-year-old woman was admitted to the emergency department with complaining of severe right flank pain and anuria. Twelve days earlier, we had placed retrogradely a ureteral metallic Resonance stent (Resonance; Cook Ireland Ltd,Limerick, Ireland) for the treatment of a ureteral compression from pelvic recurrence of an appendical colloid mucosal carcinoma in a solitary functioning right kidney. A percutaneous nephrostomy catheter was placed, and an antegrade nephrostogram demonstrated complete distal ureter obstruction. The patency of the ureteral stent was restored spontaneously and then, nephrostomy catheter was removed. Two weeks later, she presented with obstructed ureteral stent. Percutaneous nephrostomy was performed and Resonance stent was removed definitively. Ureteroscopy with biopsy confirmed the tumour extension into the ureteral lumen. CONCLUSION: The risk of subsequent obstruction after Resonance metallic ureteral stent placement is real. Patients with intra-ureteral tumour extension are presumably not good candidates for Resonance stent management.

[Ureteral injuries in gynaecologic surgery]. / Les traumatismes de l'uretère d'origine gynécologique.

Surgical injury to the ureter is an important problem that confronts the urologist, the gynaecologist and the general surgeon. We report 38 cases of iatrogenic ureteral injuries observed after gynaecological surgery between January 1972 and December 2004. Hysterectomy accounted for 22 injuries. Injuries were intra-operatively recognized in 3 cases and were treated immediately. In the case of lesions identified secondarily, a ureter-vesical implantation was performed in 66% of cases with a good result in 84% of them. Four patients required nephrectomy. We discuss the cicumstances of development, diagnosis approach and treatment of this lesion and review the literature about this subject.

[Intra vesical explosion during an endoscopic resection of a vesical tumor]. / Explosion intra vésicale au cours de la résection endoscopique d'une tumeur vésicale.

The intra vesical combustion of hydrogen and oxygen, form one mixture of explosive gas. Intra vesicale explosion during trans urethral resection is one rare incident. Its most dangerous manifestation during is vesical rupture. We demonstrate one case of intra vesical explosion during one endoscopic resection of one in the anterior face tumor of bladder. Damages on bladder are small. By going back to literature, we try to discuss the origin of intra vesical hydrogen and oxygen as well as the different preventive measures.