ELISA-based quantification of neurotrophic growth factors in urine from prostate cancer patients.

Non-invasive procedures are needed for prostate cancer management, and urine represents a potential source of new biomarkers with translational value. Recent evidence has shown that the growth of new nerves in the tumor microenvironment is essential to prostate cancer progression. Neurotrophic growth factors are expressed by prostate cancer cells and contribute to prostate tumor innervation, but their presence in urine is unclear. In the present study, we have assayed the concentration of neurotrophic factors in the urine of prostate cancer patients. Urine was collected from a prospective cohort of 45 men with prostate cancer versus 30 men without cancer and enzyme-linked immunosorbent assay was used to quantify nerve growth factor (NGF) and its precursor proNGF, brain-derived neurotrophic factor (BDNF) and proBDNF, neurotrophin-3, neurotrophin-4/5, and glia-derived neurotrophic growth factor. The results show that neurotrophic factors are detectable in various concentrations in both cancer and healthy urine, but no significant difference was found. Also, no association was observed between neurotrophic factor concentrations and prostate cancer grade. This study is the first quantification of neurotrophins in urine, and although no significant differences were observed between prostate cancer patients versus those without prostate cancer, or between prostate cancers of various grades, the potential value of neurotrophins for prostate cancer diagnosis and prognosis warrants further investigations in larger patient cohorts.

The diagnostic utility of diffusion weighted MRI imaging and ADC ratio to distinguish benign from malignant renal masses: sorting the kittens from the tigers.

BACKGROUND: MRI is playing an increasing role in risk stratification and non-invasive diagnosis of the undifferentiated small renal mass. This study was designed to assess the reliability of MRI in diagnostic evaluation of renal masses, specifically characterising lesions with diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) values. METHODS: This is a retrospective analysis of patients undergoing MRI as part of their clinical workup for a renal mass suspicious for renal cell carcinoma (RCC) on CT or ultrasound followed by biopsy and/or surgical excision. All cases were conducted on 3 Tesla MRI, with conventional breath-held sequences, DWI and dynamic contrast enhanced phases. Tumour regions of interest were evaluated on ADC maps and compared with T2 weighted and post-contrast images. RESULTS: Of the 66 renal tumours included, 33 (50.0%) were Clear Cell RCC, 11 (16.7%) were Oncocytoma, nine (13.6%) were Angiomyolipoma (AML), nine (13.6%) were Papillary RCC and four (6.1%) were Chromophobe RCC. Oncocytoma had the largest ADC values, significantly larger than AMLs and all RCC subtypes (p < 0.001). The average ADC value was also significantly larger in Clear Cell RCCs compared to AMLs, and other RCC subtypes (p < 0.001). CONCLUSIONS: MRI with DWI/ADC imaging may aid the differentiation of oncocytomas from RCCs and stratify RCC subtypes, Further studies are required to validate these findings. TRIAL REGISTRATION: Not applicable/retrospective study.

Bladder perforation: A rare complication of retention management.

A healthy 25 year old woman presented with acute urinary retention following alcohol ingestion. A 14 french foley catheter drained over 1 L of haematuria immediately. Due to worsening and persistent abdominal pain, CT and ultrasound imaging was performed, demonstrating only a small amount of free fluid. Diagnostic laparoscopy revealed an intraperitoneal bladder perforation with the foley catheter visible. The bladder defect was repaired and she recovered well. This is a rare case of likely iatrogenic bladder perforation from simple catheterisation without predisposing comorbidities, highlighting the importance of correct technique and awareness of potential complications.

Novel approach to locating a hypoplastic kidney in a unique variant of uterine didelphys syndrome presenting with continuous incontinence.

Mullerian abnormalities such as uterine didelphys have an association with renal abnormalities. Ureteric ectopia must be considered as a differential diagnosis of incontinence. We describe the case of a 21-year-old woman who presented with low volume continuous incontinence with a history of right renal agenesis and uterus didelphys. A right kidney was not identified on CT intravenous pyelogram but excretory phase images suggested the presence of a right ureter. Diethylenetriaminepentaacetic acid renogram confirmed an area of perfusion consistent with a poorly functioning right kidney remnant. Cystoscopic investigation demonstrated an orthotopic left ureteric orifice, and an ectopic right ureteric orifice was identified in the posterior fornix of the right vagina. A laparoscopic right nephrectomy was performed, with a new application of indocyanine green aiding in identification of the right hypoplastic kidney with fluorescence imaging. The patient recovered well postoperatively and experienced complete resolution of incontinence, with preserved normal renal function.