Artificial urinary sphincter implantation with periprostatic cuff placement for urinary incontinence in men.

Introduction: Artificial urinary sphincter (AUS) implantation is the treatment of choice for male urinary incontinence (UI). The aim of the present study was to evaluate treatment outcomes of UI in men using an AUS with a cuff placed around the prostatic urethra. Material and methods: Forty-three men with preserved prostatic urethra were selected for AUS implantation due to UI. Twenty patients had the cuff implanted around the prostate using the retropubic approach (Group 1), and 23 had the cuff placed around the bulbous urethra (Group 2). Both groups were compared in terms of continence quality as well as intra- and postoperative complications. Results: The groups were comparable with respect to age and duration of follow-up. Median time to complications was 90.3 and 10.7 months in Group 1 and Group 2, respectively (p = 0.007). The complication rate was 40% and 58.3% in Group 1 and 2, respectively (p = 0.001). Complete continence was obtained in 80% of patients from Group 1 and 33.3% of men from Group 2A (p = 0.001). Conclusions: The analysis indicates that cuff placement around the prostatic urethra results in better continence and is characterised by fewer complications. This method is dedicated for patients who have not had the prostate gland removed. Due to the retrospective nature of this analysis and small groups of patients, it is not possible to formulate ultimate recommendations.

Student evaluation of online learning during the COVID-19 pandemic.

The aim of the paper is to provide knowledge with regard to what extent a student's engagement, travel time to the business school, and nationality determine their perception of the value of business school education. We have analyzed what determines the evaluation of online studies, the frequency of participation in online courses, and the preferences regarding the mode of study in the future (offline vs. online). For this purpose, we conducted research in late March and early April 2020 among management students attending one business school in Warsaw. The respondents included native residents of Poland, as well as migrants from countries of the former Soviet Union. We analyze survey responses provided by 317 respondents. We used the chi-squared test, the Kruskal-Wallis test, and the Mann-Whitney test to verify relationships between variables. According to the analysis, the student engagement variable determines the current evaluation of online studying, the change in frequency of participation since the introduction of online classes, and the preferred mode of study (online or offline). The time required to commute to the business school determines only the preferred mode of study in the future, while students' nationality determines their assessment of online studying and the frequency of participation in online courses.

Image analysis discloses differences in nuclear parameters between ERG+ and ERG- prostatic carcinomas.

Prostatic carcinoma (PC) is the most frequent urologic cancer and one of the most frequent cancers in males; it is a heterogeneous disease, in terms of molecular features, morphology and prognosis. About half of cases depends on TMPRSS2-ETS translocation which leads to a production of ERG transcription factor. ERG+ and ERG- cancers seem to differ in a number of features, which could lead to an altered nuclear structure; the aim of the study was to test this hypothesis. The material consisted of total 39 PC cases, representing ERG+ and ERG-, as well as Gleason pattern 3 and 4. Filtering by color deconvolution and automatic segmentation were used, and the properly detected nuclei were manually selected. From each case fifty nuclei were obtained; then geometric features and texture parameters were assessed. The analysis of the collected data showed differences both between ERG+/ERG- and Gleason pattern 3 and 4 cases in most of the features analyzed. Our results suggest that indeed the ERG status, thus likely TMPRSS2-ETS translocation, has an impact on morphology of nuclei in PC, and their differences are evident enough to be detectable by image analysis.

3D laparoscopy as a tertiary cytoreductive (TCR) surgery in infiltrating ureter recurrent epithelial ovarian cancer - case report and a mini-review of the literature.

The paper describes a case of a 61-year-old woman with recurrent epithelial ovarian cancer infiltrating the ureter treated with 3D laparoscopy as a tertiary cytoreductive surgery (TCR). In addition, a mini-review of the literature concerning TCR is presented.

Anorectal malformation as a cause of recurring perineal abscesses - value of anorectal endosonography and magnetic resonance imaging: a case report.

Malformations of the rectum and urinary tract frequently coexist, and the prevalence of urogenital defects in patients with a rectal defect ranges from 20 to 54%. In most patients, anorectal malformations are diagnosed and treated surgically in early childhood. In this report, we present a case of a 52-year-old male with a history of urological operations in infancy due to a congenital urethral malformation and multiple recurrent episodes of perineal abscesses with urinary retention. Anorectal endosonography and magnetic resonance imaging revealed the presence of a large cystic lesion adjacent to the rectal wall which became smaller at the level of the puborectalis. The walls of the lesion had a layered structure identical to the wall of the rectum. In addition, the examinations showed hypotrophy of the left lobe of the prostate and lack of left semnal vesicles. Thus, the lesion was diagnosed as duplication of the rectum or rectal diverticulum. Surgery was performed by an interdisciplinary team of colorectal surgeons and urologist. The lesion was removed laparoscopically. The pathological report revealed that the cystic wall was typical of the intestinal wall, consistent with a diagnosis of rectal duplication.

Laparoscopic nephrectomy in a hemophilia B patient.

Surgery in patients with hemophilia is a serious challenge. It requires a comprehensive approach, as well as careful postoperative monitoring. We present here the first case of a transperitoneal laparoscopic radical nephrectomy (TLRN) for renal cell carcinoma, of the clear-cell type, performed in a hemophilia B patient. The level of factor IX clotting activity before surgery and on postoperative days 1-6 was maintained at 65-130% and at 30-40% on subsequent days until healing of the post-operative wound was achieved. The intraoperative and postoperative courses were uneventful. TLRN can therefore be considered safe and effective for renal cell carcinoma. In hemophilia patients, the TLRN procedure requires proper preparation, as well as adequate substitution therapy for the deficient coagulation factor provided by a multidisciplinary team in a comprehensive center.

Obesity and renal cancer incidence and mortality--a systematic review of prospective cohort studies.

INTRODUCTION AND OBJECTIVE: There have been many studies published recently on obesity and the risk of renal cancer; however, the epidemiological evidence for such an association has not been consistent. Therefore, a systematic review was conducted of the prospective cohort studies to assess the association between obesity and the risk of renal cancer incidence and death. MATERIALS AND METHODS: A search was conducted of the PubMed database and references to published studies from inception until May 2013. Guidelines for Assessing Quality in Prognostic Studies on the Basis of Framework for Potential Biases were followed for quality assessment of studies included in the systematic review. RESULTS: Twenty eligible studies were identified and included in the systematic review. Among the 20 selected studies, overall study quality was high. Although the evidence from the prospective cohort studies, linking obesity with renal cancer incidence, has not been entirely consistent, there is a convincing body of data for a positive relationship. Moreover, cumulative data is compelling for a strong positive association between obesity and fatal renal cancer. CONCLUSIONS: There is a relatively consistent amount of evidence that obesity increases the risk of renal cancer and fatal renal cancer. Further research is needed as better understanding of mechanisms by which obesity may influence renal cancer development and progression will aid the fostering of strategies for prevention and treatment of one of the most lethal human malignancies.

Kidney ultrasound - what is important for a urologist?

Kidney ultrasound is one of the basic procedures in the practice of a urologist. Apart from the location and the size, description of renal morphology should contain the thickness of the anterior lip parenchyma in a transverse section and the location of possible narrowings. Uneven outline of the kidney is a sign of past inflammatory conditions. In the case of the pelvicalyceal system dilation, it is advised to specify the dimensions of the pelvis and calyces. Convex shape of the calyces proves elevated pressure within the pelvicalyceal system. Hydronephrosis is present when urinary retention has led to thinning the renal parenchyma. In each case, one should identify the reason for urinary retention in the upper urinary tract. Urinary retention on both sides requires one to exclude urinary bladder tumor, it may also be caused by a benign prostatic hyperplasia. Ultrasound examination is a sensitive method of renal stones detection, regardless of their chemical composition. Cyst description in an ultrasound image should cover its morphological features, differentiating between the so-called simple or complex cysts. In the case of a solid lesion, ultrasound makes it possible to detect parenchymal lesions usually starting with the size of 2-2.5 cm. It enables one to particularly diagnose angiomyolipomas. As regards the remaining parenchymal lesions, differentiation of the lesion nature is impossible. In some cases of angiomyolipoma, when it contains bleeding areas present and when it is deficient in adipose tissue, it resembles adenocarcinoma. It is necessary that the description includes the exact location, especially the dimensions and relation of the tumor to the renal sinus. In the case of larger lesions, respiratory motion of the kidney, the condition of the adrenal gland and the presence of enlarged lymph nodes should be controlled. Additionally, one should evaluate the renal vein and inferior vena cava in terms of a neoplastic plug presence.

Prostate cancer with different ERG status may show different FOXP3-positive cell numbers.

Prostatic carcinoma is the most frequent cancer in males in the Western world. A significant proportion of these cancers have a recurrent translocation involving ETS family genes, which leads to the overexpression of ERG transcription factor. Prostate cancers, which bear this mutation, differ in a number of features, including tumor microenvironment. One of the components of the tumor microenvironment is FOXP3 positive lymphocytes, which may participate in breaking immunosurveillance and promoting tumor growth. The aim of the study was to analyze the relationships between ERG expression, number of FOXP3 positive cells and other features of the tumor. The study group consisted of 65 cases. Tissue microarrays composed of 2 mm tissue cores were used for immunohistological evaluation. Immunohistochemistry for ERG and FOXP3 was performed according to the routinely applied protocol. The FOXP3 positive cells were counted and the results were expressed as the number of cells per mm2. The average number of FOXP3 positive cells was 33.30/mm2 for all cases, 21.43/mm2 for the ERG negative and 42.28/mm2 for the ERG positive group (p < 0.02). There were no significant relationships between FOXP3 positive cell count and any other parameters studied. Our results suggest that the immune response may differ between ERG negative and ERG positive prostatic carcinomas.

Mast cells influence neoangiogenesis in prostatic cancer independently of ERG status.

A significant proportion of prostatic adenocarcinomas show recurrent translocation leading to ERG expression. Previously we found that ERG+ cases have higher microvessel density than negative ones. One factor influencing angiogenesis in cancer is mast cells. The aim of the present study was to evaluate the relationship between microvessels, mast cells and ERG status. Tissue microarrays prepared from 113 radical prostatectomy specimens were analyzed with immunohistochemistry for CD31, tryptase and chymase. Vascular profiles and tryptase-positive and chymase-positive cells were counted. The average number of tryptase-positive cells was 28.93/mm2 and chymase-positive cells 9.91/mm2. The average number of CD31+ vascular profiles was 352.66/mm2. The average number of tryptase-positive cells was 26.35/mm2 for ERG- cases and 32.12/mm2 for ERG+ cases. The average number of chymase-positive cells was 8.14/mm2 for ERG- cases and 12.06/mm2 for ERG+ cases. The average number of CD31+ vascular profiles was 321.34/mm2 for ERG- cases and 390.74/mm2 for ERG+ cases. The number of CD31+ vascular profiles was positively correlated with the number of tryptase-positive and chymase-positive cells (R = 0.26 and R = 0.20). In summary, we demonstrated an interrelationship between mast cells, microvascular density and ERG status in prostatic carcinoma.

Laparoscopic implantation of an artificial urinary sphincter around the prostatic urethra.

OBJECTIVE: To report the first laparoscopic periprostatic implantation of an artificial urinary sphincter (AUS) after a transurethral resection of the prostate. BACKGROUND: The implantation of an AUS is a standard procedure for severe urinary incontinence. In men it is usually implanted through a perineal approach, with the cuff placed around the bulbous urethra, bladder neck, or even around the prostate. METHOD: We report a laparoscopic periprostatic implantation of an AUS after a transurethral resection of a prostate in a 72-year-old-man with incontinence. RESULTS: The operative duration was 180 min and the blood loss was 150 mL. There were no complications. After activating the AUS the patient was totally continent. CONCLUSION: The laparoscopic periprostatic implantation of an AUS is a safe, effective and considerably less invasive procedure.

Modified technique for laparoscopic running vesicourethral anastomosis.

INTRODUCTION: A vesicourethral anastomosis is the most challenging and time-consuming step of radical prostatectomy. In 2003, van Velthoven introduced his own technique of connecting the bladder neck with the membranous urethra, which has remained the most popular method since. Despite being effective, this method is time consuming and is not free from the risk of complications. AIM: Here we describe our technique for laparoscopic vesicourethral anastomosis using a running suture as an alternative to the traditional approach. MATERIAL AND METHODS: The vesicourethral anastomosis is created using a running stitch placed first at the 5 o'clock position on the posterolateral aspect of the bladder outside-in and then through the urethra at the same location inside-out. Proceeding anticlockwise, the running suture is placed 5 times more through both the bladder neck and the urethra in a similar fashion until it meets the free end at the 5 o'clock position. A single knot is then tied outside the bladder. RESULTS: The anastomotic technique has been used in 28 patients with clinically organ confined prostate cancer. The mean anastomosis time was 9.53 min, the mean operative time was 155.20 min, the mean drain permanence was 2.71 days, and the mean catheterisation time was 17.28 days. Continence rate 3 months after surgery was 92.85%, and 100% at 6- and 12-month follow-up visits. CONCLUSIONS: We describe a safe, feasible and efficient technique for vesicourethral anastomosis. Further studies on a larger group of patients are needed to confirm our encouraging preliminary results.

Laparoscopic radical prostatectomy with bladder neck preservation: positive surgical margin and urinary continence status.

INTRODUCTION: Preservation of the bladder neck (BN) has been controversial, as limited excision of the bladder neck may result in incomplete resection of the disease. Moreover, the urinary continence rate may not be improved. AIM: To evaluate the effect of bladder neck sparing on urinary continence, and surgical margins status in prostate cancer (PCa) patients treated with laparoscopic radical extraperitoneal prostatectomy. MATERIAL AND METHODS: A retrospective analysis of 295 consecutive patients who had undergone laparoscopic radical extraperitoneal prostatectomy for clinically localised prostate cancer in a single institution was performed. Positive surgical margin (SM(+)) and urinary continence status at 3, 6, and 12 months were evaluated. RESULTS: The distribution of SM(+) for pT2, pT3, and pT4a was 15.3% (27/176), 49.1% (58/118), and 100% (1/1), respectively. Overall, there were 55.61%, 80.61%, and 84.69% of men continent at 3, 6, and 12 months, respectively. However, when limiting the analysis to those who did not receive adjuvant radiotherapy within 12 months following surgery, urinary continence rates were 59.23%, 85.86%, and 90.21% at 3, 6, and 12 months, respectively. Preoperative prostate-specific antigen (PSA) and pathological T stage were identified as significant predictors of positive surgical margins. CONCLUSIONS: Laparoscopic radical extraperitoneal prostatectomy with bladder neck preservation has been a safe procedure which has resulted in good functional outcome. We observed a relatively high incidence of positive surgical margins which could be attributed to a large number of extracapsular disease cases.

Is determination of transition zone volume by transrectal ultrasound in patients with clinically benign prostatic enlargement sufficiently reliable in the clinical setting?

INTRODUCTION: Controversies exist regarding the accuracy of transrectal ultrasound (TRUS) determination of transition zone volume (TZV) when compared with enucleated adenoma weight. AIM: To determine the accuracy and reliability of measurements of the TZV by TRUS, by comparing preoperative radiological findings with the enucleated prostate adenoma volume, measured by fluid displacement volumetry (FDV), after retropubic prostatectomy performed by the Millin method, and, moreover, to evaluate changes in the surgical capsule size in the intermediate postoperative period. MATERIAL AND METHODS: We measured TZV preoperatively using TRUS and postoperatively with FDV in 112 patients who underwent retroperitoneal prostatectomy for benign prostatic hyperplasia (BPH). RESULTS: The TRUS volume correlated well with specimen volumes (r = 0.945, p < 0.0001). The median (quartile 1, quartile 3) absolute error was 7.35 ml (4.15 ml, 9.28 ml) and the median percent error was 9.12% (4.75%, 14.98%). Percent error, but not absolute error, was significantly related to TRUS TZV (p < 0.001 and 0.217, respectively). Adenomas > 80 cc were associated with lower percent error. The median volume of the residual prostate tissue measured 3.5 years after prostatectomy was 92.65 cc (65.75 cc, 109.58 cc), whereas the median volume of the surgical capsule, depending on the equation used for its calculation, was 24.80 cc (16.25 cc, 37.37 cc) and 31.43 cc (23.14 cc, 43.32 cc). CONCLUSIONS: The TRUS TZV correlated well with values determined by FDV. It can be reliably used in clinical management of BPH.

Determination of prostate adenoma weight reduction due to vaporisation process occurring during transurethral resection of the prostate.

INTRODUCTION: Transurethral resection of the prostate (TURP) is regarded as the gold standard surgical treatment for benign prostatic hyperplasia (BPH). The completeness of TURP may be assessed indirectly by estimation of the weight of glandular tissue removed. This parameter is often lower than expected. Tissue vaporisation in the course of TURP could be a contributory cause. AIM: To quantitatively evaluate tissue vaporisation occurring in the course of transurethral resection of the prostate and electrovaporisation of the prostate (EVAP) performed under experimental conditions. MATERIAL AND METHODS: The study was performed on 26 prostate glands removed during retropubic prostatectomy. Immediately following surgery all adenomas were halved and TURP or EVAP were carried out on both halves of each gland for period of 5 min. The amount of prostate tissue which vaporised during EVAP and TURP were calculated. RESULTS: The mean weight (± standard deviation) of the adenoma lost due to resection and vaporisation in the TURP group was 10.00 ±2.92 g and 4.26 ±1.59 g, respectively. The latter accounted for 30.10 ±7.71% of total prostate weight reduction. The mean prostate weight lost in the course of EVAP was 5.03 ±1.58 g. CONCLUSIONS: The vaporisation significantly contributes to the prostate tissue loss occurring during transurethral resection of the prostate.

ERG positive prostatic cancer may show a more angiogenetic phenotype.

In Western populations, roughly half of prostatic carcinoma (PC) cases show translocations involving the ETS transcription factor family genes and overexpression of the ERG transcription factor. ETS transcription factor family is known to be involved in angiogenesis. Microvascular density (MVD) influences the prognosis of various solid tumors, yet its significance in PC remains unclear. The aim of the study was to analyze microvascular density in prostatic adenocarcinoma in relationship to ERG expression. This is a retrospective study of 112 cases whose aim is to compare MVD in ERG-positive and negative cases and to test its relationship with other pathological parameters. Immunohistochemical stains for ERG and CD31 were done using standard methods, using tissue microarrays. The cases were classified as ERG-positive and negative and the CD31-positive vessels were counted. Fifty-one cases (45.54%) were positive for ERG, and the average MVD was 111.81 vessels/mm(2) (standard deviation, SD 54.20) for the entire group, 101.30 vessels/mm(2) (SD 50.60) for ERG-negative and 124.38 vessels/mm(2) (SD 56.17) for ERG-positive cases. There was only a slight tendency for higher MVD in higher grades and stages of cancer. None of other parameters, such as patients' age, lymphovascular invasion, presence of intraductal carcinoma or positive surgical margin, showed a significant relationship to MVD. This shows for the first time that ERG expression and MVD may have a significant relationship in prostatic adenocarcinoma.

Selected morphologic features influencing the prognosis of conventional renal cell carcinomas co-expressing P53 and MDM2.

Renal cell carcinoma is the most deadly of common urologic malignancies. The classical prognostic factors, including tumor type, grade and stage, as well as performance status of the patient, offer important information, but there is a need for new biomarkers which could improve the quality of prognostication. It has been proposed that tumors co-expressing P53 and MDM2 could represent a specific, more aggressive subgroup. The aim of the study was to explore this hypothesis using tissue microarrays, using two different anti-P53 antibodies. The material analyzed consisted of 470 cases of renal clear cell carcinoma. Reaction for P53 was positive in 15.1 or 13.2% of cases, depending on the antibody used. Reaction for MDM2 was positive in 37.9% of cases; 6.5 or 5.3% of cases coexpressed P53 and MDM2. Both P53-positive and double P53/MDM2-positive cases were higher grade and more likely to contain a sarcomatoid component, but their stage was similar to negative cases. PAb1081 P53-positive MDM2-positive cases were larger than the rest of the tumors (7.6 cm vs. 6.1 cm, p < 0.001). Our data support the hypothesis of prognostic significance of P53, and double P53/MDM2 positivity, yet further studies are needed to clarify the issue.

Sonography of tumors and tumor-like lesions that mimic carcinoma of the urinary bladder.

One of the basic abdominal organs that is assessed during transabdominal ultrasound examination for urological reasons is the urinary bladder. The bladder must be filled with urine. This is a prerequisite for a reliable assessment and, at the same time, an acoustic window in examining adjacent structures and organs, for instance the prostate gland. In some cases, doubts occur with respect to the nature of lesions detected. The paper presents anatomic lesions, defects and pathologies which might be erroneously interpreted as tumors of the urinary bladder, i.e. transitional cell carcinoma of the urinary bladder. The following lesions are discussed: 1) anatomic defects (including urachus remnants, ligaments that stabilize the bladder or cyst in the opening of the ureter into the bladder - ureterocele); 2) tumor- like lesions in the lumen of the urinary bladder (such as blood clots, fungus balls, stones or foreign bodies); 3) bladder wall pathologies (i.e. cystitis or endometriosis), focal decidual transformation of stromal cells or inflammatory pseudotumor; 4) lesions impressing on the bladder from the outside (the mesentery of the sigmoid colon, the bowel, pathological lesions in organs adjacent to the urinary bladder, inflammatory infiltration, vasogenic compression of the bladder, pelvic lipomatosis, pathological lesions of the pubic symphysis); 5) postoperative lesions. All these lesions may mimic carcinoma of the urinary bladder in sonography. Bearing this fact in mind is significant in establishing a diagnosis. Due to the malignant character of carcinoma of the urinary bladder and the need for aggressive surgical treatment, a correct diagnosis of this disease is essential for patients, particularly because the lack of adequate treatment and delayed treatment considerably affect prognosis.

Novel trends in transrectal ultrasound imaging of prostate gland carcinoma.

Carcinoma of the prostate gland is the most common neoplasm in men. Its treatment depends on multiple factors among which local staging plays a significant role. The basic method is transrectal ultrasound imaging. This examination enables imaging of the prostate gland and its abnormalities, but it also allows ultrasound-guided biopsies to be conducted. A conventional gray-scale ultrasound examination enables assessment of the size, echostructure and outlines of the anatomic capsule, but in many cases, neoplastic lesions cannot be observed. For this reason, new sonographic techniques are implemented in order to facilitate detectability of cancer. The usage of contrast agents during transrectal ultrasound examination must be emphasized since, in combination with color Doppler, it facilitates detection of cancerous lesions by visualizing flow which is not observable without contrast enhancement. Elastography, in turn, is a different solution. It uses the differences in tissue elasticity between a neoplastic region and normal prostatic parenchyma that surrounds it. This technique facilitates detection of lesions irrespective of their echogenicity and thereby supplements conventional transrectal examinations. However, the size of the prostate gland and its relatively far location from the transducer may constitute limitations to the effectiveness of elastography. Moreover, the manner of conducting such an examination depends on the examiner and his or her subjective assessment. Another method, which falls within the novel, popular trend of combining imaging methods, is fusion of magnetic resonance imaging and transrectal sonography. The application of multidimensional magnetic resonance imaging, which is currently believed to be the best method for prostate cancer staging, in combination with the availability of a TRUS examination and the possibility of monitoring biopsies in real-time sonography is a promising alternative, but it is associated with higher costs and longer duration of the examination. This paper presents the most important novel trends in transrectal imaging in prostate cancer diagnosis based on the review of the articles available in the PubMed base and published after 2010.

Enterovesical fistulae: aetiology, imaging, and management.

Background and Study Objectives. Enterovesical fistula (EVF) is a devastating complication of a variety of inflammatory and neoplastic diseases. Radiological imaging plays a vital role in the diagnosis of EVF and is indispensable to gastroenterologists and surgeons for choosing the correct therapeutic option. This paper provides an overview of the diagnosis of enterovesical fistulae. The treatment of fistulae is also briefly discussed. Material and Methods. We performed a literature review by searching the Medline database for articles published from its inception until September 2013 based on clinical relevance. Electronic searches were limited to the keywords: "enterovesical fistula," "colovesical fistula" (CVF), "pelvic fistula", and "urinary fistula". Results. EVF is a rare pathology. Diverticulitis is the commonest aetiology. Over two-thirds of affected patients describe pathognomonic features of pneumaturia, fecaluria, and recurrent urinary tract infections. Computed tomography is the modality of choice for the diagnosis of enterovesical fistulae as not only does it detect a fistula, but it also provides information about the surrounding anatomical structures. Conclusions. In the vast majority of cases, this condition is diagnosed because of unremitting urinary symptoms after gastroenterologist follow-up procedures for a diverticulitis or bowel inflammatory disease. Computed tomography is the most sensitive test for enterovesical fistula.