Primer malignant giant cell tumour of kidney: a case report.

Osteoclast-like giant cell tumours of the kidney are extremely rare and usually accompanied by a conventional urothelial neoplasm such as papillary, transitional renal cell, or sarcomatoid carcinoma. Although they have morphological features similar to those of the giant cell tumours in the skeletal system, their counterparts in the urinary system show highly malignant features. Our case is the third primer malignant giant cell tumour of the kidney in the literature. The patient was a 50-year-old male and underwent nephroureterectomy for a mass of 18×14×13cm in his left kidney. However, the patient died in the second month postoperatively as a result of local recurrences and multiple distant metastases. The general condition of the patient deteriorated progressively; hence, he could not have any adjuvant therapy. Having more information about the pathological and clinical findings of these exceedingly rare tumours can help inform treatment steps.

Evaluation of sex hormones and sperm parameters in male epileptic patients.

OBJECTIVES: The aim of this study was to investigate the effect of carbamazepine (CBZ) and sodium valproate (VPA) monotherapy on sexual functions, sex hormones, and semen analysis and quality in male patients with epilepsy. METHODS: A total of 59 male patients with epilepsy, of which 30 were on VPA monotherapy and 29 were on CBZ monotherapy, were included in the study between January 2015 and March 2016. A control group was established with 30 healthy males. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), free testosterone (fT), estradiol (E2), sex hormone-binding globulin (SHBG) levels and bioactive testosterone (BAT)/bioactive estradiol (BAE), and BAT/LH ratio were studied in groups. All groups received semen analysis and International Index of Erectile Function Scale (IIEF-5) test for erectile dysfunction. RESULTS: E2 and DHEAS levels were higher in VPA and CBZ groups compared to control group (P < .001, P = .014). The decrease in fT levels in the VPA group was statistically significant (P = .038). No significant difference was detected in levels of SHBG, LH, and FSH (P > .05). BAT/BAE ratios were low both in VPA and CBZ groups (P < .001; P < .001), while BAT/LH ratios were low only in CBZ group (P = .033). In semen analysis, semen volume and number of normal sperms were found to be significantly lower in patients receiving antiepileptic drugs compared to control group (P < .05). There were no differences between the groups in rates of abnormal sperm morphology. IIEF-5 scores were found to be significantly lower in VPA and CBZ groups (P < .001). CONCLUSION: VPA or CBZ therapy may lead to dysregulation of sex hormones, sexual dysfunction, and alterations in semen analysis in male patients with epilepsy. This must be considered for the selection of antiepileptic drugs in young male patients.

C-reactive protein levels in girls with lower urinary tract symptoms.

INTRODUCTION: Daytime lower urinary tract (LUT) conditions are identified as daytime incontinence problems for children in whom any cause of neuropathy and uropathy has been excluded. C-reactive protein (CRP) is a common marker of acute or chronic inflammation and infection. Increased CRP levels have been detected in the studies conducted on adults diagnosed with overactive bladders and interstitial cystitis. OBJECTIVE: This study aimed to investigate the role of serum CRP levels in girls suffering from daytime LUT conditions. STUDY DESIGN: Out of the 752 patients who presented to the outpatient clinics with lower urinary tract symptoms, 709 were excluded due to: being boys, having previous urinary tract surgery, an active urinary tract infection, a neurological anomaly, a urinary system anomaly, having rheumatic disease, any chronic disease, any febrile infection over the past week, a history of constipation, and enuresis nocturna. Forty-three girls with LUT conditions and aged 8-10 years were included in the study as the patient group. Forty girls who attended the urology outpatient clinic without LUT conditions, or active urinary tract infections and any chronic disease requiring follow-up constituted the control group. Under the control of the parents, all subjects were asked to fill out 3-day voiding diaries. The voiding diaries identified frequency, urgency, urgency urinary incontinence, and functional bladder capacity data. All subjects also completed a dysfunctional voiding scoring system (DVSS). The serum CRP levels of all subjects were measured. RESULTS: There was a significant difference in serum CRP levels and DVSS between the patient group and the control group (P = 0.001, P = 0.001). The mean serum CRP levels showed a significant increase when frequency and urgency scores were ≥8, the urge incontinence score was ≥2 and the DVS score DVSS was ≥14 in the voiding diaries of the patient group (Table). DISCUSSION: Lower urinary tract dysfunction is defined as a condition involving abnormalities of filling and/or emptying of the bladder. This frequently encountered problem constitutes >40% of all pediatric urology outpatient visits. The relationship between LUT conditions and serum CRP in both genders has been detected. However, it is believed that to our knowledge, this is the first study looking at the relationship between daytime LUTS and increased CRP levels in children. The most important limitations of the study were: having a small number of patients, and the sample consisting of only one gender and a specific age group. CONCLUSION: The serum CRP levels were significantly higher in the girls with daytime LUT conditions than in the control group. Also, the CRP levels significantly increased as DVSS, frequency, urgency, and urge incontinence scores increased.

Premature ejaculation in patients with ankylosing spondylitis.

We aimed to evaluate the premature ejaculation (PE) among ankylosing spondylitis (AS) patients. Fifty male patients with AS who were diagnosed according to the modified New York criteria and fifty normal healthy controls (NHC) were included in this study. The details of patient age, disease duration, morning stiffness, laboratory activity, disease severity and medication use were obtained by reviewing the medical record. The Bath AS Functional Index (BASFI) was used to measure the functional status of the patients with AS. By taking a careful medical and sexual history, patients were classified as lifelong, natural variable, acquired PE or premature ejaculatory dysfunction. In addition to medical and sexual history, self-estimated intravaginal ejaculatory latency times (IELT) of patients were used in the classification of patients. To our knowledge, this is the first study of frequency of PE in men with AS. The prevalence rates of PE in patient and healthy controls were 32 and 30%, respectively (p = 0.331). The prevalence of PE was not significantly different between AS patients and NHC groups as regards the four PE syndromes. Average estimated IELT was 10,009 ± 51.9 sec in the PE group and 145.26 ± 43.01 sec in the non-PE group (p = 0.000). Patients with lifelong PE had a significantly lower mean estimated IELT than the other group (p = 0.000). Patients with premature-like ejaculatory dysfunction had the highest estimated IELT (p = 0.000). There was a significant association between self-estimated IELT and distribution of the patients according to the four PE syndromes (p = 0.01). Both AS patients and NHC groups have the same results. The present study demonstrates that PE in men with AS is as prevalent as it is in the general population. Although this study is restricted in terms of the number of patients, it is the first study ever conducted. For more meaningful results, multi centred studies with more patients are required.

P53 mutations and other prognostic factors of renal cell carcinoma.

OBJECTIVE: Tumor stage, histological pattern, cell type, diameter and cell ploidy are the factor that have been proposed for predicting the prognosis of renal cell carcinoma (RCC). There is a wide variation in the reported incidence of p53 mutation in RCC, and its prognostic significance for this tumor is unknown. We investigated the prognostic value of p53 mutations among other prognostic factors. PATIENTS AND METHOD: We evaluated the stages, tumor diameters, histological grades, cellular patterns and the presence of mutant p53 protein in 50 cases of RCC. The survival function of each parameter was estimated by Kaplan-Meier and log-rank tests, and the significance of each parameter on survival was evaluated by logistic regression analysis. RESULTS: The p53 mutation incidence was 20% in the RCC cases included in the study (n = 50). The survival rates of stages pT(2), pT(3) and pT(2-3)N+ were 87.8, 61.0 and 0%, respectively (p = 0.0462). The survival analysis of grade 1-2 and grade 3-4 tumors revealed 92.3 and 51.5% survival rates, respectively (p = 0.002). The survival rates of mutant p53+ and mutant p53- cases were 33.3 and 84.2%, respectively (p = 0.0027). The logistic regression test analysis demonstrated that tumor grade, tumor stage and mutant p53 positivity status were the most significant prognostic factors (p < 0.03). The survival rates of mutant p53+ and p53- cases at stages pT(2), pT(3) and pT(2-3)N+ were 66.67 versus 91.48%, 33.3 versus 71.43% and 0 versus 100%, respectively (p = 0.0392). A similar finding was present at each stage for cellular grades (p = 0.0093). The survival rates of mutant p53+ and p53- cases for grades 3 and 4 were 33.33 and 74.48%, respectively (p = 0.2731). CONCLUSION: Our results suggested that many parameters can affect survival of RCC cases, but among these, tumor grade, tumor stage and p53 mutation status are the most important prognostic factors, but p53 mutation status and cellular grade can afford additional prognostic information at each stage.

A large primary malignant melanoma of the female urethra.

We present a case of large, primary malignant melanoma of the female urethra with poor prognosis in this case report. Malignant melanoma is one of the rare tumors of the female urethra and accounts for 0.2% of all malignant melanoma cases. Large (5.6 cm in diameter), primary malignant melanoma of the female urethra is exceedingly rare.