The clinical significance of circulating miR-21, miR-142, miR-143, and miR-146a in patients with prostate cancer.

Background: Prostate cancer (PCa) is the most common type of solid tissue cancer among men in western countries. In this study, we determined the levels of circulating miR-21, miR-142, miR-143, miR-146a, and RNU 44 levels as controls for early diagnosis of PCa. Methods: The circulating miRNA levels in peripheral blood samples from 43 localized PCa patients, 12 metastatic PCa (MET) patients, and a control group of, 42 benign prostate hyperplasia (BPH) patients with a total of 97 volunteers were determined the by PCR method. Results: No differences in the DCT values were found among the groups. In PCa and PCaMet groups the expression of miR21 and miR142 were higher compared to the BHP group. No other differences were observed among the other groups. miR21 expression in the PCa group was 6.29 folds upregulated whereas in the PCaMet group 10.84 folds up-regulated. When the total expression of miR142 is evaluated, it showed a positive correlation with mir21 and mir 146 (both p<0.001). Also, the expression of miR146 shows a positive correlation with both miR21 and miR143 (both p<0.001). Expression of miRNAs was found to be an independent diagnostic factor in patients with Gleason score, PSA, and free PSA levels. Conclusions: Our study showed that co-expression of miR21, miR-142, miR-143, and miR-146a and the upregulation of miR-21 resulted in increased prostate carcinoma cell growth. In the PCaMet group, miR21 is the most upregulated of all miRNAs. These markers may provide a novel diagnostic tool to help diagnose PCa with aggressive behavior.

Does Previous Open Stone Surgery Affect the Outcome of Shock Wave Lithotripsy Treatment in Children?

INTRODUCTION: The aim of the study was to evaluate the efficiency of shock wave lithotripsy (SWL) in children who previously underwent ipsilateral open renal stone surgery (ORSS). METHODS: A total of 315 renal units (RUs) with renal stones underwent SWL treatment in our department over a period of 18 years. A total of 274 RUs (87%) with no history of ORSS were categorized as group 1 and 41 RUs (13%) with a history of ORSS were categorized as group 2. The characteristics of the patients and renal stones, as well as the treatment modalities, were reviewed retrospectively, and the results were compared in terms of the rates of stone-free patients and complications. RESULTS: The stone-free rates were statistically lower in patients with an existing history of ORSS (p = 0.002), especially for stones located at the lower calyx (p = 0.006). However, there were no differences between groups in the rate of complications (p = 0.75). History of ipsilateral ORSS, age, and stone burden were independent risk factors that predicted a stone-free status in the regression analysis (p = 0.016, p = 0.045, and p = 0.001, respectively). CONCLUSION: The overall stone-free rate after SWL was found to be significantly lower in children with a history of ORSS than in those without, and this finding was significantly prominent for lower calyx stones. In spite of the possible difficulties in achieving surgical access due to anatomical changes in retrograde intrarenal surgery or mini-/micro-percutaneous nephrolithotomy, we believe that these techniques might be good alternatives for SWL in future cases.

The Role of 68GA-PSMA PET/CT Scan In Patients with Prostate Adenocarcinoma who Underwent Radical Prostatectomy.

PURPOSE: To determine whether a 68Ga-PSMA PET/CT scan evaluation before radical prostatectomy (RP) is an effective imaging modality for clinical local and lymph node (LN) staging compared with the pathological results. MATERIALS AND METHODS: We performed a preoperative 68Ga-PSMA PET/CT scan in 51 patients with prostate cancer (PCa), who were scheduled for an RP operation between January 2014 and June 2016 in our clinic. The correlation between the RP pathology and the results of the 68Ga-PSMA PET/CT scan was investigated. RESULTS: When the 68Ga-PSMA PET/CT scan results were evaluated according to the risk groups, intraprostatic activity was found in 5 of 12 patients (41.7%) in the low-risk group, 15 of 19 patients in the intermediate risk group (78.9%), and 90% patients in the high-risk group. The 68Ga-PSMA PET/CT scan sensitivity, specificity, positive and negative predictive values and accuracy were calculated as 58.2%, 75.3%, 84.4%, 44%, and 63%, respectively for intraprostatic tumor localization; 68.4%, 75%, 61.9%, 80%, and %72.6%, respectively for extracapsular extension; 63.6%, 92.3%, 70%, 90%, and 86%, respectively for seminal vesicle involvement; 50%, 100%, 100%, 88%, and 89.3%, respectively for LN metastasis. CONCLUSION: The 68Ga-PSMA PET/CT scan accurately demonstrates intraprostatic tumor localization in high-risk group and presence of seminal vesicle involvement, which can help to accurately detect the target lesion before prostate biopsy. In addition, with its high sensitivity and specificity values, 68Ga-PSMA PET/CT is a valuable imaging method for the assessment of LN metastasis in intermediate- and high-risk groups and also provides accurate nodal staging before RP.

Which antimuscarinic agents used in the treatment of overactive bladder increase heart rate? a prospective randomized clinical trial.

PURPOSE: To compare the heart rate increase side effect of different antimuscarinic drugs used in overactive bladder (OAB). METHODS: Overall 341 patients were consecutively randomized to take seven different antimuscarinic drugs between January 2014 and June 2016 at three institutions, and 250 patients who completed the follow-up visits were accepted into this study. Ninety-one patients who never came to visits were excluded. Drugs were classified into two groups as selective (darifenacin hydrobromide, solifenacin succinate and oxybutynin hydrochloride) and non-selective (fesoterodine fumarate, tolterodine tartrate, trospium chloride and propiverine hydrochloride) antimuscarinic drugs. The cardiac pulse rates and the blood pressures were recorded during the baseline, first visit (1 week) and second visit (1 month). Data were compared for drugs and two groups (selective versus non-selective) by using ANOVA test. RESULTS: Baseline characteristics were similar among the patients using different antimuscarinic drugs. Statistically significant increase in heart rate occurred in patients treated with non-selective antimuscarinic drugs compared to those treated with selective drugs (p < 0.001), and this increase was especially evident in patients treated with trospium chloride, tolterodine tartrate, fesoterodine fumarate and propiverine hydrochloride (p < 0.001, 0.003, 0.011 and 0.37, respectively). There was no statistical difference for the other side effects. CONCLUSIONS: Our results showed that heart rate significantly increased in OAB patients treated with non-selective antimuscarinic drugs. Trospium chloride, tolterodine tartrate, fesoterodine fumarate and propiverine hydrochloride seem to have the most unfavorable properties with regard to increased heart rate side effect when compared to the other antimuscarinic drugs (darifenacin hydrobromide, solifenacin succinate and oxybutynin hydrochloride).

Renal stone composition does not affect the outcome of percutaneous nephrolithotomy in children.

PURPOSE: We sought to investigate the association between renal stone composition and percutaneous nephrolithotomy outcomes in pediatric patients and define the characterization of the stone composition. METHODS: The data of 1157 children who underwent percutaneous nephrolithotomy between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. The study population comprised 359 children (160 girls, 199 boys) with stone analyses. Patients were divided into five groups according to the stone composition [group 1: calcium oxalate; group 2: calcium phosphate; group 3: infection stones (magnesium ammonium phosphate, ammonium urate); group 4: cystine; group 5: uric acid, xanthine stones]. RESULTS: Patient characteristics, perioperative, postoperative, and stone characteristics were compared considering the stone composition. There were no significant differences between the groups concerning age, sex, side involved, preoperative hematocrit levels, and solitary renal unit. Patients with cystine stones were more likely to have a history of stone treatment. Groups 2 and 5 had mostly solitary stones. However, group 3 had staghorn stone more often, and group 4 frequently had multiple stones. Overall stone-free rate (79.4%) was similar among the groups. Although stone composition was related to blood transfusion and prolonged operative and fluoroscopy screening times on univariate analysis, it was not a significant predictor of them on multivariate analysis. CONCLUSIONS: Stone composition was not a predictor of outcomes of pediatric percutaneous nephrolithotomy. However, cystine and infection stones, which are larger and filled multiple calyxes due to the nature of stone forming, were more challenging cases that need multiple tracts.

Does Previous Open Renal Stone Surgery Affect the Outcome of Extracorporeal Shockwave Lithotripsy Treatment in Adults with Renal Stones?

PURPOSE: To evaluate the effects of previous ipsilateral open renal stone surgery (ORSS) on outcomes of extracorporeal shockwave lithotripsy (SWL) in adults with renal stones. MATERIALS AND METHODS: A total of 2097 renal units with renal stones underwent SWL treatment at our institution between March 1997 and February 2013. One thousand eight hundred thirty-nine (87.7%) of these had no history of ORSS and were categorized as group 1, and 258 (12.3%) patients having history of ipsilateral ORSS were categorized as group 2. Characteristics of patients, stone and treatment, stone-free, and complications rates were documented in detail and compared in each group. These groups were also subclassified into four subgroups according to the stone location. RESULTS: The stone-free rates were statistically higher in group 1 than group 2 (73.2% and 61.6%, respectively). There were no differences between groups regarding the complications and steinstrasse. The stone-free rate of SWL for stones located at lower calix has significant difference according to groups 1 and 2 (64% vs 48.4%, p = 0.001). Logistic regression analysis showed that history of ORSS increased SWL failure rate 1.39 times. CONCLUSION: Overall stone-free rates after SWL treatment was found to be significantly lower in patients with the history of ORSS than in patients without, and this finding was significantly prominent for lower calix stones. We believe that retrograde intrarenal surgery or mini- /micro-percutaneous nephrolithotripsy, despite its possible difficulties in accessing due to anatomical changes, might be a good alternative for SWL.