A. Mandressi

Renal tubular damage after renal stone treatment.

Summary50 patients were studied with respect to renal tubular damage related to open operative, percutaneous and extracorporeal shock wave treatment of renal stones. Preoperative and postoperative urinary N-acetyl-glucosaminidase (NAG) levels were measured as a marker of renal damage. There was no significant evidence of renal tubular damage in patients who underwent a conventional or percutaneous nephrolithotomy; urinary NAG excretion was significantly increased after ischaemic surgery. After extracorporeal shock wave lithotripsy (ESWL) serum NAG levels increased, probably because a damage of the white blood cells in cutaneous and renal circulation, but a slight increase of urinary NAG excretion could suggest a mild renal tubular damage especially in case of more than 2,000 shocks.

Familial Aggregation of Renal Calcium Stone Disease

The question of a familial predisposition towards stone formation in primary nephrolithiasis has not been explored completely. In a sample of 214 calcium stone patients, and 428 age and sex-matched controls we observed a higher frequency of stones among the first degree relatives of stone patients compared to the relatives of controls. A family history of renal stones was more common among the female (45 per cent) than among the male patients (31 per cent). There was no relationship between family history of renal stones, and abnormal calcium and oxalate excretion rates. A significant association between a family history and a higher urinary pH was observed among the female calcium stone patients. A genetic defect in urinary acidification with variable expressivity might be associated with a high frequency of stone formation. Moreover, uric acid excretion was higher in male stone patients with a family history of stones. Finally, the parents and siblings of the renal stone patients were affected more by calculi than were the corresponding relatives of their spouses.

Olfactory System of Highly Trained Dogs Detects Prostate Cancer in Urine Samples

PURPOSE We established diagnostic accuracy in terms of the sensitivity and specificity with which a rigorously trained canine olfactory system could recognize specific volatile organic compounds of prostate cancer in urine samples. MATERIALS AND METHODS Two 3-year-old female German Shepherd Explosion Detection Dogs were trained to identify prostate cancer specific volatile organic compounds in urine samples. They were tested on 362 patients with prostate cancer (range low risk to metastatic) and on 540 healthy controls with no nonneoplastic disease or nonprostatic tumor. This cross-sectional design for diagnostic accuracy was performed at a single Italian teaching hospital and at the Italian Ministry of Defense Military Veterinary Center. RESULTS For dog 1 sensitivity was 100% (95% CI 99.0-100.0) and specificity was 98.7% (95% CI 97.3-99.5). For dog 2 sensitivity was 98.6% (95% CI 96.8-99.6) and specificity was 97.6% (95% CI 95.9-98.7). When considering only men older than 45 years in the control group, dog 1 achieved 100% sensitivity and 98% specificity (95% CI 96-99.2), and dog 2 achieved 98.6% sensitivity (95% CI 96.8-99.6) and 96.4% specificity (95% CI 93.9-98.1). Analysis of false-positive cases revealed no consistent pattern in participant demographics or tumor characteristics. CONCLUSIONS A trained canine olfactory system can detect prostate cancer specific volatile organic compounds in urine samples with high estimated sensitivity and specificity. Further studies are needed to investigate the potential predictive value of this procedure to identify prostate cancer.

Secretory immunoglobulin A and inhibitory activity of bacterial adherence to epithelial cells in urine from patients with urinary tract infections

SummaryTo assess the role of local immune response against bacterial invasion of the urinary tract we studied 168 patients with bacteriuria. Urinary secretory immunoglobulins A (sIgA) were measured using radial immunodiffusion or enzyme-linked immunosorbent assay (ELISA). In particular, ELISA is a very suitable assay for measuring the low levels of sIgA in urine. Furthermore, we used a quantitative in vitro adherence assay to investigate the attachment of Escherichia coli to human uroepithelial cells after incubation in urine from patients with urinary tract infection. Urine from patients with ileocystoplasty was significantly more potent in inhibiting bacterial adherence than was urine from other groups of patients with urinary tract infection. The presence of high urinary sIgA may help explain the increased antiadherence activity of urine in patients with ileocystoplasty. Mean urinary sIgA in patients with upper urinary tract infection was higher than in patients with uncomplicated infection in the lower urinary tract. Alterations in mucosal immune functions may account for the propensity toward bacterial colonization in women prone to uncomplicated urinary tract infection.

Urinary Excretion of Citrate, Glycosaminoglycans, Magnesium and Zinc in Relation to Age and Sex in Normal Subjects and in Patients who form Calcium Stones

One hundred and ninety-seven healthy subjects and 104 patients with idiopathic calcium stone disease had their urinary excretion of citrate, glycosaminoglycans, magnesium, and zinc measured and the results correlated with sex and age. In normal subjects the daily excretion of citrate, magnesium, and zinc increased with age to a maximum during the fifth decade and remained relatively constant until the eighth decade when they decreased. The daily excretion of magnesium and zinc were higher in men than in women, which was attributed to the higher body weights of the men. The urinary excretion of citrate, magnesium, and zinc related to creatinine remained relatively constant with age in adult life; analyses of magnesium and zinc excretion rates divided by urine creatinine did not distinguish men from women. There was no significant difference between men and women for citrate excretion in 24 hour urine, but the citrate:creatinine ratio was significantly higher in women than men. The higher citrate excretion in women may explain the lower incidence of calcium stones in women. The highest glycosaminoglycan excretion rates were seen during the first two decades which is why children and teenagers are less prone to develop calcium stones in spite of high urinary calcium concentrations. Urinary citrate and magnesium excretion were lower, and glycosaminoglycan and zinc excretion were higher, in stone formers than in controls. It seems that a decreased excretion of citrate and magnesium together with an increased excretion of calcium, may contribute to the formation of calcium stones. The role of urinary glycosaminoglycans and zinc in the formation of calcium stones remains uncertain.

Long-term followup after extracorporeal shock wave lithotripsy treatment of kidney stones in solitary kidneys

A total of 64 treatments by the Dornier HM3 lithotriptor was performed on 52 solitary kidneys with stones. A slight increase but no significant variations in serum creatinine was noted in 15 patients without obstruction just after treatment (p greater than 0.05). No significant increases in serum creatinine were found even at the short-term, mid-term and long-term followup. After 12 to 56 months hypertension developed in only 1 previously normotensive patient. Of 37 patients at mid-term followup (12 to 24 months) 62% were stone-free, 24% had passable fragments, 8% had recurrent stones and 5% had regrowth of the residual fragments. At long-term followup (24 to 56 months) 50% of 26 patients were stone-free, 19% had dust or passable fragments, 19% had recurrences and 11% had regrowth of the residual fragments. The demonstrated effectiveness, small number of complications at the short-term followup, lack of sequelae at the long-term followup and relatively small number of recurrences confirm that extracorporeal lithotripsy is not only effective but also safe. It can be proposed as the treatment of first choice even when the stone is in a single remaining kidney.

Urinary NAG excretion after anesthesia-free extracorporeal lithotripsy of renal stones: a marker of early tubular damage

SummarySecond generation lithotripters require a higher number of shocks per session as well as an increased rate of secondary treatments for complete stone disintegration compared to the original spark gap lithotripter. The clinical relevance of biological side effects caused by such treatment are less known. We evaluated urinary excretion of N-acetyl-glucosaminidase (NAG) before and after lithotripsy in 50 patients treated with a low pressure spark gap lithotripter (Dornier HM3) and in 36 patients treated with a piezoelectric lithotripter (Wolf Piezolith 2200) in an attempt to evaluate their side effects on renal tissue. The urinary excretion of NAG increased after both spark gap lithotripsy using the modified HM3 and piezoelectric lithtripsy. These changes may be associated with slight tubular damage that would occur after anesthesia-free lithotripsy in patients subjected both to a high number of shocks and to secondary treatments.

Highly-trained dogs' olfactory system for detecting biochemical recurrence following radical prostatectomy

*Corresponding author: Gianluigi Taverna, Department of Urology, Ospedale Humanitas Mater Domini, Castellanza, Via Gerenzano 2, 21053 Varese, Italy, E-mail: gianluigi.taverna@humanitas.it Lorenzo Tidu, Paolo Sardella and Giuseppe Latorre: Italian Ministry of Defense’s, Military Veterinary Center, CEMIVET, Grosseto, Italy Fabio Grizzi: Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Rozzano, Milan, Italy Brian Stork: West Shore Urology, Muskegon, Michigan, USA Alberto Mandressi, Mauro Seveso and Giorgio Bozzini: Department of Urology, Ospedale Humanitas Mater Domini, Castellanza, Varese, Italy Giovanni Lughezzani, Nicolò Buffi, Paolo Casale, Girolamo Fiorini, Massimo Lazzeri and Giorgio Guazzoni: Department of Urology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy Letter to the Editor

Pharmacological Prevention of Renal Calcium Stones After Extracorporeal Shock-Wave Lithotripsy

Since the advent of extracorporeal shock-wave lithotripsy (ESWL), some clinicians have questioned the medical approach in the management of nephrolithiasis (1, 2). New machines require little or no anesthesia so treatment has become faster and safer. In order to re-evaluate the role of medical treatment in the prevention of renal calcium stones, we surveyed the long-term results of pharmacological treatment in our stone clinic.

MP64-07 VASCULAR HURST INDEX IN NON-TUMORAL BIOPSY CORES AS POTENTIAL HISTOPATHOLOGICAL PARAMETER TO SELECT PATIENTS WITH HIDDEN PROSTATE CANCER

METHODS: 44 cases were analyzed that are surgically operated with robot-assisted radical prostatectomy performed from February to September in 2016. Preoperative MRI have been conducted for all 44 cases, and the prostate cancer local diagnoses (Region of Interest: ROI) were determined by radiologists using MRI T2 weighed image and Diffusion Weighed Image (DWI), then finally the scores of ADC were calculated. IHC for aSMA, vimentin, CD105, and Tenascin-C (TNC-C) were conducted and classified into three group (none stained, weakly stained, strongly stained) to check the relation of those IHC findings to MRI ADC score before the treatment. RESULTS: The average of minimum ADC scores in ROC of these prostate cancer patients before surgery was 0.779 (SD1⁄40.173). IHC comparison were made according to the cut off value of the minimum ADC scores between more (n1⁄418, group A) and less (n1⁄426, group B) than 0.800. 66% (12/18) patients showed strongly stained findings for aSMA in group A. Meanwhile, vimentin, CD105, and TNC-C showed strong stained in B group, 22.2% (4/18) and 61.5% (16/26), 22.2% (4/18) and 0% (0/26), and, 33.3% (6/18) and 76.9% (20/26) in group A and B, respectively.(Conclusions) CONCLUSIONS: To use these multi-parametric MRI findings, especially pretreatment ADC scores, our results suggested postoperative IHC findings and more to address, tumor microenvironment could be predicted.Themorevarious treatmentselectionhavebeenandcouldbeapplied to prostate cancer, such as upfront chemotherapy and wide resection for surrounding tissues, themorepreciseprocedureareneeded topredict tumor microenvironment in order to detect potentially aggressive prostate cancer.