Athanasios Bantis

Massive hematuria due to a congenital renal arteriovenous malformation mimicking a renal pelvis tumor: a case report.

IntroductionCongenital renal arteriovenous malformations (AVMs) are very rare benign lesions. They are more common in women and rarely manifest in elderly people. In some cases they present with massive hematuria. Contemporary treatment consists of transcatheter selective arterial embolization which leads to resolution of the hematuria whilst preserving renal parenchyma.Case presentationA 72-year-old man, who was heavy smoker, presented with massive hematuria and flank pain. CT scan revealed a filling defect caused by a soft tissue mass in the renal pelvis, which initially led to the suspicion of a transitional cell carcinoma (TCC) of the upper tract, in view of the patients age and smoking habits. However a subsequent retrograde study could not depict any filling defect in the renal pelvis. Selective right renal arteriography confirmed the presence of a renal AVM by demonstrating abnormal arterial communication with a vein with early visualization of the venous system. At the same time successful selective transcatheter embolization of the lesion was performed.ConclusionThis case highlights the importance of careful diagnostic work-up in the evaluation of upper tract hematuria. In the case presented, a congenital renal AVM proved to be the cause of massive upper tract hematuria and flank pain in spite of the initial evidence indicating the likely diagnosis of a renal pelvis tumor.

The expression of metallothioneins on imprint smears of prostate carcinoma : Correlation with clinicopathologic parameters and tumor proliferative capacity

Aims and Background Metallothioneins are a family of metal- binding cysteine-rich proteins that play an important role in cellular processes such as proliferation and apoptosis, protection against oxidative stress and metal ion homeostasis and detoxification. Recent findings suggest that metallothioneins might play a significant role in the development and progression of prostate cancer. It has been also demonstrated that Ki-67 expression may have prognostic value for disease-free survival in cases of prostate carcinoma. Study Design Imprint smears samples obtained from 70 patients immediately after radical prostatectomy for prostatic carcinoma were immunostained with monoclonal antibodies against metallothioneins and Ki-67. Metallothionein expression was correlated with Ki-67 immunostaining, Gleason score, stage, preoperative prostate-specific antigen levels and biochemical recurrence. Results Metallothionein expression was shown to correlate strongly with Gleason score (P <0.001) and significantly with pathological staging and Ki-67 immunostaining (P <0.001, P <0.05, respectively). In contrast, no significant association between metallothioneins and preoperative PSA was demonstrated. Both of the studied markers (metallothioneins and Ki-67) correlated with recurrence (P = 0.009, P = 0.006, respectively). Conclusions The present findings support the independent predictive value of metallothioneins and Ki-67 in prostate cancer. However, additional data are needed in order to reveal the factors that influence the expression of metallothioneins in epithelial neoplastic cells and clarify their mechanism of action.

Bisphosphonate-induced osteonecrosis of the jaw in patients with bone metastatic, hormone-sensitive prostate cancer. Risk factors and prevention strategies.

AIMS AND BACKGROUND Evidence from the literature suggests that osteonecrosis of the jaw is emerging as a serious complication of treatment with bisphosphonates for patients with advanced prostate cancer. METHODS AND STUDY DESIGN This study is a series of 60 patients with osseous metastases from prostate cancer under complete androgen deprivation therapy. All patients also received bisphosphonates intravenously every 3 to 4 weeks. Over a period of 3 and a half years, we recorded the incidence, presenting signs and symptoms of osteonecrosis of the jaw among those patients and the diagnostic workup required. RESULTS Nine of the 60 patients with metastatic prostate cancer were found to be affected with osteonecrosis of the jaw secondary to bisphosphonate administration at the Urology Department at the University Hospital of Alexandroupolis between January 2006 and August 2009. For diagnostic reasons, all 9 patients underwent computed tomography scan and magnetic resonance imaging of the maxillary region, as well as a three-phase whole body bone scan. CONCLUSIONS; There is evidence that administration of bisphosphonates in patients with advanced prostate cancer may increase the risk of osteonecrosis of the jaw. Guidelines regarding the diagnosis and management of those patients are needed.

A simplified technique for ureteral spatulation in laparoscopic pyeloplasty.

One of the most difficult, time-consuming, and at the same time critical steps of laparoscopic pyeloplasty is ureteral spatulation. We describe a reproducible technique that greatly simplifies this surgical step. Using standard laparoscopic scissors, the ureter is partially cut just inferior to the ureteropelvic junction (UPJ) at a point where a normal (nonstenotic) ureter is discerned. This first cut involves only half of the circumference of the ureter. The ureter remains attached to the UPJ. Through the most cephalad port, a 5-mm articulating laparoscopic scissors is inserted in the abdomen. The instrument is fully articulated so that the axis of the jaws is almost in line with the ureteral axis. The jaws are opened, one jaw is inserted in the ureteral lumen, and the ureter is spatulated to the requisite length. At this point, the first apical ureteral stitch is placed outside-in while the ureter is stabilized by its remaining attachment to the UPJ. Subsequently, the ureter is freed completely from the UPJ; the UPJ is excised, and the rest of the procedure is performed in a standard fashion.

Minimal invasive treatment options in pregnant women with ovarian vein syndrome.

PurposeTo describe the treatment modalities of symptomatic ovarian vein syndrome in pregnancy.MethodsIn our study, we included 12 pregnant women with right ureter and kidney dilatation; caused by ureteric obstruction. In 11 out of 12, we insert a DJ stent and in one woman we applied percutaneous nephrostomy, because of intermittent abdominal pain, resistant on analgetic therapy or feverish pyelonephritis. DJ stents and nephrostomy were inserted under ultrasound guidance without anaesthesia.ResultsAfter insertion of DJ stents, respective percutaneous nephrostomy colic attacks went back immediately and the feverish pyelonephritis in few days. At no time during these procedures, there was a risk for pregnancy.ConclusionOvarian vein syndrome in pregnancy can lead to violent colic pain and can become complicated by accompanied pyelonephritis. In these cases insertion of a DJ stent or percutaneous nephrostomy under ultrasound guidance is possible and safe, and leads to an improvement of complaints immediately.

Arteriovenous malformation of the spermatic cord as the cause of acute scrotal pain: a case report

Arteriovenous malformations of the lower urinary tract are uncommon lesions, usually presenting as scrotal masses. A case of recurrent acute scrotal pain mimicking testicular torsion that was attributed to the presence of an arteriovenous malformation of the spermatic cord is described. To our knowledge this is the first reported case of an arteriovenous malformation of the spermatic cord presenting with acute scrotal pain.

Can Tumor Necrosis Factor-α and Interleukin-6 Be Used as Prognostic Markers of Infection following Ureteroscopic Lithotripsy?

Introduction. Ureteroscopic lithotripsy (URS) although highly effective for the treatment of ureteral stones is associated with certain complications, the more common of which are postoperative fever and infection. In the present study we aimed to evaluate the levels of serum cytokines in patients undergoing ureteroscopic lithotripsy and investigate any possible correlation between levels of cytokines and infectious complications after URS. Materials and Methods. Thirty patients (19 males, 11 females), with a mean age of 47 (range: 26–68) that underwent URS lithotripsy for ureteral stones, and 10 healthy volunteers serving as the control group were enrolled in this study. Serum samples for TNF-α and IL-6 were obtained before surgical intervention and after 1, 24, and 48 hours and 2 , 24, and 48 hours, respectively. The preoperative and postoperative levels were compared and correlated with the possible complications after URS. Results. Serum TNF-α levels were statistically significant, increased 1 hour (P = 0.0083) and 48 hours (P < 0.001) after operation. IL-6 levels were found statistically significant, elevated after 2 and 24 hours from the URS (P < 0.001). In 2 patients we observed postoperative fever (>38.5°C). These two patients had high preoperative values of TNF-α and IL-6 ( 30 and 50 pg/mL, resp.) and these values increased postoperatively. Conclusion. High preoperative levels of serum TNF-α and IL-6 may indicate a predisposition for postoperative inflammation and infection following URS lithotripsy.

The influence of ejaculation and abstinence on urinary flow rates.

To investigate the relationship between urinary flow rate and ejaculation in healthy young men.

Radiological findings and the clinical importance of megacalycosis

Objective To describe the radiological findings and the clinical importance of megacalycosis. Materials and methods On the basis of a case report and literature review, diagnostic criteria and clinical significance of megacalycosis are presented. Result Megacalycosis is mostly asymptomatic and is usually discovered either accidentally or as a result of its complications, such as stone formation, flank pain, hematuria, infection, and fever. The renal pelvis, infundibulum, and ureter are not dilated. Calyces have a semilunar configuration rather than the conventional triangular or conical form. The tip of each pyramid is flat, and the calyces possess neither fornix nor papillae impressions. The number of calyces is increased compared to the healthy condition, typically from 20–25. The renal parenchyma has a normal width but with a slight narrowing of the renal medulla. The kidney exhibits normal function, in particular with respect to its ability to concentrate the urine. Conclusion Megacalycosis is a rare, usually unilateral dilatation of the kidney calyces in the presence of a normal, undilated renal pelvis and ureter. Its pathological significance lies in the occurrence of complications.

Metastatic Mucinous Adenocarcinoma of the Prostate with PSA Value of 8.6 ng/mL at 5-Year-Followup after Prostatectomy, Radiotherapy, and Androgen Deprivation

Introduction. Mucinous adenocarcinoma of the prostate is a rare variant of prostate cancer. Its malignant potential and the clinical course of the affected patients remain, by and large, controversial. No data exist about the course of metastatic mucinous adenocarcinoma of the prostate. Case Presentation. This case report describes the excellent clinical course of a 68-year-old patient with metastatic mucinous adenocarcinoma of the prostate, treated by radical prostatectomy, irradiation, and androgen deprivation. Conclusion. In our case, mucinous adenocarcinoma of the prostate does not appear to behave differently than acinar prostate cancer. Its malignant potential is dependent on its Gleason score.