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Computerized Tomography for Detecting Perivesical Infiltration and Lymph Node Metastasis in Invasive Bladder Carcinoma

Objectives: Computerized tomography (CT) is used in the preoperative staging of invasive bladder carcinoma. We evaluated the role of CT for detecting perivesical invasion and lymph node metastases in patients who had undergone radical cystectomy and pelvic lymphadenectomy for invasive bladder carcinoma. Patients and Methods: We retrospectively analyzed the clinical and pathological data of 100 patients with invasive bladder carcinoma who had undergone radical cystectomy. The preoperative CT images were reevaluated and interpreted by one uroradiologist blinded to the final pathological results for evidence of extravesical tumor extension or lymph node metastases. Results: Of the 100 patients, CT showed extravesical tumor involvement in 57. Of these 57 cases, 22 displayed no evidence of extravesical tumor involvement in the final pathological analysis. In 6 cases, although perivesical invasion was identified in the final pathological analysis, preoperative CT showed no evidence of extravesical tumor involvement. Regarding extravesical tumor spread, the differences between CT and pathological stages were statistically significant (p < 0.001). CT was highly suggestive of lymph node metastases in 9 cases, but only 4 were pathologically confirmed. On the other hand, in 9 patients pelvic lymph node metastasis were pathologically diagnosed, but there was no evidence of lymphadenopathy on CT. Regarding lymph node involvement, there was moderate concordance between CT and pathological findings (p = 0.003, κ = 0.29 ± 0.14). Conclusion: CT has limited accuracy in detecting perivesical infiltration and lymph node metastasis in invasive bladder carcinoma. The information provided by CT is insufficient and we urgently need more reliable staging techniques.

Microvessel density as a prognostic marker in bladder carcinoma: correlation with tumor grade, stage and prognosis.

Introduction: The aim of our study was toevaluate tumor angiogenesis as a prognosticmarker of transitional cell carcinoma of thebladder and to asses its relationship toestablished variables for survival and responseto therapy.Patients and method: Microvessel density(MVD), a measure of tumor angiogenesis, wereevaluated in 77 primary bladder cancers.Forty-three superficial carcinomas and 34invasive carcinomas were analysed. Tumorspecimens of all patients were obtained bytransurethral resection (TUR) and all thetumors were transitional cell carcinomas.Twenty-two patients with invasive bladdercancer have undergone M-VEC chemotheraphy. Thecorrelation between MVD and histopathologicalgrade, tumor stage and prognosis was evaluated.MVD was identified by immunostaining ofendothelial cells using anti-CD34 antibody. Forstatistical analysis Kruskal-Vallis,Mann-Whitney U and Fisher’s exact tests were used.Results: MVD was correlated with tumorgrade, stage and prognosis. Significantlyhigher MVD was determined in invasive tumorsthan superficial tumors (p < 0.05). MVDincreased with tumor grade and stage(p < 0.05). High MVD was correlated with therisk of clinical progression in bothsuperficial and invasive bladder carcinomas(p < 0.05, p < 0.001 respectively). Invasivetumors with remission after M-VEC chemotheraphyhad lower MVD than tumors with progressionafter M-VEC.Conclusion: These data demonstrate thatMVD in bladder carcinoma correlates with grade,stage and malignant potential of the tumor.Quantification of tumor angiogenesis may allowselection of the type of treatment for bladdercancer patients.

Urological Complications in Renal Transplantation: Long-Term Follow-Up of the Woodruff Ureteroneocystostomy Procedure in 433 Patients

Purpose: The two major types of urologic problems after renal transplantation are urinary leakage and obstruction. In this study, we report the urological complications of renal transplantations performed in our hospital during a 22-year period. Patients and Methods: Between 1978 and 2000, 433 consecutive patients underwent renal transplantation. Of those transplants, 50 were cadavers and 383 were living-related donor transplantation. All ureteroneocystostomies were performed with the same technique described by Woodruff. Results: Urological complications developed in 19 (4.23%) recipients. Those complications were urinary leakage in 9 (2%), ureteral obstruction in 9 (2%) and ureteral necrosis in 1 patient (0.23%). All complications occurred during the 6-month postoperative period and after re-operation or conservative management no graft or patient was lost due to urological complications. Conclusion: The quoted overall rate of urological complications varies from 2.9 to 12.5%; our complication rate was 4.23%. This relatively low rate is probably due to the Woodruff ureteroneocystostomy technique.

Increased Prostate-Specific Antigen in Subclinical Prostatitis: The Role of Aggressiveness and Extension of Inflammation

Objectives: Subclinical prostatitis is a very frequent histologic finding in pathological examinations of prostate biopsy and prostate surgery material. In this study, we tried to investigate the correlation between the morphological parameters of histological prostatitis and total serum prostate-specific antigen (PSA)-PSA density (PSAD) to determine if either the extent or aggressiveness of inflammation might affect serum PSA. Methods: 269 patients who had undergone TURP or transvesical prostatectomy with pathological diagnosis of BPH and prostatitis were included in the study. We retrospectively reviewed and scored the extent and aggressiveness of inflammation in prostate specimens of BPH, according to the scale that has been reported by Irani et al. and then correlated those scores with PSA and PSAD. Results: When the inflammation grades correlated with PSA and PSAD, the extent of the inflammation did not show a significant correlation with total PSA and PSAD (p > 0.05). However, there was a statistically significant correlation between aggressiveness grades and total PSA and PSAD (p < 0.001). Median PSA levels in grades 0, 1 and 2 of aggressiveness of inflammation were 3.2, 4.2 and 5.8 respectively. Conclusion: Aggressiveness grade of the inflammation in subclinical prostatitis is the most important morphological factor that is responsible for PSA elevation. We believe that it should be a more accurate guide for the clinician if pathologists report on the aggressiveness grades of the inflammation, especially on initial prostate biopsies, in order to help for timing of the further biopsy.

Solitary metastasis of renal cell carcinoma to the parotid gland 10 years after radical nephrectomy

Abstract  Renal cell carcinoma metastasis to the parotid gland after tumor nephrectomy is extremely rare. We report a case of solitary parotid metastasis from clear cell renal cell carcinoma in a 59‐year‐old woman, who presented 10 years after primary treatment. To our knowledge this is the first case in the published literature presenting with solitary parotid metastasis after such a long time. Superficial parotidectomy with preservation of the facial nerve was performed. One year after, the patient developed contralateral multiple kidney tumors and underwent left radical nephrectomy. She is currently on a dialysis program and no additional metastasis has been observed for 18 months.

Long-Term Results of Anderson-Hynes Pyeloplasty in 180 Adults in the Era of Endourologic Procedures

Introduction: The aim of the present study wasto evaluate the long-term results of adult open pyeloplasties performed by the Anderson-Hynes technique in the era of new endourologic procedures. Materials and Methods: The medical records of 180 adult patients who underwent Anderson-Hynes pyeloplasty with a diagnosis of ureteropelvic junction (UPJ) obstruction, were retrospectively reviewed. Pre- and postoperative results were compared with clinical, radiologic and radionuclide studies. The mean age of the patients was 33.2 (16–65) years. The minimum clinical follow-up time was 12 months and the mean time from the operation was 9.4 years (between 1 and 17 years). Results: Success was defined as resolution of symptoms and decrease in pyelocaliceal volume and calicectasis. The overall success rate was 91.1%. The success rate was between 93.1 and 100% in patients with grades I–III and 62.5% in patients with grade IV hydronephrosis and contribute to renal function less than 25%. The pyelocaliceal volume returned to normal in 39 (21.7%) patients, significantly decreased in 82 (45.5%), and the flow of contrast media from renal pelvis to ureter improved in 43 (23.9%) and did not change or increased in 16 (8.9%). The failure happened in the first 3 months in 57% of patients and in long-term follow-up in 43% of patients. Conclusion: Despite newer endoscopic techniques, Anderson-Hynes pyeloplasty, with an over 90% success rate remains the gold standard in the treatment of primary UPJ obstruction.

Isolated local recurrence of renal cell carcinoma after radical nephrectomy: experience with 10 cases

OBJECTIVES Isolated local recurrence of renal cell carcinoma after radical nephrectomy is very uncommon and the effect of aggressive surgical management of this clinical entity remains controversial. We report our experience with 10 such cases. METHODS Between 1994 and 2002, 10 patients with isolated local recurrence of renal cell carcinoma without any evidence of metastatic disease after radical nephrectomy were treated at our department. The mean patient age was 51.7 years (range 26 to 74); 7 patients were men and 3 were women. All patients underwent extensive surgery for local recurrence. RESULTS Only 3 patients were symptomatic, and the others were diagnosed during routine follow-up examinations. The mean time to local recurrence was 33.6 months (range 3 to 68), and the mean size of the recurrent tumor was 8.45 cm (range 3 to 12). An aggressive surgical approach was taken in all patients. One patient died in the postoperative period because of a surgical complication. Of the remaining 9 patients, 2 died of metastatic disease after a mean survival of 8.5 months (range 3 to 14). Seven patients were alive with a mean survival of 16.6 months (range 3 to 38+). CONCLUSIONS We believe that patients with isolated local recurrence after radical nephrectomy may benefit from an aggressive surgical approach, but this kind of surgery may also have significant complications.

The value of transrectal ultrasound guided needle aspiration in treatment of prostatic abscess

INTRODUCTION Prostatic abscess (PA) is a very uncommon disorder. The value of transrectal ultrasound (TRUS) guided aspiration in the treatment of PA has not been clearly defined. We present our experience with six such patients. MATERIALS AND METHODS Between July 1997 and December 2002, six patients with PA were diagnosed by TRUS and treated by TRUS guided needle aspiration in our department. PA was defined as hypoechoic, inhomogeneous, thick walled fluid collection. TRUS guided needle aspiration of the abscess was performed transrectally in all patients with a 20-cm long 18 gauge Chiba needle. Successful treatment criteria were defined as clinical improvement in symptoms and decrease of more than half of the estimated abscess volume on follow up TRUS control. Patients with continuing clinical symptoms were defined as treatment failures. RESULTS The most common TRUS finding was detection of a hypoechoic area with inhomogeneous structures, which was determined in all patients (100%). In some patients irregular contour and heterogeneous areas were additionally described. TRUS guided needle aspiration treatment of PA was successful in five of six patients (83.3%). In one patient treatment failed and the abscess recurred 3 weeks after the procedure. As this patient had additionally a bladder outflow obstruction, transurethral resection of the prostate was performed instead of a repeat procedure. There were no complications associated with the procedure. CONCLUSIONS In conclusion, TRUS has an important value in diagnosis and treatment of PA. TRUS guided aspiration is an effective and minimally invasive treatment modality for PA which causes no serious complications.

Gemcitabine plus vinorelbine chemotherapy in patients with advanced bladder carcinoma who are medically unsuitable for or who have failed cisplatin-based chemotherapy.

OBJECTIVE To evaluate the efficacy and toxicity of gemcitabine plus vinorelbine chemotherapy in patients with advanced bladder carcinoma who are unsuitable for or who have failed cisplatin-containing chemotherapy. PATIENTS AND METHODS Thirty-one patients with advanced transitional cell carcinoma (TCC) of the bladder were scheduled to receive gemcitabine and vinorelbine chemotherapy. Twenty-one patients had received no prior chemotherapy and their creatinine clearance was below 50 ml/min (group 1), and the remaining 10 patients did not respond to previous cisplatin-containing chemotherapy (group 2). RESULTS In group 1, objective response rate was 47.6%, including 2 (9.5%) complete and 8 (38.9%) partial responses. In group 2, partial response was observed in 2 (20%) patients. The median survival time for patients in group 1 and 2 were 15 months (range 3-23) and 7 months (range 3-21), respectively. Grades 3 or 4 leukopenia developed in 16.1% of patients. Overall, 12.9% of the patients suffered from grade 3 nonhematologic toxicity. CONCLUSION Our preliminary data indicate that the combination of gemcitabine and vinorelbine is active and well tolerated especially in patients with advanced TCC who are unsuitable for cisplatin-based chemotherapy.

Thrombospondin-1, Vascular Endothelial Growth Factor Expression and Microvessel Density in Renal Cell Carcinoma and Their Relationship with Multifocality

OBJECTIVE To evaluate the relevance of microvessel density (MVD) and the angiogenic factors, vascular endothelial growth factor (VEGF, an important angiogenic factor in solid tumors) and thrombospondin-1 (TSP-1, a potent inhibitor of angiogenesis), to multifocality of renal cell carcinoma (RCC). PATIENTS AND METHODS Using immunohistochemistry the expression of CD34, TSP-1 and VEGF was assessed in 38 archival tissue specimens from 19 patients with unifocal RCC and 19 with multifocal RCC. Immunostaining results for VEGF was scored for the appropriate percentage of positive tumor cells and relative immunostaining intensity (score range 0-12). Only extracellular immunoreactivity was considered positive for TSP-1 and the same method was used to score the stromal staining. The microvessel density was measured by immunohistochemical staining with anti-CD34 monoclonal antibody. RESULTS VEGF immunoreactivity> or =1% was detectable in all unifocal and multifocal tumors. TSP-1 immunoreactivity was detected in 14 (73.7%) of 19 unifocal RCCs and in 16 (84.2%) of 19 multifocal RCC specimens (p=0.69). There were no statistically significant differences in the immunostaining intensity, percentage of immunopositive cells and the staining scores of VEGF and TSP-1 among the two groups. Additionally, there was no difference in MVD in multifocal and unifocal tumors. CONCLUSION As there is no difference in MVD count, and expression of angiogenic factors (VEGF and TSP-1) in multifocal and unifocal tumors, multifocality of RCC is not determined by VEGF/TSP-1 expression.