Hani H. Nour

Diagnostic and Prognostic Significance of Serum and Tissue Galectin 3 Expression in Patients with Carcinoma of the Bladder

Background: Galectins are group of proteins found in the cytoplasm, nucleus, cell surface and extracellular matrix. Galectin 3 (Gal-3) displays pathological expression in a variety of processes such as tumorigenesis. Patients and Method: 70 patients classified into the control group, cystitis group, transitional cell carcinoma group, and squamous cell carcinoma group were enrolled in this study which aimed to detect the serum level and the intensity of tissue expression of Gal-3. Results: Both serum level and tissue expression of Gal-3 were statistically higher in bladder cancer patients compared to the other groups. Gal-3 level expression increased from low to high grade urothelial tumors, with a statistically significant increase of its level and expression between muscle invasive and non-muscle invasive Ta urothelial tumors. Conclusion: The serum Gal-3 level is sensitive and specific for the diagnosis of bladder cancer. The prognostic significance of tissue expression is to be confirmed.

Percutaneous nephrolithotomy in the supine position: Safety and outcomes in a single-centre experience.

Abstract Objectives: To assess the feasibility of performing percutaneous nephrolithotomy (PCNL) with the patient supine. Although PCNL with the patient prone is the standard technique for treating large (>2 cm) renal stones including staghorn stones, we evaluated the safety and efficacy of supine PCNL for managing large renal stones, with special attention to evaluating the complications. Patients and method: In a prospective study between January 2010 and December 2011, 54 patients with large and staghorn renal stones underwent cystoscopy with a ureteric catheter inserted, followed by puncture of the collecting system while they were supine. Tract dilatation to 30 F was followed by nephroscopy, stone disintegration using pneumatic lithotripsy, and retrieval using a stone forceps. All patients had a nephrostomy tube placed at the end of the procedure. The results were compared with those from recent large series of supine PCNL. Results: The median (range) operative duration was 130 (90–210) min, and the mean (SD) volume of irrigant was 22.2 (3.7) L. One puncture was used to enter the collecting system in 51 renal units (94%), while three units (6%) with a staghorn stone needed two punctures. The stone clearance rate was 91%, and five patients had an auxiliary procedure. There were complications in 15 patients (28%). All patients were stone-free at a 3-month follow-up. Conclusion: Supine PCNL is technically feasible; it has several advantages to patients, urologists and anaesthesiologists. It gives stone-free rates and a low incidence of organ injury comparable to those in standard prone PCNL.

The clinical significance of HER2 protein amplification/expression in urinary bladder lesion.

Abstract Objective: To evaluate HER2 oncoprotein expression by both immunohistochemical (IHC) staining and fluorescence in situ hybridisation (FISH) in different benign and malignant bladder lesions, and the effect of bilharzial infestation on this expression. Patients and methods: In a prospective controlled study, 72 patients were classified into a control group, and groups with cystitis, urothelial carcinoma, and squamous cell carcinoma (SCC). HER2 was detected using standard IHC staining and FISH in all groups. The correlation of HER2 expression with tumour type, stage and grade in relation to normal urothelium and cystitis was assessed. The effect of schistosomal infestation was evaluated. Results: HER2 expression was statistically significantly higher in patients with malignant lesions than in the other groups, and in high-stage and -grade tumours than in low-stage and -grade tumours. The use of FISH increased the detection of HER2-positive tumours. Schistosomal infestation did not affect HER2 expression in patients with transitional cell carcinoma. Conclusion: High-stage and -grade bladder malignancies expressed HER2 much more than did benign lesions. FISH is more sensitive for detecting HER2 expression. The treatment of HER2-positive tumours might benefit from novel targeted-treatment protocols.

Galectin 3 for the diagnosis of bladder cancer.

Abstract Objective: To evaluate serum levels of galectin-3 (G-3) in patients with bladder cancer and a control group, as a potential diagnostic and prognostic serum tumour marker. Patients and methods: Between November 2012 and January 2013, 55 patients (median age 58 years) were enrolled into three groups, i.e., a control, those with transitional cell carcinoma (TCC) or those with squamous cell carcinoma (SCC). The serum G-3 level was measured the night before cystoscopy. The levels of G-3 levels were correlated with tumour type, stage and grade, and in relation to levels in normal urothelium. The results were analysed statistically using the Mann–Whitney U-test, the Kruskal–Wallis test and the receiver operating characteristic curve, as appropriate. Results: The median serum G-3 level was 100, 720 and 920 pg/mL in the control, TCC and SCC groups, respectively, with very significantly greater G-3 levels in both the TCC and SCC groups than in the control group. Patients with high-grade TCC had a statistically significantly greater serum G-3 level than those with low-grade tumours, as did those with muscle-invasive TCC than those with Ta tumours. Conclusions: The level of G-3 can aid as a diagnostic marker in patients with either TCC or SCC of the bladder, but the prognostic significance of G-3 remains to be confirmed.

Low-dose bacille Calmette-Guérin for non-muscle-invasive bladder cancer: Results of a prospective study.

Abstract Objective: To evaluate the efficacy and safety of low-dose (45 mg) intravesical bacille Calmette–Guérin (BCG) therapy in the treatment of patients with non-muscle-invasive bladder cancer (NMIBC), as intravesical BCG is the most acceptable adjuvant therapy for NMI transitional cell carcinoma of the bladder. However, in the standard regimen, undesirable effects are the main cause of treatment discontinuation. Patients and methods: The present study included 37 men with primary NIMBC. All patients underwent complete TURB and 2 weeks later, a 6-week course of 45 mg BCG diluted in 50 mL isotonic saline was instilled into the bladder and retained for 2 h. Patients were evaluated for BCG efficacy (recurrence with or without progression) and safety by documentation of minor and/or major side-effects. Results: There were no major or severe side-effects and no treatment discontinuations. Local adverse effects occurred in 20 patients, while systemic effects, in the form of fever, occurred in six patients (16.2%). There was recurrence in 14 patients (37.8%) after 18–34 months, with disease progression (muscle invasion) in four (10.8%) after 6–18 months. The recurrence index was 0.39/100 patients/month and the mean (range) tumour-free period was 30.97 (7–36) months. Conclusion: Low-dose BCG intravesical therapy is an effective adjuvant treatment in NMIBC. However, this needs to be validated in future studies and in comparison with other proposed doses and/or regimens.

Single-step renal dilatation in percutaneous nephrolithotomy: A prospective randomised study

Abstract Objective: To perform an economical single-step renal dilatation (RD) during percutaneous nephrolithotomy (PCNL), using directly a 30-F Amplatz dilator over the central Alken dilator, in a trial to reduce the operative duration and radiation exposure during RD while avoiding an exchange of dilators that might increase the risk of blood loss. Patients and methods: In a prospective randomised study including 49 patients divided into two groups, the first had RD before PCNL using the standard metallic telescopic dilators (Alken), and the second had RD using the 30-F Amplatz dilator over the central Alken dilator. The operative duration, with X-ray exposure, was calculated. The procedure outcome in terms of complications, stone-free rates and hospital stay was evaluated statistically. Results: The tract was dilated correctly in all cases. The operative duration and X-ray exposure was shorter in patients undergoing single-step RD (P < 0.05). There were perioperative complications, according to the Clavien grading system, in 17 (34%) patients but there was no statistically significant difference between the groups. The stone-free rates were comparable in both groups. Conclusion: A single-step RD during PCNL is feasible, with a shorter operative duration and X-ray exposure. The outcomes were comparable with those of a standard metallic telescopic RD.

Prostate-sparing cystectomy: Potential functional advantages and objective oncological risks; a case series and review.

Abstract Objectives: Prostate-sparing cystectomy (PSC) has been debated over the last decade; our aim was to assess the functional results and to evaluate the oncological outcome after PSC, to judge the value of this technique. Patients and methods: Twenty-six men (median age 62 years) who were candidates for radical cystectomy were operated between 2004 and 2009 in the urology departments of Foch Hospital, Suresnes, France, and Theodor Bilharz Research Institute, Giza, Egypt. They all underwent a PSC with orthotopic bladder substitution. The functional results were assessed at 1, 3 and 6 months, with the final results evaluated at 1 year. Incontinence was classified according to pads used per day, and erectile function after PSC was assessed using the International Index of Erectile Function questionnaire. There was a strict follow-up for oncological failure, with special attention given to the remnant of the prostate and prostatic urethra. Results: The final functional results were assessed at 1 year, with daytime continence achieved in 22 patients (95%) and nocturnal leak in four (13%). At 1 year, 18 patients (83%) reported having erections on sexual stimulation. The median follow-up was 43 months, with an overall incidence of recurrence of 30% and a median time to metastasis of 30 months. At 36 months, the overall survival rate was 81%, with a tumour-free survival rate of 70%. Conclusion: PSC was no better than standard radical cystectomy, and should only be offered to patients who prefer preservation of their sexual function and continence over appropriate tumour control.

Laparoscopic Management of Distal Ureteric Stone in Bilharzial Ureter : Results of a Single Center Prospective Study

No doubt, Bilharzial ureters are complicated by distal stricture due to precipitation of Bilharzial ova in distal ureter. These cases are associated with poorly functioning and grossly hydronephroic kidneys that hinder endoscopic manipulation of the coexistent distal, high burden, long standing impacted stones. Thus, laparoscopic uretrolithotomy was performed in 51 bilharzial patients with distal ureteric stones 4 trocars were used. The ureter was opened directly over the stone and the stone was extracted. A double-J stent was inserted into the ureter which was closed by 4-0 polyglactin running suture. The results showed that among 51 cases 33 males and 18 females; the mean age was 40.13 years. the mean stone size was 2.73 cm. Conversion to open surgery was in only one case; the mean operative time 92.05 (range 75-120 minutes); postoperative pain score ranged from 20 to 60, the mean number of PO analgesic request was 1.72 (range 1-3); it was once in 21, twice in 23 and thrice in 7 cases. Hospital stay ranged from 2 to 5 with a mean of 2.74 days; total duration of follow up ranged from 7 to 12 with a mean of 9.68. Stone recurrence reported in 4 cases; ureteric stricture reported in 2 cases. Stone free rate was reported to be 100%.

Expression of ERG Protein and TMRPSS2-ERG Fusion in Prostatic Carcinoma in Egyptian Patients

AIM: Prostate cancer (PCa) is the second most common cancers in men worldwide. Its incidence can be influenced by several risk factors including genetic susceptibility. Therefore the search for the expression of a certain gene (ERG) and its rearrangement could give us clues for proper identification of PCa. And the study of ERG expression and its comparison to FISH in Egyptian patients can show whether ERG immunophenotype could be used instead of FISH, as it is cheaper. MATERIALS AND METHODS: This study was performed on 85 cases of PCa, showing 30 cases with HGPIN and 30 cases of prostatic hyperplasia. All were immunohistochemistry stained using ERG monoclonal rabbit antihuman antibody was used (clone: EP111). FISH analysis was performed in 38 biopsies of PCa cases to detect TMRPSS2-ERG rearrangement using the FISH ZytoLight TriCheck Probe (SPEC TMRPSS2-ERG). RESULTS: ERG expression was found in 26% of PCa cases and 20% of HGPIN cases. FISH analysis showed fusion of 21 cases of PCa (out of 22 cases showing ERG immunoexpression). CONCLUSION: Our findings emphasise that only malignant and pre-malignant cells and not benign cells from the prostate stain positive. ERG expression may offer a simpler, accurate and less costly alternative for evaluation of ERG fusion status in PCa.

AMBULANT FLEXIBLE CYSTOSCOPY FOR FOLLOW-UP OF Ta-TI UROTHELIAL CARCINOMA OF THE URINARY BLADDER: PAIN PERCEPTION AND COST EFFECTIVE.

Ambulant flexible cystoscopy is the standard procedure in the urological practice for follow-up of Ta-T1 urothelial carcinoma (UC) due to its ability to survey the bladder for a variety of indications. It is the principal means of diagnosis and surveillance of bladder tumors. The follow-up of patients treated for Ta-T1 UC is of great importance because of the high incidence of recurrence and progression of the disease, whereby patients with Ta-T1 UC undergo cystoscopy every three months. The aim of this study to evaluate the procedure of ambulant flexible cystoscopy in proper diagnostic follow-up of Ta-T1 UC, patients acceptance in regard to pain tolerance, non-hospital stay and expenses. Twenty one patients (18 male and 3 female) were diagnosed before as Ta-T1 UC by rigid cystoscopy and transuretheral resection of bladder (TURB) lesion scheduled for follow up by flexible cystoscopy under local anesthesia using 20 ml 2% lidocain gel on an ambulatory bases. Comparison was done using a cohort of 32 patients who underwent the procedure of follow-up of Ta-T1 cystoscopy and TURB using rigid cystoscopy and resectoscope. Seventeen patients 80.9% (16 male and 2 female) proved to be bladder free from recurrent lesion, 4 patients {19.1 %} (3 males and one female) which revealed recurrent lesions in spite of that the urinary bladder was free in pelvic ultrasonography. Cold cup biopsy from the lesions sent for histopathological examination which revealed recurrence of the tumor in 3 patients (two patients with Ta and one patient T1. TURB was done to have complete resection in 4 patients, the histopathological examination revealed ulcerating mucosa and free lamina propria in 3 specimens, and T2 in the fourth specimen. Comparison between the 2 groups revealed more patients acceptance for the flexible cystoscopy group as regard pain tolerance, non-hospital stay and expenses. Ambulatory flexible cystoscopy with 20 ml of 2% lidocaine gel anesthesia is tolerated well by patients, with advantage of no hospital stay in the regular follow up of Ta-T1 tumors, pain perception was accepted by all patient provided delayed cystoscopy after lidocaine-gel instillation.