Hikmet Topaloglu

Prognostic significance of neuroendocrine differentiation in prostate adenocarcinoma.

Much progress has been made toward an understanding of the development and progression of prostate cancer (PC) and the factors that drive the development of androgen independence. Neuroendocrine (NE) cells may provide an intriguing link between NE cell differentiation (NED) and tumor progression in PC. NED in PC generally confers a more aggressive clinical behavior and less favorable prognosis than conventional PC. In this article, we review the known functions of NE cells in PC and discuss the current knowledge on stimulation of cancer proliferation, invasion, apoptosis resistance, serum and immunohistochemical markers, and the prognostic significance of NED in human PC.

A comparison of metal telescopic dilators and Amplatz dilators for nephrostomy tract dilation in percutaneous nephrolithotomy.

BACKGROUND AND PURPOSE Nephrostomy tract dilation is one of the important steps in percutaneous renal surgery. We present our experiences with using Amplatz and metal telescopic dilators (Alken) to create a percutaneous tract and compare the advantages and risk factors of both procedures. PATIENTS AND METHODS We retrospectively reviewed the medical records of 173 patients who had undergone 188 percutaneous nephrolithotomy procedures between April 2007 and December 2010. The nephrostomy tracts had been created by using Amplatz (67 cases) or Alken dilators (121 cases). Total operative time, scope time, tract formation time, decrease in hemoglobin concentrations, blood transfusion rates, tract dilation failures, and the cost of both systems were compared between the groups. RESULTS There were no statistically significant differences in total operative time (103.3 ± 46.5 vs 99.1 ± 44.4 min, P=0.583), scope time (5.23 ± 3.06 vs 5.28 ± 2.52 min, P=0.732), decrease in hemoglobin concentration (-1.5 ± 1.2 vs-1.3 ± 1.1 mg/dL, P=0.230), blood transfusion rates (13.4% vs 11.6%, P=0.709), and tract dilation failure rates (6.0% vs 1.7%, P=0.107) for Amplatz and Alken dilation groups, respectively. A shorter tract formation time (6.56 ± 3.04 vs 5.42 ± 3.07 min, P<0.001) was observed in the Alken dilation group. The approximate costs per each case were

Diagnostic Value of a Urine-Based Tumor Marker for Screening Lower Urinary Tract in Low-Risk Patients with Asymptomatic Microscopic Hematuria

220 and

The efficiency of a sedative or analgesic supplement to periprostatic nerve blockage for pain control during transrectal ultrasound-guided prostate biopsy - a prospective, randomized, controlled, double blind study

7.25 for Amplatz and Alken dilation groups, respectively. CONCLUSIONS The Alken dilation technique produces similar results to the Amplatz dilators in terms of efficiency, safety, and total operative time. Notwithstanding, it is more cost-effective in comparison.

A Comparison of Antegrade Percutaneous and Laparoscopic Approaches in the Treatment of Proximal Ureteral Stones

Background: To evaluate the use of NMP22 BladderChek® (NMP22BC) as an initial test in comparison to voided urine cytology for screening subjects with asymptomatic microscopic hematuria (AMH); those who are <40 years of age and have a low risk for bladder cancer based on a non-smoking history, and by discussing the guidelines on this subject. Methods: From October 2005 to September 2007, 164 patients (56 male, 108 female) were evaluated. Patients with risk factors according to AUA Best Practice Policy Recommendations on AMH were strictly excluded from the study. For upper urinary tract imaging, ultrasonography (USG) was performed and prior to the cystoscopic procedure freshly voided urine was sampled for urine cytology and NMP22BC assay in all patients. Biopsy was performed if suspicious lesions were seen or positive cytology was obtained. Results: The mean age was 30.8 years. As some benign urological pathologies were detected in 21 patients by USG, NMP22BC was positive in 26 patients where the cytology was confirmed as atypia in 5. Two TaG1 tumors were detected cystoscopically in a 39-year-old man and a 33-year-old woman where the NMP22BC test was positive and the cytology was negative in both patients. NMP22BC tests sensitivity, PPV and NPV values were detected to be higher compared to cytology and the likelihood ratio was 6.75. Conclusion: We recommend in evaluation of low-risk patients with AMH that, as an initial test, two non-invasive and cost-effective methods be chosen: an upper tract imaging by USG as recommended by guidelines, followed by an NMP22BC test for lower tract investigation instead of urine cytology.

Single early instillation of mitomycin C and urinary alkalinization in low-risk non-muscle-invasive bladder cancer: a preliminary study.

Introduction The aim was to examine the effect of a sedative or analgesic supplement to periprostatic nerve blockage (PNB) on pain reduction during probe insertion and needle penetration in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. We also investigated the effects of this procedure on the positive response rate in re-biopsy. Material and methods One hundred TRUS-guided prostate biopsy patients due to prostate-specific antigen (PSA) levels higher than 2.5 ng/ml and/or abnormal rectal examination findings were evaluated. Group 1 (PNB) was given periprostatic lidocaine injection before the procedure. Group 2 (analgesic) was given tramadol and PNB. Group 3 (sedative) was given midazolam and PNB. Group 4 (control) was not given any anaesthesia or analgesics. Pain scores were assessed during probe insertion and needle penetration by a visual analogue scale. Results During probe insertion, the mean pain score of the sedative group was lower than that of the control, analgesic and PNB groups (p < 0.001, p = 0.009, and p < 0.001, respectively). During needle penetration, the mean pain score of the control group was higher than that of the other groups (p < 0.001). The rate of positive response to re-biopsy was found to be 56% in the control group and between 92% and 100% in the other three groups (p < 0.001). Conclusion According to our results, it can be concluded that midazolam, given supplementary to PNB, contributes as an effective and safe alternative for pain control during both probe insertion and penetration of the biopsy needle into the prostate capsule; however, tramadol supplement does not provide any additional contributions.

Comparison of Three Different Chemotherapy Regimens Containing Epirubicin in Hormone- Refractory Prostate Cancer Patients

Purpose. To compare the effectiveness and safety of retroperitoneal laparoscopic ureterolithotomy (RLU) and percutaneous antegrade ureteroscopy (PAU) in which we use semirigid ureteroscopy in the treatment of proximal ureteral stones. Methods. Fifty-eight patients with large, impacted stones who had a history of failed shock wave lithotripsy (SWL) and, retrograde ureterorenoscopy (URS) were included in the study between April 2007 and April 2014. Thirty-seven PAU and twenty-one RLU procedures were applied. Stone-free rates, operation times, duration of hospital stay, and follow-up duration were analyzed. Results. Overall stone-free rate was 100% for both groups. There was no significant difference between both groups with respect to postoperative duration of hospital stay and urinary leakage of more than 2 days. PAU group had a greater amount of blood loss (mean hemoglobin drops for PAU group and RLU group were 1.6 ± 1.1 g/dL versus 0.5 ± 0.3 g/dL, resp.; P = 0.022). RLU group had longer operation time (for PAU group and RLU group 80.1 ± 44.6 min versus 102.1 ± 45.5 min, resp.; P = 0.039). Conclusions. Both PAU and RLU appear to be comparable in the treatment of proximal ureteral stones when the history is notable for a failed retrograde approach or SWL. The decision should be based on surgical expertise and availability of surgical equipment.

The preventive role of transurethral antibiotic delivery in a rat model

Background The purpose of this study was to determine the effectiveness of a single early instillation of mitomycin C (MMC) after transurethral resection of bladder tumor (TURBT) together with urinary alkalinization in patients with low-risk non-muscle-invasive bladder cancer (NMIBC). Methods Between February 2006 and November 2010, patients diagnosed as having a primary bladder tumor were randomized into standard and optimized treatment groups. The treatment groups were formed prospectively from patients with NMIBC according to results of pathological examination postoperatively, whereas the control group was formed retrospectively. Patients in the standard group (n = 11) were given intravesical MMC 40 mg in the first 6 hours after TURBT, while the patients in the optimized group (n = 15) underwent urinary alkalinization prior to MMC. In the control group (n = 23), no drug treatment was given. The patients were followed after surgery at months 3 and 12, and then annually for the first 5 years using cystoscopy and ultrasound. Time to recurrence and recurrence-free survival rates were calculated. Results There were no statistically significant differences between the standard and optimized groups, between the control and optimized groups, or between the control and standard groups in terms of mean recurrence-free survival rates (P = 0.132, 0.645, and 0.173, respectively). The mean time to recurrence was 34.8 (range 28.5–41.1) months in the optimized group and 51.8 (range 44.3–59.2) months in the control group. There was no recurrence during the follow-up period in the standard group. Conclusion The results of this preliminary study could not demonstrate the efficacy of urinary alkalinization before a single dose of early MMC following TURBT to increase the effectiveness of the MMC, so we did not continue the study further.

Lymphangioma of Pyeloureteral Junction: An Extremely Rare Case

We compared three different chemotherapy regimens containing epirubicin in hormonerefractory prostate cancer (HRPC) patients. Sixty-nine patients with HRPC were randomized into three groups. The first group (22 patients) received 30 mg/m2/week i.v. epirubicin for 8 weeks. The second group (24 patients) received 30 mg/m2/week i.v. epirubicin for 8 weeks followed by monthly maintenance therapy for 4–6 months. The third group (23 patients) received oral estramustine phosphate (EMP) at a dose of 840 mg/day together with weekly and monthly maintenance epirubicin. The response rates, mean survival times, and toxicity were determined. Within the first 3 months, pain and performance scores were improved by at least one degree in all the groups. One patient in group two and three patients in group three had complete response. Partial response rates were 23% in group 1, 25% in group 2, and 17% in group 3. Stable disease rates were 41% in group 1, 33% in group 2, and 26% in group 3. The progression rates within the first 3 months were 36% in group 1, 38% in group 2, and 44% in group 3. None of the patients developed complications that were significant enough to terminate the treatment. Two patients in group 3 died of cardiotoxicity. The mean survival times were 10.1, 15.8, and 16.1 months in groups 1, 2, and 3, respectively. It was determined that weekly and maintenance epirubicin treatment protocol, and estramustine treatment protocol in addition to this treatment, was only meaningfully more effective against weekly epirubicin treatment in the statistical sense (0.01 < p < 0.05). However, due to the complications of EMP, which influence the quality of life, we believe that this was usable only when measures were adopted against these effects.

Does Tadalafil Increase The Uptake of Finasteride into Prostate Tissue? A Biochemical and Histological Evaluation in Rats

Purpose There is currently an emerging need for developing improved approaches for preventing urinary tract infections (UTIs) occurring during diagnostic or interventional procedures of the lower urinary tract. We aimed to establish a rat model to assess the use of transurethral antibiotic administration and to provide evidence that this could be used as a preventive therapy. Methods Animals received fosfomycin trometamol (FOF) either urethrally or orally prior to the procedure. A third group was generated as treatment controls and did not receive any medication. Urethral dilation was conducted to recapitulate an interventional procedure prior to intravesical Escherichia coli administration in all three groups. Finally, sham-operated animals were introduced as a fourth group which did not receive antibiotics or E. coli. Colony counts of urine and tissue cultures for the identification of E. coli and histopathological examinations of the bladder and prostate were conducted. Results Evaluation of infection intensities in cultures as well as histopathological examination of the bladder and prostate demonstrated a preventative role of transurethral FOF administration. In terms of efficiency, local administration of FOF was similar to oral administration. Conclusions These results suggest that transurethral antibiotic administration is a promising alternative for preventing UTIs occurring during diagnostic or interventional procedures of the lower urinary tract.