I. Erkan

Prognostic Significance of Bladder Tumor History and Tumor Location in Upper Tract Transitional Cell Carcinoma

PURPOSE We studied prognostic factors for 5-year disease specific and recurrence-free survival in patients treated for upper urinary tract transitional cell carcinoma. MATERIALS AND METHODS Since July 1987, 72 patients with a mean age of 58.9 years have undergone nephroureterectomy with bladder cuff excision. Median followup was 62.2 months (range 6 to 192). Patient age, sex, detection duration and mode, bladder tumor history, smoking habit, stone disease history, and tumor stage, grade and location were evaluated as prognostic factors. RESULTS Overall 5-year disease specific and recurrence-free survival rates were 74.9% and 67.8%, respectively. Univariate analysis revealed anemia, positive bladder tumor history, T stage, grade and tumor location in the upper tract as significant prognostic factors. On multivariate analysis T stage, grade and tumor location in the urothelium were the only significant variables for the 5-year disease specific and recurrence-free survival rates. CONCLUSIONS High tumor stage and grade, and ureteral location were significantly associated with worse disease specific and recurrence-free survival in patients with upper urinary tract transitional cell carcinoma. Our results may help define the patient groups that need adjuvant therapy and they may form a basis for further controlled studies.

A novel surveillance protocol for stage I nonseminomatous germ cell testicular tumours.

To report the results of a novel surveillance policy for stage I nonseminomatous germ cell tumours (NSGCTs).

The role of the pathologist in the evaluation of radical prostatectomy specimens.

Objective: To compare the difference between the routinely reported pathology records and the results of re‐evaluation of the same radical retropubic prostatectomy (RRP) specimens. Material and Methods: The RRP specimens of 114 patients initially reported by a general pathologist for routine purposes were re‐examined and re‐evaluated blindly with respect to the following parameters: organ confinement; capsular invasion; seminal vesicle invasion; lymph node metastasis; surgical margin positivity; Gleason grade and pathologic stage. Repeat and step sections were performed where necessary. Prostate mapping was done for each patient. Results: A statistically significant discordance between the routine evaluation and the re‐evaluation was observed with regard to capsular invasion, organ confinement, Gleason grade and pathologic stage. In addition to pathologic stage, Gleason grade and surgical margin positivity became significant prognostic factors after the re‐evaluation. Conclusions: RRP specimens should be evaluated by an expert prostate pathologist by submitting whole prostate specimens and should include detailed prostate mapping.

Preoperative Evaluation of Hilar Vessel Anatomy With 3-D Computerized Tomography in Living Kidney Donors

OBJECTIVES Digital subtract angiography is the gold standard for anatomic assessment of renal vasculature for living renal donors. However, multidetector-row computerized tomography (MDCT) is less invasive than digital subtract angiography and provides information of kidney stones and other intra-abdominal organs. In this study, preoperative MDCT angiography results were compared with the peroperative findings to evaluate the accuracy of MDCT for the evaluation of renal anatomy. METHODS From December 2002 to May 2007, all 60 consecutive living kidney donors were evaluated with MDCT angiography preoperatively. We reported the number and origin of renal arteries, presence of early branching arteries, and any intrinsic renal artery disease. Renal venous anatomy was evaluated for the presence of accessory, retroaortic, and circumaortic veins using venous phase axial images. The calyces and ureters were assessed with delayed topograms. The results of the MDCT angiography were compared with the peroperative findings. RESULTS A total of 67 renal arteries were seen peroperatively in 60 renal units. Preoperative MDCT angiography detected 64 of them. The two arteries not detected by MDCT had diameters less than 3 mm. Anatomic variations were present in nine veins, five of which were detected by CT angiography. Sensitivity of MDCT angiography for arteries and veins was 95% and 93%, respectively. Positive predictive values were 100% for both arteries and veins. CONCLUSION MDCT angiography offers a less invasive, rapid, and accurate preoperative investigation modality for vascular anatomy in living kidney donors. It also provides sufficient information about extrarenal anatomy important for donor surgery.

Utility of the Doppler ultrasound parameter, resistive index, in renal transplant histopathology.

BACKGROUND Doppler ultrasonography is routinely used by many clinicians during long-term follow-up to identify high-risk patients without diagnosing the exact cause of graft dysfunction. Despite a number of studies showing a correlation between intrarenal resistive index (RI) and renal function in patients with kidney diseases, correlations between RI and renal histopathologic characteristics have not been sufficiently evaluated in renal transplant recipients. The aim of this study was to examine this relationship in grafted kidneys. PATIENTS AND METHODS The intrarenal RI was retrospectively compared with biopsy findings in 28 kidney recipients. All renal biopsy specimens were reviewed by light microscopy and immunofluorescence staining. For glomerulosclerosis, we considered the percentage of glomeruli showing this change; for interstitial fibrosis/tubular atrophy and interstitial infiltration, we graded abnormalities according to the methods of Kliem et al (Kidney Int 49:666, 1996). RESULTS The percentage of globally sclerosed glomeruli was significantly greater among patients with RI values higher than 0.75 than below this level (23% vs 47%; P = .022). Patients with grade 1 interstitial fibrosis and tubular atrophy (n = 14) showed lower RI values (0.68 +/- 0.03 vs 0.74 +/- 0.06; P = .047) than those with grade 3 fibrosis (n = 12). Similarly, lower RI values (0.66 +/- 0.02 vs 0.73 +/- 0.05; P = .014) were observed among patients with grade 1 (n = 13) compared with grade 3 interstitial infiltration (n = 13). CONCLUSION RI seemed to provide a prognostic marker for the graft rather than yielding an exact diagnosis of renal graft dysfunction.

Prevalence of lower urinary tract symptoms in a community-based survey of men in Turkey

Aim: The aim of the present study was to determine the frequency of lower urinary tract symptoms (LUTS), assess the impact of LUTS on quality of life (QOL) and compare the results with recent reports from other population‐based studies.

Renal Transplantation in Children With Lower Urinary Tract Dysfunction of Different Origin: A Single-Center Experience

INTRODUCTION Renal transplantation in patients with lower urinary tract dysfunction (LUTD) of various origins is a challenging issue in the field of pediatric transplantation. We report our single-center experience to evaluate patient and graft survivals as well as the risks of the surgery and immunosuppressive therapy. PATIENTS AND METHODS Among 70 pediatric transplant patients, 11 displayed severe LUTD. Videourodynamic tests were performed on all patients preoperatively as well as postoperatively if required. The cause of urologic disorders were neurogenic bladder (n = 5) and urethral valves (n = 6). Clean intermittent catheterization (CIC) was needed in six patients to empty the bladder. To achieve a low-pressure reservoir with adequate capacity pretransplantation augmentation ileocystoplasty was created in four patients and gastrocystoplasty in one patient. Three of the patients received kidneys from cadaveric and eight from living donors. All patients were treated with calcineurin-based immunosuppressive therapy. RESULTS The mean age at transplantation was 15 +/- 4.7 years. The median follow-up after transplantation was 36 months (6 to 62 months). At their last visit the median creatinine level was 0.95 mg/dL (0.8 to 2.4 mg/dL). Three patients had recurrent symptomatic urinary tract infections who had augmented bladder on CIC. One patient with ileocystoplasty who developed urinary leak and ureteral stricture in the early postoperative period was treated by an antegrade J stent. CONCLUSION Severe LUTD carried high risks for the grafted kidney. However, our data suggested that renal transplantation is a safe and effective treatment modality, if the underlying urologic diseases properly managed during the transplantation course. Since surgery and follow-up is more complicated, patient compliance and experience of transplantation team have significant impacts on outcomes.

Benign Mixed Epithelial and Stromal Tumor of the Kidney

A 51-year-old, perimenopausal, female patient with 1-month history of right flank pain who was diagnosed with a renal mass and underwent nephron-sparing partial nephrectomy is presented. The renal mass was found to be a benign, biphasic tumor composed of an epithelial component, consisting of ducts of variable size scattered within a mesenchymal component, composed of spindle cells arranged in sheets and fascicles. No atypia, mitosis, or necrosis was found. The spindle component shows desmin, smooth muscle actin, and estrogen and progesterone receptor positivity immunohistochemically. The diagnosis of benign mixed epithelial and stromal tumor of the kidney is rendered. No recurrent disease has been detected during 2 years of follow up.

Does Lower Urinary Tract Status Affect Renal Transplantation Outcomes in Children

BACKGROUND Lower urinary tract dysfunction (LUTD), an important cause of end stage renal disease (ESRD) in children, can adversely affect renal graft survival. We compared renal transplant patients with LUTD as primary renal disease to those without LUTD. METHODS The data of 60 children who underwent renal transplantation (RTx) between 2000 and 2012 were retrospectively reviewed. All patients with LUTD were evaluated with urodynamic tests preoperatively; 15 patients required clean intermittent catheterization and 9 patients underwent augmentation cystoplasty before RTx. RESULTS There were 25 children with LUTD. The mean follow-up for LUTD (+) and LUTD (-) groups were 63 (22-155) and 101 months (14-124), and graft survival were 76% for LUTD (+) and 80% for LUTD (-), respectively (P = .711). On the other hand, creatinine levels at last follow-up were significantly higher in the LUTD (+) group (1.3 ± 0.3 mg/dL vs 0.96 ± 0.57 mg/dL, P < .001). Infectious complications and postoperative urinary tract infection incidences were also higher in the LUTD (+) group (68% vs 25.7%, P = .002 and 60% vs 11.4%, P < .01). CONCLUSION UTI is significantly higher after kidney transplantation in patients with LUTD. Despite the higher risk of UTI, renal transplantation can be performed safely in those patients with careful patient selection, preoperative management, and close postoperative follow-up. Restoration of good bladder function is the key factor in the success of kidney transplantation in those patients.

HIGH PREVALENCE OF ANTIBODIES TO HEPATITIS C VIRUS AMONG RENAL TRANSPLANT RECIPIENTS : CORRELATION WITH CHRONIC LIVER DYSFUNCTION

Dr. Tekin Akpolat, Hacettepe Hastanesi, Nefroloji Bölümü, Hacettepe, TR-06100 Ankara (Turkey) Dear Sir, Chronic liver disease is a frequent and major complication in renal transplant recipients and contributes greatly to morbidity and mortality in these patients [1]. Hepatitis C virus (HCV) is the most common cause of transplant-associated liver disease [1, 2]. Currently, assays are available to detect antibody to recombinant antigens of HCV (anti-HCV). The aim of our study was to evaluate the prevalence of anti-HCV among renal transplant patients and the possible correlations of anti-HCV with chronic liver dysfunction, graft survival, number of blood transfusions, hepatitis B virus serologic markers and duration of hemodialysis therapy before transplantation in this group of patients. One hundred and sixty-one patients (119 men and 42 women; mean age 35.6 years, range 18-65) were included in the study. Seventy of 161 patients were transplanted in our unit and the rest were referred from other centers for long-term follow-up. Anti-HCV was measured by a second-generation enzyme-linked immunosorbent assay to C100-3 and 33c antigens of HCV (ELISA, Abbott). Chronic liver dysfunction was considered to be a persistent elevation of the serum alanin aminotransferase levels for more than 6 months. Statistical analysis was performed by the χ2 test with Yates’ correction or Student’s test. Ninety-two of 161 patients (57.1%) were anti-HCV positive (table 1), and in the anti-HCVpositive group, the number of patients with chronic liver dysfunction was significantly higher and the duration of hemodialysis treatment was significantly longer than in the negative group. There was no significant difference between the two groups regarding the number of blood transfusions, graft survival and hepatitis B virus serologic markers. Preliminary surveys of renal transplant recipients have shown an anti-HCV prevalence ranging from 10 to 41% [2-5]. Anti-HCV was positive in 57.1% of patients in the present