Ioannis Zachos

Nephrectomy for benign disease? A case of isolated renal echinococcosis

Abstract  Cystic hydatid disease may be found in virtually any organ, although involvement of the urinary tract is relatively uncommon. We report a case of isolated renal hydatid disease presenting with hydatiduria. A short review of the literature regarding diagnosis and management of renal echinococcosis is also presented.

Leiomyosarcoma of the Prostate: Case Report and Review of 54 Previously Published Cases

Prostate leiomyosarcoma is an extremely rare and highly aggressive neoplasm that accounts for less than 0.1% of primary prostate malignancies. We present a patient with primary leiomyosarcoma of the prostate and review 54 cases reported in the literature to discuss the clinical, diagnostic and therapeutic aspects of this uncommon tumor. Median survival was estimated at 17 months (95% C.I. 20.7–43.7 months) and the 1-, 3-, and 5-year actuarial survival rates were 68%, 34%, and 26%, respectively. The only factors predictive of long-term survival were negative surgical margins and absence of metastatic disease at presentation. A multidisciplinary approach is necessary for appropriate management of this dire entity.

Systemic therapy of metastatic bladder cancer in the molecular era: current status and future promise.

Importance of the field: Platinum-based chemotherapy is considered the standard-of-care first-line therapy for metastatic bladder cancer. Despite the initial high response rate, the vast majority of patients eventually progress and succumb to their disease, urging the need for development of novel therapies. Areas covered in this review: This article discusses the main signaling pathways implicated in the pathogenesis of bladder carcinomas, reviews recently completed and ongoing clinical trials, and anticipates the future direction of molecularly targeted agents. What the reader will gain: This manuscript presents the current status of conventional chemotherapy in advanced bladder cancer, and provides a comprehensive review of molecular targeted agents currently in clinical development for this disease. Take home message: Improved understanding of the biology of urothelial carcinogenesis has paved the way for the development of novel molecularly targeted therapies, several of which are currently tested in clinical trials. In this regard, VEGF and EGFR pathways are emerging as important therapeutic targets for metastatic bladder cancer, either alone or in combination with conventional chemotherapeutics. Other therapies, including aurora kinase inhibitors, endothelin receptor antagonists, RAS/MAPK pathway inhibitors and novel immunologic strategies, may also prove helpful in the treatment of this disease.

Molecular Pathogenesis of Non Muscle-Invasive Bladder Cancer: Implications for Novel Targeted Therapies

Approximately 70% to 80% of patients with urothelial carcinomas of the bladder are initially diagnosed with non-muscle invasive disease. Superficial, non-muscle invasive bladder cancers (NMIBCs) are managed with cystoscopic transurethral resection of all visible lesions followed by intravesical chemotherapy and/or immunotherapy. Despite this treatment, up to 70% of these tumors will recur within five years and 15% will ultimately progress to muscle-invasive disease, suggesting that novel therapeutic strategies are necessary. Recent studies have greatly advanced our understanding of urothelial carcinogenesis and have highlighted the distinct molecular pathogenesis of NMIBCs versus muscle-invasive bladder tumors. It is now clear that diverse genetic and epigenetic events are driving the oncogenesis of NMIBCs, thereby attesting to their potential as therapeutic targets for these tumors. This article reviews the molecular pathogenesis of NMIBCs, discusses recently completed and ongoing clinical trials and anticipates the future direction of molecular targeted agents in this disease.

Adverse effects of androgen deprivation therapy in patients with prostate cancer: Focus on metabolic complications

Prostate cancer is the most common cancer among men and androgen deprivation therapy (ADT) is the most effective treatment for this disease. The cornerstone of the treatment of prostate cancer is inhibition of testosterone production which interrupts testosterone-induced growth of the prostate tumor. The dramatic decrease in testosterone levels, however, has several undesirable effects on the metabolic profile and bone metabolism and can also lead to fatigue, loss of libido, gynecomastia, and anemia, provoke vasomotor flushing, and generally affect the quality of life. Due to the long-term survival rates of patients with prostate cancer, treatment-related adverse effects are highly relevant and thus, in each clinical setting, the benefits of ADT must be weighed against treatment-related adverse effects. The current review focuses on the more recently described metabolic complications of androgen deprivation therapy, including obesity, diabetes, lipid alterations, metabolic syndrome, and cardiovascular disease. In addition, it provides practical management recommendations drawn from the available guidelines issued by the American Diabetes Association and American Heart Association.

Previous Bladder Cancer History in Patients with High-Risk, Non–muscle-invasive Bladder Cancer Correlates with Recurrence and Progression: Implications of Natural History

Purpose The purpose of this study was to assess the correlation of previous bladder cancer history with the recurrence and progression of patients with high-risk non–muscle-invasive bladder cancer treated with adjuvant Bacillus Calmette–Guérin (BCG) and to evaluate their natural history. Materials and Methods Patients were divided into two groups based on the existence of previous bladder cancer (primary, non-primary). A logistic regression analysis was used to identify the possible differences in the probabilities of recurrence and progression with respect to tumor history, while potential differences due to gender, tumor size (> 3 cm, < 3 cm), stage (pTa, T1), concomitant carcinoma in situ (pTis) and number of tumors (single, multiple) were also assessed. Univariate and multivariate models were employed. In addition, Kaplan-Meier survival analysis was used to compare recurrence- and progression-free survival between the groups. Results A total of 192 patients were included (144 with primary and 48 with non-primary tumors). The rates of recurrence and progression for patients with primary tumors were 27.8% and 12.5%, respectively. The corresponding percentages for patients with non-primary tumors were 77.1% and 33.3%, respectively. The latter group of patients displayed significantly higher probabilities of recurrence (p=0.000; 95% confidence interval [CI], 4.067 to 18.804) and progression (p=0.002; 95% CI, 1.609 to 7.614) in a univariate logistic regression analysis. Previous bladder cancer history remained significant in the multivariate model accounting for history, age, gender, tumor size , number of tumors, stage and concomitant pTis (p=0.000; 95% CI, 4.367 to 21.924 and p=0.002; 95% CI, 1.611 to 8.182 for recurrence and progression respectively). Kaplan-Meier curves revealed that the non-primary group hadreduced progression- and recurrence-free survival. Conclusion Previous non–muscle-invasive bladder cancer history correlates significantly with recurrence and progression in patients with high-risk non-muscle-invasive disease treated with adjuvant BCG.

“Vanishing Penis” and Urinary Retention due to Locally Destructive Penile Cancer

Penile carcinomas are relatively rare. They usually arise from precancerous lesions and present in the form of ulcerative or exophytic tumors. They rarely give rise to urinary symptoms and complications, and are usually easy to diagnose. We present a case of an 82-year-old man with chronic urinary retention due to urethral dissemination by a locally destructive penile lesion. The penis was literally “vanished” by the lesion down to the level of the pubic bone without, interestingly, having spread to the local lymph nodes or given rise to distant metastases. A temporary suprapubic catheter was placed, followed by a perineal urethrostomy in order to reverse the established renal failure.

Macroscopic Hematuria due to Placenta Percreta: Report of Two Cases and Short Review

Herein we present two cases of pregnant women with placenta percreta and severe hematuria during the 24th and 35th weeks of pregnancy, respectively. A timely sonographic diagnosis was feasible in the first case and cesarean section was performed during the 29th week. During the operation, the placenta was invading the bladder wall and concomitant hysterectomy with cystotomy and bladder wall reconstruction was performed. The second case presented in our emergency department with vaginal bleeding during the 35th weeks of pregnancy. She underwent an emergency cesarean section with uterine preservation, cystotomy, and bladder reconstruction.

Use of haemostatic glue for fistula prevention after iatrogenic combined rupture of anterior vaginal wall, bladder and urethra, during vaginal delivery

Introduction An operative injury to the urinary tract may occur during gynaecological surgery or a complicated childbirth, due to the close developmental proximity of the lower urinary tract and the female reproductive organs (Hammad et al. 2010; Gungorduk et al. 2010). Overall, although these injuries occur rarely, they can potentially lead to serious complications later, such as the formation of vesico-vaginal fi stulae (Rafi que 2002). From this aspect, the combined rupture of the anterior vaginal wall, bladder and urethra represents an extremely rare and severe condition, which can be the cause of serious pelvic fl oor damage. Given the fact that direct surgical intervention is crucial for the management of such an emergency, it is evident that special attention should be given in the prevention of late complications, intraoperatively. We report on the use of haemostatic glue as a means of preventing fi stula formation when administered in the vesico-vaginal space, during surgery for vaginal, bladder and urethra repair aft er vaginal delivery.