Janusz Tyloch

Selenium level in benign and cancerous prostate

The dietary microelement selenium (Se) has been proposed as a potential chemopreventive agent for prostate cancer. This element is present in various amounts in all tissues. Little information is available on Se level in patients with prostate gland disorders. The levels of Se in prostatic gland of patients with prostate cancer, benign prostate hyperplasia, and healthy controls were examined. The Se level for benign prostate hyperplasia (156±30.6 ng/g) was the same as in the control group (157±26.0 ng/g), but in the gland of prostate cancer patients (182±34.1 ng/g wet weight), the Se level was significantly (p<0.01) higher than in both healthy controls and benign prostate hyperplasia. Thus, the Se level in human healthy controls is lower than in kidney and liver but higher compared with other tissues.

Lower urinary tract symptoms and their severity in men subjected to prostate biopsy

Introduction Lower urinary tract symptoms (LUTS) are one of most frequent complaints among men over 50 years of age. They usually result from benign prostate hyperplasia, which often coexists with cancer. The aim of the present study is to evaluate prospectively the incidence of LUTS and their character in men subjected to prostate biopsy. Material and methods Data of men who were subjected to transrectal ultrasound guided prostate core biopsy from 1st July 2007 to 30th July 2008 in selected urological departments in Poland were analyzed. LUTS were measured with International Prostate Symptom Score (IPSS). Results Prostate biopsy was performed in 747 men aged between 34 and 93 years (mean – 67.4; median – 68). LUTS of mild degree or no LUTS (≤7 IPSS points) were reported by 29.5% of patients. PCa was found in 60.0% of them. Among men with moderate or severe LUTS (IPSS >7 points), PCa was found in 51.4% and 55.0% of them respectively. Median PSA was 9.5 ng/ml, 9.4 ng/ml and 12.0 ng/ml in men with mild, moderate and severe LUTS respectively (NS). However, among men with severe LUTS, PCa was more likely to be less differentiated and locally advanced. Conclusions LUTS are weak predictors of a positive result of transrectal ultrasound guided prostate biopsy. However, there is a trend to diagnose more locally advanced and less highly differentiated cancers among men with severe lower urinary tract symptoms.

Novel surgical techniques, regenerative medicine, tissue engineering and innovative immunosuppression in kidney transplantation

On the 60th anniversary of the first successfully performed renal transplantation, we summarize the historical, current and potential future status of kidney transplantation. We discuss three different aspects with a potential significant influence on kidney transplantation progress: the development of surgical techniques, the influence of regenerative medicine and tissue engineering, and changes in immunosuppression. We evaluate the standard open surgical procedures with modern techniques and compare them to less invasive videoscopic as well as robotic techniques. The role of tissue engineering and regenerative medicine as a potential method for future kidney regeneration or replacement and the interesting search for novel solutions in the field of immunosuppression will be discussed. After 60 years since the first successfully performed kidney transplantation, we can conclude that the greatest achievements are associated with the development of surgical techniques and with planned systemic immunosuppression.

Re: João Silva, Rui Pinto, Tiago Carvallho, et al. Mechanisms of Prostate Atrophy after Glandular Botulinum Neurotoxin Type A Injection: An Experimental Study in the Rat. Eur Urol 2009;56:134-41

We have read an interesting paper on the influence of botulinum neurotoxin type A (BoNTA) on the rat prostate [1]. First, it must be emphasized that stroma predominates within the human prostate, while rat prostate has a huge epithelial compartment, so human and rat prostates are, in fact, not comparable. Second, BoNTA changes expression of growth factors and neurotransmitters within the nerve endings and leads to temporal tissue denervation throughout. BoNTA is used in treatment to decrease muscle tonus and contraction. A new, interesting phenomenon of prostate atrophy following BoNTA injection has been discussed. Several papers were published in this field, including clinical trials [2]. It is hard to believe in promising results of this approach. Our department performed a small trial including six patients suffering from acute urine retention due to benign prostatic hyperplasia (BPH) who were disqualified for transurethral resection of the prostate. Patients were treated with BoNTA injections directly into the prostate. Results were disappointing: Although tissue shrinkage was observed during the first month of observation, after 6 mo, all prostate volumes were similar to the starting point of the experiment. Finally, only one patient, whose prostate was only 38 ml, was able to void with acceptable postvoid residual urine levels [3]. Based on our negative results, an in vitro study was designed. BoNTA influence on human prostate fibroblasts and 3T3 mouse fibroblasts was tested in vitro. It was observed that even a dose as high as 10 U of Botox (Allergan,

Primary cancer of the anterior urethra in a male patient.

We present a 76-year-old male patient, who was diagnosed with transitional cell carcinoma (TCC) of the distal part of the urethra. Transurethral resection of the tumor (TURT) of the urethra was conducted. After establishing local relapse, surgical removal of the distal part of the urethra was proposed to the patient. Due to no consent for an open surgery, another electroresection of the tumor was performed. When the second relapse occurred, the patient provided his consent for surgical removal of the part of the urethra with anastomosis of the remaining part of the urethra with the skin from the abdominal part of the penis. Postsurgical observation did not reveal any local relapse.