Roman Zachoval

Malignant mixed epithelial and stromal tumor of the kidney.

Keywords Kidney · Malignant mixed epithelial stromal tumor · Cystic nephroma · Sarcoma Sir, We report a case of a mixed epithelial and stromal tumor of the kidney with malignant transformation of its mesenchymal component. A 46-year-old woman was operated on for a computed tomography-proven solidified cyst in the upper pole of the left kidney. No tumorous metastatic dissemination was found during further clinical examination. The kidney contained a cystic tumor 7 cm in diameter bulging into the perirenal fat. The gray–brown wall of the cyst was 0.2- to 0.3-cm thick, the inner surface was smooth, covered by light and dark brown, hemorrhagic material. A flat, red–brown prominence measuring 4×3×1.5 cm, multilocular on a cut surface, protruded into the intracystic space. The margins of the tumor were sharply demarcated from the renal parenchyma but were indistinct on the side of perirenal fat. The hemorrhagic contents of the cyst, submitted separately in a total volume of about 200 ml, were characteristic of blood clots, seemingly free of tumorous material. The renal parenchyma outside the tumor area, renal pelvis and ureter were unremarkable. The tumor showed a histological structure of a benign multilocular cyst containing cysts and septa, which comprised occasional small tubular structures. Septa were formed by fibrous stroma with uneven cellularity focally displaying ovarian stroma-like features (Fig. 1) and immunohistochemically showing positivity of vimentin, smooth muscle actin, muscle actin and desmin. Ultrastructurally, the bland-looking cells surrounded by external lamina and connected by primitive attachment sites were set in the background of collagenous matrix. They contained numerous organelles, including copious cisternae of the rough and smooth endoplasmic reticulum, intermediate filaments and Golgi complex. Numerous patches of microfilaments were focally present in the cytoplasm of the benign stromal cells. The tubules and cysts were lined with a single layer of epithelial cells, mostly showing a hobnail appearance, oxyphilic, periodic acid–Schiff base (PAS)-negative cytoplasm and large, irregular nuclei. PAS-positive material was present in some lumina. Immunohistochemically, the cells were cytokeratin and epithelial membrane antigen (EMA) positive. No heterologous tissue, renal blastema cells or poorly differentiated epithelial structures were found.

Augmentation Cystoplasty in Patients with Multiple Sclerosis

Introduction: Augmentation cystoplasty is an effective approach to the detrusor hyperreflexia which is refractory to conservative treatment. Sporadic data have been published in patients with progressive diseases such as multiple sclerosis (MS). Materials and Methods: Augmentation ileocystoplasty (Goodwin ‘cup-patch’) was performed in 9 patients (7 females, 2 males). The average Expanded Disability Status Scale score was 4.1 (range 3.0–6.5); 7 patients had relapse-remitting MS and 2 patients secondary-progressive MS. The indication was a detrusor hyperreflexia refractory to conservative treatment in 8 patients and a detrusor hyperrefluxia with third degree bilateral vesico-ureteral reflux and renal insufficiency in 1 patient. Pre- and postoperative objective parameters were evaluated by urodynamic examination, imaging methods and laboratory examination. Subjective evaluation was performed using a questionnaire on micturition symptoms (score 0–5) and on quality of life (score 0–6). Results: With a follow-up of 6–19 months, we recorded an average increase of the maximum detrusor capacity from 105 to 797 ml and decrease of maximum detrusor pressure from 53 to 30 cm H2O. Postmicturition residual urine >25% of the maximum capacity was present in 6 patients who performed clear intermittent autocatheterization postoperatively (2 patients preoperatively). In all patients there was a significant improvement in the irritation micturition symptomatology (pollakisuria, nycturia, urgency and urge incontinence) and the quality of life score improved on average from 5 to 0.7. In the case of the patient with renal insufficiency, the creatinine level decreased from 286 to 150 µmol/l; in the other patients renal function remained normal. Conclusions: Augmentation cystoplasty is a safe and effective method for indicated patients, which significantly enhances their quality of life.

A Preliminary Report on the Use of Functional Magnetic Resonance Imaging with Simultaneous Urodynamics to Record Brain Activity During Micturition

PURPOSE We mapped brain activity during micturition using functional magnetic resonance imaging with simultaneous recording of urodynamic properties during slow bladder filling and micturition. MATERIALS AND METHODS We evaluated 12 healthy female volunteers 20 to 68 years old. Eight subjects could urinate while supine. Meaningful data were obtained on 6 of these subjects. Brain activity was recorded continuously during bladder filling and micturition. Functional magnetic resonance imaging measurements made during the micturition phase were used for the final analysis. RESULTS Using group statistics we identified clusters of brain activity in the parahippocampal gyrus, anterior cingulate gyrus, inferior temporal gyrus and inferior frontal gyrus during micturition. At the individual level we also observed activation in the upper pontine region, thalamus and posterior cingulum. In subjects unable to void brain activation was documented in the frontal lobe and posterior cingulate gyrus but not in the pons, thalamus or anterior cingulate gyrus. In 5 subjects we identified a relevant pattern of brain activity during the terminal portion of the filling phase when the patient reported a strong desire to urinate. CONCLUSIONS This new protocol allows for the localization of brain structures that are active during micturition. Data suggest that additional validation studies are needed. Future studies will test modifications that include more detailed monitoring of bladder sensation, stratifying subjects based on age and gender, and increasing the number of data points by adding subjects and the number of micturitions recorded in a single subject.

Epidemiology and impact of urinary incontinence, overactive bladder, and other lower urinary tract symptoms: results of the EPIC survey in Russia, Czech Republic, and Turkey

Abstract Objective: To estimate the prevalence of urinary incontinence (UI), overactive bladder (OAB), and other lower urinary tract symptoms (LUTS) in the Czech Republic, Russia, and Turkey. Methods: Stage one of this population-based survey consisted of computer-assisted telephone interviews to obtain prevalence estimates of storage, voiding, and post-micturition LUTS. Stage two face-to-face interviews evaluated subjects with mixed urinary incontinence (MUI), stress urinary incontinence (SUI) or OAB (case group) and a control group (subjects with other incontinence or LUTS complaints, or no symptoms). Outcome measure: Prevalence of LUTS categories were determined for each country based on International Continence Society (ICS) criteria. Results and limitations: A total of 3130 individuals agreed to participate in the survey, which found high rates of LUTS (men 80%; women 84%) and OAB (men 18%; women 28%). Duration of urinary symptoms was relatively brief (approximately 60% ≤ 3 years) and was associated with relatively modest effects on quality of life and work performance in the majority of individuals. Forty percent had consulted with a healthcare provider about their urinary symptoms, of whom 37% had consulted with a physician and 34% with an urologist, and 12% had been treated with a prescription medication. Drug therapy, while uncommon, was associated with a high degree of self-reported improvement (96%). Because of between-country population differences, aggregate results may not always be representative of results for each of the three countries individually. Study limitations include reliance on patient self-report, and potential bias introduced by patients who declined to participate in the survey. Conclusions: The results of this epidemiologic survey found high rates of LUTS and OAB, but low levels of medical consultation and very low use of medication treatment, despite high levels of improvement when medications were used.

Brain activity during bladder filling and pelvic floor muscle contractions: a study using functional magnetic resonance imaging and synchronous urodynamics.

To map the brain activity during bladder filling by functional magnetic resonance imaging using a refined scanning protocol including synchronous urodynamics and pelvic floor muscle contractions.

Value of power Doppler sonography with 3D reconstruction in preoperative diagnostics of extraprostatic tumor extension in clinically localized prostate cancer

Aim:  The aim of the study is to investigate the value of preoperative power Doppler sonography with 3D reconstruction (3D‐PDS) for diagnostics of extraprostatic extension of prostate cancer.

Long-term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study.

To evaluate the long‐term effectiveness and safety of the adjustable transobturator male system (ATOMS®, Agency for Medical Innovations A.M.I., Feldkirch, Austria) in a European‐wide multicentre setting.

Solifenacin is effective and well tolerated in patients with neurogenic detrusor overactivity: Results from the double‐blind, randomized, active‐ and placebo‐controlled SONIC urodynamic study

To investigate the effect on urodynamics of 4 weeks treatment with solifenacin succinate in patients with neurogenic detrusor overactivity (NDO) due to multiple sclerosis (MS) or spinal cord injury (SCI).

Persistence in the treatment of overactive bladder syndrome (OAB) with mirabegron in a multicenter clinical study

OBJECTIVE The objective of this project was to evaluate treatment persistence in patients being treated for overactive bladder syndrome (OAB) with mirabegron, employing clinical follow-up in a prospective, multicenter study. STUDY DESIGN This is an analysis of patients who started treatment with mirabegron between May and September 2014 and were evaluated 1year after treatment commenced. During this evaluation we determined how many patients stopped treatment and established their reasons for discontinuation. RESULTS 206 patients being treated for OAB with mirabegron were evaluated a year after starting treatment. It emerged that 60 patients (29.1%) had discontinued the treatment, citing the following reasons: 24/60 insufficient treatment efficacy, 26/60 other reasons, while 10 members of the group discontinued treatment because of side effects. 75 out of 206 patients were ≤60 years old and 28% terminated the study prematurely: 131 out of 206 were >60years old and 29.2% terminated the study prematurely. In the group of patients without previous OAB treatment 35.7% discontinued treatment with mirabegron, while 28.1% of patients with previous anticholinergic treatment discontinued treatment. CONCLUSION In our clinical prospective multicenter study, persistence in treatment with mirabegron reached a figure of 71%.

Brain activity on fMRI associated with urinary bladder filling in patients with a complete spinal cord injury

Patients with complete spinal cord injury (SCI) may maintain some perception of bladder fullness. The aim of the study was to evaluate brain activation arising from anticipated extraspinal sensory pathways.