Sławomir Poletajew

Spontaneous regression of renal cell carcinoma

Renal cell carcinoma (RCC) comprises 3–4% of all malignant tumours among adults in Poland. Spontaneous regression of RCC is a rare but well-known phenomenon. Its frequency is estimated to be approximately 1% and a large part of the percentage is accounted for by the regression of pulmonary metastases in the course of clear type of RCC treatment. We searched PubMed, Embase and SciVerse Scopus databases, identifying 59 case reports of spontaneous regression of RCC. Those medical histories come from reports from around the world and date back up to 40 years. This review includes their analysis as well as description of possible explanations of this phenomenon postulated by different authors, including both misdiagnosis and immunological reactions. This study indicates that reliable diagnostics and reporting of all the cases of spontaneous regression play a key role, as this is the only method which enables a better perspective in understanding this issue.

Urothelial bladder carcinoma in young patients is characterized by a relatively good prognosis

Abstract Introduction and aim. Urothelial bladder carcinoma (UBC) is a very rare condition in patients aged below 50 years. The aim of the study was to answer the question whether the characteristics of cancer in this group of patients differ from general UBC features. Material and methods. Altogether 2160 patients treated with primary transurethral resection due to a bladder tumor were included in the study. The mean age of the cohort was 69.1 years (range 11–100). Patients were divided into three subgroups depending on age: age <41 years (group 1), age 41–50 years (group 2), age >50 years (group 3). Sex ratio, tumor grade, and stage of disease were recorded. Results. Women constituted 18.5%, 19.2%, and 25.8% of the patients in groups 1, 2, and 3, respectively (P < 0.05). WHO grade 3 tumors were diagnosed in 0%, 8.5%, and 17.2%, respectively (P < 0.05). Non-invasive papillary carcinoma was found in 100.0%, 76.7%, and 62.7%, respectively (P < 0.05). The incidence of muscle-invasive bladder cancer was 0%, 11.0%, and 15.6%, respectively (P < 0.05). Conclusions. Pathological characteristics of UBC are dependent on the patients’ age. Being a very rare condition, UBC in young patients is characterized by a relatively good prognosis.

Interobserver variability of Clavien–Dindo scoring in urology

To assess the interobserver variability of Clavien–Dindo scoring in urology.

Macroscopic Hematuria—A Leading Urological Problem in Patients on Anticoagulant Therapy: Is the Common Diagnostic Standard Still Advisable?

All urological standards of care are based on the past definition of the clinical importance of macroscopic hematuria. The aim of the study was to assess the phenomenon of iatrogenic hematuria in current clinical practice and analyze its origins in patients receiving anticoagulant drugs. Retrospective analysis of clinical documentation of 238 patients that were consulted for hematuria in 2007–2009 by 5 consultant urologists was performed. In the group of 238 patients with hematuria, 155 (65%) received anticoagulants. Abnormalities of urinary tract were found in 45 (19%) patients. Estimated cost of a single neoplasm detection reached the value of 3252 Euro (mean 3-day hospitalization). The strong correlation between the presence of hematuria and anticoagulant treatment was observed. Authors suggest to redefine the present and future role of hematuria from a standard manifestation of serious urological disease to a common result of a long-term anticoagulant therapy.

Safety and Efficacy of Intravesical Bacillus Calmette-Guérin Immunotherapy in Patients with Non-Muscle-Invasive Bladder Cancer Presenting with Asymptomatic Bacteriuria: A Systematic Review

Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy in bladder cancer patients with asymptomatic bacteriuria (ABU) remains a matter of debate. The aim of this systematic review was to present available evidence on the safety and efficacy of BCG immunotherapy in patients with ABU. A literature search within the Medline and the Embase databases was conducted with the following search terms: adverse events, bacteriuria, BCG, bladder cancer, cystitis, infection, pyuria, side effects and urinary tract infection (UTI). Sixteen relevant original articles were identified, including 6 articles directly presenting the safety or efficacy of BCG therapy in patients with ABU. None of them was a randomized controlled trial. Intravesical BCG instillations in patients with ABU were not associated with the increased risk of symptomatic UTI and did not affect negatively the recurrence- or progression-free survival. Routine urine analysis before BCG instillation created increased cost and potentially unnecessary delays in BCG therapy. ABU does not affect negatively the safety and efficacy of intravesical BCG immunotherapy. There is no evidence to support routine screening and treatment of ABU in patients scheduled for intravesical BCG instillations due to bladder cancer. However, this issue was not addressed adequately and needs further research.

The time from diagnosis of bladder cancer to radical cystectomy in Polish urological centres - results of CysTiming Poland study.

Introduction The aim of the study was to assess the waiting time, from establishing the indications for radical cystectomy to surgery, in patients with urothelial carcinoma of the bladder at different Polish urological centres and to determine its influencing factors. Material and methods Retrospective analysis of data was performed on all consecutive radical cystectomies, performed in 2008–2012, at 10 Polish urological centres. The waiting time of patients from establishing the indications for radical cystectomy to surgery, as well as factors potentially influencing this time, were assessed. University (3), provincial (3) and regional (4) hospitals were defined as the 3rd, 2nd and 1st level referral hospitals, respectively. Results A total of 575 patients qualified for radical cystectomy due to muscle invasive urothelial carcinoma of the bladder (MIBC, 68% of cases) or failure of previous treatment of non–muscle invasive urothelial carcinoma of the bladder (NMIBC, 32%) were included in the analysis. The average time after the establishment of indications to surgery was 73.4 days, with a median of 56 days. In the case of 121 patients (22.1%), the waiting time exceeded 90 days. Significant differences in waiting time were found when the hospital referral levels were taken into consideration. In the 3rd level referral hospitals the median time for cystectomy was 61.5 days (p = 0.035), in the 2nd level referral hospitals – 45 days (p = 0.000) and, in the 1st level referral hospitals – 58 days (p = 0.051). Conclusions The waiting time from establishing the indications for radical cystectomy to surgery for most cases in Poland does not exceed 90 days.

Lack of evidence for increased level of circulating urothelial cells in the peripheral blood after transurethral resection of bladder tumors

PurposeAggressive intervention against the bladder wall during transurethral resection of bladder tumors (TURBT) causes damage and leakage from blood vessels to the bladder lumen. The aim of this study was to determine whether TURBT could increase the level of circulating urothelial cells.MethodsExpression of tumor markers, discriminative for nucleated blood cells and urothelium, was evaluated by quantitative (q) RT-PCR on RNA isolated from peripheral blood samples of 51 patients who underwent TURBT for ≥cT1c bladder tumors.ResultsFour of 14 studied genes, epidermal growth factor receptor (EGFR), Collagen α-1(I) chain, Mast/stem cell growth factor receptor (KIT) and CD47, exhibited significant differences in gene expression between controls and cancer patients. While TURBT did not significantly increase the number of PCR-positive results of any transcripts, positive RT-PCR detection for EGFR was significantly less frequent on day 30 compared to results obtained before surgery.ConclusionsAlthough the results of our study do not provide evidence for increased tumor cell release into the peripheral blood after TURBT, they seem to indicate that EGFR mRNA measurement in the blood may provide useful information for urologists.

Blood loss during laparoscopic radical prostatectomy – is it significant or not?

Introduction The traditional assessment of blood loss during laparoscopic radical prostatectomy (LRP) is based on the blood volume collected intraoperatively in the suction device bottles. While this method is not perfect, analysis of changes in blood cell count (BCC) resulting from LRP is advisable. Material and methods 71 men were submitted to LRP due to prostate cancer in our institution over an 18-month time period. From this group, we isolated 60 men with clinically minimal intraoperative blood loss (<200 ml) and included them into the study. Mean age of the cohort was 62.8 years. We performed standard BCC on the day before and 6 hours after the surgery. At the same time points, we measured creatinine serum concentration and calculated eGFR to avoid the data misinterpretation resulting from impaired renal function in the postoperative period. Results Statistically and clinically significant differences regarding all BCC parameters measured pre- and postoperatively were observed. The number of red blood cells, hemoglobin concentration, and hematocrit diminished by 17.5% (4.68T/l vs. 3.86T/l, p <0.02), 17.0% (8.93 mmol/l vs. 7.41 mmol/l, p < 0.02), and 17.9% (0.429 vs. 0.352, p <0.02), respectively. Simultaneously, renal function was stable with no significant change in eGFR (82.9 ml/min/1.73 m^2 vs. 79.09 ml/min/1.73 m^2, p = 0.28). Conclusions Standard LRP brings on a significant blood loss. While clinically insignificant, this blood loss seems to be as high as approx. 600 ml based on laboratory findings. BCC seems to be a more accurate method of intraoperative blood loss estimation compared to measurement of blood volume collected intraoperatively in the suction device bottles.

Renal carcinoma infiltrating inferior vena cava and combined valvular heart disease - one-stage uro-cardiological procedure: a case report

Standard treatment of patients with coexisting cardiac and non-cardiac diseases includes two separate operations. We report a case of 55-year-old man with combined valvular heart disease and renal carcinoma infiltrating inferior caval vein, who underwent one-stage cardio-urologic procedure. In the first step, mitral and tricuspid valvuloplasty were performed by cardiac surgeons. Then, urologists performed radical nephrectomy and thrombectomy. The postoperative course was uneventful. In twelve months follow-up the patient shows no signs of reccurrence and he had no symptoms of cardiac disease. To the best of our knowledge such a case has never been reported before in the literature.

Clinical rationale and safety of restaging transurethral resection in indication-stratified patients with high-risk non-muscle-invasive bladder cancer

BackgroundIndications for restaging transurethral resection of the bladder tumor (reTURBT) in patients with non-muscle-invasive bladder cancer (NMIBC) remain controversial. This study was aimed at evaluation of clinical value and safety of reTURBT in different clinical indications.MethodsThis is a retrospective analysis of consecutive 141 patients who underwent TURBT followed by reTURBT in years 2011–2015 in a single department. Pathological results and surgical complications were analyzed in the whole study cohort and stratified by clinical stage (Ta, T1, Tx (no muscle in the specimen)) and grade (low-grade (LG), high-grade (HG)) of bladder cancer diagnosed at primary TURBT.ResultsFull data was available for 132 patients. Residual disease was found in 53 patients (40.2%) with highest rate for Ta-HG cases (57.1%) followed by T1-HG (51.4%), Tx-HG (45.2%), T1-LG (32.1%), and Tx-LG (25.8%). In the multivariate analysis, high grade (p = 0.02) was the only independent predictor of residual disease. Upstaging to muscle-invasive bladder cancer was noticed in 9 patients (6.8%). The rate of grade ≥ 2 Clavien-Dindo complications (1.5 vs. 5.3%) did not differ significantly between TURBT and reTURBT cases.ConclusionsReTURBT is a safe procedure that remains crucial for therapeutic and staging purposes in patients with T1, Tx, or high-grade bladder cancer found in the primary resection.