Sümer Baltaci

Isolated Renal Hydatidosis: Experience With 20 Cases

PURPOSE Cystic hydatidosis is an endemic disease caused by the larval form of Echinococcus granulosus. It is mostly evident in the liver and lungs, and renal hydatidosis is uncommon. Renal hydatidosis is usually associated with other organ involvement and isolated disease is extremely rare. We present our experience with isolated renal hydatidosis in 20 patients. MATERIALS AND METHODS The charts of 20 patients with isolated renal hydatidosis who were hospitalized in our department during a 25-year period were reviewed retrospectively. The clinical, laboratory and radiologic diagnosis, and treatment of these cases are discussed. RESULTS The main clinical symptom was lumbar pain. There was no specific or pathognomonic laboratory test for renal hydatidosis except hydaturia, which was present only in 1 patient (5%). Of radiologic examinations computerized tomography had the highest sensitivity and specificity. Treatment was mainly surgical. We performed nephrectomy in 13 patients, and cystectomy and marsupialization in 6. One patient refused all treatments. There was no postoperative morbidity or mortality. CONCLUSIONS Isolated renal hydatidosis is extremely rare. The main problem is the correct preoperative diagnosis. Although radiologic studies and serological-immunological tests support the diagnosis of hydatid disease, a correct preoperative diagnosis is not always easy. The treatment is mainly surgical, and with appropriate diagnosis and treatment the prognosis is good.

Influence of tumor stage, size, grade, vascular involvement, histological cell type and histological pattern on multifocality of renal cell carcinoma.

PURPOSE We assessed the influence of clinical and pathological factors on multifocality of renal cell carcinoma. MATERIALS AND METHODS Between June 1995 and September 1999 radical nephrectomy was performed in 71 men and 32 women with a mean age of 56.5 years. The 103 removed kidneys with renal cell carcinoma were sectioned at 3 mm. intervals and inspected microscopically for satellite carcinomas. We evaluated pathological stage, grade, cell type, histological pattern, vascular involvement, tumor size and the incidence of multifocality. To determine cell type we used several classification systems. RESULTS The primary tumor was 2 to 20 cm. (mean plus or minus standard deviation 7.10 +/- 3.48). Overall satellite carcinomas were present in 22 of the 103 cases (21.4%). When the predominant lesion was 5 cm. or smaller, the incidence of multifocality was 19%. The incidence of multifocality was statistically higher in patients with stage pT3 than in those with stage pT1 or pT2 disease (p = 0.022). Multiple logistic regression analysis demonstrated that only primary tumor pathological stage was a significant predictor of renal cell carcinoma multifocality in stages T3 versus T1 and T3 versus T2 cancer (odds ratio 3.45, 95% confidence interval 1.15 to 10.39 and 5.75, 1.31 to 25.29, respectively). Other parameters, such as tumor size, grade, vascular invasion, cell type and histological pattern, did not correlate with multifocality. CONCLUSIONS Our results imply that primary tumor stage is a significant factor for multifocal disease. Therefore, more precise preoperative staging of the primary lesion is required if nephron sparing surgery is indicated.

Inducible nitric oxide synthase expression in benign prostatic hyperplasia, low- and high-grade prostatic intraepithelial neoplasia and prostatic carcinoma

Objective To elucidate the incidence of inducible nitric oxide synthase (iNOS) expression in benign prostatic hyperplasia (BPH), low‐ and high‐grade prostatic intraepithelial neoplasia (PIN) and prostatic carcinoma lesions, and to explore the role of iNOS in prostate tumorigenesis.

Failure of ureteral replacement with gore-tex tube grafts

OBJECTIVES To evaluate the role of polytetrafluoroethylene (Gore-Tex) as a ureteral substitute in dogs after resection of a 5 to 8-cm-long middle segment. METHODS Five mongrel dogs underwent resection of the middle segment of the left ureter and segmental replacement of the resected part with segments of Gore-Tex over a double-J catheter. The double-J stents were removed at 21 days and the dogs were evaluated by excretory urography and abdominal ultrasonography 12 weeks after surgery. They were then killed and the ureters and the kidneys examined both grossly and microscopically. RESULTS There was radiologic evidence of advanced hydronephrosis on the left side in all 5 dogs. Grossly, the left kidneys showed marked pelvic and proximal ureteral dilatation and atrophy of parenchyma. Severe stricture at the anastomotic sites and marked fibrous tissue around the prostheses were found. No cellular lining was found in the Gore-Tex lumen. CONCLUSIONS There is no potential for ureteral replacement by Gore-Tex tube graft.

Computerized Tomography for Detecting Perivesical Infiltration and Lymph Node Metastasis in Invasive Bladder Carcinoma

Objectives: Computerized tomography (CT) is used in the preoperative staging of invasive bladder carcinoma. We evaluated the role of CT for detecting perivesical invasion and lymph node metastases in patients who had undergone radical cystectomy and pelvic lymphadenectomy for invasive bladder carcinoma. Patients and Methods: We retrospectively analyzed the clinical and pathological data of 100 patients with invasive bladder carcinoma who had undergone radical cystectomy. The preoperative CT images were reevaluated and interpreted by one uroradiologist blinded to the final pathological results for evidence of extravesical tumor extension or lymph node metastases. Results: Of the 100 patients, CT showed extravesical tumor involvement in 57. Of these 57 cases, 22 displayed no evidence of extravesical tumor involvement in the final pathological analysis. In 6 cases, although perivesical invasion was identified in the final pathological analysis, preoperative CT showed no evidence of extravesical tumor involvement. Regarding extravesical tumor spread, the differences between CT and pathological stages were statistically significant (p < 0.001). CT was highly suggestive of lymph node metastases in 9 cases, but only 4 were pathologically confirmed. On the other hand, in 9 patients pelvic lymph node metastasis were pathologically diagnosed, but there was no evidence of lymphadenopathy on CT. Regarding lymph node involvement, there was moderate concordance between CT and pathological findings (p = 0.003, κ = 0.29 ± 0.14). Conclusion: CT has limited accuracy in detecting perivesical infiltration and lymph node metastasis in invasive bladder carcinoma. The information provided by CT is insufficient and we urgently need more reliable staging techniques.

Microvessel density as a prognostic marker in bladder carcinoma: correlation with tumor grade, stage and prognosis.

Introduction: The aim of our study was toevaluate tumor angiogenesis as a prognosticmarker of transitional cell carcinoma of thebladder and to asses its relationship toestablished variables for survival and responseto therapy.Patients and method: Microvessel density(MVD), a measure of tumor angiogenesis, wereevaluated in 77 primary bladder cancers.Forty-three superficial carcinomas and 34invasive carcinomas were analysed. Tumorspecimens of all patients were obtained bytransurethral resection (TUR) and all thetumors were transitional cell carcinomas.Twenty-two patients with invasive bladdercancer have undergone M-VEC chemotheraphy. Thecorrelation between MVD and histopathologicalgrade, tumor stage and prognosis was evaluated.MVD was identified by immunostaining ofendothelial cells using anti-CD34 antibody. Forstatistical analysis Kruskal-Vallis,Mann-Whitney U and Fisher’s exact tests were used.Results: MVD was correlated with tumorgrade, stage and prognosis. Significantlyhigher MVD was determined in invasive tumorsthan superficial tumors (p < 0.05). MVDincreased with tumor grade and stage(p < 0.05). High MVD was correlated with therisk of clinical progression in bothsuperficial and invasive bladder carcinomas(p < 0.05, p < 0.001 respectively). Invasivetumors with remission after M-VEC chemotheraphyhad lower MVD than tumors with progressionafter M-VEC.Conclusion: These data demonstrate thatMVD in bladder carcinoma correlates with grade,stage and malignant potential of the tumor.Quantification of tumor angiogenesis may allowselection of the type of treatment for bladdercancer patients.

Urological evaluation of Behçet patients and the effect of colchicine on fertility.

Behçets disease is a multisystem disorder in which urogenital involvement mainly consists of genital aphthous ulcers, epididymitis, urethritis and recurrent cystitis. Colchicine is commonly used in these patients for the prevention of arthritic episodes. In this prospective study, 62 male patients under colchicine therapy for Behçets disease underwent a complete urogenital evaluation. 33 (53.2%) had no urologic complaints. Physical examination revealed genital aphthous ulcers in 42 patients (67.7%) and epididymitis in 5 (8.1%). Analysis of urine specimens demonstrated proteinuria in 54.8% and hematuria in 30.6%. To establish any possible adverse effects of colchicine administration on male fertility, sperm analysis was performed: 23 patients (37.1%) had oligonecrospermia, 2 patients (3.2%) had azoospermia. Penile color flow Doppler sonography revealed arterial insufficiency in 17 patients (27.4%). Other urological findings were interpreted as coincidental. Our results indicate that urologic manifestations of Behçets disease, and especially the possible adverse effects of colchicine administration on the reproductive potential of the treated patients should be carefully monitored.

A Prospective Randomized Study of Transurethral Resection of the Prostate and Transurethral Vaporization of the Prostate as a Therapeutic Alternative in the Management of Men with BPH

Objective: The common goals of new surgical treatment for benign prostatic hyperplasia (BPH) are to improve subjective and objective symptoms, to decrease the risk of postoperative complications and short hospitalization. Transurethral electrovaporization of the prostate (TUVP) is a new, minimally invasive and a promising alternative to standard transurethral resection of the prostate (TURP) in the treatment of BPH. The aim of this study is to compare the efficacy and safety of these two treatment alternatives. Methods: A prospective randomized trial of 60 patients with symptomatic BPH was performed. Preoperative and postoperative International Prostate Symptom Score (IPSS), maximum flow rates (Qmax) and complications were recorded in each patient. The volume of the prostate was measured preoperatively and postoperatively using transrectal ultrasound. Results: Of the 30 patients who underwent TURP, mean hospital stay was 4.5 days. The Foley catheter was removed on postoperative day 4 following surgery. IPSS decreased from 21.6 to 5.2, Qmax increased from 9.2 to 19.2 ml/s at 3 months. Mean prostatic volume at 3 months decreased from 51.7 to 26.2 g, a 49.3% reduction. Of 30 patients undergoing TUVP, mean hospital stay was 2.5 days and the catheter was removed within 2 days following surgery. Postoperative urinary retention did not occur in any patient. IPSS decreased from 19.4 to 4.1 and Qmax increased from 7.9 to 17.7 ml/s at 3 months. Mean prostatic volume decreased from 48.9 to 27.8 g, a 43.1% reduction at 3 months. In the TUVP group, none of the patients required blood transfusions or developed clinical transurethral resection syndrome. There were no major complications. Sphincteric incontinence, urethral strictures or bladder neck contractures were not recorded. At 3 months postoperatively, 13 patients in the TURP group and 7 patients in the TUVP group had retrograde ejaculation. Conclusion: Our initial experience of TUVP suggests advantages over conventional TURP through reduced blood loss and shorter hospital stay. It appears to be an effective treatment for BPH; however, long-term results should be evaluated.

The prognostic significance of advanced age in patients with bladder cancer treated with radical cystectomy

To evaluate the association of patient age with pathological and long‐term oncological outcomes after radical cystectomy (RC) for bladder carcinoma, as this disease, like many others, increases in incidence with age.

Color flow Doppler sonography in the diagnosis of vesicoureteric reflux.

We describe an alternative technique using color flow Doppler sonography (CFDS) for detection of vesicoureteric reflux (VUR). Twenty-one children, ages 2-16 years, were investigated for VUR using voiding cystourethrography (VCU) and CFDS. Forty-two ureterovesical junctions were studied and a total of 27 were found to be refluxing at VCU. Five of these 21 patients were operated for VUR and they were also reevaluated 3 and 6 months after the operation. With good diuresis ureteric jets could easily be detected with CFDS and if there was a reflux of urine into the ureter this could also be displayed. Afterwards, the patient was asked to urinate and if reflux into the ureter was detected, particular attention was paid to the detection of ureteral and pelvicalyceal dilatation by conventional gray-scale sonography. Taking VCU as the gold standard, CFDS revealed reflux in all cases except 1. There were 3 patients who had only one-sided reflux at VCU and bilateral reflux at CFDS examination (false-positive: 20%). Correlation of CFDS and VCU was 90, 100 and 75% in low grade, grade III and grade IV reflux, respectively. The results of CFDS correlated well with the results of VCU during the follow-up of 5 patients who had antireflux operations. As a conclusion, CFDS could be used as an adjunct to standard ultrasonography for detection of VUR.