Yaşar Bedük

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 Complications in Renal Transplantation: Long-Term Follow-Up of the Woodruff Ureteroneocystostomy Procedure in 433 Patients

Purpose: The two major types of urologic problems after renal transplantation are urinary leakage and obstruction. In this study, we report the urological complications of renal transplantations performed in our hospital during a 22-year period. Patients and Methods: Between 1978 and 2000, 433 consecutive patients underwent renal transplantation. Of those transplants, 50 were cadavers and 383 were living-related donor transplantation. All ureteroneocystostomies were performed with the same technique described by Woodruff. Results: Urological complications developed in 19 (4.23%) recipients. Those complications were urinary leakage in 9 (2%), ureteral obstruction in 9 (2%) and ureteral necrosis in 1 patient (0.23%). All complications occurred during the 6-month postoperative period and after re-operation or conservative management no graft or patient was lost due to urological complications. Conclusion: The quoted overall rate of urological complications varies from 2.9 to 12.5%; our complication rate was 4.23%. This relatively low rate is probably due to the Woodruff ureteroneocystostomy technique.

Solitary metastasis of renal cell carcinoma to the parotid gland 10 years after radical nephrectomy

Abstract  Renal cell carcinoma metastasis to the parotid gland after tumor nephrectomy is extremely rare. We report a case of solitary parotid metastasis from clear cell renal cell carcinoma in a 59‐year‐old woman, who presented 10 years after primary treatment. To our knowledge this is the first case in the published literature presenting with solitary parotid metastasis after such a long time. Superficial parotidectomy with preservation of the facial nerve was performed. One year after, the patient developed contralateral multiple kidney tumors and underwent left radical nephrectomy. She is currently on a dialysis program and no additional metastasis has been observed for 18 months.

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.

Histopathologic effects of extracorporeal shock wave lithotripsy on rabbit kidney

SummaryDespite the widespread clinical use of the lithotriptor, the margin of safety for the kidney during shock wave application is substantially unknown. Although a series of pilot studies have been performed in laboratory animals, long-term follow-up is mandatory to establish the effect of extracorporeal shock wave lithotripsy (ESWL) and subsequent dose-dependent changes on the kidneys. An experimental study was performed in 45 rabbits; to define and compare the early and late complications of ESWL in the kidneys. The rabbits were divided into three groups of 15 animals each that received 1000, 1500 or 3000 shock waves respectively at 15–20 kV. The rabbits in each group were killed and necropsy performed within 24 h for the first 5 animals, 1 week for the second 5 animals and 2 months post-ESWL for the last 5 animals. Dose-dependent moderate damage (subcapsular hemorrhage, interstitial hemorrhage, capsular tension and perirenal hemorrhage) were noted in all kidneys at 24 h after treatment. Evidence of permanent changes (some fibrosis, tubular and glomerular damage, chronic inflammatory alterations) was noted in long-term follow up. Complete necrosis of the treated kidney was not encountered in this study.

Isolated local recurrence of renal cell carcinoma after radical nephrectomy: experience with 10 cases

OBJECTIVES Isolated local recurrence of renal cell carcinoma after radical nephrectomy is very uncommon and the effect of aggressive surgical management of this clinical entity remains controversial. We report our experience with 10 such cases. METHODS Between 1994 and 2002, 10 patients with isolated local recurrence of renal cell carcinoma without any evidence of metastatic disease after radical nephrectomy were treated at our department. The mean patient age was 51.7 years (range 26 to 74); 7 patients were men and 3 were women. All patients underwent extensive surgery for local recurrence. RESULTS Only 3 patients were symptomatic, and the others were diagnosed during routine follow-up examinations. The mean time to local recurrence was 33.6 months (range 3 to 68), and the mean size of the recurrent tumor was 8.45 cm (range 3 to 12). An aggressive surgical approach was taken in all patients. One patient died in the postoperative period because of a surgical complication. Of the remaining 9 patients, 2 died of metastatic disease after a mean survival of 8.5 months (range 3 to 14). Seven patients were alive with a mean survival of 16.6 months (range 3 to 38+). CONCLUSIONS We believe that patients with isolated local recurrence after radical nephrectomy may benefit from an aggressive surgical approach, but this kind of surgery may also have significant complications.

Evaluation of Ischemia after ESWL: Detection of Free Oxygen Radical Scavenger Enzymes in Renal Parenchyma Subjected to High-Energy Shock Waves

To evaluate the degree of ischemic formation at the tissue level after high-energy shock wave (HESW) application in a time- and dose-dependent manner, an experimental study in rabbits was performed. Following varying numbers of HESWs (1,000-2,000-3,000 shock waves) under fluoroscopic localization, treated kidneys were removed, by assessing tissue concentrations of two different free-radical scavenger enzymes (superoxide dismutase and catalase) the degree of formation of free oxygen radicals (i.e. ischemia) was evaluated. Evaluation of our results showed a statistically significant (p < 0.05) decrease in tissue scavenger enzyme levels (i.e. formation of free oxygen radicals) after 24 h following HESW application. However, results obtained 7 days after ESWL demonstrated disappearance of ischemia with normalization of tissue enzyme levels (p > 0.05).

Use of color Doppler sonography in the evaluation of varicoceles

Color flow Doppler sonography (CFDS) has been used to evaluate the blood flow to the testes, because of its ability to visualize small vessels with low flow. A total of 39 infertile men, 18 with clinical varicocele and 21 without, were examined using CFDS to assess the clinical usefulness of this technique. In patients with varicocele, venous diameter in the pampiniform plexus was greater than 2 mm, whereas those without varicocele showed diameters of less than 1.8 mm. Of 21 patients without varicocele on physical examination, 13 were found to have reflux by CFDS. According to clinical and CFDS findings, patients were divided into five groups: varicocele negative, suspicious subclinical varicocele, subclinical varicocele, manifest varicocele with Valsalva-induced reflux, and manifest varicocele. These data suggest that the CFDS technique is a simple, sensitive and noninvasive modality for the accurate diagnosis of varicocele.