Z. Dobrowolski

Renal and ureteric trauma: diagnosis and management in Poland.

Objective To analyse retrospectively kidney and ureteric injuries (the former often associated with multiple‐organ trauma and thus optimize diagnostic and treatment methods.

Treatment of posterior and anterior urethral trauma

Objective To assess the occurrence and treatment of posterior urethral (most often caused by traffic accidents and comprising half of all cases of urinary tract traumas and anterior urethral injury (usually iatrogenic during catheterization or cystoscopy, or caused by blunt trauma, e.g. straddle injury or penetrating trauma).

TRACE ELEMENTS DISTRIBUTION IN RENAL CELL CARCINOMA DEPENDING ON STAGE OF DISEASE

OBJECTIVES The aim of this study was to identify those trace elements which can be used to distinguish between normal and malignant tissue in renal cell cancer (RCC) kidney and to assess changes in trace elements concentration in tissue with progressing malignant disease. METHODS In case control study, 36 cases of RCC were analyzed by Synchrotron Radiation Induced X-ray Emission (SRIXE) in order to establish the concentration of 19 elements. Patients with RCC were examined to obtain staging of disease after radical nephrectomy, which was performed in each case. Results were compared with 15 control kidney cortex tissue obtained during autopsy in which cause of death was trauma. RESULTS The most relevant decrease was detected in Cd content: from 81 +/- 39.2 ppm in normal control samples to 16.6 +/- 22.2 ppm concentration in RCC. We found that the concentrations of Ti, Pb and Rb were also lower in RCC tissue. On the other hand, the RCC tissue was rich in iron and zirconium. With the progress of malignant disease, assessed by TNM (UICC 1997) scale, lower concentration of S and higher concentration of Ca in both RCC and neoplastic kidney cortex can be seen. The same tendency is observed in Zn and Se concentrations. Cadmium shows raising concentration with progress of RCC only in cortex of neoplastic kidney. In all cases it was shown that the relatively high tissue concentration of iron in both investigated tissues is decreasing with the progress of disease. The zirconium has shown raising tissue concentration in advanced disease. CONCLUSION Trace elements concentration is different in malignant tissue and surrounding macroscopically unchanged kidney cortex. Progress of the disease is connected with changes in trace elements concentration. This may reflect different biology of compared tissue with potential practical implication.

External and iatrogenic trauma of the urinary bladder: a survey in Poland

Objective To assess incidence of urinary bladder injuries (frequently associated with pelvic trauma and often iatrogenic in Poland.

The therapy of benign prostatic hyperplasia using less-invasive procedures: the current situation.

Several heat therapies that are less invasive than TURP have been developed recently, e.g. microwave, radiofrequency-based, laser-interstitial contact, visual, electrovaporization and water-induced thermotherapy. They all require less anaesthesia (regional or even topical, supplemented with intravenous sedation), are easier to master than TURP, have fewer side-effects than surgery and result in comparable subjective improvements as TURP, when evaluated using quality-of-life and symptom scores. However, there is obviously a need for long-term studies to assess their role when compared with the medical management of symptomatic BPH or with surgery. Herein we review the recent results.

Preliminary Analysis of the Expression of Selected Proangiogenic and Antioxidant Genes and MicroRNAs in Patients with Non-Muscle-Invasive Bladder Cancer

Heme oxygenase-1 (HO-1) is an enzyme contributing to the development and progression of different cancer types. HO-1 plays a role in pathological angiogenesis in bladder cancer and contributes to the resistance of this cancer to therapy. It also regulates the expression of microRNAs in rhabdomyosarcoma and non-small cell lung cancer. The expression of HO-1 may be regulated by hypoxia inducible factors (HIFs) and Nrf2 transcription factor. The expression of HO-1 has not so far been examined in relation to Nrf2, HIF-1α, and potential mediators of angiogenesis in human bladder cancer. We measured the concentration of proinflammatory and proangiogenic cytokines and the expression of cytoprotective and proangiogenic mRNAs and miRNAs in healthy subjects and patients with bladder cancer. HO-1 expression was upregulated together with HIF-1α, HIF-2α, and Nrf2 in bladder cancer in comparison to healthy tissue. VEGF was elevated both at mRNA and protein level in the tumor and in sera, respectively. Additionally, IL-6 and IL-8 were increased in sera of patients affected with urothelial bladder cancer. Moreover, miR-155 was downregulated whereas miR-200c was elevated in cancer biopsies in comparison to healthy tissue. The results indicate that the increased expression of HO-1 in bladder cancer is paralleled by changes in the expression of other potentially interacting genes, like Nrf2, HIF-1α, HIF-2α, IL-6, IL-8, and VEGF. Further studies are necessary to also elucidate the potential links with miR-155 and miR-200c.

Vascular angiographic asymmetry on three‐dimensional transrectal power Doppler ultrasonography in patients with organ‐confined prostate cancer

Objective To assess whether organ‐confined prostate cancer not detected on routine transrectal ultrasonography (TRUS) can be detected using three‐dimensional (3‐D) power Doppler methods.

C163 STRATEGY IN PREVENTING OF URETERO-INTESTINAL ANASTOMOSIS STRICTURES IN PATIENTS WITH LOW PRESSURE INTESTINAL NEOBLADDER

Ureteroileal stenoses occur in 1.2-20% patients with neobladders. They constitute a serious clinical complication since, as every obstruction of urine flow from the kidney. Ureteroileal stenoses develop usually within firs 6 to 12 months following the extended urological procedure such as radical cystectomy with the creation of ileal orthotopic neobladder. Ureteroileal stenosis belongs to the most difficult complications after creation of ileal neobladder. The experience of our clinic between 2001 and 2011 covers 3500 cases of patients with bladder cancer. 226 patients underwent cystectomy, 120 were treated with urinary diversion m. Bricker and 106 underwent low pressure ileal neobladder modo Studer. Ureters anastomosed with the intestine Michalowskis way of a flap. The authors performed 344 ureteroileal anastomoses, 212 ureteroileal anastomoses with the ileal neobladder modo Studer and 11 stenoses were detected, in 5 patients one-side, in 3 bilateral. In our practice there was altogether 11 detected stenoses which constitutes 5.18%. Based on our experience, in the course of radical removal of the bladder during the preparation of the least possible damage the blood supply ureter, ureter prior to implantation should be checked for leaks, catheter should be made of soft material. The performance of the left ureter to carry out the right side of the mesentery, be careful not without angulation. In the course of the uretero-intestinal anastomosis should not be stitched in place to destroy the vascular anastomosis of ureter to intestine anastomosis and the same should be done without tension. Protect the integrity of the anastomosis, aseptic oncology. Uretero-intestinal anastomosis performed without anti-reflux protection.

The beginnings of urology in Kraków: on the 70th anniversary of the founding of the Clinic of Urology

The beginnings of urology in Poland date back to the 1880s and are closely associated with the work of Prof Ludwik Rydygier (1850–1920). In 1887 he was the first person to open the bladder through the peritoneum, and made this practice standard in such surgical treatment [1]. He devoted much attention to the problem of urinary fistula and ureteric defects caused by injury, for which he also suggested his surgical solutions. When Rydygier left for Lvov, Prof Alfred Obalinski (1843–1897), the former head of the Surgical Ward in St Lazarus Hospital in Kraków (which functioned as the University Hospital) became the head of the Surgical Clinic [2]. Obalinski was a versatile surgeon, not afraid of innovation, and was particularly interested in surgery of the urogenital system. He was the author of the first urology manual written in Polish, in 1886, entitled: ‘A Lecture on the Diseases of the Urinary Tracts in Men’. He specialized in kidney surgery; he was one of the first to conduct nephrectomy in Poland. In the academic years 1883–1885, as the first such person in Poland, he conducted lectures in the field of urology. The most outstanding assistant of Prof Obalinski was Maksymilian Rutkowski (1867–1947), who devised his own method of plastic surgery of the everted bladder, using the intestine for the first time [3]. He thus developed the precursor of ileocystoplasty, currently very popular. Moreover, in 1910 he was the first person in Poland to resect the bladder for cancer, and in 1913 he corrected a defect of the urethra using the appendix. Tadeusz Pisarski (1878–1936) was Rutkowski’s assistant and closest co-worker in St Lazarus Hospital in the field of urological surgery [4]. The professor made him the head of the urological subward, established before the First World War, and subsequently the outpatient department at the ward. Pisarski was very important in the history of the Kraków Clinic but a certain coincidence also helped in the establishment of this institution. Having completed his practice in Copenhagen, Pisarski became, in 1908, the head of the Surgical Ward in St Lazarus University Hospital and was trying to create a new ward. In 1913 he created the outpatient department, which was the first urological institution in Kraków, where he admitted patients until the outbreak of the First World War. He was conscripted during the War into the Austrian army and remained in it until 1921, finishing his career at the rank of Lieutenant Colonel. Pisarski was the author of the first habilitation dissertation in Poland in the field of urology, published in 1925, and entitled: ‘Urinary Calculus – its Structure and Formation Mechanism’. (In the early 1970s in our Clinic there was still a collection of calculi and foreign bodies removed from the bladder, started by Pisarski and continued by Michalowski, which was dispersed in 1978). Thanks to Pisarski’s efforts in 1929, the present Urology Clinic of the Collegium Medicum at the Jagiellonian University at ul Grzegórzecka 18 in Kraków was built. The following coincidence was important in this enterprise. During his service in the army Pisarski met a young mathematician, a future professor of the Lvov Technical University, Kazimierz Bartel, who in 1926 was elected Prime Minister of the Polish Republic. Bartel, who had stone disease, asked his friend from the army for help, and underwent ureterolithotomy. The grateful Prime Minister allocated one million zloty to the building of the Urology Clinic in Kraków. Pisarski supervised its building and equipped it with an operating theatre, a separate endoscopy room, an X-ray room, an analytical laboratory, an outpatient department and the most modern medical equipment available at that time. The building, which was designed for 35 patients (in the Accepted for publication 10 January 2002 BJU International (2002), 89, 596–598

Assessing the vascular-stromal coefficient in patients with benign prostatic hyperplasia or prostate cancer using transrectal ultrasonography and power Doppler analysis

Objectives To assess a coefficient of the prostatic blood supply in patients with prostate cancer or benign prostatic hyperplasia (BPH), and thus improve the diagnostic and prognostic variables needed to evaluate patients with prostate cancer.