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Background: Elevated serum C-reactive protein (CRP) level has been demonstrated to predict poorer survival of both localized and metastatic renal cell carcinoma. However, the prognostic value of intratumoral CRP expression has not been sufficiently studied. Patients and Methods: In the present study, the expression of CRP was evaluated with immunohistochemical analysis in 127 patients who had undergone curative surgery for clear cell renal cell carcinoma. CRP staining was scored using the immunoreactivity score. An immunoreactivity score of 4 (median value) or lower was considered negative, a score higher than 4 was considered positive CRP expression. Results: Univariate analysis revealed that Fuhrman grade, necrosis, vascular invasion, TNM stage and CRP expression were associated with tumor-specific survival. Multivariate analysis using the Cox proportional hazards regression method revealed only TNM stage as an independent predictor of tumor-specific survival (p = 0.001). A trend towards significance (p = 0.066) was observed with CRP expression, but it did not reach significance. Patients with a positive CRP score were 3.46 times more likely to die than patients with a negative CRP score. Conclusion: Our results suggest that the assessment of intratumoral CRP expression may be a useful tool for predicting the prognosis in patients with clear cell renal cell carcinoma. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Perforation of the upper ureter is a rare but serious complication of extracorporeal shock wave lithotripsy (SWL). Ureteral perforation can cause a series of problems including the retroperitoneal urinoma, urosepsis, abscess formation, infection, and subsequent renal function impairment. We reported here a rare case of SWL-induced upper ureteral rupture resulting in an expanding retroperitoneal urinoma that required percutaneous drainage. Ureteral perforation was treated successfully without major surgical intervention by employing temporary percutaneous drainage and antibiotics. The present case indicates that potential ureter rupture may form in rare cases; especially in patients having infected stones and exposed to a high number of shock waves. This complication further emphasizes the importance of adequate pre-and post-operative evaluation and the precise identification of the cause of the persistent pain after SWL. [ABSTRACT FROM AUTHOR]

: ObjectivesTo elucidate the action of vasoactive intestinal peptide (VIP) on detorsion injury and the heterogeneity of mast cells in the testes of rats.: MethodsPrepubertal male Sprague-Dawley rats were used in six groups. Group 1 was the control group (sham operation); group 2 had 2 hours of torsion; group 3, 2 hours of torsion and 1 hour of detorsion after administration of saline; group 4 had 2 hours of torsion and 4 hours of detorsion after administration of saline; group 5, 2 hours of torsion and 1 hour of detorsion after administration of intraperitoneal VIP (25 ng/kg); and group 6, 2 hours of torsion and 4 hours of detorsion after intraperitoneal VIP. The 2 hours of torsion was created by rotating the right testis 720° in a clockwise direction. VIP (25 ng/kg) was injected intraperitoneally 1 minute before the 1 and 4 hours of detorsion. At the end of the experiment, catalase enzyme activity was measured polarographically, and superoxide dismutase, malondialdehyde, and protein were measured spectrophotometrically. Nitric oxide was measured by capillary electrophoresis in the testicular tissue. Routine histologic examination of testicular mast cells was done under light microscopy; the histochemistry was also analyzed.: ResultsTorsion significantly induced oxidative stress, mast cell degranulation, and tissue damage. Detorsion attenuated oxidative stress without any diminution of the histologic damage to the tissue. VIP significantly protected the testicular tissue from detorsion injury. It also inhibited mast cell activity while increasing the heparin content.: ConclusionsVIP can protect testicular tissue from detorsion injury. Heparin-containing mast cells seem to be important mediator cells for this protection. [Copyright &y& Elsevier]

Purpose: It was aimed to evaluate the changes in quality of life in patients with erectile dysfunction (ED) after inflatable penile prosthesis implantation.Material and Methods: Forty-one patients who underwent to an inflatable penile prosthesis implantation surgery due to ED were included in the study. The age of the patients, the indications for surgery, and the type of prosthesis implanted were recorded. All patients were implanted two-piece inflatable (AMS Ambicor™) or three-piece inflatable (AMS 700™) prostheses. A 36-item short form (SF-36) was used to assess the life quality of patients. The scores obtained from these forms were recorded and used to compare the preoperative and postoperative quality of life of the patients.Results: The mean age of the patients was 59.9 (38-78) years. The mean follow-up was 25.1 (12-39) months. A three-piece inflatable penile prosthesis was implanted in 11 (26.8%) of the 41 patients and the others were implanted with a two-piece inflatable penile prosthesis. Average SF-36 scores were increased significantly after surgery in all groups.Conclusions: Inflatable penile prosthesis implantation is one of the most satisfactory treatment methods of ED and our study shows that with this treatment the patients can be provided a significant improvement in life quality. [ABSTRACT FROM AUTHOR]

Objective: Testicular tumors can be seen bilaterally in 2-3% of cases as synchronous or metachronous. The long cancer-specific survival in early-stage testicular cancer requires consideration for fertility and quality of life issues because of organ loss in these patients. In the present case series, the surgical outcome and histopathological features of testis-sparing surgery were evaluated using bench work after a standard radical orchiectomy in testicular tumor patients with normal contralateral testis. Materials and Methods: Patients with a testicular mass confirmed by ultrasonography and/or magnetic resonance imaging and normal contralateral testis were included in the study. All patients underwent standard radical orchiectomy. Partial orchiectomy was performed on a separate operating table (bench) following radical orchiectomy. After visual evaluation of the removed tumor mass, seven biopsies were taken from the tumor bed for frozen section examination (FSE). If a residual tumor was found in the tumor bed because of FSE, parenchymal resection was performed until a negative margin was achieved. The patients’ age, tumor marker levels, tumor type, tumor diameter, rete testis invasion, epididymis and spermatic cord invasion, necrosis, and presence of lymphatic-vascular invasion were recorded. Results: Sixteen patients were included in the study. The mean age of the patients was 31.6±11.6 years. The mean tumor diameter was 26.9±15.3 mm, and the mean tumor-testicular-volume ratio was 33.2±24.9 percentage. The surgical margin was positive in 12.5% (n=2/16) patients in the FSE. In these two patients, the tumor-testicular volume ratio was above 50%, the tumor diameter was greater than 50 mm, and necrosis and invasion of the tunica albuginea were observed in the final histopathology. The tumor histopathology of patients was pure seminoma, non-seminomatous germ cell tumors, mixed germ cell tumor, sex cord stromal tumor, and fibrosis in 50% (n=8/16), 12.5% (n=2/16), 25% (n=4/16) 6.5% (n=1/16) and 6.5% (n=1/16) of the cases, respectively. Histopathological examination revealed 37.5% (n=6/16) intratubular germ cell neoplasia in the adjacent testicular tissue. Conclusion: Our experience in the present case series shows that testis-sparing surgery is technically straightforward. Surgical margin positivity can be detected in patients with a large tumor or a high tumor-testicular-volume ratio. FSE is useful for detecting surgical margin positivity. [ABSTRACT FROM AUTHOR]

Objective: Testicular tumors can be seen bilaterally in 2-3% of cases as synchronous or metachronous. The long cancer-specific survival in early-stage testicular cancer requires consideration for fertility and quality of life issues because of organ loss in these patients. In the present case series, the surgical outcome and histopathological features of testis-sparing surgery were evaluated using bench work after a standard radical orchiectomy in testicular tumor patients with normal contralateral testis. Materials and Methods: Patients with a testicular mass confirmed by ultrasonography and/or magnetic resonance imaging and normal contralateral testis were included in the study. All patients underwent standard radical orchiectomy. Partial orchiectomy was performed on a separate operating table (bench) following radical orchiectomy. After visual evaluation of the removed tumor mass, seven biopsies were taken from the tumor bed for frozen section examination (FSE). If a residual tumor was found in the tumor bed because of FSE, parenchymal resection was performed until a negative margin was achieved. The patients' age, tumor marker levels, tumor type, tumor diameter, rete testis invasion, epididymis and spermatic cord invasion, necrosis, and presence of lymphatic-vascular invasion were recorded. Results: Sixteen patients were included in the study. The mean age of the patients was 31.6±11.6 years. The mean tumor diameter was 26.9±15.3 mm, and the mean tumor-testicular-volume ratio was 33.2±24.9 percentage. The surgical margin was positive in 12.5% (n=2/16) patients in the FSE. In these two patients, the tumor-testicular volume ratio was above 50%, the tumor diameter was greater than 50 mm, and necrosis and invasion of the tunica albuginea were observed in the final histopathology. The tumor histopathology of patients was pure seminoma, non-seminomatous germ cell tumors, mixed germ cell tumor, sex cord stromal tumor, and fibrosis in 50% (n=8/16), 12.5% (n=2/16), 25% (n=4/16) 6.5% (n=1/16) and 6.5% (n=1/16) of the cases, respectively. Histopathological examination revealed 37.5% (n=6/16) intratubular germ cell neoplasia in the adjacent testicular tissue. Conclusion: Our experience in the present case series shows that testis-sparing surgery is technically straightforward. Surgical margin positivity can be detected in patients with a large tumor or a high tumor-testicular-volume ratio. FSE is useful for detecting surgical margin positivity. [ABSTRACT FROM AUTHOR]

Bladder cancer is one of the most common cancers of urinary system and approximately 70% of the cases are low grade and non-muscle invasive. Because of the histological indicator inadequacy of heterogeneous tumors like bladder cancer, researchers tend to look into genetic and molecular markers. Furthermore, role of epigenetic changes in cancer biology to be more distinctive than other cellular changes was shown. Epigenetic changes include 3 main titles; DNA methylation, micro RNA regulation and histone modification. In the literature, many epigenetic changes were found to be associated with early detection of the disease, progression, patient prognosis, tumor recurrence, early relapse, higher pathologic stage, disease-specific survival. With the understanding of epigenetic changes better patient outcomes will be achieved in the future. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article "Papillary renal cell carcinoma and collecting duct carcinoma combination. A case report and review of synchronous renal cell carcinoma subtypes in the same kidney" published in a previous issue of the periodical is presented.

Objective: Anesthetic agents and applications affect tumor pathophysiology and immunosuppression in the postoperative period. We evaluated the changes made by hypnotic anesthetic agents used during anesthesia on neutrophil/lymphocyte ratio (NLR) in patients undergoing radical prostate surgery and its relationship with short-term morbidity. Materials and Methods: Age of patients who had radical prostatectomy, physical classification of the American Society of Anesthesiology, perioperative blood transfusion, drugs used during general anesthesia (intravenous, opioid, volatile anesthetic), duration of anesthesia, analgesics used in postoperative pain was examined. Preoperative, postoperative day-0 and day-2 NLR results were recorded. Results: The data of 159 patients who underwent radical prostatectomy were assessed. The patients were divided into 2 groups; Group pentotalsevoflurane/desflurane (PSD) (n=101) and Group propofol-sevoflurane/desflurane (PrSD) (n=58). There was no difference in terms of preoperative and postoperative 2 day NLR value, but the highest NLR values in the postoperative day 0 was found to be in Group PrSD. Postoperative complications were higher in Group PSD. However, preoperative NLR values of these complications were higher in Group PrSD. Erythrocyte (red blood cell) replacement patients were divided into 2 groups; between 0 and 2 units (n=147) and more than >2 units (n=12), their preoperative NLR ratios were 2.54 (0.7-16.3) and 3.3 (1.8-8.8) respectively. The cut value of NLR for bleeding was set at 1.77. Conclusion: Increased NLR result is associated with immunosuppression and tumorigenesis, and is an easy and inexpensive technique. In prostate cancer, preoperative high NLR (>1.7) may have a predictive value for bleeding, blood transfusion, and postoperative respiratory distress. [ABSTRACT FROM AUTHOR]

Sarcomatoid transitional cell carcinoma is a rare entity, in which a malignant, overtly epithelial component coexists with areas having a sarcoma-like appearance. Histological distinction of sarcomatoid carcinomas from carcinosarcomas is often difficult and immunohistochemistry is a helpful diagnostic adjunct in the correct diagnosis. In the present report, we describe an uncommon case of sarcomatoid transitional cell carcinoma of the renal pelvis, associated with giant cell tumor-like features. Immunoperoxidase staining for cytokeratin was positive in spindle cell component, indicating an epithelial origin. The carcinomatous component showed a diffuse membranous reactivity for E-cadherin, whereas the reactivity was sporadic and weaker in the sarcomatoid component, suggesting that the decrease of E-cadherin expression might be associated with the acquisition of sarcomatous morphology. Osteoclast-like multinucleated giant cells were positive for CD68 and negative forp53oncoprotein, suggesting that they represent a non-neoplastic component that is reactively induced in the tumor stroma. [ABSTRACT FROM AUTHOR]

Objective: The American Joint Committee on Cancer tumor-node-metastasis (TNM) classification has been updated by the 7th edition in 2010. The objective of the study was to evaluate cancer-specific survival (CSS) in patients with renal cell carcinoma (RCC) and assess the concordance of 2002 and novel 2010 TNM primary tumor classifications. Materials and Methods: A retrospective analysis of RCC registries from 25 institutions of the Urooncology Association of Turkey Renal Cancer- Study Group was performed. Patients with RCC had a radical or partial nephrectomy. The database consisted of 1889 patients. Results: Median follow-up time was 25 months (interquartile range: 11.2-47.8). The 5-year CSS rate for pT1a, pT1b, pT2a, pT2b, pT3a and pT4 tumors were 97% [95% confidence interval (CI): 0.93-0.99], 94% (95% CI: 0.91-0.97), 88% (95% CI: 0.81-0.93), 77% (95% CI: 0.64-0.86) 74% (95% CI: 0.65-0.81) and 66% (95% CI: 0.51-0.77), respectively according to the 2010 TNM classification (p<0.001). CSS comparisons between pT1a-pT1b (p=0.022), pT1b-pT2a (p=0.030), pT3a-pT3b (p<0.001) and pT3b-pT4 (p=0.020) were statistically significant. Conversely, pT2a-pT2b (p=0.070) and pT2b-pT3a (p=0.314) were not statistically significant. Multivariable analyses revealed the pT stage in the 2010 TNM classification as an independent prognostic factor for CSS (p for trend=0.002). C-indexes for 2002 and 2010 TNM classifications were 0.8683 and 0.8706, respectively. Conclusion: Subdividing pT2 does not have a CSS advantage. Moving adrenal involvement to pT4 yielded a more accurate prognosis prediction. T stage and LNI are independent prognostic factors for CSS in RCC. Overall, the novel 2010 TNM classification is slightly improved over the former one. However, shown by C-index values, this improvement is not sufficient to state that 2010 TNM outperforms the 2002 TNM. [ABSTRACT FROM AUTHOR]

Objective To determine the effect of age on recurrence and progression rates in a population of high-risk non-muscle invasive bladder cancer (NMIBC) patients treated with a second transurethral resection (TUR) and at least 1 year of maintenance Bacillus Calmette-Guerin (BCG) therapy. Materials and Methods In this multicenter study, we reviewed the data of patients treated for high-risk NMIBC between 2005 and 2012. Patients without a muscleinvasive cancer on second TUR and received induction BCG and at least one year of maintenance BCG therapy and at least 12 months of follow-up after completion of maintenance BCG were included. Effect of age was analyzed both dichotomously (<70 or ≥70 years) as well as by 10-year increments. Chi-square test, Student's T-test and analysis of variance (ANOVA) were used for comparison of the groups. Univariate and multivariate logistic regression analyses were performed to identify predictors of recurrence and progression. Results Overall, 242 eligible patients were included. Baseline parameters were similar. With a mean follow-up of 29.4±22.2 months, neither 3-year recurrence-free survival nor 3-year progression-free survival differed between the age groups when examined either dichotomously or by 10- year increments. Conclusion In high-risk NMIBC patients treated with a second TUR and received maintenance BCG therapy, age was not associated with increased rates of neither recurrence nor progression. Until a randomized prospective clinical trial assess the appropriate adjuvant intravesical therapy in the elderly, elderly patients should probably be treated in the same manner as younger patients. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the effect of the interval between the initial and second transurethral resection ( TUR) on the outcome of patients with high-risk non-muscle-invasive bladder cancer ( NMIBC) treated with maintenance intravesical Bacillus Calmette-Guérin ( BCG) therapy. Patients and Methods We reviewed the data of patients from 10 centres treated for high-risk NMIBC between 2005 and 2012. Patients without a diagnosis of muscle-invasive cancer on second TUR performed ≤90 days after a complete first TUR, and received at least 1 year of maintenance BCG were included in this study. The interval between first and second TUR in addition to other parameters were recorded. Multivariate logistic regression analysis was used to identify predictors of recurrence and progression. Results In all, 242 patients were included. The mean ( sd, range) follow-up was 29.4 (22.2, 12-96) months. The 3-year recurrence- and progression-free survival rates of patients who underwent second TUR between 14 and 42 days and 43-90 days were 73.6% vs 46.2% ( P < 0.001) and 89.1% vs 79.1% ( P = 0.006), respectively. On multivariate analysis, the interval to second TUR was found to be a predictor of both recurrence [odds ratio ( OR) 3.598, 95% confidence interval ( CI) 1.885-8.137; P = 0.001] and progression ( OR 2.144, 95% CI 1.447-5.137; P = 0.003). Conclusions The interval between first and second TUR should be ≤42 days in order to attain lower recurrence and progression rates. To our knowledge, this is the first study demonstrating the effect of the interval between first and second TUR on patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of lymph node metastasis, skip metastasis, and other factors related to lymph node status on survival in patients who underwent radical cystectomy (RC) and extended lymph node dissection (eLND). Materials and Methods: RC and eLND were performed in 85 patients with a diagnosis of bladder cancer. Disease-free survival (DFS) and overall survival (OS) were determined by using a Cox proportional hazards model that included the number of excised lymph nodes, the presence of pathological lymph node metastasis, the anatomical level of positive nodes, the number of positive lymph nodes, lymph node density, and the presence of skip metastasis. Results: The mean number of lymph nodes removed per patient was 29.4±9.3. Lymph node positivity was detected in 85 patients (34.1%). The mean follow-up duration was 44.9±27.4 months (2-93 months). Five-year estimated OS and DFS for the 85 patients were 62.6% and 57%, respectively. Three of 29 lymph node-positive patients (10.3%) had skip metastasis. Only lymph node positivity had a significant effect on 5-year OS and DFS (p<0.001). No difference in OS and DFS was found between the three patients with skip metastasis and other lymph node-positive patients. Other factors related to lymph node status had no significant effect on 5-year OS and DFS. Conclusions: No factors related to lymph node status predict DFS and OS, except for lymph node positivity. OS and DFS were comparable between patients with skip metastasis and other lymph node-positive patients. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to evaluate the role of balloon dilatation of the ureteral orifice on the decision to stent after ureteroscopy. Materials and methods: We prospectively enrolled 505 patients from two clinics, undergoing ureteroscopy (URS) for urolithiasis. Patients having balloon dilatation of the ureteral orifice and uncomplicated ureteroscopy were randomized to be either stented ( n = 144) or nonstented ( n = 142). Ureteroscopy was done with a 9.8 rigid ureteroscope. For dilatation of ureteral orifice, 18Fr-4 cm balloons were used (Uromax™, Boston Scientific, USA). Holmium laser or pneumatic devices were used for lithotripsy. In the second postoperative week, patients were asked to assess: pain, dysuria, and urgency using a 10-cm visual analog score (VAS) and unplanned visits. In each visit, urinalysis, urine culture, plain X-ray, and ultrasound examinations were performed. Six months after URS, follow-up IVU was performed to evaluate ureteral narrowing. Results for the separate clinics were not revealed until the end of study. Results: There were no significant differences between the two groups regarding gender, age, preoperative serum creatinine levels, stone size, stone side and location, lithotripsy type, pain, infectious complications, unplanned visits, and ureteral narrowing. However, irritative symptoms were more common in the stented group. Success rates of 97.8 and 97.2% were similar in the unstented and stented groups. Conclusion: In uncomplicated URS, balloon dilatation of the ureteral orifice should not significantly affect the decision for or against stent placement. Avoiding stents lowers costs and gives fewer irritative symptoms. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate the accuracy of frozen section examination (FSE) for detecting lymph node (LN) metastases and whether we can use this information to decide the extent of LN dissection during cystectomy. PATIENTS AND METHODS From August 2005 to August 2009 FSE of obturator LNs was performed in 118 patients with bladder cancer, who were undergoing radical cystectomy with extended LN dissection. Removed tissues from 12 well defined LN regions were sent separately for pathologic evaluation. The FSE results of obturator regions were compared with the final histopathologic results of these node regions. RESULTS The mean number of removed nodes per patient was 29.4 ± 9.3 (median 28, range 12 to 51). The sensitivity, specificity, positive and negative predictive values of FSE for the 118 right obturator LN regions were 94.7%, 100%, 100% and 99%, respectively. The same values for the 118 left obturator LN regions were 86.7%, 100%, 100% and 98.1%, respectively. At final pathologic examination 28 of 118 (23.7%) patients had LN metastasis at obturator regions. Skipped metastasis was found in 15/90 patients (16.7%). Clinical and pathological stage of the primary tumour were found to be significant parameters for skipped metastasis ( P = 0.008 and P < 0.001, respectively). CONCLUSIONS Performing FSE of the obturator LNs seems to be a reliable procedure for their evaluation with acceptable negative and positive predictive values. The information obtained with FSE of obturator LNs can be used to determine intraoperatively the extent of LN dissection, especially in patients with significant comorbidity. Our study also showed that if the clinical stage of the primary tumour is < cT2, the possibility of skipped metastasis is zero. [ABSTRACT FROM AUTHOR]

Abstract: A case of fibroepithelial polyp of the penis in a 59-year-old man is presented. The physical examination showed that the lesion affected the ventral surface of the glans, near the urethral meatus. No communication was found with the urethra. The patient had a history of long-term condom catheter use. He was successfully treated by wide local excision. The histopathologic diagnosis was a fibroepithelial polyp. Postoperatively, the follow-up examinations at 3, 6, 12, and 24 months showed normal findings and no recurrence. [Copyright &y& Elsevier]

To determine the prevalence of Y-chromosome microdeletions among infertile men and to correlate the clinical presentation of the men with specific deletions, microdeletion analysis in 53 infertile men (30 nonobstructive azoospermic, 23 severely oligozoospermic patients), and 100 age-matched, fathered normospermic men who had fathered children was performed by the multiplex PCR with 18 different Y-chromosome-specific STS primer sets, spanning the AZFa, AZFb, AZFd, and AZFc regions. Detection of the same locus deletion of the AZFd region in three cases indicated the possible importance of the genes located in this region in spermatogenesis. [Copyright &y& Elsevier]

Verrucous carcinoma (VC) is a rare variant of squamous cell carcinoma (SCC) with an extremely well-differentiated microscopic appearance. It is able to show extensive local invasion, but practically never metastasizes. VCs mostly occur in the oral cavity, larynx, nasal cavity, esophagus, vulva, vagina, anorectal region, penis and skin. VCs sometimes coexist with conventional SCCs, and in these instances they are associated with a higher recurrence rate than pure VCs. The occurrence of VC in the renal pelvis is very rare and to date only 4 cases have been reported. We report here a case of VC with a focus of conventional SCC in the renal pelvis. The patient showed fistula formation by residual tumor in the follow-up period. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]