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Spina bifida is a congenital condition that often leads to significant urological complications, including an increased risk of kidney and bladder stones. Performing percutaneous nephrolithotomy (PCNL) on patients with spina bifida presents unique challenges due to the anatomical deformities. We present a case of a spina bifida patient with right staghorn stone and bladder stones in a previously augmented bladder. Simultaneous tubeless supine PCNL and cystolitholapaxy was successfully performed. This case highlights the versatility of the supine position in managing complex stones in patients with spina bifida., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: MicroRNAs (miRNAs) play a regulatory role in various human cancers. The roles of hsa-miR-15a-5p, hsa-miR-99b-5p, and hsa-miR-181a-5p have not been fully explored in the angiogenesis of renal cell carcinoma (RCC)., Aims: The present study aimed to evaluate the expression of these miRNAs in tumorous and adjacent healthy tissues of RCC., Methods: Paired tumorous and adjacent normal kidney tissues from 20 patients were studied. The expression levels of hsa-miR-15b-5p, hsa-miR-99b-5p, and hsa-miR-181a-5p were quantified by TaqMan miRNA Assays. Putative targets were analyzed by qRT-PCR., Results: Significant downregulation of all three miRNAs investigated was observed in tumorous samples compared to adjacent normal kidney tissues. Spearman analysis showed a negative correlation between the expression levels of miRNAs and the pathological grades of the patients. Increased expression of vascular endothelial growth factor-A (VEGF-A) and hypoxia-inducible factor-1α (HIF-1α), a tissue inhibitor of metalloproteinases-1 (TIMP-1), was observed in tumorous samples compared to adjacent normal tissues. Depletion of tissue inhibitors of metalloproteinase-2 (TIMP-2) and metalloproteinase-2 (MMP-2) was detected compared to normal adjacent tissues. The examined miRNAs might function as contributing factors to renal carcinogenesis. However, more prospective studies are warranted to evaluate the potential role of miRNAs in RCC angiogenesis.

The genetic profiling of renal tumors has revealed genomic regions commonly affected by structural changes and a general genetic heterogeneity. The VHL, PTEN, and BAP1 genes are often mutated in renal tumors. The frequency and clinical relevance of these mutations in renal tumors are still being researched. In our study, we investigated VHL, PTEN, and BAP1 genes and the sequencing of 24 samples of patients with renal tumors, revealing that VHL was mutated at a noticeable frequency (25%). Six of the investigated samples showed mutations, and one genetic polymorphism (rs779805) was detected in both heterozygote and homozygote forms. PTEN gene mutation was observed in only one sample, and one specimen showed genetic polymorphism. In the case of the BAP1 gene, all of the samples were wild types. Interestingly, VHL mutation was detected in two female patients diagnosed with AML and in one with oncocytoma. We assume that VHL or PTEN mutations may contribute to the development of human renal cancer. However, the overall mutation rate was low in all specimens investigated, and the development and prognosis of the disease were not exclusively associated with these types of genetic alterations.

Purpose: We introduce a new modified penile skin reconstruction technique to treat paraffin-induced sclerosing lipogranuloma of the penis., Materials and Methods: From 2017 to 2020, 49 patients underwent the procedure. Complete removal of the lipogranuloma-involved penile skin was performed. A subcutaneous tunnel was then created between a horizontal scrotal incision and a proximal penile circumferential incision. The denuded penis was pulled through the tunnel, and a subcoronal and longitudinal dorsal penile suture line was made. An inverted V-shaped incision was made on the scrotum on the ventral side of the penis, followed by longitudinal closure. Outcomes and complications of the procedure were retrospectively studied. The long-term effect of surgery on sexual function and overall satisfaction was measured using a patient-reported questionnaire, which was completed by 30 patients., Results: The overall complication rate was 26.5%. Clavien-Dindo grade 1, 2, 3a, 3b, 4 and 5 complications occurred in the postoperative period 5, 0, 8, 1, 0 and 0 times, respectively, in 13 patients. Surgery was successful in 27 (90%) patients according to the patient-reported questionnaire. Erectile dysfunction, pain/tension during erection, premature ejaculation and penile lymphedema were observed in 2, 3, 1 and 1 patients, respectively. All patients reported sexual intercourse ability., Conclusions: The type of penile skin reconstruction after the removal of sclerosing lipogranuloma of the penis is controversial. The reconstruction technique presented herein is an effective single-stage treatment option with a high success rate in patients with sclerosing lipogranuloma of the penis with intact scrotal skin.

Background: The prognosis of patients with synchronous metastatic renal cell carcinoma (mRCC) is poor. Whereas single-agent tyrosine kinase inhibition (TKI) is clearly insufficient, the effects can be enhanced by combinations with immune checkpoint inhibitors. Innovative treatment options combining TKI and other immune-stimulating agents could prove beneficial., Objective: To evaluate the clinical effects on metastatic disease when two doses of allogeneic monocyte-derived dendritic cells (ilixadencel) are administrated intratumorally followed by nephrectomy and treatment with sunitinib compared with nephrectomy and sunitinib monotherapy, in patients with synchronous mRCC., Design Setting and Participants: A randomized (2:1) phase 2 multicenter trial enrolled 88 patients with newly diagnosed mRCC to treatment with the combination ilixadencel/sunitinib (ILIXA/SUN; 58 patients) or sunitinib alone (SUN; 30 patients)., Outcome Measurements and Statistical Analysis: The primary endpoints were 18-mo survival rate and overall survival (OS). A secondary endpoint was objective response rate (ORR) assessed up to 18 mo after enrollment. Statistic evaluations included Kaplan-Meier estimates, log-rank tests, Cox regression, and stratified Cochran-Mantel-Haenszel tests., Results and Limitations: The median OS was 35.6 mo in the ILIXA/SUN arm versus 25.3 mo in the SUN arm (hazard ratio 0.73, 95% confidence interval 0.42-1.27; p  = 0.25), while the 18-mo OS rates were 63% and 66% in the ILIXA/SUN and SUN arms, respectively. The confirmed ORR in the ILIXA/SUN arm were 42.2% (19/45), including three patients with complete response, versus 24.0% (six/25) in the SUN arm ( p  = 0.13) without complete responses. The study was not adequately powered to detect modest differences in survival., Conclusions: The study failed to meet its primary endpoints. However, ilixadencel in combination with sunitinib was associated with a numerically higher, nonsignificant, confirmed response rate, including complete responses, compared with sunitinib monotherapy., Patient Summary: We studied the effects of intratumoral vaccination with ilixadencel followed by sunitinib versus sunitinib only in a randomized phase 2 study. The combination treatment showed numerically higher numbers of confirmed responses, suggesting an immunologic effect., (© 2022 The Author(s).)

Bladder cancer (BC) is the tenth most frequently detected cancer in both sexes. Type-I luteinizing hormone-releasing hormone (LHRH) receptor (LHRH-R-I) is expressed not only in the pituitary, but also in several types of cancer disease. There are few data about LHRH-R-I expression in human BC. This study aimed to investigate the expression of LHRH and LHRH-R-I in the transitional cell carcinoma (TCC) type of human BC. RNA was extracted from 24 human bladder tumor specimens and three BC cell lines. RT-PCR was performed to detect mRNA for LHRH and LHRH-R-I. The protein of LHRH-R-I was further studied by immunohistochemistry (IHC), ligand competition assay, and Western Blot. PCR products of LHRH were found in 19 of 24 (79%) specimens and mRNA of LHRH-R-I was detected in 20 of 24 specimens (83%). Positive immunostaining for LHRH-R-I with different expression intensity was found in all samples examined, showing negative correlation with TCC grade. Radioligand binding studies also showed the presence of specific LHRH-R-I and high affinity binding of LHRH analogs. The high incidence of LHRH-R in BC suggests that it could serve as a molecular target for therapy of human BC with cytotoxic LHRH analogs or modern powerful antagonistic analogs of LHRH.

Aim: Clear cell renal cell carcinoma (ccRCC) is the third most common urological cancer after prostate and bladder cancer but has the highest rate of mortality affecting over 40% of patients. microRNAs (miRNAs) are small noncoding RNAs that have become potential biomarkers and molecular targets for cancer treatment. Molecular markers such as miRNAs may have a role in the diagnosis of ccRCC. In this study, we examined the expressions of miRNA-21 and miRNA-221 in renal cancer patients׳ tumor and adjacent paired normal tissues investigating the possible role of these miRNAs in the development of ccRCC., Materials and Methods: Renal tumors (n = 24) and paired normal renal tissue (n = 24) samples, obtained from the Department of Urology, University of Debrecen, were analyzed for miRNA-21 and miRNA-221 expressions with quantitative real-time polymerase chain reaction., Results: miRNA-21 and miRNA-221 expressions were significantly up-regulated in tumor specimens compared to normal tissue (P<0.05). miRNA-21 and miRNA-221 showed coexpression pattern in 19 (79.2%) cases of tumor samples and 8 (33.3%) cases of paired normal renal tissues. Increased miRNA pattern showed a positive correlation with pathological status of the patients., Conclusions: Expression of oncogenic miRNA-21 and miRNA-221 in human ccRCC tumor tissue samples compared to adjacent nontumorous tissues might suggest that these miRNAs are involved in the development of ccRCC., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: To compare the androgen receptor (AR) status of the appendix testis (AT) in congenital undescended and retractile testes., Materials and Methods: Twenty-four appendix testes (AT) were removed from 21 boys to detect AR expression by immunohistochemistry and immunofluorescence staining. Group 1 (n = 3) includes ATs from three patients with unilateral and group 2 (n = 6) with bilateral congenital undescended testis. All patients with bilateral form had been previously treated with human chorionic gonadotropin (hCG) without an acceptable effect. Group 3 (n = 12) includes ATs collected from 12 boys with acquired undescended testis or retractile testicle. Group 4 (n = 3) includes ATs from three young adults who received hCG treatment for undescended testis in their childhood and underwent open testicular biopsy to investigate infertility. Further seven ATs were collected to detect AR mRNA using RT-PCR analysis., Results: Both immunohistochemistry and immunofluorescence staining of ATs showed AR expression in 100 % of the cases in groups 3 and 4 (12/12 and 3/3), but there was no visible AR expression in groups 1 and 2 (0/3 and 0/6); however, RT-PCR analysis revealed mRNA expression of AR both in congenital undescended and in retractile testicles., Conclusions: The presence of AR in the epithelial cells of AT in patients with retractile testicle and its absence in patients with congenital undescended testis can be a possible cause of the effectiveness of hormonal treatment in retractile testis and its inefficacy in patients with congenital undescended testis.

Testicular cancer affects men mostly in their reproductive age with a cure rate over 90%. Preserved fertility is one of the main concerns of the survivors. To further elucidate the question of fertility after anticancer treatment for testicular cancer, we performed a survey among patients who underwent sperm cryopreservation procedure in our department. A structured questionnaire was designed to collect data on demography, anticancer treatment, histological type of cancer, family planning intentions and fertility prior to and after treatment. During a period of 11 years 86 men underwent semen cryopreservation before starting chemo-or radiotherapy. Fifty-nine of them consented to participate in the study. The average length of follow up was 4.6 +/- 3.8 years. In case of 11.9% of the patients their banked sperm was used, which led to live birth in 57% of the couples. The partners of 6 patients became pregnant after in vitro fertilization (IVF) resulting in 4 live births and 2 miscarriages. The spontaneous pregnancy rate was 22%. Spontaneous pregnancy occurred in 13 partners resulting in 18 pregnancies followed by 12 live births, 2 artificial abortions and 4 miscarriages. We could not prove any association between preserved fertility and anticancer treatment or the histological type of the cancer. In conclusion, although spontaneous pregnancy rate is remarkably high after anticancer treatment for testicular cancer, the risk of infertility after receiving gonadotoxic treatment cannot be predicted. Cryopreservation is a safe and effective method to preserve fertility in these cases. As a result we strongly recommend discussing the advantages of semen cryopreservation with all patients awaiting treatment for testicular cancer.

Introduction: Secondary bladder neoplasms are uncommon and they represent only 2% of all malignant bladder tumors., Case Presentation: The authors present a case of a 59-year-old Caucasian man with a primary gastric adenocarcinoma that had been surgically removed 10 years before he developed bladder metastasis. He presented with low abdominal pain after 10 years without any symptoms. Cystoscopy and an abdominal computed tomography scan showed a bladder tumor. A transurethral resection of the bladder tumor was performed. A histological examination revealed an adenocarcinoma, which turned out to be a metastasis of the primary gastric tumor. One year later, abdominal surgery revealed peritoneal metastases., Conclusion: This is the first known case in Europe where bladder metastasis occurred 10 years after surgical removal of a primary gastric neoplasm. There are only four cases in the literature where metastases of the peritoneum developed 11 years after surgical removal of a primary gastric tumor.

Air guns are known as low-velocity arms and are considered harmless. However, injuries from air weapons can be serious and even fatal, particularly in children. We present a potentially life-threatening penetrating retroperitoneal injury of a 3-year-old boy caused by an air gun, and the successful removal of the bullet via a laparoscopic approach. The patient was brought to our center with a penetrating air gunshot wound on his right side in the waist area. He was accidentally shot by his brother at their home. The patient's clinical condition was stable. Computed tomography scan showed the bullet in the retroperitoneum near the inferior vena cava. A three-port laparoscopic transperitoneal approach was performed. The bullet was found just 0.5 cm caudal to the right renal hilum and 0.5 cm near the inferior vena cava; it was then removed. Operation time was 42 min and the postoperative course was uneventful. Thanks to improvements in laparoscopic surgical techniques, laparoscopy has become a feasible and effective treatment modality even for the removal of foreign bodies in children., (Copyright © 2012 S. Karger AG, Basel.)

The purpose of this study was to investigate the effects of an elevated hydrostatic pressure of hydrocele on the structural integrity and steroid receptor expression pattern of the appendix testis in children. Twenty-six testicular appendages were obtained from boys (aged between 13 and 79 months, mean 40 months) who underwent surgical exploration because of hydrocele or congenital inguinal hernia. The tissue sections of testicular appendages were stained with hematoxylin-eosin. Immunohistochemistry and immunofluorescence laser microscopy were performed using monoclonal mouse anti-human receptors against androgen and estrogen receptors. Patients were divided into three groups: group A (n = 8) represented patients with groin hernia without hydrocele, who served as control group; group B (n = 7) represented patients with communicating hydrocele; and group C (n = 11) represented patients with noncommunicating hydrocele. The tissue sections of appendix testis expressed both androgen and estrogen receptors in all patients in groups A and B, and epithelial destruction was not present. The presence of androgen receptor (two of 11, P < 0.001) and estrogen receptor (four of 11, P = 0.006) was lower and the number of appendix testes with epithelial destruction was higher (eight of 11, P = 0.001) in group C. We demonstrated that groin hernia and communicating hydrocele did not influence the receptor expression pattern and the anatomic structure of testicular appendages, whereas noncommunicating hydrocele caused damage as indicated by the absence of steroid receptors and destruction of the epithelial surface. A better understanding of the physiological role of testicular appendages may change the indications of surgical treatment in patients with noncommunicating hydrocele.

The presence of four different isoforms of luteinizing hormone-releasing hormones (LHRH) and one LHRH receptor (LHRH-R) has been reported in vertebrates. In the human genome only LHRH-I and LHRH-II genes have been identified. The human LHRH-I gene is composed of four exons separated by three introns. Three LHRH receptor or receptor-like genes have been demonstrated. The well-established type-I LHRH receptor (LHRH-R-I) gene is composed of three exons separated by two introns. In this study we investigated the expression of transcript forms of LHRH-R-I in human benign prostatic hyperplasia (BPH) with reverse transcriptase-polymerase chain reaction (RT-PCR) using gene specific primers. Thirty-five human BPH specimens were obtained at surgery. Normal human pituitaries collected at autopsy served as control. RNA extraction and RT-PCR with gene-specific primers for LHRH-R-I forward (F1)/reverse (R1), LHRH-R-I F2/R3, LHRH-R-I F1'/R2' were carried out to determine the mRNA expression for LHRH-R-I transcript forms. The expected PCR products amplified with gene specific primers were LHRH-R-I F1/R1 with 319 bp, LHRH-R-I F2/R3 with 309 bp and LHRH-R-I F1'/R2' with 219 bp. PCR products for LHRH-R-I F1/R1 were detected in 21 (60%) and for LHRH-R-I F2/R3 in 5 of 35 (14%) BPH samples. No PCR products for LHRH-R-I F1'/R2' were found. In conclusion, we detected mRNA for LHRH-R-I in human BPH specimens. Our results suggest that LHRH-R-I gene may have more than two splice variants or uncharacterised transcript forms of LHRH-R-I. Our findings support the merit of further investigation of the expression of LHRH-R-I and its transcript forms in human BPH.

Objective: Several authors have investigated the background of the process of testicular descent, but the role of the appendix testis has not been studied. The human appendix testis was found to express both estrogen and androgen receptors. We determined and compared the occurrence of testicular appendices intraoperatively in descended and undescended testes., Methods: The number of appendix testis was evaluated retrospectively in 208 boys who underwent uni- or bilateral orchiopexy, hydrocele or hernia repair and the testis was visible during operation., Results: The incidence of appendix testis was 76% (78 in 103) in descended and 24% (30 in 125) in undescended testes. Mean age at orchiopexy was lower in patients without appendix testis (39 months) compared to those patients who were found with appendix (61 months)., Conclusion: The incidence of appendix testis was significantly lower (p < 0.05) in undescended testes, suggesting that the appendix testis might play a role in the process of testicular descent., (2008 S. Karger AG, Basel)

Purpose: We describe our initial experience with hand-assisted laparoscopic retroperitoneal lymph node dissection for nonseminomatous testicular cancer., Materials and Methods: Between April 2002 and December 2004, 10 patients with testicular tumor were operated on, 6 on the right side and 4 on the left side. Eight patients were in clinical stage I, one patient was in clinical stage IIA, and one patient was in clinical stage IIB disease. Depending on the tumor site, a 6-7 cm mid-lower or -upper laparotomy was done, the HandPort (Smith and Nephew, Andover, MA) was placed in the abdominal wall, and the left hand of the surgeon was inserted into the abdomen. Four laparoscopic ports were also inserted. The ascending or descending colon was mobilized completely. The retroperitoneal lymph nodes were dissected and removed according to the modification of Weissbach and colleagues., Results: The average operative time was 258 min (range, 150-432 min). One patient required re-operation because of postoperative bleeding. The average postoperative hospital stay was 3.5 (range, 3-10) days. Patients with stage IIA or IIB disease on histopathology received 2-3 courses of combined chemotherapy. Antegrade ejaculation was preserved in all patients. During follow-up that ranged from 9 to 36 months, there was no local recurrence or distant metastasis., Conclusion: Hand assistance makes the laparoscopic operation simpler, faster, and safer. A 6-7 cm muscle-splitting incision should be advantageous for patients compared to the xyphopubic laparotomy of the open procedure. To our knowledge this is the first report on hand-assisted laparoscopic retroperitoneal lymph node dissection.

Renal tumor is likely to become one of the most important indications for laparoscopic surgery. We present an old woman, who underwent single-session laparoscopic nephrectomy and contralateral partial nephrectomy due to bilateral kidney tumor. The advantages of simultaneous bilateral intervention are reduced psychological stress, single anaesthesia, less medication, less blood loss, shorter hospital stay and convalescence, and considerable cost-effectiveness.

We report on an 11-weeks pregnant woman, who under went a percutaneous nephrolithotomy without the use of X-rays during the procedure due to 8-mm left upper ureteric stone. In the available literature, we didn't find any reported case about percutaneous stone removal without the use of X-rays.

Purpose: To evaluate our experience and results with endopyelotomy in the pediatric population., Patients and Methods: Between 1990 and 2002, we performed percutaneous antegrade endopyelotomy under general anesthesia in 37 children because of ureteropelvic junction (UPJ) stricture. The youngest patient was 4.5 years and the oldest 17 years at the time of the procedure (mean age 11.5 years). One patient had bilateral stenosis; the two sides were operated on separately. After insertion of a 4F ureteral catheter and filling the collecting system with colored contrast material, a middle calix was punctured under fluoroscopic control. The tunnel was dilated to 26F by telescopic metal dilators. After insertion of a 0.035-inch gidewire through the UPJ, all its layers were cut by a cold knife in the dorsolateral direction so that the periureteral fatty tissue could be seen. Finally, the ureteral wound was stented by a 6F to 12F transrenal drain or a double-J catheter, which was removed after 6 weeks., Results: Among the 37 patients, the procedure had to be repeated in 1 because the transrenal drain stenting the UPJ slid back to the renal pelvis. We had to perform open pyeloplasty or nephrectomy in two patients because of bleeding or failed procedure. The average postoperative hospital stay was 6 days. Comparison of the preoperative intravenous urograms with studies performed 1 year after endopyelotomy showed an overall success rate of 89%. All patients are without complaints at the moment., Conclusions: In experienced hands, endopyelotomy is a safe and effective method for the treatment of UPJ stricture, not only in the adult, but also in the pediatric, population.

Purpose: We report 52 percutaneous urterolithotomies in 51 patients having large, impacted middle ureteral stones. Direct percutaneous stone removal can be performed as successfully as in cases of renal stones treated with percutaneous nephrolithotomy., Methods: The operation is performed under local anesthesia; therefore, the procedure is quicker and simpler than the laparoscopic or retroperitoneoscopic intervention. All patients became stone free. In two patients (4%), ultrasound disintegration was necessary; in the remaining cases, there was no need for any fragmentation: the stone was removed intact. A retroperitoneal drain was always left at the end of the procedure. With the exception of two cases, the ureter was always stented without closure of the ureteral incision., Results: Fever (> or = 38 degrees C) was observed in 15 patients (29%) for 2 days. Retroperitoneal hematoma 5 cm in diameter was seen in one patient. One patient had urine leakage through the retroperitoneal drain in the postoperative period for 18 days. Also, one patient came back 3 days after discharge with urine leakage through the percutaneous retroperitoneal tract., Conclusion: Direct percutaneous ureterolithotomy is an effective way to remove impacted middle ureteral stones but is advisable only for endourologists with considerable experience.