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The primary testicular non-Hodgkin lymphoma, which has been first described in 1866, is a very uncommon type of urological neoplasia occuring mostly in the elderly ages. It only gives 5% of the testicular tumors, 2% of extranodal lymphomas, and barely 1% of all non-Hodgkin diseases. Patients with testicular non-Hodgkin lymphomas need prompt multidisciplinary aid because without treatment the outcome can be unfavorable. The authors discuss the attributes, diagnostic modalities and treatment options of the primary testicular non-Hodgkin lymphoma and present a case of a 68-year-old patient who underwent orchiectomy, chemo- and radiotherapy after having been diagnosed with the tumor. The follow-up PET-CT and cerebrospinal fluid analysis found no further sign of the disease, and complete remission has been achieved.

Aim: Follow-up and review of patients who underwent surgery for renal cell cancer combined with tumor thrombus of the inferior vena cava at the Department of Urology Semmelweis University, Budapest, Hungary., Material and Methods: From l998 to 2010 twenty one patients underwent surgery for renal cell cancer combined with tumor thrombus of the inferior caval vein. Preoperative symptoms, TNM classification of the tumors, types of surgical interventions, complications, postoperative management and survival results were involved in the analysis. Mean follow-up period was 39 months, ranging from 3 to 101 months., Results: In five cases of level 3 thrombi the liver was mobilized without thoracotomy, and endoluminar occlusion was applied in one case. Intraoperative mortality was 9,5%. Survival time of patients with distant metastases was 12.1 months (3-9). Three patients without metastases died in the follow up period, their survival time was 26.7 months ranging from 22 to 31 months. Eight patients (73%) were alive at the time of the last follow-up. The mean survival time was 5.6 years ranging from 39 to 101 months., Conclusion: Our results support that level 3 caval vein tumor thrombus can be removed by less aggressive surgical approach and underline the benefit of the surgical intervention without thoracotomy.

Unlabelled: Several reports are known about the effects of nutrition supplements in the improvement of quality of life of patients with tumor, however, the physiological background remains largely unknown. Table beet affects numerous biochemical reactions, enzymes and metabolic-synthesis., Methods: Natural table beet product come from commercial service was given twice 10 g daily for 1 month for 24 patients (mean age 68+/-8 years) with hormone-resistant and metastatic prostate cancer treated with taxan chemotherapy, who report themselves first, mean 3,6+/-2,8 years ago with their complains. 18 men's data were amenable after treatment for evaluation. In addition to routine laboratory examination values of HbA1c, 9 cytokines and levels of 3 growth factors, the global parameters of redox-homeostasis, few elements of their metal-ions, Zn- and level of free protoporfirin, trans-metilating processes before and 1 month after treatment were determined., Results: In most of the patients, favorable impact of beet was enforced and significantly high levels of Zn- and free protoporfirin decreased; furthermore, trans-metilating processes fastened., Conclusions: According to results, it seems that moderate and permanent consumption of table beet product affects the life expectancy of patients favorably; however, due to the increasing values of EGF, medical control is necessary for patients with prostate cancer treated by chemotherapy.

Unlabelled: Inverted papilloma of the urinary bladder is a rare entity. According to literature data, this disease is not malignant, and has low recurrence rate. Authors studied cases detected at the Urology Department and Urooncological Centrum at Semmelweis University in the last 11 years. They aimed to find out the rate of inverted papilloma recurrences, and transformations into malignant bladder cancer., Materials and Methods: Thirty patients with histologically proven inverted papilloma were followed after transurethral resection of bladder, which meant urine tests every three months, abdominal ultrasound and cystoscopy. After a year, these examinations were done in every six months., Results: Three patients presented transitiocellular carcinoma (17, 60, 92 months later) during this period. In one case, inverted papilloma and transitiocellular tumor (pTa G1) were detected. In one patient, inverted papilloma was found by control cystoscopy after transurethral resection of bladder (pT1 G2) and local chemotherapy 15 months later., Conclusions: Based on authors' experience, inverted papilloma of the urinary bladder is a benign lesion, but malignant changes or concomitant transitiocellular tumor may occur, thus follow-up is needed. Although references are not standardized, authors suggest following patients with inverted papilloma as a primary (pTa G1) bladder cancer.

Radical prostatectomy is the curative surgical management of organ confined prostate cancer. Erectile dysfunction may follow surgery as the most common complication decreasing the quality of life of the patient. Thanks to spreading PSA screening probability increases to detect prostate cancer in its early stage and so the expected number of surgery is increasing, too. Higher number of operation as well as surgery more frequently performed in younger age calls the attention to the importance of erectile dysfunction and its management. Nowadays the physiology of erectile dysfunction due to radical prostatectomy has been revealed, and as a consequence, the nerve sparing surgery for its prevention is already known. The paper presents the different kind of possible invasive and non-invasive treatments of erectile dysfunction, and surveys their history and effectiveness. The erectile function of patients who underwent radical prostatectomy between 1998 and 2007 at the Department of Urology and Uro-oncological Centre was assessed by IIEF- and MMM questionnaire and letters with questions of habit of medicine taking. The results show that 59% of patients who desire sexual activity are capable of it spontaneously or with medical management.

Fulminant gangrene of the penis was described by Fournier more than two hundred years ago, however, to this day there are a number of controversies regarding its management. The diagnosis of Fournier's gangrene is essentially clinical, and although laboratory and various imaging techniques can be used, every acute and severe subcutaneous inflammatory process must be considered as the onset of Fournier's gangrene. Immediate treatment is essential and includes the use of combined broad spectrum antibiotics effective against both aerobic and anaerobic bacteria. Intensive supportive care is required for septicaemic patients. Immediate surgical debridement must be performed, this includes excision of necrotic tissue and drainage. Repeated surgery is usually required. To achieve better cosmetic results, special plastic surgery methods must be applied for reconstruction.

Medical treatment of benign prostatic hyperplasia is reviewed by the author. Experiences with herbal extracts have been known for more than 2 decades. Treating benign prostatic hyperplasia with these extracts is recommended in initial phase. Prostate volume is decreased and mechanical component of dysuria is improved by treating for a long time (months, years) with 5-alpha-reductase finasteride which contains hormone. This drug is indicated when volume of the prostate is over 40 g. Dynamical component of benign prostatic hyperplasia is treated with alpha-receptor blockers which act on the bladder neck. These medicines have effects earlier and are recommended for all patients with benign prostatic hyperplasia independently of prostate volume. These might have some side effects like hypotension. The improving effects of 5-phosphodiesterase inhibitors on BPH have been discovered recently. The same effect has been described of alpha-blockers on sexual activity.

Introduction: Malignant tumour of the penis is a rare disease. Although most of the cases are squamous cell carcinoma histologically, operation is managed by the urologist because of its location., Aim and Method: Experience with the treatment and attendance of penile cancer is presented by the author. Results were both retrospectively and prospectively worked up., Results: Between June 1996 and June 2006 there was operation performed in 50 patients. Mean age of men was 63.1 (31-83) years. Ninety-four percent of tumours were squamous cell carcinoma, 2 (4%) verrucosus carcinoma, in one case malignant melanoma. Pathological T stadium was T1 in 23 cases (46%), T2 in 19 (38%) patients, in 6 (12%) cases T3 and in 1 (2%) T4. Differentiation was grade 1 in 12 (24%), grade 2 in 27 (54%) and grade 3 in 10 (20%) cases. One side inguinal lymph node metastases were found in 11 (22%) and both side in 8 (16%) patients. In anamnesis 4 (8%) patients underwent circumcision because of phimosis, and 25 (50%) patients had had phimosis by identification of cancer. Seventeen patients (34%) were given chemotherapy after surgical treatment. Mean survival time of all patients was 31,4 (2-114) months., Conclusion: Phimosis plays an important role in development of penile cancer, that's surgical treatment does not prevent the higher chance of incidence rate. The disease behaves aggressively, spreading through lymphatic vessels, where in advanced stadium, or in low differentiation cases it is already demonstrable by diagnosis. In the choice of therapy, stadium-oriented principle should be predominant. With early operation, long-term survival can be achieved.

Introduction and Aims: Prostate cancer is the most common malignant tumor in male; its diagnostic algorithm and therapy were investigated. The goal of the study was to compare the data from the first year of clinical use of prostate specific antigen (1994) and the data of 2004., Results: During the first decade, the number of prostate biopsies has increased 4.5-fold times. In 1994, 36.2%, while in 2004, 47.5% of the biopsies demonstrated cancer. The average age of the patients, who underwent biopsy, decreased from 69.7 to 62.3 years; however, the average age of patients who suffered from prostate cancer remained constant (70.8 vs. 71.3 years old)., Conclusion: In 2004, along with the earlier used PSA level, the free-PSA and PSA-density was also involved in the diagnostic algorithm. The prostate biopsy is guided by a transrectal US, in contrast to the earlier used blind or transperineal method. Consequently, the effectiveness of the prostate biopsy has improved, but the earlier diagnosis and identification are not assured. The Gleason score of the diagnosed prostate cancer was lower; therefore, more patients were selected for curative surgery. The increased average PSA level reflected a higher number of patients at an advanced stage, which could only be treated palliatively.

Introduction: The tumour of the bladder is the third most frequent urological malignancy. Muscle invasive cancer can be cured by radical cystectomy. After removing the bladder; a sufficient urinary diversion should be performed., Aim and Method: The authors introduce the operative process of the pouch and their experiences with the procedure. The analysis of results were performed retrospectively., Results: Between 1998 and 2005 the authors performed radical cystectomy in 76 patients followed by: Mainz pouch II urinary diversion. The average age of the patients was 59.8 (20-78) years. The distribution by gender was: 58 male, 18 female patients. The average pathological T stage was 2.3; 22 patients (29%) had metastatic lymph nodes. 94% of the cases were transitional cell cancers, 3 (4%) of them had adenocarcinoma and one leiomyosarcoma. Reoperation was carried out in 7 cases (9.2%) because of wound healing defects, and one patient was reoperated because of bleeding and ileus respectively. Transitionally nephrostomy was performed in 5 cases (6.5%) because of upper urinary tract dilatation due to a stricture of ureter anastomosis. The average survival period was 24.4 (1-98) months., Conclusion: Urinary diversion Mainz pouch II provides for safe, continent diversion requiring no urine bag; with an acceptable QL (quality of life). On the basis of the low number of complications and the acceptable QL; the authors consider this method as appropriate.

Introduction: The most used treatment of localised prostate cancer is: retropubic radical prostatectomy., Objective: The authors present their own results, on the basis of detailed discussions of 100 cases and compare them with international ones., Methodology: The authors analyse the data of 100 radically operated patients suffering of localised prostate cancer. The indication of the operations was based on the results of rectal digital examinations, serum PSA concentration levels and ultrasound guided, rectally performed, prostate biopsies. The average preoperative PSA level was 13.6 ng/ml; the mean age of the patients was 61.1 years. They analyse the early and late complications. They follow up the patients on a regular basis assessing the PSA level, continence and potency., Results: The operation time, blood loss, amount of blood transfusion all decreased linearly during operations performed between 1998 and 2005. The longest period of follow up lasted for 70 months; the shortest lasted for 5 months. None of the patients died in the course of an operation or in 30 days following it; they lost one patient 18 months after the operation because of progression. From the late complications: in 22% of all cases they noticed anastomotic stricture constrictions which were resolved by urethrotomy. From all patients: 86% are fully continent; the rest mostly have grade 1 incontinence (requiring 1 pad per day). Altogether 18% of all patients have retained their potency without the use of drugs or appliances., Conclusions: The results are comparable to international data and are in harmony with them. Therefore early recognition and radical surgery of prostate tumors would be advisable.

Introduction: Nowadays more and more couples face the fact that they cannot have babies in spite of many years of trying. The male factor can be identified in about half of these cases., Aim: The aim of this study was to analyse chromosomal alterations in patients with azoospermia. These patients may be candidates for testicular sperm retrieval and intracytoplasmatic sperm injection., Materials and Methods: Preoperative evaluation included routine andrological investigation with 2 semen analysis, ultrasound, hormonal and genetic examination. Traditional histological examination and embryological diagnostic of tissue samples was performed. Cryopreservation of retrieved testicular tissue was also done. Between January 2001 and June 2005 73 biopsies were performed in 71 patients for testicular sperm extraction. In order to obtain an exact diagnosis, the traditional cytogenetic methods and fluorescence in situ hybridization analyses were performed in combination with molecular genetic techniques. Patients were offered to participate in the assisted reproduction programme on the base of their genetic results., Results: In this study, the most characteristic cases were numerical deviations, such as 47,XXY (2 cases), mosaic 47,XXY/49,XXXXY (1 case), 47,XYY (1 case) and mosaic 46,XY/45,X (1 case) karyotypes. Non-obstructive azoospermia was diagnosed in 53 patients (79%)., Conclusions: Authors emphasised the importance of cyto- and molecular examinations in cases of genetical disorders. The results provide a chance for patients to be spared from long-drawn moreover psychological burdening examinations. In addition the costs of different clinical intervention could be saved too.

Patients and Methods: The authors have collected and processed data of 307 patients at Urological Department Semmelweis University, who were treated for renal tumour from June 1997 to December 2002., Results: During this process on the basis of their work, they formed their opinion of the main steps of diagnostical, surgical and conservative therapeutical procedure with patients suffering from renal cell cancer. They established the fact that the data is parallel with retraceable international literature, therefore this work can be the starting-point of long term prospective studies. They call attention to the fact that 70% of the tumours were recognized without any symptoms, during examination indicated for other reasons, due to the widely spreading of ultrasound, computed tomography and other imaging techniques., Conclusion: The tumours are recognized and removed in earlier stages and it is to be hoped that it prolongs their life expectancy, and makes the quality of life of our patients much better.

Introduction: The two main reasons of stress incontinence, according to the present consensus, are urethral hypermotility due to descended bladder floor and intrinsic sphincter deficiency. Distinction between them used to be achieved by determining urethral pressure profile only. In recent years a less invasive method, measuring the Valsalva Leak Point Pressure, has been developed for a differentiation., Aims: To determine Valsalva Leak Point Pressure using a simple technique for differential diagnosis of stress incontinence without a complete urodynamic test., Method: A minimally invasive technique is presented. Authors have performed parallel measurements of leak point pressure and urethral pressure profile during urodynamic examination in 43 stress incontinent patients. Difference in the results have also been evaluated., Results: A specificity of 98% and a sensitivity of 51% with the method was found in intrinsic sphincter deficiency. In cases without vaginal descent the sensitivity was 100%, while in patients with urethral hypermobility the sensitivity and the specificity were 91% and 58% respectively., Consequences: In stress incontinent patients without urethral hypermotility an abdominal leak point pressure of less than 40 H2O cm perfectly reflects weakness of the urethral sphincter. Based on these data we suggest that the invasive urethral pressure profile test can be avoided in appr. 20% of stress incontinence cases by weakness of the sphincter.

Medical treatment for benign prostatic hyperplasia is reviewed by the author. Experiences with herbal extracts have been known for more than 2 decades. Treating benign prostatic hyperplasia with these extracts are recommended in initial phase. Effectiveness of these drugs are approved by some placebo controlled double blind studies. However effectiveness of these are not as good as medical drugs'. It is well known that they have no side effects and are cheaper than medicines. Prostate volume is decreased and mechanical component of dysuria is improved by treating for long time (months, years) with 5 alfa reductase finasterid which contain hormone. This drug is indicated when volume of the prostate is over 40 g. Dynamical component of benign prostatic hyperplasia is treated with a receptor blockers which act on the bladder neck. These medicines effect earlier and are recommended for all benign prostatic hyperplasia patients independently of prostate volume. These might have some side effect like hypotension.

The authors determined serum PSA levels in combination with digital rectal examination (DRE) and evaluated their role in the differential diagnosis of prostate diseases with special reference to cancer. The possible causes of differences between the observed cut-off level of PSA and the standard level PSA were analyzed. In the last few years the PSA determination found its clinical role in the diagnosis of prostate cancer.

Introduction: The treatment of prostate cancer is still controversial. One of the most common treatment form is the use of LHRH analogs, but its way of action is still not cleared enough., Aims: The aim of this study was to determine the predictive value of some histological and immuno-histochemical parameters based on repeated biopsies taken from prostate carcinoma patients., Patients/method: At the time of diagnosis by needle biopsy the TNM stage, serum PSA level, Gleason's grade, apoptotic and mitotic index, as well as Ki67, p53 and bcl2 expression were investigated in 60 prostate carcinoma patients. Anti-androgen therapy supplemented with surgical or chemical castration (with LHRH analogs) was administered. Serum PSA-test and needle biopsy were repeated 13-14 weeks after starting the therapy, simultaneously with determination of the apoptotic and mitotic index, Ki67, p53 and bcl2 expression., Results: Forty-seven patients were alive at the end of the study (average 23.46 +/- 8.6 months) and thirteen patients died (average 25.3 +/- 14.8 months). Initial TNM stage and Gleason's score proved to be of prognostic value. Decrease in mitotic index and increase in apoptotic index during therapy proved to predict favourable long-term response to androgen ablation therapy. Similarly, lower Ki67 and (mutant) p53 expression in the first and also in the second biopsy pointed to a favourable effect of antiandrogen and especially of LHRH analog treatment. Since the ratio between Ki67 percentage and apoptotic index strongly decreased in the survivors upon therapy, changes in Ki67/apoptosis ratio may be recommended as a histologically detectable predictive factor. However, bcl2 expression did not show significant correlation with the outcome of the disease., Conclusion: Histological evaluation of parameters such as mitotic and apoptotic index as well as Ki67 and p53 expression in repeated biopsies during treatment may contribute to predicting the value of the actual treatment and may be useful to institute alterations in therapy.

Complete removal of the tumour or deep invasion can be proven by repeated transurethral resection of bladder wall at the previous tumour site. Six weeks after transurethral resection of bladder tumour (TURB), in all but TaG1 cases repeated resection were performed for the evaluation of radicality in 62 patients, 43 males and 19 females, suffering bladder cancer, from October 1998. In the case of positive histology another resection was performed for security reason. In the case of 38 superficial (Tis, Ta, T1) cancers, repeated resection revealed negative, identical or different T stage compared with previous histology in 28, 5 and 5 cases, respectively. In 7 cases repeated resection was applied as second intervention after the incomplete resection of large tumour mass. Indication of repeated resection was insufficient depth of resection and carcinoma in situ in 13 and 4 cases, respectively. Based on our data, we conclude that repeated resection should be performed when tumour-free status is not justified and biopsy according to Bressel was not taken.