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Purpose: To evaluate the effect of artery-only (AO) and artery-vein (AV) clamping during partial nephrectomy (PN) on short- and long-term renal function outcome., Methods: Medical records of 154 patients in the AO group and 192 patients in the AV group who underwent open and minimally invasive (laparoscopic/robotic) PN between January 2011 and January 2018 were retrospectively assessed. Preoperative patient and tumor-specific characteristics in addition to perioperative factors and renal function outcomes were compared. The change in the estimated glomerular filtration rate (eGFR) from postoperative 1-3 days, 12 and 24 months after surgery was calculated. Acute kidney injury (AKI) was defined a as a > 25% reduction in eGFR., Results: There were no statistically significant differences between the clamping techniques in terms of postoperative 1-3 days, 12 and 24 months eGFR change percentage and risk of progression to chronic kidney disease (CKD). No significant difference in short- and long-term renal functions was found between the minimally invasive or open AO and AV clamping subgroups at any time point. In multivariate analysis, the R.E.N.A.L score (AO group p = 0.026, AV group p < 0.001) and preoperative eGFR (AO group p < 0.001, AV group p = 0.010) were strong predictors of the acute kidney injury in both groups. Older age (AO group p = 0.045, AV group p = 0.010) and preoperative eGFR (AO group p = 0.008, AV group p = 0.002) were significantly associated with CKD progression at 2-year follow-up in both groups., Conclusion: AV clamping does not adversely affect postoperative renal function compared to AO clamping. Preoperative patient- and tumor-related factors are more important for renal function regardless of the clamping technique.

Purpose: To investigate the role of urinary neutrophil gelatinase-induced lipocalin (uNGAL) measurement in the early diagnosis of acute kidney injury that may occur after intraoperative ischemia in patients undergoing partial nephrectomy (PN)., Methods: This prospective study included 86 patients who underwent open laparoscopic or robotic partial nephrectomy between May 2017 and May 2019. During the surgery, whether the patients had ischemia or not, type of vascular clamping and the ischemia time were noted. The definition of acute kidney injury (AKI) was classified according to Acute Kidney Injury Network (AKIN) criteria. Urine samples were collected preoperatively and 3 h after renal pedicle clamp removal and uNGAL was measured., Results: AKI was recorded in 34 (39.5%) of 86 patients after PN. Of the 34 patients, 26 (76.4%) had level 1 and 8 (23.6%) had level 2 AKI. uNGAL levels increased significantly as an early reflection of AKI in patients who underwent intraoperative total or renal artery clamping (p = 0.024). There was no significant postoperative increase in uNGAL in the non-ischemic group (p = 0.163). uNGAL expression was detected well before serum creatinine increase. Patients with AKI after PN had higher uNGAL expression (p = 0.008) However, there was no correlation between the level of AKI and uNGAL expression (r = 0.201, p = 0.066)., Conclusion: Ischemic acute kidney injury after nephron-sparing surgery can be detected early by uNGAL measurement. In future studies comparing outcomes of different surgical techniques on renal functions after PN, uNGAL levels may be used.

The aim of this study was to investigate the relationship between microvessel density (MVD), positive and negative angiogenic factors, and established prognostic factors in prostate cancer (PC), and, to clarify the effect of angiogenic factors to angiogenesis. The vascularization of neoplastic, non-neoplastic prostate tissue was determined by CD34 immunostaining. Angiogenetic mediators VEGF, bFGF, TSP-1, and p53 were studied by immunohistochemistry. Neovascularization and p53, VEGF, and TSP-1 expressions of tumorous tissue were higher than non-tumorous tissue. The bFGF expression in these tissues was not different. The p53 expression was not correlated with the expressions of VEGF, bFGF, and TSP-1 in PC. Our results demonstrate a significant increase in MVD, VEGF, TSP-1, and p53 expressions in prostate tumorigenesis. The pretreatment sPSA was the only parameter demonstrating significant correlation with tumor grade and may have a value in the prediction of aggressive tumor behavior in PC.

Introduction: The aim of our study was to evaluate tumor angiogenesis as a prognostic marker of transitional cell carcinoma of the bladder and to asses its relationship to established variables for survival and response to therapy., Patients and Method: Microvessel density (MVD), a measure of tumor angiogenesis, were evaluated in 77 primary bladder cancers. Forty-three superficial carcinomas and 34 invasive carcinomas were analysed. Tumor specimens of all patients were obtained by transurethral resection (TUR) and all the tumors were transitional cell carcinomas. Twenty-two patients with invasive bladder cancer have undergone M-VEC chemotheraphy. The correlation between MVD and histopathological grade, tumor stage and prognosis was evaluated. MVD was identified by immunostaining of endothelial cells using anti-CD34 antibody. For statistical analysis Kruskal-Vallis, Mann-Whitney U and Fisher's exact tests were used., Results: MVD was correlated with tumor grade, stage and prognosis. Significantly higher MVD was determined in invasive tumors than superficial tumors (p < 0.05). MVD increased with tumor grade and stage (p < 0.05). High MVD was correlated with the risk of clinical progression in both superficial and invasive bladder carcinomas (p < 0.05, p < 0.001 respectively). Invasive tumors with remission after M-VEC chemotheraphy had lower MVD than tumors with progression after M-VEC., Conclusion: These data demonstrate that MVD in bladder carcinoma correlates with grade, stage and malignant potential of the tumor. Quantification of tumor angiogenesis may allow selection of the type of treatment for bladder cancer patients.

Objectives: To investigate the value of proliferating cell nuclear antigen (PCNA), Ki-67 antigen labelling indices and nucleolar organizer region (NOR) score in relation to histological grade, stage, recurrence and progression of the bladder tumor., Materials and Methods: Tissue specimens from 77 bladder cancer patients (43 superficial, 34 invasive) were immunostained with PCNA and Ki-67 and stained with AgNOR. Thirteen specimens of normal bladder mucosa served as controls., Results: In comparison to normal bladder mucosa the values of the three indicators were significantly greater (p < 0.001). There was a significant relationship between PCNA, Ki-67 indices, AgNOR scores and grade and stage of the tumor (p < 0.001). All indicators also correlated with each other (p < 0.001). The Kaplan-Meier curves for recurrence-progression free survival revealed that patients with a PCNA labelling index >36.22%, Ki-67 labelling index >29.68% and AgNOR score > 3.34 had a worse prognosis than those with <36.22%, <29.68% and <3.34, respectively., Conclusions: PCNA, Ki-67 indices and AgNOR scores correlated with each other and with tumor grade and stage. These proliferation markers may give objective and accurate information about the biological behavior of bladder transitional cell carcinoma.

Primary malignant lymphoma of the urethra is very rare. Fifteen cases are reported in the literature and only four of them belong to the male urethra. We present the fifth case of primary Non-Hodgkin's lymphoma of the male urethra that is managed by conformal radiotherapy.

To evaluate the efficacy and toxicity of interferon alpha-2b (IFN-alpha2b) and levamisole treatment regimen in patients with metastatic renal cell carcinoma (RCC). Seventeen patients with metastatic RCC were treated using recombinant IFN-alpha2b at a dose of 10 MU/m2 body surface subcutaneously three times in a week, for 3 months, with levamisole 50 mg t.d.s orally on days 1-3 on alternate weeks. The mean follow-up period was 10.7 (range 2-23) months. We achieved 1 complete response (lasting for 12+ months) and 1 partial response (lasting for 15 months), for an objective response rate of 11.7%. A further 7 patients (41%) had a stabilization of disease. The overall toxicity was moderate, with mainly grade I or II side effects. Grade III toxicities reported among 3 patients including vomiting (2 patients) and anorexia (1 patient). There was no treatment related death. Although additions of levamisole to IFN-alpha do not result in any significant increase in treatment toxicity, the response rate appears to be no better than IFN-alpha monotherapy reported in the literature.

Tumours of the epididymis, both primary and secondary, whether benign or malignant are very rare. We report a case of leiomyoma of the epididymis and discuss the treatment of this tumour.

Activities of arginase, prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) were determined in sera of healthy male controls, benign prostatic hypertrophy (BPH) and prostatic cancer patients. Serum arginase activity in the cancer group (22.8+/-11.6 U/l) was significantly lower than in both the control (33.64+/-16.19 U/l) and the BPH group (58.8+/-11.6 U/l) (p<0.001, respectively), while the BPH group had significantly higher levels compared to the controls (p<0.05). However, serum arginase levels in all groups had no statistically significant correlation with PAP and PSA. Serum arginase activity correlated inversely with the Gleason grades. These results suggest that serum arginase assay may be used for the pretreatment evaluation of patients with prostatic diseases.

Fresh operative cells from 27 renal cell carcinomas (RCC) were cultured in vitro for the determination of in vitro drug sensitivity. Two samples were not culturable. Incubation was carried out in triplicate in the presence and absence of various concentrations of chemotherapeutic agents. Sensitivity of the tumour cells to interferon-alpha (IFN-alpha), cisplatin (CDDP), mitomycin C (MMC), vinblastine (VBL), doxorubicin (DOX), etoposide (ETOP), bleomycin (BLM), vincristine (VCR) were tested by a colorimetric assay using MTT. A preexposure viability over 75% was essential for in vitro drug sensitivity assay (IVDSA). Sensitivity was determined by a more than 50 +/- 2 SD% reduction from the control absorbance. All eight drugs in their low concentrations exhibited cell proliferation inhibition in 0-12% of RCCs. On the other hand, IFN-alpha in its higher concentration (60 IU/ml) was effective in 88% of RCCs. After IFN, CDDP was found to be the second most effective drug in its higher concentration (36% efficacy). The results indicate that IFN appears to be the most effective in vitro agent in our 25 RCCs and the clinical trials either as a monotherapy or multiple combinations of various agents should include IFNs for the treatment of RCC.

In spite of the significant advances in the chemotherapy of germ cell neoplasms, some patients do not achieve disease-free status and ultimately die from their diseases. Therefore, it is reasonable to select the best chemotherapeutic agents in these patients by in vitro drug sensitivity assay (IVDSA) in order to apply the most effective agent in case of resistance to primary chemotherapy. Fresh operative cells from 12 testicular germ cell tumours (TGCT) were cultured in vitro. Sensitivity of the tumour cells to interferon-alpha (IFN-alpha), cisplatin, mitomycin C, vinblastine, doxorubicin, etoposide, bleomycin, vincristine (VCR) were tested by a colorimetric assay using MTT. A preexposure viability over 75% was essential for IVDSA. Sensitivity was determined by a more than 50 +/- 2 SD% reduction from the control absorbance. All eight drugs in their high concentrations exhibited cell proliferation inhibition in 83.3 +/- 100% of TGCT. But in low concentrations efficacy of IFN and VCR were found to be lower than the others (33.3% and 58.3%, respectively). The results indicated that although TGCT are highly sensitive to various agents IVDSA may help to identify the effective agents which might be necessary for second line chemotherapy in a small percentage of patients.

We report a 49-year-old woman with exstrophy of the bladder. Our living case constitutes a rare example of bladder exstrophy cases, who lived about 50 years without any severe complication or intervention.

Corpora cavernosa of 4 impotent patients with arterial pathology and 6 with venous insufficiency were studied by electron microscopy. The findings in all of the smooth muscle samples were the following: pronounced thickening of the basal lamina; marked reduction of contractile myofilaments and electron dense bodies; finger-like cytoplasmic projections; increase in mitochondria with swelling and aggregation; huge protrusions of nuclear membrane into the cytoplasm; increased proportion of interstitial matrix to smooth muscle cells. These were more marked in the dark than in the light cells, which was considered as the beginning of degeneration. Another finding was degenerative changes in the endothelial cell lining of the sinusoids, especially denudation, fragmentation and marked thickening of the basal lamina. Severity of the symptoms did not change in any of the patients with different pathologies. So, we can assume that the pathological alterations may be due to chronic penile vascular insufficiency or vice versa.

In a prospective study, 71 patients with superficial transitional cell carcinoma of the bladder were given topical immunotherapy with bacillus Calmette-Guerin after transurethral resection and the impact of cystoscopy and bladder wash-out cytology in assessment of recurrent tumours was investigated. Sixteen recurrences were noted histopathologically during the follow-up and 15 of them were also diagnosed properly by wash-out cytology (sensitivity 93.8%). During the follow-up, 10 patients had positive cytology results without evidence of recurrent tumour and 6 of them had recurred cystoscopically in 3 months' time. However, the remaining 4 patients were still tumour-free cystoscopically after a follow-up of 6 months (specificity 92.7%, positive predictive value 78.9%). Although, some false-positive results may be obtained by urine cytology after topical immunotherapy, urine cytology seems to be a reasonable alternative to more invasive and expensive methods during the follow-up of bladder tumours.

To evaluate the extent of renal parenchymal injury following high energy shock wave (HESW) application we measured the urine levels of two renal tubular brush border enzymes: leucine aminopeptidase (LAP) and gamma-glutamyltranspeptidase (GGT) the day before, 24 hours and 7 days after extracorporeal shock wave lithotripsy (ESWL) in 23 patients. All patients had caliceal stones and were treated with a Dornier MPL 9000 lithotriptor under sedoanalgesia. Creatinine concentration of each sample together with total shock wave effect (TSWE) values were also assessed and comparatively evaluated with enzymuria levels. Our results indicated a statistically significant rise in urinary excretion of both enzymes after 24 hours following lithotripsy (p < 0.05). All these values returned to normal limits within 7 days after ESWL (p > 0.05). Transient tubular damage due to HESW was found to be related to TSWE values assessed in our group.

Neuron specific enolase (NSE) is an isoenzyme of the glycolytic enzyme enolase. It is not only a marker for all types of neurons but also for all neuroendocrine or paraneuronal cells and various malignant tumours, even of non-neuroendocrine types. We had studied serum NSE in 25 consecutive patients with renal cell carcinoma (RCC). The study included 10 stage I, 3 stage II, 3 stage III-B and 9 stage IV-B patients. Both pretreatment and posttreatment levels were evaluated. Regardless of stage, overall we observed elevated levels of NSE in 80% (20/25) at diagnosis. After the appropriate treatment, according to the stage, there had been a statistically significant (p < 0.05) decrease in the serum levels in all stage I, II and III-B patients. The posttreatment values were not available for stage IV-B patients because they did not come for follow-up. The preliminary results of our study revealed that serum NSE may be considered as a useful marker in the evaluation and surveillance of RCC.

Serum levels and tissue expression of beta subunit of human chorionic gonadotropin were determined in 25 patients with bladder carcinoma. Elevated gonadotropin levels in serum were observed in 5 (20%) patients and immunoreactive cells were found in 5 (20%) tumours. The correlation was poor between serum level and immunohistochemical gonadotropin status. Only one patient showed both elevated serum level and immunohistochemical gonadotropin expression. Our observations suggest that elevated serum levels of gonadotropin may be an indicator of poor prognosis. However, immunohistochemical expression of gonadotropin did not seem to have a similar impact on prognosis in this series.

In a nonrandomized retrospective study, 133 patients with superficial transitional cell carcinoma of the bladder were evaluated to identify any clinical prognostic features which indicate the necessity of intravesical therapy (IVT). The risk factors taken into account were stage, grade and multiplicity of the tumour. All patients were treated initially by complete transurethral resection (TUR); 27 patients received no further treatment after resection of the tumour, 106 patients received adjuvant IVT over a period of 6 weeks. The mean follow-up was 23 and 18.8 months in the TUR-only group and TUR+IVT group, respectively. In the TUR-only group 7 and in the TUR+IVT group 29 recurrences were encountered. Patient group with no risk factors (Ta, GI, solitary tumour) or with only one risk factor revealed no statistical difference in terms of the recurrence rate from the identical control group. So it does not seem worthwhile to give additional therapy in the low-risk group. Another notable outcome of this study was that the higher the potential risk factors, the higher the likelihood of recurrence. The results suggest that T1 tumours, multifocal tumours, and high-grade tumours have poor prognosis, making additional treatment necessary.

We describe a patient with 371 bladder calculi secondary to benign prostatic hyperplasia. To our knowledge this patient had one of the highest numbers of the bladder calculi reported.

Five patients with Peyronie's disease were operated and the tissue specimens from the plaque involving the tunica albuginea and from the tunica of the unaffected contralateral side were obtained. The specimens were then subjected to histopathological examination and the findings were correlated with those of men proved not to have Peyronie's disease but operated for other reasons. In the specimen of plaque, the changes varied from collagen destruction to cartilaginous and osseous metaplasia. However, in the tunica of the contralateral side the changes such as disregularity of collagen bundles extending even to widespread focal areas, and appearance of pale, rough, eosinophilic collagen degeneration, instead of its characteristic bright birefringence, and focal mucinous degeneration were noted. Interestingly, these alterations were not observed in the specimens of normal tunica albuginea in the control group. But the existence of minimal alterations, the regularity in the apparently normal contralateral tunica albuginea specimens in Peyronie's disease implied that there was an active turnover in collagen production, and the possible factor causing collagen degeneration and so plaque formation was probably the microtraumatization of the tunica albuginea.