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Cranberry (Vaccinium macrocarpon) is being studied for use in the prevention of recurrent urinary tract infection (rUTI) where it affects the adhesion Escherichia coli to the uroepithelium. This 6 month, randomized, double-blind, placebo-controlled trial aimed to evaluate whether a daily dose of 500 mg Pacran® could prevent UTI occurrences in sexually active women with a medical history of at least 2 symptomatic UTI in the previous 12 months. Study participants were randomized to the Pacran® or the placebo group and were followed up for 6 months. The intent-to-treat analysis included 176 participants (n=93 in placebo and n=83 in Pacran® group). In the Pacran® group, the proportion of women experiencing at least one UTI was significantly lower than in the placebo group [10.8% versus 25.8%, respectively, p=0.04, with age adjusted 12-month UTI history (p=0.01), age (p=0.73), and age-squared (p=0.05) also included in the model]. There was a similar finding when risk of an E. coli UTI was assessed (p=0.03). Wh...

Introduction. Primary hyperaldosteronism is a common cause of secondary hypertension. In patients with proven unilateral overproduction of aldosterone adrenalectomy can cure hyperaldosteronism with high probability and a positive effect on hypertension. The aim of the study was to determine the effects of unilateral adrenalectomy on blood pressure and laboratory parameters. The secondary objective was to identify parameters that would allow the prediction of hypertension cure. Methods. We performed a cross-sectional analysis of the data of patients who underwent unilateral adrenalectomy for primary aldosteronism at the Department of Urology of University Hospital Olomouc in the years 2000-2011. We assesed the preoperative clinical conditions of patients, the results of biochemical and radiological examinations, course of the surgery and post-operative course including laboratory and clinical parameters during the 12 months postoperatively. Results. 62 patients underwent adrenalectomy for primary aldosteronism in this period. Four patients were excluded from the study due to surprising histology (myelolipoma in 2, carcinoma in 2), seven patients had incomplete postoperative data. The statistical analysis therefore included 51 patients, of which 57% were females. CT or MRI was performed in all patients; 63% patients underwent superselective catheterization of adrenal veins (AVS). Adrenalectomy was performed in all cases laparoscopically. Histology most often showed adrenal hyperplasia (59%), adenoma was detected in 37% and adenoma on the basis of micronodular hyperplasia in 4%. Twelve months after surgery the antihypertensive drugs were discontinued in 17/51 (33%) and the number or dose of antihypertensive drugs was reduced in 25/51 (49%). Normokalemia and normalisation of the aldosterone-renin ratio (ARR) was detected in 92% and 84% of the patients. Performing AVS did not statistically significantly influence the rate of blood pressure control or normalization of ARR, which is probably due to small study size. This study demonstrated a better effect of surgery on blood pressure in younger patients. Conclusions. Unilateral adrenalectomy had a positive effect in 82% of the patients operated for primary aldosteronism and lead to either blood pressure normalization or reduction of the antihypertensive medication.

Background Both androgenetic alopecia (AGA) and carcinoma of the prostate (CaP) or benign prostatic hyperplasia (BPH) are androgen-dependent disorders. Objective To investigate the relationships between male androgenetic alopecia, androgen receptor (AR) gene polymorphism (SNP rs6152) and clinical characteristics of BPH and prostate cancer. Methods Overall, 309 male subjects with prostate disease (BPH or CaP) were examined. We evaluated the standard grades of AGA (I–VII) by Hamilton–Norwood classification and 195 patients were also assessed by phototrichogram. Prostate-specific antigen (PSA) and testosterone levels were also measured. Polymorphism rs6152 of the AR was evaluated from blood samples by PCR-RFLP. Data were statistically evaluated. Results The expected positive correlation between age and AGA grade and the expected negative correlation between hair density and age and between anagen/telogen and AGA were found. A statistically significant difference between patients with A and G alleles in terms of AGA grade was found. The predominant G allele was more frequent in patients with higher grade of alopecia and in patients with significantly higher PSA. There was no correlation between diagnosis (BPH or CaP) and polymorphism. Patients with prostate inflammation had a statistically significant higher grade of AGA, together with higher PSA. Conclusions We confirmed that the AR gene polymorphism (SNP rs6152 G>A) is associated with the development of AGA and higher PSA levels in patients with BPH but not cancer. A novel finding of our study is that BPH patients with prostate inflammation had a significantly higher grade of AGA together with significantly higher PSA levels.

Background. Silymarin, a milk thistle flavonolignan mixture, has anti-proliferative and anti-angiogenic activities in xenografts of human prostate cancer (PCa). Low dietary selenium on the other hand has been associated with increased incidence of PCa. The purpose of the current trial was to determine whether a daily administration of a silymarin and selenium (SM-Se) combination for 6 months would alter basic clinical chemistry and oxidative stress markers, and improve the quality of life score (QoL) in men after radical prostatectomy (RP). Methods. Thirty seven participants, 2–3 months after RP, were randomly assigned to receive 570 mg of silymarin and 240 μg of selenium as selenomethionine (n = 19, SM-Se group) or placebo (n = 18, Placebo group) daily for six months. Both groups had similar clinical and demographic characteristics. Physical examination, QoL score, haematology, basic clinical chemistry and oxidative stress markers, selenium and testosterone levels, antioxidant status were evaluated at baseline, at 3 and 6 months. Results. The six months administration of silymarin and selenium improved the QoL score, decreased low density lipoproteins (LDL) and total cholesterol and, increased serum selenium levels. The combination had no effect on blood antioxidant status and no influence on testosterone level. No adverse events were recorded. No improvement was found in the placebo group. Conclusions. The selected combination of silymarin and selenium significantly reduced two markers of lipid metabolism known to be associated with PCa progression, LDL and total cholesterol in the blood of men after RP. This suggests that this combination may be effective in reducing PCa progression.

Background: We analyzed data gathered from initial and repeated prostate biopsies at the University Hospital in Olomouc, Czech Republic. We evaluated the diagnostic yield of repeated transrectal ultrasound (TRUS) guided biopsies. We also assessed whether the result of the repeated biopsy depended on the benign diagnosis of the previous biopsy. Methods: From June 2006 till December 2008, the total of 794 men underwent a TRUS guided biopsy. The following parameters were recorded for each patient: age, total Prostatic Specific Antigen (PSA) level, free PSA level, digital rectal examination record, total prostate volume, and the histo-pathological evaluation. For patients undergoing a repeated biopsy, the histo-pathological result of the previous biopsy was also available, as well as the total number of previous biopsies and the time since the last biopsy. These data were analyzed using standard statistical methods. Results: Initial biopsy was positive for prostate cancer in 157 out of 566 men (27.7%). The total PSA level was confirmed to be a significant (P < 0.001) predictor of prostate cancer. The ratio of free PSA to total PSA (the socalled PSA index) was found to be significantly lower (P < 0.001) for patients suffering from adenocarcinoma. A total of 191 men underwent a repeated biopsy. The repeated biopsy was positive for adenocarcinoma in 39 cases (20.4%). Although this yield is lower, the significance is at the threshold (P = 0.04700). In the group of rebiopted men, total PSA level and PSA index were again significant (P = 0.0024 and P = 0.0015 respectively) predictive factors for prostate carcinoma. The diagnostic yield of repeated biopsy was assessed with respect to the most common types of the benign findings in the previous biopsy - adenomyomatous hyperplasia, inflammation, high grade prostatic intraepithelial neoplasia, and suspected adenocarcinoma. No significant difference in the diagnostic yield was found (P = 0.38431). Conclusions: Total PSA level and PSA index are the most significant precursors of adenocarcinoma in both initial and repeated biopsy. The histo-pathological result of a repeated biopsy was found to be independent of the type of benign diagnosis of the previous biopsy. A substantial number of prostate cancer is diagnosed in repeated biopsies which advocates for the indication of a repeated biopsy in case of a negative result of the initial one.

OBJECTIVE To investigate the relationship of urine fetuin-A and other promotors and inhibitors of urine crystalization with urolithiasis, as fetuin-A inhibits the precipitation of hydroxyapatite from supersaturated solutions of calcium and phosphate in vitro but no information on urine fetuin-A in patients with urolithiasis is available. PATIENTS AND METHODS In all, 39 patients with urolithiasis and 22 individuals with no urolithiasis or probands with undetected stones were involved. All patients underwent kidney ultrasonography and X-ray examination, and body mass index (BMI) was calculated. Serum creatinine, parathyroid hormone, calcium, magnesium, anorganic phosphate, uric acid and urine creatinine, albumin, α1-microglobulin, sulphate, oxalate, citrate and fetuin-A (ELISA) were determined. RESULTS The patients with urolithiasis had lower urine fetuin-A levels (median 4.9 vs 0.77 mg/day; P

Objectives We evaluated porcine small intestinal submucosa (SIS) used in the treatment of inflammatory, iatrogenic, posttraumatic, and idiopathic strictures of bulbar and penile urethra. Midterm maintenance of urethral patency was assessed. Methods Fifty patients aged 45–73 yr with anterior urethral stricture underwent urethroplasty using a porcine SIS collagen-based matrix for urethral reconstruction. Stricture was localized in the bulbar urethra in 10 patients, the bulbopenile area in 31 cases, and in the distal penile urethra in nine patients. All patients received a four-layered SIS patch graft in an onlay fashion. A voiding history, retrograde and antegrade urethrography, and cystoscopy were performed preoperatively and postoperatively. Failure was defined as stricture confirmed on urethrogram. Results After a mean follow-up of 31.2 mo (range: 24–36 mo), the clinical, radiological, and cosmetic findings were excellent in 40 (80%) patients. Restricture developed in one of 10 bulbar, five of 31 bulbopenile, and four of nine penile strictures. These all occurred in the first 6 mo postoperatively. All patients with recurrences needed further therapy, but there has been no additional recurrence observed to date. No complications such as fistula, wound infection, UTI, or rejection were observed. Conclusions Use of inert porcine SIS matrix appears to be beneficial for patients with bulbar and bulbopenile strictures. Midterm results are comparable to skin flaps and mucosal grafts.

Testicular blood supply and semen quality were compared in two groups of patients undergoing laparoscopic varicocelectomy: group I (n = 27) with spermatic artery ligation and group II (n = 48) with spermatic artery preservation.Laparoscopic varicocelectomy was performed on 75 patients divided on the basis of whether ligation took place during surgery or not. The blood flow parameter (resistance index-RI) measured using color Doppler sonography was the index of vascular efficiency selected.Mean RI was 0.69 in group I and 0.65 in group II. The difference was not significant. Both groups showed improvements in sperm density and motility but there was no significant difference between groups for either parameter.Using color Doppler sonography confirms that ligation of the testicular artery during varicocelectomy does not lead to major changes in testicular blood supply or sperm quality.

DNA methylation changes as potential biomarkers in the treatment of bladder cancer Introdution Bladder Cancer (BC) is the second most common malignancy of the urinary tract. BC has two categories. Approximately 75 % of patients with BC present with disease confined to the mucosa or submucosa (non muscle invasive bladder tumor - NMIBC). Carcinoma in situ (CIS) is a very specific subgroup of NMIBC, because it is not a papillary lesion but a flat tumor, which is why CIS can be missed in cystoscopy. CIS is always a high grade tumor. Without any treatment, approximately 54% of patients with CIS progressed to muscle- invasive or metastatic disease. The second category covers patients with muscle-invasive BC (MIBC). These patients have a higher prevalence of progression rates and higher cancer- specific mortality. Patients with NMIBC are indicated to transurethral tumor resection (TUR) alone or with adjuvant treatment (intravesical chemotherapy or intravesical Bacillus Calmette- Guérin - BCG immunotherapy). BCG is an attenuated mycobacterium developed as a vaccine for tuberculosis that has demonstrated antitumor activity in BC intravesical instillation, and significantly reduces the progression risk of high grade papillary lesion and CIS. The therapy of MIBC is radical cystectomy - hard mutilating surgery...

Charles University in Prague, Faculty of Pharmacy in Hradec Králové Department of Biochemical Sciences Candidate Mgr. Renata Veselá Supervisor Prof. Ing. Vladimír Wsól, Ph.D. Title of Doctoral Thesis On Purinoceptors in the Rat Urinary Bladder Both divisions of autonomic nervous system regulate the urinary bladder function. In addition to the classical autonomic neurotransmitters, noradrenaline and acetylcholine, other autonomic transmitters and signalling molecules play important roles in the physiology and pathophysiology of the lower urinary tract. Interstitial cystitis (IC) is a chronic inflammation of the bladder of non-infectious origin and unclear etiology and pathophysiology, characterized by urinary frequency, urgency and sharp pelvic pain that fade away while urinating. Non-adrenergic, non-cholinergic (NANC) systems influence functional responses in the inflamed bladder. The aim of this study was to investigate purinergic and nitrergic mechanisms involved in the IC pathogeneses and in urodynamic dysfunction. Methods: A single dose of i.p. injection of cyclophosphamide caused CYP-induced cystitis; a condition very similar to IC and for that property was used as a model of the inflamed bladder throughout our experiments. The organ bath set was employed in investigation of functional...