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Varicocele is a dilatation of the spermatic veins, particularly on the left side, and represents one of the most frequent causes of male infertility. Its frequency in pre-adolescence varies from 10% to 15%. Even today varicocele pathogenesis is not clear. In the period from August 1990 to August 1999, 35 males between 10 and 16 years of age were treated surgically in our Institution via interruption of the internal spermatic vein using Palomo's technique. Patients that reached the age of 18 after surgery have had a spermiogramm. The problem of varicocele therapy in pre-adolescence has not yet been resolved with regard to surgical therapy and follow-up. Pediatr Med Chir

INTRODUCTION: Benign prostate hyperplasia (BPH) has been treated with various types of electromagnetic radiation methods such as transurethral needle ablation (TUNA), interstitial laser therapy (ILC), holmium laser resection (HoLRP). In the present study, the effects of a noninvasive method based on the exposure of patients with BPH to a pulsative EM Field at radiofrequencies have been investigated. MATERIALS AND METHODS: Twenty patients with BPH, aging 68-78 years old (y.o), were enrolled in the study. Patients were randomly divided into two groups: the treatment group (10 patients, 74.0 +/- 5.7 y.o) treated with the alpha-blocker Alfusosin, 10 mg/24 h for at least 4 weeks, and the electromagnetic group (10 patients, 73.7 +/- 6.3 y.o) exposed for 2 weeks in a very short wave duration, pulsed electromagnetic field at radiofrequencies generated by an ion magnetic inductor, for 30 min daily, 5 consecutive days per week. Patients of both groups were evaluated before and after drug and EMF treatment by values of total PSA and prostatic PSA fraction, acid phosphate, U/S estimation of prostate volume and urine residue, urodynamic estimation of urine flow rate, and International Prostate Symptom Score (IPSS). RESULTS: There was a statistically significant decrease before and after treatment of IPSS (P < 0.02), U/S prostate volume (P < 0.05), and urine residue (P < 0.05), as well as of mean urine flow rate (P < 0.05) in patients of the electromagnetic group, in contrast to the treatment group who had only improved IPSS (P < 0.05). There was also a significant improvement in clinical symptoms in patients of the electromagnetic group. Follow-up of the patients of this group for one year revealed that results obtained by EMFs treatment are still remaining. CONCLUSION: Pulsed electromagnetic field at radiofrequencies may benefit patients with benign prostate hyperplasia treated by a non-invasive method. Int Urol Nephrol

In the present review article a global approach regarding the usefulness of genomic microarrays in prostate cancer management, is attempted. Cancer is a multistep process of mutations in key regulatory genes and epigenetic alterations that result in loss of balanced gene expression. A complete knowledge of the interaction between the genetic variability of the neoformation (tumor profiling) and the genetic variability of the host (inherited genome profiling), will be able to determine the better strategy against the cancer and the less toxicity for the patient. Alterations in the sequence of the hormone binding domain of the androgen receptor as well as mutations in some genes, determine radioresistance and resistance or sensitivity to some chemotherapeutic drugs. New therapies using monoclonal antibodies directed against specific extracellular binding domains of some receptors are based on molecular alterations observed in tumors. В обзоре обсуждается целесообразность применения геномных микрочипов для выявления рака предстательной железы. Рак является многоэтапным процессом мутаций в ключевых регуляторных генах и эпигенетических изменений, приводящих к утрате сбалансированной экспрессии генов. Фундаментальные знания о взаимосвязи между генетической вариабельностью опухолевых клеток (молекулярном профиле опухоли) и генетической вариабельностью хозяина (наследуемый геномный профиль) позволит выбрать наилучшую стратегию противоопухолевой терапии при низкой токсичности таковой. Изменения последовательности гормонсвязывающего домена рецептора андрогена наряду с мутациями некоторых генов определяют устойчивость к лучевой терапии и устойчивость или чувствительность к ряду химиопрепаратов. Новые виды терапии с использованием моноклональных антител против специфичных внеклеточных связывающих доменов ряда рецепторов основаны на данных о молекулярных особенностях новообразований.

Intraoperative penile erection during endoscopic surgery, although an infrequent occurrence, is a troublesome complication and a challenge to the urologist. It is difficult to perform the procedure during penile erection, because various complications may occur. The etiology is unclear, and a number of pharmacological remedies have been discussed in the literature. Herein, we describe the treatment and outcomes for 3 patients with intraoperative penile erection and provide a brief review of the associated literature. Intraoperative penile erection is a rare event during transurethral procedures, with a frequency of approximately 0.1% in our institution. To our knowledge, no generally accepted protocols for the prevention or treatment of this phenomenon have been reported in the literature. We recommend intracorporeal injection of 250 microg of phenylephrine: detumescence occurred rapidly in all patients after a single injection. The mode of administration is simple, and no complications have been reported. J Androl

Throughout the past six decades, our understanding of cancer of the prostate and the treatment of the disease using endocrine therapy has been centred on the classical investigations of Charles Huggins, which established that tumor tissue of the prostate as well as the normal tissue of the gland retained some degree of androgen dependence. Attention must now be focussed on the 20-40% of patients who are resistant to endocrine therapy. These patients are non-responders to conventional endocrine treatment after 3 to 6 months, quickly progress and die of the disease. In terms of molecular endocrinology related to the progressive stage of the disease, it would be expected that the cancer is being driven by the uncontrolled action of growth factors. Experiments combining oligonucleotide treatment with cytotoxic chemotherapeutic agents demonstrated a marked increase in the sensitivity of the prostate cancer cells. Results indicate that despite the presence of Bcl-x pre-mRNA in a number of cell types, the effects of modification of its splicing by antisense oligonucleotides vary depending on the expression profile of the treated cells. The transition from androgen-dependent to androgen non-dependent prostate cancer is accompanied by a number of molecular genetic changes, including overexpression of the Bcl-2 gene. Overexpression of Bcl-2 protein decreases the pro-apoptotic response to such cellular insults as irradiation, chemotherapy, and androgen withdrawal. The future looks promising and this kind of treatment offers a novel approach to alternative therapeutic options for advanced prostate cancer. Although numerous chemotherapeutic regimens have been evaluated for patients with hormone-refractory prostate cancer, none has improved survival. Exp Oncol

Prostate cancer is the second leading malignancy in men associated with an enormous research interest in all aspects of the disease. It is well recognized that the regulation of prostatic growth is a complicated biological process. Further more the androgenic dependence of the advanced prostate cancer is well know and in the last 50 years significant progresses regarding the principle of deprivation of androgens for the treatment of the disease occured. Prostate cancer is now diagnosed in earlier stages and treatment results in increased potential for cure or extension of overall survival. Unfortunately, every treatment for prostate cancer has adverse effects with negative impact in health-related quality of life. Surgical or pharmacological castration has a significant negative impact on quality of life in patients with prostate cancer (loss of sexuality, osteoporosis, and loss of muscle mass, e.g.). Antiandrogen monotherapy is considered to be a treatment in well-informed patients who wish to remain sexually active, can be administered orally, and is well tolerated by patients with prostate cancer. This review is focused on antiandrogen monotherapy in the treatment of advanced prostate cancer. Exp Oncol

Epithelial cadherin (E-cadherin, E-cad) is a calcium-dependent cell-cell adhesion molecule that binds cells through homotypic fashion interactions. Its role is crucial in the induction and maintenance of cell polarity and differentiation. Downregulation or loss of its function is associated with an invasive and aggressive phenotype in many types of human cancers. 45 male patients (mean age 63 years, age range from 29 years to 87 years) with transitional cell carcinoma (TCC) of the bladder were included in the study. E-cad expression was estimated immunohistochemically in a semiquantitative fashion using light microscopy. An avidin-biotin immunoperoxidase technique was employed using anti E-cad murine monoclonal antibodies. Loss of the E-cad normal surface expression by the bladder cells was found in 32/45 (71%) of patients compared to normal bladder epithelia observed at the intercellular borders (p

N-acetyltransferase-2 (NAT-2) and Glutathione-S-transferase M1 and T1 (GSTM1 and GSTT1) polymorphism have been implicated in the detoxification of urothelial carcinogens, such as arylamines and polycyclic aromatic hydrocarbons. The results of epidemiological studies examining the role of NAT-2, GSTM1 and GSTT1 genotypes on the risk factors for bladder cancer were controversial, although suggesting that there may be an increased risk of the disease associated with these genotypes. The aim of the present study was to examine the independent effect and a possible interaction of NAT-2, GSTM1 and GSTT1 genotypes on the risk of bladder carcinogenesis, in the frame of a case-control study. We also investigated the possible association of specific genotype combinations with more aggressive disease in terms of tumor grading and local staging at the time of initial diagnosis. Between August 1996 and May 1998, 89 newly-diagnosed bladder cancer patients (transitional cell type) and 147 controls were included in the study. All patients were selected at the time of first diagnosis, done in the Department of Urology at the University Hospital of Ioannina, in north-western Greece. GSTM1 and NAT-2 deficient genotypes were found to be independently associated with the risk of bladder cancer (odds ratios 2.87 and 2.64, respectively). The GSTT1 genotype did not present any significant association with bladder cancer risk. We did not find a significant interaction between genotypes. These results could be explained by the independent activity of the two enzymes. Studies that will simultaneously examine the role of several genetic and environmental factors involved in bladder carcinogenesis are needed to give a global picture for the risk factors of bladder cancer and their potential interaction. Anticancer Research

To examine seasonal trends of cryptorchidism in Greece, 583 males with true isolated cryptorchidism were analyzed. All 208 912 live-born boys born during the same period were used as a comparison group. Seasonality by month of birth was evaluated using both Edwards’ model with adjusted frequencies and exact theta(i), and Walter-Elwood method with exact theta(i). Both tests resulted in consistent findings. The incidence of cryptorchid births in Greece follows a documented cyclic pattern of simple harmonic type with spring being the season of statistical predominance (peak in March with a second, almost equivalent, peak in May). In contrast, in autumn the incidence of cryptorchid births was considerably lower (trough in September). Given the fact that no significant differences in daylight length are found among seasons in Greece. the detection of a significant seasonal variation suggests that factors other than light are involved in the pathogenesis of cryptorchidsm. Low environmental temperature is proposed as a causative factor negatively influencing the maternal hCG profiles and the inguinoscrotal phase of testicular descent. This is further supported by: (i) the similarity of our results to those reported by other European countries of different longitude and geographical width and (ii) our data showing significantly smaller maternal hCG profiles at the 26th week of gestation during winter compared with summer. ‘...Whoever wishes to investigate medicine properly should proceed thus: In the first place to consider seasons of the year and what effect of them produces...’ Hippocrates: Airs, Waters and Places.

We herein present a case of formation of a large infectious bladder calculous resulted from placement of a double pigtail catheter for an extensive period. The concomitant poor function of the corresponding renal unit made selection of nephroureterectomy unavoidable in the management of our patient. Int Urol Nephrol

OBJECTIVES: This study was conducted (1) to examine whether the GSTM1 and GSTT1 null genotypes are risk factors for bladder cancer, and (2) to study a possible association of these genotypes with disease severity. METHODS: This case-control study was undertaken over a 21-month period and included 89 newly diagnosed transitional cell bladder cancer patients and 147 controls; both patients and controls originated from a defined population (residents of the loannina region, Northwestern Greece) and were similar with regard to mean age, male to female ratio and smoking habits. The GSTM1 and GSTT1 genotypes were identified by multiplex polymerase chain reaction on peripheral blood DNA samples. Genotype frequencies among patients and controls were assessed and the association of the genotypes with tumor grade and stage at presentation were statistically evaluated by the chi(2) test. RESULTS: The GSTM1 null genotype was strongly associated with bladder cancer. The odds ratio, attributable and population attributable risks were estimated at 2.76, 0.64 and 0.40, respectively. The correlation between the GSTM1 null genotype with stage, although not statistically significant, was estimated at an odds ratio of 2.6 for invasive disease. The correlation of GSTM1 null genotype with tumor grade did not yield a statistically significant result. The GSTT1 null genotype was not statistically associated with bladder cancer. CONCLUSION: According to our study, individuals with the GSTM1 null genotype carry a substantially higher risk for bladder carcinogenesis. The GSTM1 null genotype is not associated with more aggressive disease in terms of tumor grade, although there is a correlation between this genotype and stage of the disease. Eur Urol

We hereby present a rare case of a 46,XY/45,XO/47,XXY mosaic male patient with a predominance of the XY cell line. The patient, who exhibited phenotypic stigmata of both XO gonadal dysgenesis and Klinefelter syndromes, suffered from infertility and multiple urogenital abnormalities, as our investigation revealed. Urol Int

The relationship between renal stones and urinary tract infection is frequent but not well-known. In this study, urinary tract infection was found in 12% of renal stone formers. It is four times more common in females than in males. Urea splitting bacteria (Proteus, Klebsiella, Staphylococcus and Pyocyaneus) lead to stone formation. They were identified in 72% of cases. Proteus was predominant and the organism most frequently found in staghorn stone formers. Other non urea-splitting bacteria (E. coli, Enterobacter, Streptococcus) were observed in 25% to 30% of cases. The percentage of the various bacteria varies according to the degree of resistance to therapy and the patients sex. Ann Urol (Paris)

Surgical injury to the ureter is an important problem that confronts the urologist, the gynecologist and the general surgeon. The authors report 20 cases of iatrogenic pelvic ureteral injuries (22 ureters) observed after gynecological surgery between January 1985 and January 1995. The ureter was injured during ligation of the lumbo-ovarian vascular pedicle because it was inadequately protected during the operation. Open surgery and double pigtail stent insertion using retrograde route were used for treatment. The iatrogenic ureteral injury was in 18 patients unilateral and in the remaining 2 patients both ureters were damaged. As regards treatment, the authors recommend immediate repair, whenever the lesion is noticed at operation. In the post-operative period, ureteral stent or double pigtail stent insertion using balloon dilatation or ureteroscope, may be a successful conservative treatment. If the damage is only diagnosed subsequently, they recommend a ureterovesical implantation, using the psoas hitch bladder procedure or the Boari-Cassati-Kuss procedure if the lesion is in the lower ureter or a transuretero-ureterostomy if it is in the upper ureter. J Urol (Paris)

The ureteral double pigtail stents are versatile and valued for proper urinary drainage in the setting of trauma, fistula formation, after extra-corporeal shock wave lithotripsy (ESWL) and surgical manipulations of the upper urinary tract. Also they are used for prolonged urinary drainage in patients with chronic tumor-induced ureteral obstruction, and present an exceptional patient tolerance. The authors' experience is based upon 54 patients treated for ureteral obstruction of malignant origin between January 1989 and October 1995. Complications of this method as well as the quality of life of these patients are analysed and the results compared with those of the literature. The patient tolerance was excellent. Mean survival time after ureter catheterisation was 18 months. Complete urine diversion was achieved and hydronephrosis disappeared soon after stent placement in 42 patients (80%). In addition hydronephrosis persisted in 12 cases (20%), despite orthotopic positioning of the catheter and numerous stent changes for larger caliber stents. The palliative use of the double pigtail stent when no other treatment is possible for malignant ureteral obstruction, precludes the need for ureterostomy and offers the patient a comfortable quality of life. Bladder disease is a contraindication to the use of these catheters, although their insertion is rarely impossible. In case of acute obstruction, it is better to prepare the pathway with a standard ureteral catheter, which is easier to manage. It is always possible to insert the pigtail stent after some time has elapsed. J Urol (Paris)

A case of unilateral torsion of the spermatic cord in a newborn is reported. Extra-vaginal neonatal torsion of the spermatic cord, although rare, is being recognized with increasing frequency. Treatment requires immediate surgical exploration. Controversy exists concerning the urgency of exploration as well as the need for contralateral orchiopexy, since some reports suggest that the contralateral testicle is not a risk for torsion. Treatment of the ipsilateral testicle is determined by operative findings. Minerva Urol Nefrol

The results observed in a series of 40 patients treated for urethral stricture by endoscopic resection of the callus after internal endoscopic urethrotomy (Guillemin's technique) are presented. The mean age of the patients was 57 years, with a follow-up of five years. The authors obtained 80% (32 patients) of very good results for urethral strictures less than 1 cm long. The success rate of the technique was 10% (4 patients) when the callus was between 1 and 2 cm long. The recurrence rate was high for strictures longer than 2 cm (4 patients) (10%). Complications consisted of 2 cases of acute epididymitis, 2 cases of urethral perforation, 2 cases of urethral haemorrhage, 2 cases of perineal haematoma and 3 cases of meatal stenosis. The indications of this original technique therefore depend more on the length of the urethral stricture than on its topography or its aetiology. J Urol (Paris)

From 1987 to 1990, 719 subjects (385 males and 334 females) were screened, by means of urocystin-kit, for cystinuria and cystine lithiasis, in Epirus district (North-West Greece). The positive results were confirmed by chromatographic analysis of urine aminoacids and laboratory tests. Forty patients, belonging to six cystinuric families, were identified. These patients were excreting 3,1 +/- 1,7 mmol/24 h of cystine in urine. All patients were treated by per os administration of alpha-MPG in daily doses of 400-1200 mg/24 h). We therefore report the results of a 4 +/- 2 year follow-up of these patients. We conclude that treatment with alpha-MPG is very effective with minimal side effects inpatients suffering from cystinuria or cystine urinary calculi. Journal D Urologie

Three rare cases of benign ureteral polyps are presented. The rareness of benign mesenchymal ureteral tumors and the difficulty in pre-operative differential diagnosis from malignant epithelial are remarkable. The diagnosis is made on characteristic appearance at operation and is confirmed by frozen section and histological examination. Minerva Urol Nefrol

From 1987 to 1990, 719 subjects (385 males and 334 females) were screened, by means of urocystin-kit, for cystinuria and cystine lithiasis, in Epirus district (North-West Greece). The positive results were confirmed by chromatographic analysis of urine amino acids and laboratory tests. Forty patients, belonging to six cystinuric families, were identified. These patients were excreting 3.1 +/- 1.7 mmol/24 h of cystine in urine. All patients were treated by per os administration of alpha-MPG in daily doses of 400-1,200 mg/24 h). We therefore report the results of a 4 +/- 2 year follow-up of these patients. We conclude that treatment with alpha-MPG is very effective with minimal side effects in patients suffering from cystinuria or cystine urinary calculi. J Urol (Paris)

Secondary testicular tumors are very rare. Since 1935, approximately 200 cases have been documented in the international literature. Testicular metastases of prostatic carcinoma are reported more frequently and other common primary tumor sites are the lung, kidney, colon, stomach and other sites. A review of the literature revealed 43 cases originating from prostatic carcinoma with 4 bilateral cases. The authors add a rare case of bilateral metastasis to the testis originating from prostatic carcinoma. This patient had been treated by transurethral resection of the prostate and bilateral orchidectomy 24 months previously. Ann Urol (Paris)

We report a case of renal oncocytoma which was found incidentally during the nephroureterectomy for renal pelvis carcinoma. The coexistence of two tumors on the kidney with absolutely different origin one from the other is extremely rare and interesting. Herein we discuss the clinical, morphological, histological, ultrastructural and angiographical characteristics of oncocytoma. Minerva Urol Nefrol

A case of interstitial cystitis in a patient with a 5-year history treated by intravesical instillations of Lidocaine is reported. The repeated treatment relieved the patient from her pain and induced a potent anti-inflammatory effect on the bladder wall. The concentrations of plasma Lidocaine were between 1.4 and 1.1 mg/ml. No adverse reactions were reported with a follow-up of 2-years. Arch Ital Urol Nefrol Androl

Seventy patients with urethral strictures underwent endoscopic urethrotomy in the Department of Urology of the Ionnina University Hospital since 1983. The mean age of the patients was 58 years and they were treated for single (53 cases) or multiple (17 cases) urethral strictures. The cause of stricture was traumatic, post-infections, iatrogenic (post-TURP or open adenomectomy) or unknown in 6, 21, 28 and 15 patients respectively. Good results were obtained after the first endoscopic urethrotomy in 36% of cases (25 patients), at 5 year follow-up. The success rate of repeated internal urethrotomies was satisfactory in 54% of cases (38 patients). Finally, 4 patients (6%) had 5 or 6 internal urethrotomies and many urethral dilatations and were then treated by urethrectomy followed by termino-terminal urethrraphy. J Urol (Paris)