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Introduction: Inguinal hernia and varicocele are common conditions in male population. Laparoscopy brings the opportunity to treat them simultaneously, through the same incision. However, there are different opinions about the risks for testicular perfusion of multiple procedures in the inguinal region. In this study, we assessed the feasibility of simultaneous laparoscopic procedures by studying clinical and surgical outcomes of patients undergoing bilateral inguinal hernioplasty using the transabdominal preperitoneal (TAPP) technique with and without concomitant bilateral laparoscopic varicocelectomy (VLB). Methods: a sample of 20 patients from the University Hospital of USP-SP with indirect inguinal hernia and varicocele with indication for surgical correction was selected. Patients were randomized into two groups, 10 undergoing TAPP (Group I) and 10 undergoing simultaneous TAPP and VLB (Group II). Data regarding total operative time, complications and postoperative pain was gathered and analyzed. Results: there was no statistical difference between groups regarding total operative time and postoperative pain. Only one complication (spermatic cord hematoma) was observed in Group I and no complications were observed in Group II. Conclusions: simultaneous TAPP and VLB in was shown to be effective and safe, which provides a basis for conducting studies on larger scales. RESUMO Introdução: hérnia inguinal e varicocele são doenças comuns na população masculina. O advento da laparoscopia traz a oportunidade de tratá-las simultaneamente, pelo mesmo acesso. Entretanto, existem divergências sobre os riscos para a perfusão testicular de múltiplos procedimentos na região inguinal. Neste estudo, avaliamos a viabilidade de procedimentos laparoscópicos simultâneos estudando resultados clínicos e cirúrgicos de pacientes submetidos à hernioplastia inguinal bilateral pela técnica transabdominal préperitoneal (TAPP) com e sem varicocelectomia laparoscópica bilateral (VLB) concomitante. Métodos: uma amostra de 20 pacientes do Hospital Universitário da USP-SP com hérnia inguinal indireta e varicocele com indicação de correção cirúrgica foi selecionada. Os pacientes foram randomizados em dois grupos, sendo 10 submetidos à TAPP (Grupo I) e 10 submetidos à TAPP e VLB simultâneas (Grupo II). O tempo operatório total, complicações e dor pós-operatória foram coletados e analisados. Resultados: não houve diferença estatística entre os grupos com relação ao tempo operatório total e à dor pós-operatória. Apenas uma complicação (hematoma do cordão espermático) foi observada no Grupo I e não foram observadas complicações no Grupo II. Conclusões: no mesmo procedimento, submeter pacientes à TAPP e à VLB no mesmo procedimento se mostrou eficaz e seguro, o que fornece embasamento para a realização de estudos em maiores escalas.

Introduction: semi-rigid ureteroscopy is the procedure of choice for the treatment of ureterolithiasis, but it requires a learning curve to be performed safely. Objective: To describe an estimate of the learning curve for performing semi-rigid ureterorenolithotripsy in patients with small-sized ureterolithiasis and to estimate the minimum number of procedures necessary to safely perform the surgical procedure. Methods: this is a prospective study evaluating the learning curve of a resident of urology in the first 60 semirigid ureteroscopies in patients with ureterolithiasis up to 1cm. The patients were divided into three groups: Group I one to twenty surgeries, Group II twenty one to forty surgeries and Group III forty one to sixty surgeries. The surgeries were recorded and analyzed by two urologists experienced in endourology. A qualitative analysis was performed based on a previously validated tool and a quantitative analysis. Results: all qualitative variables had significant variation between Groups I and II (p

Background: An accurate prediction of progression is critical to define the management of bladder cancer (BC). The ectonucleotidases CD39 and CD73 play strategic roles in calibrating purinergic signals via an extracellular balance between ATP and adenosine. The altered expression of these enzymes plays a potential role in tumor invasion and metastasis, therefore, has been proposed to be used for prognosis of solid tumor. In BC this is not yet clear. Objective: This study aimed to evaluate CD39 and CD73 expression in a cohort of patients with non-muscle-invasive (NMI) and muscle-invasive (MI) BC regard to its association with clinicopathological features. Materials and Methods: Retrospective clinical follow-up data and primary urothelial BC specimens of 162 patients were used (87 from patients who underwent transurethral resection and 75 from cystectomized patients). Tissue microarrays were constructed, and immunohistochemistry for CD39 and CD73 was performed to make associations with clinicopathological data. Results: Overall, 96 were NMI (59.3%) and 66 MI (40.7%). CD39 immunoreactivity in BC cells was found in 72% of the cases, while CD73 was found in 97%. High CD39 expression alone was more frequent in NMI BC (p < 0.001), while CD73 expression was not powerful to predict the stage of BC. The association of both markers confirmed that only CD39 has potential in BC prognosis. Conclusions: The altered expression of CD39 presented herein supports the idea that this ectonucleotidase may be involved in bladder tumorigenesis. High expression of CD39 in tumor cells is correlated with the early stage of BC.

Indoleamine 2,3-dioxygenase (IDO1) is an enzyme that acts as an immunomodulatory molecule. It is found in several types of cancer where it seems to be associated with tumor escape due to its immunosuppressive mechanisms. However, the role of IDO1 expression in prostate cancer (PC) is unclear. The aim of our study was to evaluate the expression of IDO1 in localized PC and to correlate with the classic prognostic factor and recurrence after surgical treatment. We retrospectively evaluated surgical specimens from 111 patients with localized PC, who underwent radical prostatectomy. Recurrence was defined as a prostate specific antigen (PSA) level exceeding 0.2 ng/mL postoperatively, and the follow-up was 123 months. IDO1 expression was evaluated by immunohistochemistry in 72 cases of which 42 (58%) had biochemical recurrence. Lower IDO1 expression was associated with higher Gleason score (p = 0.022) and PSA levels (p = 0.042). The multivariate analyses revealed that the loss of IDO1 and higher PSA were independently associated with biochemical recurrence. The chance of recurrence was increased by 85% in patients with lower IDO1 [OR = 0.15; p = 0.009 CI 95% (0.038–0.633)] and increased by 5.5 times in patients with higher PSA [OR = 5.51; p = 0.012 CI 95% (1.435–21.21)]. The recurrence-free survival curve also demonstrates that lower IDO1 was associated with lower time to biochemical recurrence (p = 0.0004). The loss of IDO1 expression was associated with increased chance of biochemical recurrence, higher PSA, and a Gleason score in localized PC.

Introduction: despite being infrequent, urinary incontinence has a huge impact on the quality of life of patients undergoing radical prostatectomy, even with the robotic-assisted technique. Objective: to assess the evolution of urinary symptoms from preoperative to 12 months after robotic-assisted radical prostatectomy. Methods: data was collected from 998 patients who underwent robotic-assisted radical prostatectomy. Demographic data, preoperative and postoperative information on patients were documented. The ICIQ and IPSS questionnaires were also applied preoperatively and after 1, 3, 6 and 12 months after the operation. Results: Out of 998 patients, 257 correctly completed all questionnaires. The mean age of the patients was 60 ± 0.74 years. We found that the total IPSS increased initially and at 6 months after the operation, it was already lower than the initial preoperative value (7.76 at 6 months vs. 9.90 preoperative, p

Introducao: A adocao da biopsia de prostata guiada por fusao de imagens de ressonância magnetica (RM) multiparametrica esta se tornando um metodo importante no diagnostico do câncer de prostata, especialmente para aqueles com suspeita de lesao localizada na regiao anterior, que normalmente nao e amostrada na biopsia randomizada. Metodos: Aqui relatamos um caso de homem com PSA persistentemente elevado e com uma biopsia randomizada anterior negativa. O PSA atual era de 8,1 ng / dL e a ressonância magnetica multiparametrica mostrou uma lesao suspeita PIRADS-4 de 2 cm localizada na regiao anterior da zona de transicao direita na altura da base e terco medio da glândula. Foi realizada uma biopsia transretal guiada por fusao de imagens de ressonância multiparametrica (TRUS / mpMRI) e o exame anatomopatologico mostrou a presenca de adenocarcinoma escore de Gleason 3 + 4 (ISUP II) apenas nos fragmentos amostrados na area suspeita da mpMRI. Revisamos o papel da mpMRI no diagnostico do câncer de prostata na rebiopsia.

Background The ability to metastasize is one of the most important characteristics of neoplastic cells. An imbalance between the action of some matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs drives the invasion process. Some studies have suggested that MMP-2 is involved in metastasis, while other studies have reported that collagen production by cancer cells might also contribute to motility. However, decreased expression of microRNA-29b (miR-29b), which may control MMP-2 and collagen gene expression, has been shown in prostate cancer (PCa). The objectives of the present study were to clarify whether MMP-2 as well as collagens I and III (encoded by COL1A1 and COL3A1, respectively) are controlled by miR-29b and to determine whether metastasis is altered by this relationship. Methods PCa DU145 and PC-3 cells were transfected with 100 μL of OPTI-MEM I containing 100 nmol of miR-29b (or its inhibitor) along with 1.5 μL of lipofectamine. Positive and negative controls were prepared using the same protocol. MMP-2, COL1A1 and COL3A1 messenger RNA (mRNA) levels were evaluated via real-time polymerase chain reaction (qRT-PCR). For qRT-PCR, 6 × 104 cells were used. Invasion studies were conducted with Matrigel assays, which simulate invasion of the extracellular matrix by neoplastic cells. After transfection of 3 × 104 cells, invasion was allowed to proceed for 48 h. Invasive cells were counted under an optical microscope. Each experiment was performed in triplicate. Results MMP-2 mRNA was not expressed in DU145 cells after transfection with miR-29b. After transfection of cells with the miR-29b inhibitor, COL1A1 (p = 0.02) and COL3A1 (p = 0.06) mRNA expression was increased in DU145 cells, and a large number of transfected DU145 and PC3 cells invaded the Matrigel membrane. Conclusions In vitro studies showed that reducing the amount of miR-29b may lead to higher PCa cell invasion via a process that is independent of MMP-2. Collagen expression, controlled by miR-29b, may facilitate this motility process. Thus, the present study suggests that collagen production plays an active role in metastasis control and restoration of miR-29b levels may decrease metastasis. Altogether, these findings support further exploration of drug therapy targeting this aspect of the metastasis circuit.

BackgroundSome studies have reported that deletions at chromosome arm 9p occur frequently and represent a critical step in carcinogenesis of some neoplasms. Our aim was to evaluate the deletion of locus 9p21 and chromosomes 3, 7 and 17 in localized prostate cancer (PC) and correlate these alterations with prognostic factors and biochemical recurrence after surgery.MethodsWe retrospectively evaluated surgical specimens from 111 patients with localized PC who underwent radical prostatectomy. Biochemical recurrence was defined as a prostate-specific antigen (PSA) >0.2 ng/mL and the mean postoperative follow-up was 123 months. The deletions were evaluated using fluorescence in situ hybridization with centromeric and locus-specific probes in a tissue microarray containing 2 samples from each patient. We correlated the occurrence of any deletion with pathological stage, Gleason score, ISUP grade group, PSA and biochemical recurrence.ResultsWe observed a loss of any probe in only 8 patients (7.2%). The most common deletion was the loss of locus 9p21, which occurred in 6.4% of cases. Deletions of chromosomes 3, 7 and 17 were observed in 2.3%, 1.2% and 1.8% patients, respectively. There was no correlation between chromosome loss and Gleason score, ISUP, PSA or stage. Biochemical recurrence occurred in 83% cases involving 9p21 deletions. Loss of 9p21 locus was significantly associated with time to recurrence (p = 0.038).ConclusionsWe found low rates of deletion in chromosomes 3, 7 and 17 and 9p21 locus. We observed that 9p21 locus deletion was associated with worse prognosis in localized PC treated by radical prostatectomy.

Background The imbalance between the action of the tissue inhibitors of matrix metalloproteinases (TIMPs) and the matrix metalloproteinases (MMPs) is one component of metastasis physiology. TIMP-1 overrides MMP-9 activity in cancer and might be regulated by miR-618. The aims of this study were to clarify whether TIMP-1 expression is modified by miR-618 and to clarify the effect of miR-618 expression on the invasion of prostate cancer cells. We also studied miR-618 expression in surgical specimens of patients with localized prostate cancer submitted to open radical prostatectomy. Methods After transfection of miR-618 or its antagonist in DU145 cells, qRT-PCR for TIMP-1/MMP-9 and both ELISA and zymography for MMP-9 were performed. Total miRNA was extracted from surgical specimens of PCa, and miR-618 expression was examined for correlations with Gleason score, pathological status and biochemical recurrence. Results DU145 cells transfected with miR-618 had a 76% reduction in TIMP-1 expression relative to control cells (p = 0.003). miR-618 inhibition reduced MMP-9 expression by 31% (p = 0.032) and MMP-9 absorbance evaluated with ELISA assay (p = 0.06).Zymography suggested higher MMP-9 activity in DU145 cells transfected with miR-618 than those transfected with miR-618 inhibitor, but the difference was not significant (p = 0.55). However, miR-618 expression was lower in surgical specimens of patients with Gleason score > 7 (p = 0.08) and more advanced disease (p = 0.07). Conclusions In vitro, miR-618 overexpression decreases TIMP-1 and miR-618 inhibition decreases MMP-9, suggesting that miR-618 might be an oncomiR. However, the analysis of clinical samples of localized prostate cancer revealed an inconsistent pattern, as increased miR-618 expression was associated with lower Gleason score and pathological status. Further studies are needed to address whether miR-618 is a context-dependent miRNA.

Introduction and objective: Overexpression of MMPs has been related to biochemical recurrence after radical prostatectomy. TIMP1 and TIMP2 are controllers of MMPs and the aim of this study is to evaluate the expression levels of MMPs and their regulators using immunohistochemistry in tissue microarray of localized prostate cancer (PC). Materials and Methods: Immune-expression of MMP-9, MMP-2, TIMP1, TIMP-2, MMP-14 and IL8, were analyzed by immunohistochemistry in radical prostatectomy specimens of 40 patients with localized PC who underwent surgery between September 1997 and February 2000. Protein expression was considered as categorical variables, negative or positive. The results of the immune-expression were correlated to Gleason score (GS), pathological stage (TNM), pre-operatory PSA serum levels and biochemical recurrence in a mean follow up period of 92.5 months. Results: The loss of TIMP1 immune-expression was related to biochemical recurrence. When TIMP1 was negative, 56.3% patients recurred versus 22.2% of those whose TIMP1 was positive (p=0.042). MMP-9, MMP-2, IL8 and MMP-14 were positive in the majority of PC. TIMP-2 was negative in all cases. Conclusion: Negative immune-expression of TIMP1 is correlated with biochemical recurrence in patients with PC possibly by failing to control MMP-9, an important MMP related to cancer progression.

Objective To identify factors associated with survival after palliative urinary diversion (UD) for patients with malignant ureteric obstruction (MUO) and create a risk-stratification model for treatment decisions. Patients and Methods We prospectively collected clinical and laboratory data for patients who underwent palliative UD by ureteric stenting or percutaneous nephrostomy (PCN) between 1 January 2009 and 1 November 2011 in two tertiary care university hospitals, with a minimum 6-month follow-up. Inclusion criteria were age >18 years and MUO confirmed by computed tomography, ultrasonography or magnetic resonance imaging. Factors related to poor prognosis were identified by Cox univariable and multivariable regression analyses, and a risk stratification model was created by Kaplan–Meier survival estimates at 1, 6 and 12 months, and log-rank tests. Results The median (range) survival was 144 (0–1084) days for the 208 patients included after UD (58 ureteric stenting, 150 PCN); 164 patients died, 44 (21.2%) during hospitalisation. Overall survival did not differ by UD type (P = 0.216). The number of events related to malignancy (≥4) and Eastern Cooperative Oncology Group (ECOG) index (≥2) were associated with short survival on multivariable analysis. These two risk factors were used to divide patients into three groups by survival type: favourable (no factors), intermediate (one factor) and unfavourable (two factors). The median survival at 1, 6, and 12 months was 94.4%, 57.3% and 44.9% in the favourable group; 78.0%, 36.3%, and 15.5% in the intermediate group; and 46.4%, 14.3%, and 7.1% in the unfavourable group (P < 0.001). Conclusions Our stratification model may be useful to determine whether UD is indicated for patients with MUO.

OBJECTIVE: The aim of this study is to verify the expression of proteins that are controlled by miR-let7c, 100 and 218 using immunohistochemistry in tissue microarray representative of localized and metastasized the lymph nodes and bone prostate cancer. METHODS: To verify the expression of proteins that are controlled by miR-let7c (C-MYC, BUB1, RAS) 100 (SMARCA5, RB) and 218 (LAMB3) and cell proliferation (Ki-67) we used immunohistochemistry and computerized image system ImageJ MacBiophotonics in three tissue microarrays representative of localized prostate cancer and lymph node and bone metastases. miRNA expression was evaluated by qRT-PCR using 60 paraffin blocks to construct the tissue microarray representative of localized disease. RESULTS: RAS expression was increased in localized prostate cancer and bone metastases compared to the lymph nodes (p = 0.017). RB showed an increase in expression from localized prostate cancer to lymph node and bone metastasis (p = 0.036). LAMB3 was highly expressed in localized and lymph node metastases (p

Background Extracellular matrix homeostasis is strictly maintained by a coordinated balance between the expression of metalloproteinases (MMPs) and their inhibitors. The purpose of this study was to investigate whether the expression of MMP-9 and its specific inhibitors, TIMP-1 and RECK, are expressed in a reproducible, specific pattern and if the profiles are related to prognosis and clinical outcome in prostate cancer (PC). Methods MMP-9, TIMP-1, and RECK expression levels were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR) in fresh-frozen malignant tissue specimens collected from 79 patients with clinically localized PC submitted to radical prostatectomy (RP). Frozen benign prostatic tissue from another 10 men with prostate cancer, also submitted to RP, was analyzed to determine if the profile of gene expression was maintained. The control group consisted of 11 patients with benign prostate hyperplasia (BPH). Results In the tumor samples, MMP-9 was overexpressed by 9.2 times, and TIMP-1 and RECK were underexpressed (0.75 and 0.80 times, respectively). Overexpression of MMP-9 was significantly related to PSA levels above 10 ng/mL (p=0.033). In addition, MMP-9 overexpression was related to biochemical recurrence, with a marginal statistical significance (p=0.089). MMP-9 was also overexpressed in benign tissues of patients with PC, as were TIMP-1 and RECK, in contrast to their underexpression in tumor samples. Conclusion Our results show that MMP-9 is overexpressed and its negative regulators are underexpressed in PC tissue, emphasizing a possible role of MMP-9 in the carcinogenesis process. Additionally, we noticed a relationship between MMP-9 overexpression and increased levels of PSA, an important prognostic factor. In benign tissue adjacent to tumors, the MMP-9 equilibrium is likely maintained because the expression of its negative regulators is preserved.

PURPOSE: The incidence of renal cell carcinoma (RCC) has been rising by 2.3 to 4.3% every year over the past three decades. Previously, RCC has been known as the internist’s tumor; however, it is now being called the radiologist’s tumor because 2/3 are now detected incidentally on abdominal imaging. We compared patients who were treated toward the end of the 20th century to those treated during the beginning of the 21st century with regard to RCC size and type of surgical treatment. MATERIALS AND METHODS: The study included 226 patients. For analysis of tumor size, we considered a cut point of < 4 cm and > 4 cm. For analysis of type of surgery performed, we considered radical and partial nephrectomy. RESULTS: After the turn of the century, there was a reduction of 1.57 ± 0.48 cm in the size of the RCC that was operated on. Nephron sparing surgeries were performed in 17% of the cases until the year 2000, and 39% of the tumors were < 4 cm. From 2001, 64% of the tumors measured < 4 cm and 42% of the surgeries were performed using nephron sparing techniques. Mean tumor size was 5.95 cm (± 3.58) for the cases diagnosed before year 2000, and cases treated after the beginning of 21st century had a mean tumor size of 4.38 cm (± 3.27). CONCLUSIONS: Compared with the end of the 20th century, at the beginning of the 21st century due to a reduction in tumor size it was possible to increase the number of nephron sparing surgeries.

Introduction The knowledge about the molecular biology of clear cell renal cell carcinoma (ccRCC) is evolving, and Carbonic Anhydrase type IX (CA-IX) has emerged as a potential prognostic marker in this challenging disease. However, most of the literature about CA-IX on ccRCC comes from series on metastatic cancer, with a lack of series on non-metastatic cancer. The objective is to evaluate the expression of CA-IX in a cohort of non-metastatic ccRCC, correlating with 1) overall survival, and 2) with established prognostic parameters (T stage, tumor size, Fuhrman nuclear grade, microvascular invasion and peri-renal fat invasion). Materials and Methods This is a retrospective cohort study. We evaluated 95 patients with non-metastatic clear cell renal cell carcinoma, as to the expression of CA-IX. The analyzed parameters where: overall survival (OS), TNM stage, tumor size (TS), Fuhrman nuclear grade (FNG), microvascular invasion (MVI), peri-renal fat invasion (PFI). We utilized a custom built tissue microarray, and the immunoexpression was digitally quantified using the Photoshop® software. Results: Th e mean follow-up time was 7.9 years (range 1.9 to 19.5 years). The analysis of CA-IX expression against the selected prognostic parameters showed no correlation. The results are as follows: Overall survival (p = 0.790); T stage (p = 0.179); tumor size (p = 0.143); grouped Fuhrman nuclear grade (p = 0.598); microvascular invasion (p = 0.685), and peri-renal fat invasion (p = 0.104). Conclusion Carbonic anhydrase type IX expression does not correlate with overall survival and conventional prognostic parameters in non-metastatic clear cell renal cell carcinoma.

Background Cell adhesion molecules (CAMs) are essential for maintaining tissue integrity by regulating intercellular and cell to extracellular matrix interactions. Cadherins and catenins are CAMs that are located on the cell membrane and are important for adherens junction (AJ) function. This study aims to verify if hypercholesterolemic diet (HCD) or bladder outlet obstruction (BOO) promotes structural bladder wall modifications specific to alterations in the expression of cadherins and catenins in detrusor muscle cells. Methods Forty-five 4-week-old female Wistar rats were divided into the following three groups: group 1 was a control group that was fed a normal diet (ND); group 2 was the BOO model and was fed a ND; and group 3 was a control group that was fed a HCD (1.25% cholesterol). Initially, serum cholesterol, LDL cholesterol and body weight were determined. Four weeks later, groups 1 and 3 underwent a sham operation; whereas group 2 underwent a partial BOO procedure that included a suture tied around the urethra. Six weeks later, all rats had their bladders removed, and previous exams were repeated. The expression levels of N-, P-, and E-cadherin, cadherin-11 and alpha-, beta- and gamma-catenins were evaluated by immunohistochemistry with a semiquantitative analysis. Results Wistar rats fed a HCD (group 3) exhibited a significant increase in LDL cholesterol levels (p=0.041) and body weight (p=0.017) when compared to both groups that were fed a normal diet in a ten-week period. We found higher β- and γ-catenin expression in groups 2 and 3 when compared to group 1 (p = 0.042 and p = 0.044, respectively). We also observed Cadherin-11 overexpression in group 3 when compared to groups 1 and 2 (p = 0.002). Conclusions A HCD in Wistar rats promoted, in addition to higher body weight gain and increased serum LDL cholesterol levels, overexpression of β- and γ-catenin in the detrusor muscle cells. Similar finding was observed in the BOO group. Higher Cadherin-11 expression was observed only in the HCD-treated rats. These findings may be associated with bladder dysfunctions that occur under such situations.

Objective: Extracellular matrix homeostasis is strictly maintained by a coordinated balance between the expression of metalloproteinases (MMPs) and their regulators. The purpose of this study was to investigate whether MMP-2 and its specifi c regulators, TIMP-2, MT1-MMP and IL-8, are expressed in a reproducible, specifi c pattern and if the profi les are related to prognosis and clinical outcome of prostate cancer (PCa). Materials and Methods: MMP-2, TIMP-2, MT1-MMP and IL-8 expression levels were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR) in freshly frozen malignant and benign tissue specimens collected from 79 patients with clinically localized PCa who underwent radical prostatectomies. The control group consisted of 11 patients with benign prostate hyperplasia (BPH). The expression profi le of the MMP-2 and its regulators were compared using Gleason scores, pathological stage, pre-operative PSA levels and the fi nal outcome of the PCa. Results: The analysis of 79 specimens of PCa revealed that MMP-2, TIMP-2, MT1MMP and IL-8 were underexpressed at 60.0%, 72.2%, 62.0% and 65.8%, respectively, in malignant prostatic tissue in relation to BPH samples. Considering the prognostic parameters, we demonstrated that high Gleason score tumors (≥ 7) overexpressed MMP-2 (p = 0.048) and TIMP-2 (p = 0.021), compared to low Gleason score tumors (< 7). Conclusion: We have demonstrated that MMP-2 and its regulators are underexpressed in PCa. Alternatively, overexpression of MMP-2 and TIMP-2 was related to higher Gleason score tumors. We postulate that alterations in metalloproteinase expression may be important in the control of tissue homeostasis related to prostate carcinogenesis and tumor behavior.

BACKGROUND Integrins and other adhesion molecules are essential for maintaining the epithelial phenotype. Some studies have reported correlations between abnormalities in their expression and carcinogenesis, but their role in prostate cancer is unclear. Our aim was to study the expression profile of integrins in surgical specimens of prostate cancer and associate their expression patterns with patient outcomes. METHODS We selected 111 patients with localized prostate cancer who had undergone radical prostatectomy. Of these patients, 60 had no tumor recurrence after a median follow-up of 123 months. Integrin expression was evaluated by immunohistochemistry in a tissue microarray containing two tumor samples per patient. A semiquantitative analysis was employed. We measured the association between the expression of eight integrins and tumor recurrence. RESULTS Multivariate analysis showed that expression of α3 and α3β1 was related to worse outcome. When α3 expression was strong and α3β1 expression was positive, the odds of recurrence were 3.0- and 2.5-fold higher, respectively. Only 19% and 28% of patients were recurrence-free in a mean period of 123 months of follow up when their tumors showed strong α3 or positive α3β1 immuno-expression, respectively. CONCLUSIONS We have shown that the expression of integrin α3β1 was independently associated with tumor recurrence after radical prostatectomy, suggesting that this integrin is a potential prognostic marker. Prostate 70: 1189–1195, 2010. © 2010 Wiley-Liss, Inc.

PURPOSE: The aim of our study is to evaluate the undergrading and understaging rates in patients with clinically localized insignificant prostate cancer who underwent radical prostatectomy. MATERIALS AND METHODS: Between July 2005 and July 2008, 406 patients underwent radical prostatectomy for clinical localized prostate cancer in our hospital. Based on preoperative data, 93 of these patients fulfilled our criteria of non-significance: Gleason score < 7, stage T1c, PSA < 10 ng/mL and percentage of affected fragments less than 25%. The pathologic stage and Gleason score were compared to preoperative data to evaluate the rate of understaging and undergrading. The biochemical recurrence free survival of these operated insignificant cancers were also evaluated. RESULTS: On surgical specimen analysis 74.7% of patients had Gleason score of 6 or less and 25.3% had Gleason 7 or greater. Furthermore 8.3% of cases showed extracapsular extension. After 36 months of follow-up 3.4% had biochemical recurrence, defined by a PSA above 0.4 ng/mL. CONCLUSIONS: Despite the limited number of cases, we have found considerable rates of undergrading and understaging in patients with prostate cancer whose current definitions classified them as candidates for active surveillance. According to our results the current definition seems inadequate as up to a third of patients had higher grade or cancer outside the prostate.

PURPOSE: Tumor banks have the primary responsibility for collecting, cataloging, storing and disseminating samples of tissues, cells and fluids, which are used by researchers to identify diagnostic molecular markers, prognostic indicators and therapeutic targets. The objective of this review was to describe a simple, reliable and reproducible protocol for obtaining and storing samples of urological tumors. MATERIALS AND METHODS: Urogenital tumor tissues were collected by the surgeons from the Urology Division of University of Sao Paulo Medical School. The obtained surgical specimens were immediately placed in liquid nitrogen, dry ice or in a tube containing RNAlater ®, and then stored by cryopreservation (-80°C). A mirror fragment was fixed in 10% formalin processed routinely and embedded in Paraplast®. RESULTS: We developed a protocol for the collection, cataloging, storage, conservation and use of tumor samples. During a period of one year the Urological Tumor Bank of the Urology Division stored 274 samples of prostate, bladder, kidney, penis and testicle tumors of different histological types, 74 urine and 271 serum samples. CONCLUSIONS: Having biological materials characterized and available along with the clinical patient information provides an integrated portrait of the patients and their diseases facilitating advances in molecular biology. It also promotes the development of translational research improving methods of diagnosis and cancer treatment.

Objetivo: As moléculas de adesão celular (MAC) são essenciais para a manutenção do fenótipo epitelial. Alguns estudos têm relatado associação entre as alterações de sua expressão e a carcinogênese, mas o seu papel no câncer de próstata não é claro. Nosso objetivo foi estudar o perfil de expressão de E-caderina, cateninas e integrinas em espécimes cirúrgicos de câncer de próstata e associar as suas expressões com a evolução do tumor. Avaliamos também o perfil de expressão em metástases ósseas e linfonodais, a fim de compreender a influência destes marcadores na progressão do câncer de próstata. Materiais e Métodos: Foram selecionados 111 pacientes com câncer de próstata localizado tratados com prostatectomia radical pelo mesmo cirurgião. Sessenta pacientes não apresentaram recidiva tumoral após acompanhamento médio de 123 meses. A expressão das MAC foi avaliada por imuno-histoquímica (IH) em microarranjo tecidual (TMA), contendo duas amostras de cada tumor. Empregamos análise semiquantitativa para avaliação da expressão e determinamos a associação entre a expressão de cada MAC com a recorrência do tumor após a cirurgia. Avaliamos também a expressão das MAC por IH em TMA contendo espécimes de 28 metástases ósseas e em outro TMA contendo 19 metástases linfonodais com seus 19 tumores primários correspondentes. Resultados: Nos tumores primários a análise multivariada mostrou que a expressão das integrinas 3 e 3 1 relaciona-se com recidiva da doença. Quando a expressão de 3 foi forte e a expressão de 3 1 foi positiva, as chances de recorrência foram de 3,0 e 2,5 vezes maior. Apenas 19% e 28% dos pacientes estavam livres de recidiva após seguimento médio de 123 meses, quando os tumores apresentavam forte imunoexpressão de 3 ou positiva para 3 1 respectivamente. Outras integrinas apresentaram expressão reduzida, exceto 6 que foi expressa pela maioria dos tumores primário e metástases. A E-Caderina e as cateninas não mostraram associação com o prognóstico no tumor de próstata localizado. No sítio metastático, houve perda global de expressão das MAC. Encontramos ganho de expressão com a progressão do câncer de próstata somente para a integrina 3 que mostrou forte expressão em metade das metástases ósseas e linfonodais. Encontramos forte expressão de e -catenina foi em 94% dos linfonodos e 45% Conclusões: Nossos experimentos demonstram que a expressão das integrinas 3 e 3 1 está independentemente associada à recidiva de câncer de próstata após prostatectomia radical, e que a perda das moléculas de adesão celular pode ser considerada uma característica da progressão desta neoplasia Purpose: Cell adhesion molecules (CAM) are essential for the maintenance of epithelial phenotype. Some studies have reported correlations between abnormalities in their expression and carcinogenesis, but their role in prostate cancer is unclear. Our aim was to study the expression profile of E-cadherin, catenins and integrins in surgical specimens of prostate cancer and associate their expression with outcome. We also assessed these expressions in bone and lymph node metastases in order to understand their influence in the progression of prostate cancer. Materials and Methods: We selected 111 patients with localized prostate cancer who underwent radical prostatectomy performed by the same surgeon. Sixty patients had no tumor recurrence after a median follow-up of 123 months. The CAM expression was evaluated by immunohistochemistry in a tissue microarray (TMA) containing two samples of each tumor. A semiquantitative analysis was employed and we measured the association between the expression of CAM and tumor recurrence. We also evaluated CAM expression by immunohistochemistry in a TMA containing 28 bone metastases and in other TMA containing 19 lymph node metastases with their corresponding 19 primary tumors. Results: In primary tumors, multivariate analysis showed that expression of 3 and 31 integrins was related to worse outcome. When 3 expression was strong and 31 expression was positive,the odds of recurrence were 3.0 and 2.5 fold higher. Only 19% and 28% of patients were recurrence-free in a mean follow up period of 123 months, when tumors showed strong 3 or positive 31 immuno-expression respectively. Other integrins have shown reduced expression, except 6 , which was expressed in most primary and metastatic cases. E-cadherin and catenins expressions were not associated with primary tumor outcome. At the metastatic setting, there was a global loss of CAM expression. We observed reliable gain of expression with prostate cancer progression only for integrin 3 that showed strong expression in half of bone and lymph node metastases. Interestingly, strong expression of and -catenin was observed in 94% of lymph node and 45% of bone metastases. Conclusions: We have demonstrated that the expression of integrins 3 and 31 was independently associated with recurrence after radical prostatectomy. In addition, we have shown that the loss of cell adhesion molecules can be considered a characteristic of prostate cancer progression

Background Extracellular matrix homeostasis is strictly maintained by a coordinated balance between the expression of metalloproteinases (MMPs) and their inhibitors. The purpose of this study was to investigate whether the expression of MMP-9, MMP-2 and its specific inhibitors, are expressed in a reproducible, specific pattern and if the profiles are related to prognosis in Bladder Cancer (BC). Methods MMP-9, MMP-2 and its specific inhibitors expression levels were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR) in fresh-frozen malignant tissue collected from 40 patients with BC submitted to transurethral resection of bladder. The control group consisted of normal bladder tissue from five patients who had undergone retropubic prostatectomy to treat benign prostatic hyperplasia. Results MMP-9 was overexpressed in 59.0 % of patients, and MMP-2, TIMP-1, TIMP-2, MMP-14, RECK and IL-8 was underexpressed in most of the patients. Regarding prognostic parameters we observed that high-grade tumors exhibited significantly higher levels of MMP-9 and IL-8 (p = 0.012, p = 0.003). Invasive tumors (pT1-pT2) had higher expression levels of MMP-9 than superficial tumors (pTa) (p = 0.026). The same was noted for IL-8 that was more expressed by invasive tumors (p = 0.015, p = 0.048). Most importantly tumor recurrence was related with higher levels of both MMP-9 (p = 0.003) and IL-8 (p = 0.005). Conclusion We have demonstrated that the overexpression of MMP-9 and higher expression of IL-8 are related to unfavorable prognostic factors of urothelial bladder cancer and tumor recurrence and may be useful in the follow up of the patients.

Integrins and adhesion molecules are responsible for the maintenance of the epithelial phenotype. Cell culture studies have reported the correlation between adhesion molecule expression and prostate carcinoma, but their role in the metastatic process is not yet known. Our aim is to study the expression profiles of these molecules and evaluate their association with the metastatic behavior of prostate adenocarcinoma.A Tissue Microarray containing two samples from 19 primary tumors and one from their corresponding lymph node metastases was constructed and subjected to immunohistochemical analysis of the expression of integrins, E-cadherin and beta and gamma-catenins. Within each case, paired analyses were also performed to evaluate gains or losses in metastasis compared to its primary tumor.The expression of av, alphavbeta 3, alpha2beta 1 and gamma-catenin were abnormal in almost every case. Marked loss of E-cadherin and beta 4 integrin was found in primary and metastatic lesions. beta -catenin was normal in all primary cases and in 94% of metastases. a6 was normal in all primary tumors and metastases. alpha3 and alpha3beta 1 were normal in 32% of primary cases and in 53% and 6% of metastases, respectively. In paired analyses, loss of E-cadherin, beta 4, alphav, alpha3beta 1 and alphavbeta 3 was found in 65%, 71%, 59%, 53% and 47% of patients, respectively. Catenins and alpha2beta 1 showed maintenance of expression in most of the cases.In this preliminary study we have shown that the loss of cell adhesion molecules can be considered a characteristic of the metastatic phenotype in prostate cancer. Larger series should be evaluated in order to confirm our findings.

CONTEXTO. O papel da linfadenectomia pélvica estendida (LNDPE) no tratamento cirúrgico de pacientes com câncer de próstata (CaP) permanece controverso, principalmente pela falta de ensaios clínicos randomizados. MÉTODOS. Neste estudo randomizado controlado de fase 3, homens recém-diagnosticados com CaP de risco intermediário ou de alto risco, clinicamente localizados, que escolheram a cirurgia como abordagem terapêutica foram tratados no Instituto do Câncer do Estado de São Paulo, Brasil. Os participantes foram designados aleatoriamente (1:1) para uma dissecção estendida (LNDPE) ou dissecção limitada de linfonodos pélvicos (LNDPL) durante a prostatectomia radical (PR). A LNDPL incluiu a cadeia obturadora bilateralmente, enquanto que a LNDPE incluiu as cadeias obturadora, ilíaca externa, ilíaca interna, ilíaca comum e pré-sacral, bilateralmente. O objetivo primário foi a sobrevida livre de recorrência bioquímica (SLRB) e os objetivos secundários foram a sobrevida livre de metástase (SLM), sobrevida câncer específica (SCE), achados histopatológicos e taxa de complicações. Este estudo foi registrado na plataforma ClinicalTrials.gov, sob número NCT01812902. RESULTADOS. Entre maio de 2012 e dezembro de 2016, 300 homens foram recrutados, dos quais 150 foram aleatoriamente designados para LNDPE e 150 para LNDPL. A mediana de seguimento foi de 54,3 meses. A LNDPE detectou 4,9 vezes mais metástases linfonodais (16,8% [n = 25] no grupo LNDPE vs. 3,4% [n = 5] no grupo LNDPL, p < 0,001). A mediana de SLRB foi de 61,4 meses no grupo LNDPL e não foi alcançada no grupo LNDPE (HR 0,91; IC 95% 0,63- 1,32; p = 0,623). A mediana de SLM não foi alcançada nos dois grupos (HR 0,57; IC 95% 0,17-1,8; p = 0,345). Os dados da SCE não estavam disponíveis porque nenhum paciente morreu de câncer de próstata antes da data de corte. Na análise por intenção de tratamento, a LNDPE aumentou o tempo operatório, a perda estimada de sangue, o tempo de internação, a taxa de transfusão e a incidência de complicações durante os primeiros 90 dias de pós-operatório, de acordo com a escala de Clavien-Dindo. Na análise exploratória de subgrupos, os pacientes com biópsia pré-operatória da Sociedade Internacional de Patologia Urológica (ISUP), graus 3-5, alocados na LNDPE, apresentaram melhora na SLRB (HR 0,33, IC 95% 0,14-0,74, interação p < 0,001). CONCLUSÕES. A LNDPE não está associada a uma melhora na recorrência bioquímica entre homens submetidos à PR para CaP localizado de riscos intermediário e alto. A LNDPE está associada a um melhor estadiamento tumoral e a um aumento das taxas de complicações. Análises exploratórias de subgrupos sugerem que a biópsia pré-operatória ISUP 3, 4 ou 5 pode estar associada a uma melhora na SLRB para pacientes submetidos a LNDPE Background: The role of extended pelvic lymph node dissection (EPLND) in the surgical management of prostate cancer (PCa) patients remains controversial, mainly because of lack of randomized controlled trials (RCT). Methods: In this randomized controlled phase 3 study, men with newly diagnosed clinically localized intermediate- or high-risk PCa who had chosen surgery as their treatment approach were enrolled from Sao Paulo State Cancer Institute, Brazil. Participants were randomly assigned (1:1) to have either extended (EPLND) or limited pelvic lymph node dissection (LPLND) at radical prostatectomy (RP). LPLND included the obturator chain bilaterally, whereas EPLND involved included obturator, external-, internal-, commoniliac and pre-sacral chains bilaterally. The primary endpoint was biochemical recurrence-free survival (BRFS) and the secondary outcomes were metastasis-free survival (MFS), cancer-specific survival (CSS), histopathologic findings and complications. This trial was registered with ClinicalTrials.gov, number NCT01812902. Findings: Between May 2012 and December 2016, 300 men were enrolled, of which 150 were randomly assigned to EPLND and 150 to LPLND. Median follow-up was 54.3 months. EPLND detected 4.9 times more lymph node metastases (16.8% [n=25] in the EPLND group vs. 3.4% [n=5] in the LPLND group, p < 0.001). The median BRFS was 61.4 months in the LPLND group and not reached in the EPLND group (HR 0.91; 95% CI 0.63-1.32; p=0.623). The median metastasis-free survival was not reached in both groups (HR 0.57; 95% CI 0.17-1.8; p=0.345). CSS data were not available because no patient died from prostate cancer prior to the cutoff date. In an intention-to-treat analysis, EPLND increased operative time, estimated blood loss, length of hospital stays, transfusion rate and incidence of complications during the first 90 postoperative days according to Clavien-Dindo scale. In exploratory subgroup analysis, patients with preoperative biopsy International Society of Urological Pathology (ISUP) grades 3-5 who were allocated to EPLND had improved BRFS (HR 0.33, 95% CI 0.14-0.74, interaction p < 0.001). Conclusions: EPLND is not associated with an improvement in biochemical recurrence among men undergoing RP for intermediate- and high-risk localized PCa. EPLND is associated with better tumor staging and increased complication rates. Exploratory subgroup analyses suggest that preoperative ISUP 3, 4 or 5 biopsy may be associated with an improvement in BRFS for patients undergoing EPLND

Introdução: o câncer de próstata é o tipo mais comum entre os tumores malignos que afetam o homem. Dentre as opções terapêuticas para o tratamento do câncer de próstata localizado, destaca-se o tratamento cirúrgico pela prostatectomia radical com elevadas taxas de cura, porém com duas complicações possíveis: a incontinência urinária e a disfunção erétil. Apesar de mais infrequente, a incontinência urinária gera imenso impacto na qualidade de vida dos pacientes. Dentre as diversas vias de acesso para a prostatectomia radical, atualmente, a via robótica-assistida tem sido frequentemente utilizada, mundialmente. Objetivo: avaliar a evolução dos sintomas urinários desde o préoperatório até 12 meses após a operação baseado em questionários validados e tentar identificar preditores da incontinência urinária nos pacientes submetidos à prostatectomia radical robótica-assistida. Métodos: foram coletados prospectivamente os dados de 998 pacientes submetidos à prostatectomia radical robótica-assistida pelo mesmo cirurgião desde março de 2010 até maio de 2018. Foram documentados dados demográficos, informações pré-operatórias e pósoperatórias dos pacientes. Também foram aplicados os questionários ICIQ e IPSS no pré-operatório e após 1, 3, 6 e 12 meses de pós-operatório de cada paciente. Os dados foram tabulados e submetidos a análise estatística com significância de 5%. Resultados: de 998 pacientes, 257 preencheram corretamente todos os questionários pré-operatórios e tiveram todos as variáveis a serem estudadas, coletadas. A idade média dos pacientes foi de 60 ± 0,74 anos, o IMC médio foi de 26,88 kg/m2 ± 0,47 kg/m2, PSA pré-operatório foi de 6,15 ng/mL ± 0,36 ng/mL, volume prostático de 38,6 cm3 ± 2,0 cm3, 62 (24%) pacientes tinham tumor ISUP 1, 152 (59%) tumor ISUP 2, 38 (15%) ISUP 3, nenhum paciente com tumor ISUP 4 e 5 (2%) dos pacientes com tumor ISUP 5; tempo operatório total de 149 ± 4,4 minutos, sangramento aspirado de 282 mL ± 24 mL. Verificou-se que o IPSS subia inicialmente e aos 6 meses após a operação, este já se tornava inferior ao valor inicial pré-operatório (7,76 aos 6 meses vs. 9,90 pré-operatório). Quanto às variáveis do ICIQ, houve elevação com a prostatectomia radical e nenhuma delas retornou ao patamar préoperatório. Quanto aos preditores de incontinência urinária, com 1 mês de pósoperatório verificou-se na análise multivariada que idade (OR = 0,95, IC95% 0,912-0,992, p = 0,0057), margem circunferencial (OR = 0,40, IC95% 0,209-0- 791, p = 0 0106) e questão 4 do IPSS (OR = 0,77, IC95% 0,626-0,969, p = 0,0250) foram preditoras de incontinência. Conclusões: o IPSS inicialmente piora após a prostatectomia radical robótica-assistida e depois regride para valores abaixo dos valores pré-operatórios após 6 meses da operação. O ICIQ se eleva com a operação e se estabiliza cerca de 12 meses após a mesma. Idade avançada, margem cirúrgica circunferencial positiva e a quarta questão do IPSS são preditores precoces de incontinência urinária Introduction: prostate cancer is the most common type among malignant tumors that affect men. Among the therapeutic options for the treatment of localized prostate cancer, surgical treatment by radical prostatectomy with high cure rates stands out, but with two possible complications: urinary incontinence and erectile dysfunction. Although more infrequent, urinary incontinence has a huge impact on patients\' quality of life. Among the various access techniques for radical prostatectomy, currently, the robotic-assisted tecnhique has been the most accepted worldwide. Objective: to assess the evolution of lower urinary tract symptoms from the preoperative period up to 12 months after the operation based on validated questionnaires and to attempt to identify predictors of urinary continence in patients undergoing robotic-assisted radical prostatectomy. Methods: data were prospectively collected from 998 patients who underwent robotic-assisted radical prostatectomy by the same surgeon from March 2010 to May 2018. Demographic data, preoperative and postoperative information on the patients were documented. The ICIQ and IPSS questionnaires were also applied preoperatively and 1, 3, 6 and 12 months after prostatectomy to each patient. The data was tabulated and submitted to statistical analysis with a significance of 5%. Results: of 998 patients, only 257 correctly completed all preoperative questionnaires and had all variables to be studied, collected. The mean age of the patients was 60 ± 0.74 years, the mean BMI was 26.88 kg/m2 ± 0.47 kg/m2, preoperative PSA was 6.15 ng/mL ± 0.36 ng/mL, a prostate volume of 38.6 cm3 ± 2.0 cm3, 62 (24%) patients had ISUP 1 tumor, 152 (59%) ISUP 2 tumor, 38 (15%) ISUP 3 tumor, no patient with ISUP tumor 4 and 5 (2%) patients with ISUP 5 tumor; total operative time of 149 ± 4.4 minutes, aspirated blood loss was 282 mL ± 24 mL. It was found that the IPSS rose initially and at 6 months after the operation, it was already lower than the initial preoperative value (7.76 at 6 months vs. 9.90 preoperative). As for the ICIQ variables, there was an increase with radical prostatectomy and none of them returned to the preoperative level. Regarding the predictors of urinary continence, 1 month after the operation, in multivariate analysis, age (OR = 0.95, 95% CI 0.912-0.992, p = 0.0057), circumferential margin (OR = 0.40, 95% CI 0.209-0-791, p = 0 0106) and question 4 of the IPSS (OR = 0.77, 95% CI 0.626-0.969, p = 0.0250) were predictors of incontinence.. Conclusions: IPSS initially worsens after robotic-assisted radical prostatectomy and then regresses to values below preoperative values 6 months after the operation. The ICIQ rises with the operation and stabilizes about 12 months after it. Advanced age, positive circumferential surgical higher scores in the fourth question of the IPSS questionnaire are early predictors of urinary incontinence

INTRODUÇÃO: Os rins são alvos de diversas patologias que comprometem o seu funcionamento em graus variáveis, e em muitos casos, a nefrectomia é o melhor tratamento disponível. Atualmente existe um grande interesse na literatura no intuito de tentar prever como será a evolução da função renal do paciente após uma nefrectomia. Alguns estudos retrospectivos propuseram métodos para esta estimativa, no entanto, suas metodologias possuem falhas e seus resultados são contraditórios. OBJETIVOS: Avaliar de maneira prospectiva os fatores prognósticos préoperatórios associados a evolução da função renal seis meses após nefrectomias unilaterais utilizando para esta análise, um método radioisotópico de referência (51Cr- EDTA). Em seguida, elaborar um modelo matemático com o objetivo de predizer o ritmo de filtração glomerular (RFG) pós-operatório. Além disso, avaliar qual das equações mais usadas para estimativa do RFG por meio da creatinina sérica (Cockcroft-Gault, MDRD e CKD-EPI) tem melhor concordância com o 51Cr-EDTA. MÉTODOS: Este é um estudo prospectivo onde foram coletados dados demográficos, clínicos, laboratoriais e radiológicos pré-operatórios e seis meses após a nefrectomia, incluindo variáveis pouco ou nunca antes estudadas como a função renal diferencial na cintilografia com DMSA e o RFG mensurado por meio de estudo radioisotópico (51Cr-EDTA). Análises univariadas e multivariadas foram realizadas para identificar possíveis fatores de risco independentes para a piora da função renal. Essas variáveis foram então utilizadas na elaboração de um modelo matemático cujo objetivo foi estimar a função renal pós-operatória dos pacientes, utilizando para isso, apenas variáveis pré-operatórias. Por meio de estudos de correlação, os valores do RFG estimados pelas equações que utilizam a creatinina sérica foram comparados aos valores mensurados por meio do 51Cr-EDTA para avaliar qual tinha melhor concordância com o método padrão-ouro. RESULTADOS: De Abril de 2014 a Janeiro de 2018, 107 pacientes foram incluídos e completaram o protocolo de pesquisa. Doenças benignas foram responsáveis pela indicação da nefrectomia em 63,6% dos casos. Na análise univariada, diversas variáveis foram identificadas como possíveis fatores associados à evolução da função renal: idade, HAS, DM, DLP, DMSA e 51Cr-EDTA pré-operatórios. Entretanto, a análise multivariada demonstrou que a idade avançada (p=0,008), uma função relativa alta no DMSA do rim retirado (p < 0,001) e um valor de 51Cr-EDTA pré-operatório reduzido (p < 0,001) foram as variáveis que mantiveram significância e portanto foram consideradas fatores de risco independentes. A partir destas variáveis, elaborou-se um modelo matemático para estimativa do RFG pós-operatório (51Cr-EDTA pós-operatório = 37,9 - (0,29 x Idade) - (0,42 x DMSA RA) + (0,67 x 51Cr-EDTA pré-operatório). Por meio de análises de correlações, demonstrou-se que os valores do RFG obtidos por meio da equação CKD-EPI apresentavam melhor concordância com os valores mensurados com o 51Cr-EDTA. CONCLUSÕES: O presente protocolo de pesquisa demonstrou que a idade, o DMSA e o 51Cr-EDTA pré-operatórios estão significativamente associados à evolução da função renal após nefrectomias unilaterais e possibilitou a construção de um modelo para predizer o RFG pós-operatório. Também demonstrou que a equação CKD-EPI apresenta melhor concordância com o método considerado padrão-ouro para medida do RFG nesta população de pacientes INTRODUCTION: The kidneys can be affected by pathologies that compromise their function in several degrees and unilateral nephrectomy is the best treatment option in many cases. However, there are still controversies about the renal function outcomes after nephrectomies and there are few retrospective studies that proposed models to estimate the postoperative glomerular filtration rate (GFR) after surgery. Moreover, they have methodological flaws and contradictory results. OBJECTIVES: To prospectively evaluate preoperative prognostic factors associated to renal function outcomes six months after unilateral nephrectomies with a gold-standard isotopic technique (51Cr-EDTA). To formulate a model for estimate the postoperative GFR. And to evaluate which equation for GFR estimation using serum creatinine has the best concordance to the 51Cr-EDTA. METHODS: Preoperative variables were prospectively collected and included: demographics, clinical, laboratorial and imaging studies. Univariate and multivariate analyses were done to identify the independent risk factors associated to renal function outcomes. These variables were used to create a model in order to predict the postoperative GFR. Correlation analyses were performed to evaluate which equation for GFR estimation using serum creatinine has the best concordance to the gold-standard isotope technique. RESULTS: One hundred and seven patients were enrolled and completed the study protocol from April 2014 to January 2018. Nephrectomy was performed for a benign disease in 63,2% of patients. After univariate and multivariate analyses, older age (p=0,008), higher split function of the affected kidney in DMSA scintigraphy (p < 0,001) and lower values of preoperative 51Cr-EDTA (p < 0,001) were identify as independent risk factors for postoperative GFR worsening. Using these variables, a mathematical model was elaborated to predict the postoperative GFR (postoperative 51Cr-EDTA = 37.9 - (0.29 x Age) - (0.42 x DMSA) + (0.67 x preoperative 51Cr-EDTA). Correlation analyses showed that GFR estimated by CKD-EPI equation has the best concordance to GFR measured by 51Cr-EDTA. CONCLUSIONS: The present study protocol demonstrated that age, DMSA and preoperative 51Cr-EDTA are significantly associated to postoperative renal function outcomes after unilateral nephrectomies and permitted the elaboration of a model to predict the postoperative GFR. Also demonstrated that CKD-EPI equation has the best concordance to the gold-standard technique for GFR measurement

Introdução: Biopsia de próstata com único fragmento comprometido geralmente associa-se a um câncer de próstata (CaP) pequeno e de baixo risco. O objetivo é avaliar e comparar os achados patológicos dos pacientes com único versus múltiplos fragmentos comprometidos à biopsia que foram submetidos a prostatectomia radical (PR) e correlacioná-los com CaP de baixo risco. Material e Métodos: Foram avaliados 249 pacientes com único fragmento comprometido à biopsia (grupo 1) e 250 pacientes com múltiplos fragmentos (grupo 2) que foram submetidos a PR. Os grupos foram pareados de acordo com idade, peso da próstata, níveis de antígeno prostático específico (PSA) e estadio clínico. Foram avaliadas a concordância do escore de Gleason (EG), margem cirúrgica positiva (MCP), extensão extraprostática (EEP) e invasão de vesículas seminais (IVS). Também foram avaliadas a influência do número de fragmentos biopsiados e do peso prostático. Resultados: EG da biopsia foi idêntico ao EG pós-PR em 55% no grupo 1 e 45% no grupo 2 (p = 0,028). Biopsias com 12 ou mais fragmentos mostraram maior concordância em ambos os grupos quando comparadas aos com menos de 12 fragmentos (p = 0,01 no grupo 1). Subgraduação foi a discrepância mais comum no EG (35% no grupo 1 e 50% no grupo 2), com uma proporção maior no grupo 1 quando menos de 12 fragmentos foram biopsiados (p = 0,007). O grupo 1 apresentou menores taxas de MCP (20,9% vs 37,6%, p < 0,001), de EEP (10% vs 26%, p < 0,001) e IVS (6% vs 13,2%, p = 0,006). As taxas de MCP, EEP e IVS aumentaram com o aumento de EG em ambos os grupos. No grupo 1, biopsias com menos de 12 fragmentos obtiveram maiores taxas de MCP em relação as com 12 ou mais fragmentos (37% vs. 16%, p < 0,001), e esta diferença não ocorreu no grupo 2 (p = 0,69). No grupo 1, pacientes com EG >= 8 tiveram 3,5 vezes mais chance de estar associado com MCP quando comparados àqueles com EG = 8 was 3,5 times more likely associated with PSM than GS

Introdução: Os micro RNA (miRNA) são formados a partir de RNA precursores de fita dupla que contém entre 60 a 110 nucleotídeos e formam estruturas do tipo hairpin. Imediatamente após sua transcrição pela RNA polimerase II a enzima Dicer promove a clivagem do RNA precursor em seqüências menores contendo 19 a 22 nucleotídeos. Após a clivagem, o miRNA integra-se ao complexo silenciador induzido pelo RNA (RISC) que o conduz ao seu RNA mensageiro (mRNA) homólogo recém transcrito. Esta associação promove a degradação do mRNA, ou interfere na tradução da proteína caracterizando um grande mecanismo de controle da expressão dos genes. Este mecanismo está relacionado ao desenvolvimento de órgãos e tecidos, e está envolvido no processo de carcinogênese. Nosso objetivo é identificar um perfil de expressão de miRNA que defina o adenocarcinoma de próstata de prognóstico favorável e desfavorável considerando os níveis de PSA e dados anatomopatológicos. Materiais e métodos: Foram selecionados 53 pacientes com tumores desfavoráveis (mediana do escore de Gleason igual a 8, 79,2% estadiados pT3, mediana de PSA 10,1 ng/mL e mediana do volume tumoral de 23%) e 45 considerados favoráveis (mediana do escore de Gleason igual a 5, 80% estadiados pT2, mediana de PSA de 7,8 ng/mL e mediana do volume tumoral de 11,5%). O controle foi representado por 7 pacientes com hiperplasia prostática benigna (HPB). Todos os pacientes foram submetidos a prostatectomia radical pelo mesmo cirurgião. Os espécimes cirúrgicos foram examinados na sua totalidade pelo mesmo patologista. A análise dos miRNA foi feita a partir de tecido congelado e tecido incluído em parafina usando a técnica da reação em cadeia da polimerase em tempo real quantitativa (qRT-PCR) utilizando primers e sondas Taqman® específicas. O RNU43 foi usado como controle interno. Resultados: Com exceção dos miRNA 199a, 21, 15a, 16 e 25 que se mostraram subexpressos tanto nos casos desfavoráveis como nos favoráveis, houve uma diminuição global na expressão dos miRNA com redução estatisticamente significativa na expressão dos miRNA 143, 145 e 146a, 191, 218 e Let7c em tumores desfavoráveis em relação aos tumores favoráveis. Conclusão: Demonstramos que no processo de transição entre os carcinomas favoráveis e desfavoráveis de próstata existe uma perda global na expressão de miRNA que podem ser importantes controladores de expressão de uma série de genes relacionados a progressão desta neoplasia. Dados experimentais avaliando o papel desses miRNA devem ser conduzidos para que possamos definir seu papel na evolução do câncer de próstata Introduction: micro RNA (miRNA) are formed from double-stranded RNA precursors that contain between 60-110 nucleotides and form structures such as hairpin. Immediately after their transcription by RNA polymerase II, the enzyme Dicer promotes the cleavage of precursor RNA sequences containing minor 19-22 nucleotides. After cleavage, the miRNA is part of the RNA-induced silencing complex (RISC) that leads to its messenger RNA (mRNA) newly transcribed counterpart. This association promotes the degradation of mRNA, or interferes with the protein translation characterizing a great mechanism for controlling gene expression. This mechanism is related to the development of organs and tissues, and may be involved in the process of carcinogenesis. Our goal is to identify a miRNA expression profile that distinguishes prostate adenocarcinoma of favorable and unfavorable prognosis considering the PSA and pathological findings. Material and Methods: We studied 53 patients with tumors considered unfavorable (Median of Gleason score 8, 79.2% staged pT3, median of PSA 10.1 ng/mL and median of tumor volume of 23%) and 45 considered favorable (Median of Gleason score 5, 80% staged pT2, median of PSA 7.8 ng/mL and median of tumor volume of 11.5%). The control group was represented by seven patients with benign prostatic hyperplasia (BPH). All patients underwent radical prostatectomy by the same surgeon. The surgical specimen was examined entirely by the same pathologist. The analysis of miRNA was made from frozen and paraffin embedded tissue by quantitative real-time polymerase chain reaction (qRT-PCR) using the Taqman® specific primers and probes. The RNU43 was used as a internal control. Results: Except for miRNAs 199a, 21, 15a, 16 e 25 that were underexpressed by both favorable and unfavorable prostate cancer, there was a global decrease of all miRNAs studied, and some differences were statistically significant as miRNAs 143, 145 e 146a, 191, 218 e Let7c that were underexpressed in unfavorable carcinomas compared favorable tumor. Conclusion: We have demonstrated that in the process of transition between favorable and unfavorable prostate cancer there is a global loss of expression of miRNAs. These molecules can be important controllers of a series of genes related to cancer progression. Experimental studies are needed in order to comprehend the role of these genes in prostate carcinogenesis

Introdução: A eficácia da litotripsia extracorpórea por ondas de choque (LECO) no tratamento de cálculos em cálice inferior do rim ainda é motivo de controvérsia. Variáveis que possam impactar nos resultados da LECO ainda não estão bem estabelecidos. Objetivo: Avaliar quais variáveis impactam na fragmentação e eliminação de cálculos em cálice inferior do rim após LECO. Material e Métodos: Avaliamos prospectivamente pacientes submetidos à LECO para tratamento de cálculos de cálice inferior de 5 a 20 mm. O índice de massa corpórea (IMC) e a circunferência abdominal foram medidos em cada caso. Um único radiologista, cego aos resultados da LECO, mensurou o tamanho, área e densidade dos cálculos, assim com a distância pele-cálculo, o comprimento, largura e altura infundibular, e o ângulo pielo-calicinal baseado na tomografia computadorizada (TC) realizada antes do procedimento. As taxas de fragmentação, sucesso (cálculos residuais 30 kg/m2 apresentam uma menor taxa de fragmentação dos cálculos. Tamanho (> 10 mm) e densidade (>900 UH) do cálculo, assim com o comprimento infundibular (>25 mm) influenciam negativamente nos resultados da LECO Introduction: The efficiency of shock wave lithotripsy (SWL) for treatment of lower pole stone is still controversial. Variables that could impact on SWL outcomes are not well established. Objective: To evaluate which variables impact fragmentation and clearance of lower pole calculi after SWL. Material and Methods: We prospectively evaluated patients undergoing SWL for solitary lower pole kidney stones ranging from 5-20mm. Patient\'s body mass index (BMI) and abdominal waist circumference were recorded. One radiologist, blinded to SWL outcomes, measured stone size, area and density, stone-skin distance, infundibular length, width and height, and infundibulopelvic angle based on baseline noncontrast computed tomography (NCCT). Fragmentation, success (residual fragments 30 Kg/m2 have a lower stone fragmentation rate. Stone size ( > 10 mm) and stone density (>900 UH), as well as infundibular length ( > 25 mm) impact negatively on SWL outcomes

INTRODUÇÃO: O câncer de próstata é responsável por 15% dos casos novos de câncer que acometem os homens e pela 5ª causa de morte. As técnicas minimamente invasivas, sobretudo a cirurgia robótica tornou-se a técnica comumente empregada nos Estados Unidos. Muitos artigos tentam demonstrar a curva de aprendizado necessária para a estabilização dos resultados, mas a implementação de novas tecnologias passa por diversos desafios, além da avaliação de seus resultados e dos custos, o que em países em desenvolvimento pode ter um importante impacto no sistema de saúde. OBJETIVO: Avaliar a curva de aprendizado da prostatectomia radical laparoscópica robótica assistida (PRRA) para o tratamento do câncer de próstata, de acordo com a continência urinária, a potência sexual, o tempo cirúrgico e o controle oncológico. MÉTODOS: Duzentos pacientes com neoplasia de próstata localizada submetidos à PRRA por um único cirurgião foram divididos em quatro grupos de acordo com a sequência das cirurgias. Foram avaliados os dados intra-operatórios, como: tempo cirúrgico, perda sanguínea estimada e as margens cirúrgicas. Também durante o pósoperatório foram avaliadas a potência (IIEF) e a continência (ICIQ). RESULTADOS: Os pacientes apresentaram idade média de 60,6 anos (59,72-61,61), volume prostático ao toque retal de 40 gramas e valor do PSA 6,95 ng/ml (5,79-8,10) semelhantes em todos os grupos (p > 0,05). A biópsia prostática pré-operatória mostrou diferença no escore de Gleason e no tamanho da próstata, sendo que o escore 6 foi menos frequente no grupo 4, representado por 23 pacientes (46%) e no grupo 1, com 39 pacientes (78%) (p < 0,01). Já o tamanho prostático avaliado pelo USTR foi de 39,6 gramas (29,75-48,7) no grupo 4 e 30,5 gramas (23,0-38,15) no grupo 2. A curva de aprendizado estabelecida demonstrou uma diminuição no tempo cirúrgico de 157 minutos (145-170) no grupo 1, para 132 minutos (119-140) no grupo 2 (p < 0,01). A perda sanguínea estimada também se reduziu aproximadamente pela metade: de 395 ml (250-500) no grupo 1, para 200 ml (150-250) no grupo 3 (p < 0,01). As margens positivas reduziram de 16% para apenas 8%, mas se mostraram estatisticamente semelhantes (p=0,236). A capacidade de penetração com doze meses praticamente dobrou de 38% (19 pacientes) no grupo 1 para 80% (40 pacientes) no grupo 4 (p=0,003). A continência avaliada com um ano mostrou-se melhor no grupo 4 (98%) quando comparado aos pacientes do grupo 1 (94%) (p=0,001). As complicações foram estatisticamente semelhantes entre os quatro grupos (p = 0,668). A análise da recidiva bioquímica não demonstrou diferença (p > 0,05). CONCLUSÕES: A curva de aprendizado da PRRA é variável de acordo com o parâmetro a ser avaliado, e apesar do equipamento e da tecnologia, à medida que se aumenta a experiência do cirurgião, melhores resultados são obtidos. O tempo de cirurgia e o sangramento estabilizaram-se, respectivamente, após 50 e 100 PRRA. A potência e a continência, por sua vez, estabilizaram-se após 150 PRRA. É importante ressaltar que o controle oncológico necessita de um período de acompanhamento mais longo para ser avaliado BACKGROUND: Prostate cancer is responsible for 15% of new cases of male cancer and is the fifth leading cause of death. Minimally invasive and mainly, robotic surgery technique became the technique most widely utilized in the United States. Many articles have tried to demonstrate the required learning curve to achieve the plateau. Although, new techniques implementation go through many challenges besides the evaluation of its results, costs also became an issue, which may impact in developing countries health system. OBJECTIVE: We aim to evaluate the learning curve of robot-assisted radical prostatectomy (RARP) for the treatment of prostate cancer, according to continence, potency, surgical time and oncologic control. METHODS: Two hundred patients with localized prostate cancer that underwent RARP by a single surgeon were divided into four groups according to its surgical sequence. Intraoperative data, such as surgical time, estimated blood loss and margins were recorded. Also postoperative functional parameters as continence and potency were gathered using validated questionnaires (ICIQ and IIEF). RESULTS: Patients mean age were 60.6 years (59.72- 61.61), mean prostate volume at digital rectal examination was 40 grams and PSA value 6.95 ng/ml (5.79-8.10) were similar in all groups (p > 0.05). Pre-operative prostate biopsy showed difference in Gleason score and prostate size. Gleason score 6 was less frequent in group 4, 23 patients (46%), than group 1, 39 patients (78%)(p 0.05). CONCLUSIONS: Therefore, the learning curve of the RARP is variable according to the evaluated parameter and obviously, despite the equipment and technology, the increase of surgical experience the best the outcome. Surgery time plateau were achieved at 50 RARP, estimated blood loss stabilized after 100 surgeries, sexual function and urinary continence after 150 RARP. Cancer control requires a longer follow-up period for review