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The potential association of acute renal infarction with multiple thrombophilic gene polymorphisms and the experience of treatment with tenecteplase are described for the first time in the international literature.The case of a 50-year old male with segmental acute renal infarction potentially associated with multiple thrombophilic gene polymorphisms is presented. He was thrombolysed with a single intravenous bolus of tenecteplase in a weight-adjusted dose (0.53mg/Kg bodyweight). Within 30 minutes after drug administration, the patient's symptoms were completely relieved. Patient's clinical course was uneventful with an acceptable renal function outcome eight weeks post-treatment. The following gene polymorphisms were identified: G455A (b-fibrinogen); C677T; A1298C (methylenetetrahydropholate reductase); T196C (platelet glycoprotein IIIa); 4G/5G (plasminogen activator inhibitor-1).Tenecteplase is a safe and simple to use thrombolytic, with favourable pharmacokinetic profile, which might be useful if administered early, especially when local thrombolysis is impossible or unavailable and therefore warrants further investigation in clinical trials. Hippokratia 2014; 18 (1): 67-70.

Context: Compared with standard white-light cystoscopy, photodynamic diagnosis with blue light and the photosensitiser hexaminolevulinate has been shown to improve the visualisation of bladder tumours, reduce residual tumour rates by at least 20%, and improve recurrence-free survival. There is currently no overall European consensus outlining specifically where hexaminolevulinate is or is not indicated. Objective: Our aim was to define specific indications for hexaminolevulinate guided fluorescence cystoscopy in the diagnosis and management of non-muscle invasive bladder cancer (NMIBC). Evidence acquisition: A European expert panel was convened to review the evidence for hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and management of NMIBC (identified through a PubMed MESH search) and available guidelines from across Europe. On the basis of this information and drawing on the extensive clinical experience of the panel, specific indications for the technique were then identified through discussion. Evidence synthesis: The panel recommends that hexaminolevulinate-guided fluorescence cystoscopy be used to aid diagnosis at initial transurethral resection following suspicion of bladder cancer and in patients with positive urine cytology but negative white-light cystoscopy for the assessment of tumour recurrences in patients not previously assessed with hexaminolevulinate, in the initial follow-up of patients with carcinoma in situ (CIS) or multifocal tumours, and as a teaching tool. The panel does not currently recommend the use of hexaminolevulinate-guided fluorescence cystoscopy in patients for whom cystectomy is indicated or for use in the outpatient setting with flexible cystoscopy. Conclusions: Evidence is available to support the use of hexaminolevulinate-guided fluorescence cystoscopy in a range of indications, as endorsed by an expert panel. (c) 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.

The introduction and common use of serum PSA (Prostate Specific Antigen) has been demonstrated a useful index on latent prostate cancer diagnostic but in the same time has increased surgical intervention on histological forms with no eventual future evolution. Benign comportment of latent carcinomas being well known in advance, we correlated in vitro serum PSA from latent tumors, with the samples from a control group (prostates without signs of malignization). Levels of PSA were slightly elevated compared to age norms, mainly in cases with a large coexistent hypertrophy. Our reduced sample does not stand any statistic analysis, but this observation could eventually explain increased diagnostic and hyper-treatment of non-important carcinomas from a clinical point of view.

Aims: To study the value, in diagnostic terms, of performing transrectal ultrasound (TRUS)-guided anastomotic biopsy immediately following the diagnosis of biochemical failure in patients treated by radical retropubic prostatectomy. Methods: We report on 50 sessions of TRUS-guided biopsy obtained during post-radical retropubic prostatectomy follow-up, immediately after the diagnosis of biochemical failure. No patient had received either adjuvant or further treatment due to biochemical failure status prior to the biopsy session. In each case, tissue sampling involved cores taken by a standard protocol (random) as well as TRUS-guided biopsy to sonographically suspicious areas. Statistical analysis focused on identifying the statistical importance of various pre- and post-treatment variables in predicting biopsy outcome. Results: 10/50 cases with local evidence of malignancy (1 case harboring both benign and malignant glands) were identified and in another 10/50 cases benign prostatic tissue was diagnosed. The remaining (30) cases have shown fibromuscular tissue only. Statistical analysis of various parameters has demonstrated a significant correlation between local evidence of cancer and the finding of sonographically remarkable areas. Conclusion: Performing TRUS-guided anastomotic biopsy close to the onset of biochemical failure can frequently identify but also may easily miss the suspected local presence of prostate tissue. We believe that, with minimal risks of morbidity, there is merit in exploring its possibilities to trace local prostatic tissue, since it may provide useful information for further treatment actions also in an earlier time. Copyright © 2008 S. Karger AG.

Background/aim: The effects of printed educational material on cancer screening in women (Pap test and mammography) are well documented and confirmed by several studies. The aim of our study was to evaluate the impact of similar printed educational material on prostate cancer screening by PSA and DRE. Material and methods: Thousand five hundred men aged between 50 and 86 years of age, who attended our institutions for various medical conditions except prostate-related conditions, were randomly assigned to two study groups. Men in the informed group, received an educational leaflet with simple, general information on prostate cancer screening methods given by their physician along with treatment and other regular recommendations, while men in the non-informed group, were only informed by their physician in the examination room during an interview. Results: After 24 months, there was no statistically significant difference between the two groups in terms of DRE screening. The percentages of men who were actually screened by DRE were 4 and 5% in the informed and non-informed groups, respectively, while the difference in the percentages of PSA screening was of statistical significance, with 31% of men screened in the non-informed group as compared to 93% of men screened in the informational leaflet group. Conclusions: A single, one-shift distribution of printed educational material on prostate cancer screening, changed their attitude regarding prostate cancer screening only in favour of PSA testing, while did not manage to change the DRE acceptance behavior. However, since the combination of the two tests is more sensitive for diagnosis than either one alone, there is a need of introducing intervention strategies, in the efforts of ameliorating the prostate cancer screening behavior. © Springer-Verlag 2008.

Objective: To explore whether or not statins have any impact on the progression of components of benign prostatic hyperplasia (lower urinary tract symptoms severity, prostate volume and serum prostate specific antigen (PSA) when combined with other agents inhibiting growth of prostate cells. Materials and Methods: This was a preliminary, clinical study. Eligible patients were aged > 50 yrs, with International Prostate Symptom Score (IPSS) between 9 and 19, total prostate volume (TPV) > 40 mL, and serum PSA > 1.5 ng/mL. Patients were divided in two groups: those with and those without lipidemia. After selection, eligible BPH patients with lipidemia (n = 18) were prescribed lovastatin 80 mg daily and finasteride 5 mg daily, while eligible patients without lipidemia (n = 15) were prescribed only finasteride 5 mg daily. IPSS, TPV and serum PSA were evaluated at end point (4 months). Results: There was no difference between the two groups on the primary end point of mean change from baseline in IPSS (p = 0.69), TPV (p = 0.90) and PSA (p = 0.16) after 4 months of treatment. Conclusions: Short-term lovastatin treatment does not seem to have any effect on IPSS, TPV and PSA in men with prostatic enlargement due to presumed BPH.

Background: The discrepancy between minimal disease on biopsy and disease found in the subsequent prostatectomy specimen, in terms of the size and grade of tumor, extracapsular extension or positive margins, led several authors to dispute the existence of clinically insignificant impalpable tumors of the prostate. However, considering that prostate-specific antigen (PSA) is an indicator of prostate malignancy and since many impalpable prostatic carcinomas (PCs) are detected by a combination of PSA, transurethral ultrasound and needle biopsy (T1c), in the era of PSA screening, it is expected that most of the impalpable tumors found incidentally at transurethral resection of the prostate (stage T1a/b), could be clinically insignificant. Aim: The aim of this study was to identify the characteristics of latent, impalpable PCs and to analyze the incidence of clinically insignificant PCs among hypothetical stage T1 prostate cancers in tumors found incidentally at postmortem examination. Methods: We examined 40 cases of impalpable PCs found in 212 prostate autopsy specimens of men between 30 and 98 years of age who died of diseases other than carcinoma of the prostate and related conditions. Results: Most of T1 histological PCs (57.5%) had a Gleason score between 2 and 4, while 30% had Gleason score between 5 and 6. Only 5 (12.5%) had a Gleason score above 7. Twenty-nine of 40 stage T1 histological cancers (67.5%) had volume of

The aim of this paper is to describe a rare clinical case of spontaneous haemorrhagic rupture of a multicystic kidney in a patient on haemodialysis for acquired cystic disease. We also discuss current issues about the management of this rare condition, with a short review of the literature.

A series of 212 prostate specimens of men dead between August 2002 -August 2004, have been sectioned in consecutive autopsies and subjected to whole mount analysis in purpose to determine the epidemiology of impalpable prostate cancer in Greece. Impalpable prostate carcinomas were found in 40 cases (18.8%) most in the peripheral region. In all, 29 of 40 impalpable cancers (70.7%) had volume less than 1cm3. Most of impalpable carcinomas were of favorable (Gleason score 2-4) or intermediate (Gleason score 5 and 6) histological type (55 and 27.7%7, respectively) while only five (12.5%) were undifferentiated (Gleason score 7 and 8). In all, 24 (60%) of the 40 impalpable carcinomas were multifocal and consisted of two or more foci, most of small size (

OBJECTIVE. The present study investigates the incidence of impalpable carcinoma of the prostate and the pathological findings of impalpable prostate carcinoma (PC) detected in autopsy material. The frequency of pre-carcinomatous and non-carcinomatous lesions as well as their relationship to the impalpable PC, were also examined. MATERIALS AND METHODS. Data were obtained from 212 autopsy specimens of the prostate gland, of men aged above 30 and under 98 years of age, born and living in Greece, who died (between 8/2002 and 8/2004), of causes other than carcinoma of the prostate. RESULTS. The age-independent frequency of histological PC in our study’s population is 18.8% (ranging from 0% to 56.2% according to different age groups), whereas the age-independent frequency of histological benign prostate hyperplasia is 65.5% (ranging from 27.7% to 90.6%), of atypical adenomatous hyperplasia 15.5% (ranging from 5.5% to 25%), of prostatic intraepithelial neoplasia (PIN) 26.4% (ranging from 5.5% to 47.2%) and of prostate atrophy (PA) 10.3% (ranging from 0% to 43.7%). There was a statistically significant correlation between PIN and PC volume. Most impalpable carcinomas found within necropsy material were characterized by small volume, favorable histological type, and relatively low aggressiveness. The prevalence of PC and pre-carcinomatous lesions in our study population appears to be lower than that of most autopsy studies. CONCLUSIONS. The frequency of clinical PC in a certain population could be related to the frequency and prevalent model of impalpable carcinoma as well as to the frequency of pre-carcinomatous lesions.

To investigate the possible role of hypoxia-inducible factor 1alpha (HIF-1alpha, a transcription factor important in regulating O-2 homeostasis and physiological responses to oxygen deprivation) in the recurrence and progression of superficial urothelial bladder cancer, and to examine its expression in relation to proliferation status, apoptotic activity and intratumoral angiogenesis. Paraffin wax-embedded tissue from 140 patients with superficial primary urothelial bladder carcinoma was immunostained for HIF-1alpha, Ki-67, single-stranded DNA antibody for apoptotic cells, p53, bcl-2, vascular endothelial growth factor and CD31 antigen. We calculated the proliferative rate, the apoptotic index and the microvessel density (MVD). The mean (SEM) follow-up was 46 (3.5) months, within which 86 patients relapsed while 18 progressed to a higher tumour stage and/or grade. HIF-1alpha expression was more common in high-grade superficial urothelial carcinomas. The positivity was related to increased proliferative activity (P = 0.012), apoptotic rate (P = 0.006) and MVD (P < 0.001). HIF-1alpha overexpression had a marginal adverse influence on progression-free survival (P = 0.058; univariate analysis), but when combined with p53 overexpression, the unfavourable impact was statistically important (P = 0.028). In multivariate analysis, only grade and the high Ki-67 labelling index were significant predictors of recurrence-free survival, while T-stage and the HIF-1alpha+/p53+ phenotype emerged as the only independent variables of adverse prognostic significance for time to progression. HIF-1alpha overexpression combined with aberrant mutant p53 nuclear protein accumulation seem to indicate an aggressive phenotype, suggesting a potential biological model predictive of future risk of disease progression in patients with superficial urothelial bladder carcinoma. These indicators may be helpful in clinical practice to discriminate superficial bladder cancer worth a more intensive follow-up, or more aggressive treatment.

Introduction and objectives: Hypoxia-inducible factor 1alpha (HIF-1alpha) is a critical regulatory protein of cellular response to hypoxia and is closely related to the triggering of the angiogenic process. We examined the relationship between hypoxia and angiogenesis, as well as their prognostic impact in patients with urothelial bladder cancer. Methods: The immunohistochemical expression of HIF-1alpha was evaluated in 93 formalin-fixed paraffin-embedded primary transitional cell carcinoma tissue samples. HIF-1alpha was recognized through nuclear staining of positive cells. The angiogenic profile was individually assessed immunohistochemically using a monoclonal antibody to vascular endothelial growth factor (VEGF) and microvessel density (MVD) was calculated with immunohistochemical staining of the adhesion molecule CD31 of the endothelial cells. Results: A significant positive association between HIF-1alpha immunoreactivity and histological grade (p = 0.009) was found. VEGF and MVD were closely related to tumor grade (p = 0.006 and p < 0.001) and clinical stage (p = 0.04 and p < 0.001, respectively). HIF-1alpha was significantly correlated with VEGF expression (p = 0.01) and MVD (p < 0.001). Patients characterized by HIF-1alpha overexpression had significantly worse overall (p = 0.009) and disease-free survival (p = 0.03). When HIF-1alpha, histologic grade and stage were included in multivariate Cox regression analysis, HIF-1alpha emerged as an independent prognostic factor (p = 0.02) along with grade and stage, but lost its independent prognostic value after the inclusion of angiogenic factors in the multivariate model. In the subgroup of patients with T1 disease, HIF-1alpha emerged as a significant negative predictor of the time to first recurrence. Conclusions: HIF-1alpha and angiogenesis markers may play an important predictive and prognostic role in patients with bladder cancer. HIF-1alpha maybe of biologic and clinical value as its overexpression is related to up-regulation of VEGF, the stimulation of angiogenesis and worse prognosis. (C) 2004 Elsevier B.V. All rights reserved.

Our aim was to compare the stone free rate and the financial cost between in situ and after manipulation shock wave lithotripsy (SWL) for proximal ureteral stones. A total of 130 patients with proximal ureteral stones were prospectively randomized into two groups. Sixty-five patients (group 1) underwent SWL in situ and 65 patients (group 2) underwent SWL after an attempt was made to push back the stone into the kidney with the help of a ureteral catheter. The mean per person financial cost of both techniques was estimated after a follow up period of 3 months. The stone free rate 1 month post treatment was 83% (54/65 patients) for group 1 and 95% (62/65) for group 2. The higher success rate at 1 month for the pushback group was statistically significant (P=0.04) but was correlated with a higher cost (e852 vs e1,008.5). Fifteen additional sessions of SWL and follow up visits were needed in group 1, therefore making the final costs of the two therapeutic pathways almost equal (e1,050.9 vs e1,088.9), with no great difference in the overall fragmentation rates at 3 months between groups (94% and 97%, respectively). Stone manipulation offers higher stone free rates faster than in situ extracorporeal SWL, but is more expensive. This disparity in cost is diminished when costs are corrected for follow-ups and treatment of complications.

Encrusted cystitis (EC) and encrusted pyelitis (EP) are rare chronic inflammatory diseases of the bladder and renal pelvis, respectively, and are characterized by mucosal inflammation with deposits of ammonium magnesium phosphate on the urothelium. Corynebacterium urealyticum is the pathogen responsible in the vast majority of cases. We report 4 cases of EC and 1 case of EP, In 1 case of EC Ureaplasma urealyticum was isolated as the microorganism responsible. To the best of our knowledge, U, urealyticum-induced EC has never been reported previously. Copyright (C) 2000 S. Karger AG, Basel.

Objective: Early detection of prostate cancer has become a matter of vital importance in modern societies. Ultrasound guided transrectal biopsy is the current standard urological procedure to detect prostate cancer. In this study our intention was to confirm the high tolerance and low complication rate of this procedure, facts already established in urologists' minds. Material and methods: In order to evaluate the morbidity as well as the acceptance of the procedure, we investigated 120 patients who underwent ultrasound guided transrectal biopsies of the prostate, in our department from September 1995 to January 1996. All patients at each biopsy underwent 6 needle passes and took periprocedural antibiotic therapy. Alongside with recording the periprocedural side effects of this method patients answered a questionnaire in order to evaluate the pain they experienced by this procedure. Results: Twenty patients were found to have prostate cancer at various stages. All patients tolerated well the whole procedure. Pain was the most common complaint among patients. Several complications were recorded; the most common of all was haematuria. Only two patients required admission to hospital because they developed fever after the procedure. Conclusion: Ultrasound guided transrectal biopsy of the prostate is a well-tolerated and effective method for obtaining multiple biopsy specimens from the prostate with low incidence of serious complications. Its is also accurate enough, allowing its use in everyday urology, as a diagnostic procedure.

Objective. To compare the efficacy of three different doses of intravesical interferon α-2b (IFNα-2b) in reducing recurrence and progression rates in superficial grade II, transitional cell carcinoma (TCC). Patients and methods. Eighty-nine patients with primary or recurrent TCC stage Ta/T1, grade II, were randomly allocated into four groups after transurethral resection (TUR) of the tumour. Group A (20 patients) received no further treatment, serving as the control group; group B (22 patients) received 40 MU of IFNα-2b, group C (24 patients) 60 MU and group D (23 patients) 80 MU. The instillations started within 48-72 h after TUR and were performed weekly for 2 months, bimonthly for the next 4 months and thereafter monthly for 6 months. The patients were followed for 36 months. The four groups were compared for the number of recurrences (simple recurrence rate), progression in stage, disease-free interval and recurrence rate per 100 patient-months. Results. During the follow-up, 22 patients had recurrence (13, eight, seven and five in groups A to D, respectively). The simple recurrence rate was 65% for group A, compared with 36% (P = 0.06), 29% (P < 0.05) and 22% (P < 0.01) for groups B, C and D, respectively. The differences in simple recurrence rates between the groups treated with IFNα-2b were not statistically significant. Eleven patients experienced progression in stage, with six, three, one and one in groups A to D, respectively. The differences were statistically significant only between groups A and C (P < 0.05) and groups A and D (P < 0.05). The disease-free interval was 15 months for group A, compared with 21.4 (P < 0.05), 26.1 (P < 0.001) and 30 months (P < 0.001) for groups C to D, respectively. The disease-free intervals of the groups treated with IFNα-2b were significantly different between all patients in groups B and D (P < 0.01) and only for those with stage T1 between groups C and D (P < 0.01). Finally the recurrence rate per 100 patient-months was 2.91, 1.19, 0.88 and 0.63 for groups A to D, respectively (all P < 0.001). The results were always in favour of the patients treated with the high dose, the only exception being the difference between groups C and D (P = 0.026). No side-effects of the drug were noted, nor was any adverse reaction reported from any patient. Conclusion. These results show a significant advantage for adjuvant intravesical IFNα-2b treatment over TUR alone for the 36 months of follow up and indicate that IFNα-2b can modify the clinical course of superficial TCC at least in the short term. The appropriate dose was apparently 80 MU, for although 40 MU was better than TUR alone, it was less effective than 60 MU and 80 MU; the 80 MU dose was slightly better than 60 MU and thus this regimen is recommended.

Purpose: We investigated the activity of combination chemotherapy consisting of cisplatin, ifosfamide, methotrexate and vinblastine in patients with metastatic urothelial cancer. Materials and Methods: A total of 32 consecutive patients was treated with 30 mg./m.(2) cisplatin on days 1 through 3, 1.5 gm./m.(2) ifosfamide with mesna on days 1 through 3, 30 mg./m.(2) methotrexate and 3 mg./m.(2) vinblastine on day 1 plus 5 mu g./kg. granulocyte colony-stimulating factor on days 7 through 11. Courses were repeated every 21 days for a maximum of 6 cycles. Results: Major toxicity was granulocytopenia in 56% of patients, including 11 episodes of granulocytopenic fever. Anemia and thrombocytopenia developed in a third of the cases. No other significant toxicity or treatment related death was noted. An objective response was achieved in 20 patients (62.5%, 95% confidence interval 44 to 79). Median time to progression was 7 months and median survival was 13 months. Conclusions: The cisplatin, ifosfamide, methotrexate and vinblastine regimen appeared active in patients with metastatic urothelial carcinoma. This regimen was associated with significant but manageable hematological toxicity and the incidence of mucositis or renal impairment was low. Prospective randomized studies are needed to assess whether the addition of ifosfamide to other active agents will improve the survival of patients with this disease.

Twenty-four patients with medullary sponge kidneys (MSKs), diagnosed on a recent IVU, and renal lithiasis were treated by extracorporeal shock wave lithotripsy (ESWL). A detailed history regarding frequency of renal colic and urinary tract infection (UTI) was recorded and compared to the post-ESWL frequency of the symptoms. Our results show that the stone clearance rate is similar to that of non-MSK patients but there is a great reduction in the frequency of renal colic and UTI.

Transurethral radio frequency thermotherapy for symptomatic benign prostatic hyperplasia was performed in 50 selected patients, using the THERMEX II device. High surgical risk patients were included, among them 13 previously catheterized ones, because of unresolved retention for more than 6 months. The treatment consisted of a three-hour single session at 47 °C. Follow-up studies were carried out at 1, 3, 6 and 12 months using Madsen score, maximum flow rate, residual urine volume determinations and prostate bulk measurement by transrectal ultrasound. Subjective and objective improvement (of more than two parameters) was noticed in 62% of the patients. Prostatic volume did not change. In the retention group 54% of the patients remained free of catheter. Postoperative histology in 8 cases that failed to respond, revealed focal haemorrhagic and necrotic changes in periurethral glandular tissue. This is a promising method for selected high risk patients that achieves reasonable but not comparable results to TURP and requires further investigation in larger patient groups with BPH.