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Background: The prediction of positive surgical margins (SM) after radical prostatectomy (RP) is important for planning the surgical modality and adjuvant therapy in patients with prostate cancer (PCa)., Objectives: To investigate factors affecting SM positivity in patients diagnosed with PCa who underwent RP using the PCa database of the Urooncology Association (Turkey)., Methods: Patients who underwent RP due to clinically T1c-T3 PCa and who had detailed SM data for the RP specimen were included in the study. Pathological data of 12 core transrectal ultrasound prostate biopsies and RP were evaluated. Patients were divided into 2 groups (SM positive and SM negative) according to SM status after RP. Data were compared between the groups. Factors affecting SM positivity, the number of positive SM sites, and the location of positive SM were separately evaluated with regression models., Results: A total of 2,643 patients from 6 different centers (median age: 63 years) with a prostate-specific antigen (PSA) level of 7.3 ng/mL were investigated in the study. BMI, PSA, biopsy Gleason score (GS), and perineural invasion (PNI) were found to be independent predictive factors for SM positivity and the number of positive SM locations, respectively (p < 0.05). According to the positive SM location, PSA was found to be associated with positive SM in apex, anterior prostate, and bladder neck locations. Also, according to posterolateral SM status, PNI and nerve-sparing RP (nsRP) rates were 21.3 and 44% for patients with negative posterolateral SM, and rates were 35.4 and 50.6% for patients with positive posterolateral SM, respectively (p < 0.05). In patients who underwent nsRP, positive SM was present in 22.2% of patients who did not have PNI on prostate biopsy, whereas positive SM was present in 40.6% of patients with PNI (p < 0.001). Similarly, 10.9% of patients without PNI had positive posterolateral SM, whereas 17.3% of patients with PNI had positive posterolateral SM (p = 0.031)., Conclusions: BMI, PSA, biopsy GS, and biopsy PNI positivity were found to be predictive factors affecting SM positivity. The most important factors affecting posterolateral positive SM were biopsy PNI and nsRP, indicating that the nsRP approach may cause positive SM in the posterolateral margin of the prostate (neurovascular bundle location) in patients with positive PNI on biopsy., (© 2020 S. Karger AG, Basel.)

Retrovesical masses can be of various histopathological origin, most often prostatic. Primary tumours as well as metastatic lesions should be considered in the differential diagnosis. Metastatic thymoma, as presented in this case report, can be an extremely rare cause of retrovesical space occupying lesion.

Introduction: We investigated whether CA9 protein could be used as a prognostic tumor marker as well as a diagnostic biomarker in renal clear cell carcinoma., Materials and Methods: Nephrectomy specimens from 92 patients were used in this study. 80 of these were renal cell carcinomas, 10 adenomas and 2 oncocytomas. Of the renal cell carcinomas, 67 were clear cell carcinomas. Immunohistochemical analysis using CA9 monoclonal antibody (M75) was performed on paraffin-embedded specimens. CA9 staining was correlated with tumor stage, grade, lymph node involvement, distant metastasis and cumulative survival time., Results: CA9 was present in 91.2% of clear cell carcinomas. Low staining was a poor prognostic factor, and conversely high staining a good prognostic one. CA9 expression was found to be the best prognostic factor when compared with T stage and grade. Even in low-grade and stage tumors, the presence of low expression correlated with lowered survival times., Conclusions: On the basis of our study, CA9 is a significant molecular marker in renal clear cell carcinomas. Decreased CA9 expression is independently associated with poor survival. CA9 can be used to predict clinical outcome and identify high-risk patients in need for adjuvant immunotherapy and CA9 targeted therapies.

Purpose: We assess the safety and efficacy of rigid ureteroscopy for the treatment of pediatric ureterolithiasis., Materials and Methods: The records of 33 children with an average age of 7.4 years (range 9 months to 15 years) treated with rigid ureteroscopy between May 1995 and July 2003 were reviewed. In 35 ureteral units use of a rigid 6.9 to 10Fr ureteroscope was planned for treating stones at various levels of the ureter. Stones were located in the upper ureter in 6 cases, middle ureter in 3 and lower ureter in 26. Dilatation of the ureteral orifice was necessary in 11 cases., Results: Stone size varied from 3 to 10 mm (mean 5.3). In 33 patients (94%) all stone fragments were removed successfully. Stones were fragmented with pneumatic lithotripsy in 20 cases and removed by forceps without fragmentation in 13. In 1 child an upper ureteral stone migrated up to the kidney during ureteroscopy but following extracorporeal shock lithotripsy therapy she was rendered stone-free. In another child it was not possible to remove the stone. In a 9-month-old female patient with bilateral stones it was not possible to enter the left ureter because of a tight orifice resistant to balloon dilation. At the end of the procedure a 3 or 4Fr ureteral or a 4.8Fr Double-J (Medical Engineering Corp., New York, New York) stent was left in place for 3 days to 3 weeks in 12 cases. There were no cases of ureteral perforation. Of the patients 31 were followed for 1 to 36 months. No incidence of vesicoureteral reflux was detected in 9 who underwent postoperative cystography., Conclusions: After becoming experienced and meticulously working with finer instruments in adults, rigid ureteroscopy can be a safe and efficient treatment for ureteral stones in every location in children.

Objective: The purpose of this study is to determine the morbidity of lumbotomy incision used in the last 100 living related donor nephrectomies retrospectively., Methods: Since March 1991, 100 donor nephrectomies were made to living donors with lumbar incision. Incisions made in lateral decubitus position, subcostally or by an 11th or 12th rib resection. Left nephrectomy to 83, and right nephrectomy to 17 donors was performed. In 2 patients, there had been a peritoneal defect which was closed with primary sutures. In 19 patients 3 cm or shorter and in 5 patients longer than 3 cm of pleural entry had occurred. In all of the patients laceration was repaired without placement of a chest tube, however a chest tube had to be placed in 2 donors after obtaining a control chest x-ray postoperatively., Results: All the patients mobilized and began to take orally in the first post-operative day. Wound infection, pneumonia and deep vein thrombosis had detected in none of the patients. The patients were discharged on the 4th and 5th postoperative day. During their control after 1 month from the operation it was found that all of them had returned to their daily life. In the postoperative period incisional hernia occurred in 7 patients which didn't need surgical repair and none of them complained of cosmetic problem. There was no any other late term complication was seen due to flank incision., Conclusion: Lumbotomy incision in donor nephrectomy, either a rib resection or supracostal approach, is reliable, provides excellent exposure for surgeon and has minimal morbidity.