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Despite being standard tools for decision-making, the European Organisation for Research and Treatment of Cancer (EORTC), European Association of Urology (EAU), and Club Urologico Espanol de Tratamiento Oncologico (CUETO) risk groups provide moderate performance in predicting recurrence-free survival (RFS) and progression-free survival (PFS) in non-muscle-invasive bladder cancer (NMIBC). In this retrospective combined-cohort data-mining study, the training group consisted of 3570 patients with de novo diagnosed NMIBC. Predictors included gender, age, T stage, histopathological grading, tumor burden and diameter, EORTC and CUETO scores, and type of intravesical treatment. The models developed were externally validated using an independent cohort of 322 patients. Models were trained using Cox proportional-hazards deep neural networks (deep learning; DeepSurv) with a proprietary grid search of hyperparameters. For patients treated with surgery and bacillus Calmette-Guérin-treated patients, the models achieved a c index of 0.650 (95% confidence interval [CI] 0.649-0.650) for RFS and 0.878 (95% CI 0.873-0.874) for PFS in the training group. In the validation group, the c index was 0.651 (95% CI 0.648-0.654) for RFS and 0.881 (95% CI 0.878-0.885) for PFS. After inclusion of patients treated with mitomycin C, the c index for RFS models was 0.6415 (95% CI 0.6412-0.6417) for the training group and 0.660 (95% CI 0.657-0.664) for the validation group. Models for PFS achieved a c index of 0.885 (95% CI 0.885-0.885) for the training set and 0.876 (95% CI 0.873-0.880) for the validation set. Our tool outperformed standard-of-care risk stratification tools and showed no evidence of overfitting. The application is open source and available at https://biostat.umed.pl/deepNMIBC/. PATIENT SUMMARY: We created and validated a new tool to predict recurrence and progression of early-stage bladder cancer. The application uses advanced artificial intelligence to combine state-of-the-art scales, outperforms these scales for prediction, and is freely available online.

Bladder cancer (BC) is the most common urological malignancy and has a high incidence of recurrence. BC cells alter their nutrient uptake and metabolic pathways in order to continue the production of sufficient levels of ATP and metabolic intermediates for proliferation and survival. Changes in metabolic pathways regarding the rate of the enzymatic reaction and transport lead to differences in the content of natural isotopes (13C, 15N, 34S) between normal and cancerous tissues. The assessment of the stable isotopes of carbon, nitrogen, and sulfur in normal urothelium and bladder cancer samples was performed using Isotope Ratio Mass Spectrometry (IRMS). The natural abundance of 15N and 13C was decreased in bladder cancer samples when compared to normal urothelium. No significant correlation was observed in BC specimens depending on the tumor grade and stage. Samples derived from bladder tumors and normal urothelium had a different pattern of 15N and 13C isotope abundance. Decreased 13C natural isotopes in the normal urothelium of BC patients were significantly associated with a shorter DFS. Our results suggest that isotopic analysis of normal urothelium of BC patients can be used to predict bladder cancer recurrence.

Implementation of ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI) into abdominal cavity diagnostics enabled early detection of cT1 graded renal cancers. According to European Association of Urology (EAU) and Polish urological Association (PUA) recommended method of treatment is sparing resection of renal parenchyma with tumour—nephron-sparing surgery (NSS). In selected cases other methods such as thermal ablation (TA) or cryoablation can be introduced /1/. Objectives: To evaluate the results of treatment of cT1 renal tumours with the use of NSS and TA methods. Material and methods: 140 patients with cT1 renal carcinoma were treated in 2nd Department of Urology of Medical University of Lodz between 2014 and 2017. Neuron-sparing surgery was performed in 56 cases (40%), while percutane-ous thermal ablation (TA) in 84 cases (60%). Demographic data, clinical data (lab results, Charlson index), nephrometry data (tumour size, location, R.E.N.A.L. score) post-operative data (Clavien-Dindo classifica-tion) were investigated. Histopathology results, Fuhrman malignancy grading, as total three-year survival of patients were evaluated. The following methods were used for statistical evaluation: Chi2, Fisher, W Shapiro-Wilk, U Mann-Whitney tests, Kaplan-Meier’s curve and Cox model. The results were displayed in a form of median and upper and lower quartile values (25–75%). Results: No statistical differences in gender nor left/right kidney location were observed. Patients, who underwent TA were at average 10 years older and had multiple comorbidities (median age for TA was 79, for NSS 68; median Charlson index for TA was 5 and for NSS was 3). TA patients had lesser haematological values (Hb, Ht). R.E.N.A.L. scoring demonstrated comparable nephrometry in both groups. NSS procedure was open laparotomy without temporary clamping of renal vessels. Surgical margins of resected tumours were negative. TA was performed with Cool-Tip Covidienequipment with the use of Cluster electrode and was ultraso-nography-guided. Post-treatment complications evaluated with the use of Clavien-Dindo classification were slightly more frequent for NSS method. Patients after NSS were discharged at average after 8.5 days and after TA after 3 days. Histopathological type and Fuhrman malignancy grading were comparable in both groups. TA treated patients’ death risk was 9-fold of that observed in NSS treated patients. There was 1 death for each group in perioperative period. Conclusion: 1. NSS was associated with slightly higher side effect rate but resulted in prolonged survival. 2. TA was applied to elderly patients with comorbidities. Despite less invasive treatment this group had poorer/reduced survival. 3. Charlson Comorbidity Index (CCI) and the treatment method were relevant survival factors in patients treated due to cT1 renal cancer tumours.

Genetic polymorphisms in DNA repair genes may affect DNA repair efficiency and may contribute to the risk of developing cancer. The aim of our study was to investigate single nucleotide polymorphisms (SNPs) in RAD51 (rs2619679, rs2928140, and rs5030789) and XRCC3 (rs1799796) involved in DNA double-strand break repair and their relationship to prostate cancer. The study group included 99 men diagnosed with prostate cancer and 205 cancer-free controls. SNP genotyping was performed using the PCR-RFLP method. A significant association was detected between RAD51 rs5030789 polymorphism and XRCC3 rs1799796 polymorphism and an increased risk of prostate cancer. Our results indicate that RAD51 and XRCC3 polymorphism may contribute to prostate cancer.

Background This manuscript contains the results of Podkarpackie Voivodeship (Poland) ethnomedical studies on the treatment of urinary tract diseases using wild and cultivated plants. The study concerns plants mainly used for the supportive treatment of urinary tract infections, urolithiasis and benign prostatic hyperplasia. In this present study, we aim to collect and assess the ethnomedicinal potential of plants used in Podkarpackie Voivodeship (Poland) to treat urological diseases. Methods This article is based on interviews with fourteen recognized traditional healers (urban areas) and nine informants (rural areas) living in the south-eastern region of Poland - Podkarpackie Voivodeship. The survey took place between November 2019 and January 2021. For each plant mentioned in herbal remedies, polish name, part used, mode of preparation, and their properties, according to the healers and informants, were recorded. Results For the analysis, 123 species that belong to 43 families were selected. The most common families used to treat urinary diseases in Podkarpackie herbal medicine are the Compositae (18 species), Rosaceae and Apiaceae (11 species in each), Leguminosae (9 species), and Ericaceae (6 species). Of the species listed, Apium graveolens L., Arctium lappa L., Arctostaphylos uva-ursi (L.) Spreng., Elymus repens (L.) Gould, Juniperus communis L., Matricaria chamomilla L., Petroselinum crispum (Mill.) Fuss, Solidago virgaurea L., Urtica dioica L., and Viola tricolor L. were the most frequently mentioned. Most plants are used in multicomponent blends, which are given in the form of infusions or decoction. The described plants have mainly antiseptic, diuretic, spasmolytic and anti-inflammatory properties. Conclusions The results of the research described in this paper indicate that herbal treatment of urinary tract diseases is still used in Poland in the Podkarpackie Voivodeship. It is mainly used by people who do not want to use allopathic medicine, especially antibiotics. They are both inhabitants of large cities and villages. The latter often because of the multi-generational tradition, prefer self-healing.

Aim: To evaluate the level of lipid peroxidation in patients with nephrolithiasis before and after extracorporeal shock wave lithotripsy (ESWL). Materials & methods: Isoprostane concentration (8-isoPGF2α) was measured in urine, and thiobarbituric acid reactive substance production in serum and erythrocytes. In addition, the concentrations of selected compounds (uric acid, glucose and creatinine) were measured in serum. Results: The patients (before and after ESWL) demonstrated significantly higher levels of two different biomarkers of lipid peroxidation compared with the control group. A correlation was identified between increased amounts of uric acid and biomarkers of lipid peroxidation in patients with nephrolithiasis, both before and after ESWL. Conclusion: Uric acid may be associated with lipid peroxidation in patients with nephrolithiasis.

Total reflection X-ray fluorescence analysis and X-ray powder diffraction were used for elemental and chemical composition analysis of 83 samples of human kidney stones. Samples came from patients after surgical removal of stones. Elements such as P, K, Ca, Fe, Zn, Ni, Br, Sr, and Pb were determined in all samples. Other elements Mg, S, Cl, Ti, V, Cr, Mn, Cu, Se, Rb, I, and Bi were found in some of the analyzed kidney stones (censoring effect). Descriptive statistics were calculated for all elements paying particular attention to the censored elements. From diffraction measurements, the following crystalline substances were determined in the stones: apatite, struvite, uric acid, weddellite, whewellite, magnesium phosphate, and calcium phosphate. Information of chemical composition was applied to classify the analyzed kidney stone into four groups. Statistical analysis of the results included multigroups comparison, testing of element concentration distribution, and elemental correlations in the dependence of kind of kidney stones. The presented studies are part of wider microbiological studies focusing on the correlation between different kinds of bacteria and fungi presented in the samples of kidney stones and their elemental as well as chemical composition. Information on stone composition can be helpful in understanding kidney stone formation and complemented by additional metabolic blood and urine tests. This, in turn, can lead to appropriate medical treatment together with the reduction of the risk as regards forming new stones.

Purpose In patients with nephrolithiasis, oxidative stress, especially lipid peroxidation is observed. Moreover, various invasive methods (including extracorporeal shock wave lithotripsy (ESWL)) for treatment of nephrolithiasis may induce not only the oxidative stress, but they may modulate hemostasis. The study was aimed to evaluate the oxidative damages of lipids and proteins in patients with nephrolithiasis (before and after ureteroscopic lithotripsy - URSL). The aim of the present study was also determine selected parameters of hemostasis in these patients. Methods 56 patients with nephrolithiasis and 49 healthy participants were included: 30 men and 26 women (for patient group); 27 men and 22 women (for healthy group). We measured the level of selected typical two biomarkers of oxidative modification of lipids (such as the production of thiobarbituric acid reactive substances (TBARS) and isoprostane concentration (8-isoPGF2)) and two biomarkers of oxidative damages of proteins (carbonylation and the level of thiol groups) in patients with nephrolithiasis (before and after URSL). The following parameters of hemostasis were measured: blood platelet count, the level of fibrinogen and D-dimer, and coagulation times (the activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT) of plasma). Results We observed the difference in the level of lipid peroxidation between patients before URSL and patients after URSL. The level of oxidative damages of plasma proteins from patients (after URSL) was not changed to compare to patients (before URSL). Neither, parameter of hemostasis was influenced by the presence of nephrolithiasis, nor by treatment with URSL. Conclusion We suggest URSL does not induce the oxidative modifications of plasma proteins and does not change hemostatic parameters in patients with nephrolithiasis.

Introduction The ZSI 375 is a new artificial urinary sphincter utilised in men suffering from stress urinary incontinence (SUI). We present the first European multicentre study on the effectiveness of ZSI 375. Material and methods This study was conducted in a retrospective, non-randomized format in centres across Europe. Between May 2009 and December 2014, ZSI 375 was fitted in 109 SUI patients following radical prostatectomy, transurethral resection of prostate (TURP), rectal surgery and high intensity focused ultrasound (HIFU). Patients with history of pelvic radiotherapy or previous surgical treatment for incontinence or stricture were excluded from the series. Follow-up was completed by December 2016. The key outcome measures included overall improvement and complication rates. Results A total of 109 patients in 10 European centres were recruited and had the ZSI 375 device implanted. The average patient age was 72 years old. The indication for the majority of patients was incontinence following radical prostatectomy (100/109 patients, 91.74%). On average, patients were incontinent for 48.6 months prior to treatment. All patients used ≥4 pads daily at baseline and thus were classified as suffering from 'severe incontinence'. The average follow-up until the final visit was 43 months. The pad usage decreased to 0.84 on average by the last visit. There were no reported cases of device infection. A total of 9 patients had urethral cuff erosion (8.25%),which was the most common complication in this series. A further 3 men (2.75%) experienced mechanical failure requiring subsequent device reimplantation. The implantation of the ZSI 375 device was considered successful in 92.66% of patients. Conclusions The ZSI 375 is an effective surgical treatment option in men with severe stress urinary incontinence.

The aim of this study was to analyze the correlation between past bacterial infections and the type and chemical composition of urinary stones experienced by human patients. Bacteria have been recognized to contribute to urinary stones; however, the role of uropathogens in the development of specific stones has not been extensively investigated. The detection of past bacterial infection (eleven different bacterial species) in urinary stones from 83 patients was made on a DNA level using polymerase chain reaction (PCR) and denaturing gradient gel electrophoresis (DGGE) and correlated with the chemical composition of urinary stones measured using X-ray powder diffraction (XPRD) technique and their elemental composition by total reflection X-ray fluorescence (TXRF). In this study, two scenarios of urinary stones formation mediated by Proteus sp. or Escherichia coli are presented. The first one is associated with Proteus spp. which dominated in 84% of infectious urinary stones and is strongly correlated with struvite and calcium phosphate, in whose matrix additionally strontium, phosphorus, potassium, nickel and zinc are detected. The formation of these stones is closely correlated with urease activity. The second scenario for urinary stone mineralization is associated with E. coli identified in weddellite stones, in which matrix iron was detected. In conclusion, the statistical correlations of bacterial infections with crystalline and elemental composition showed that in mixed bacterial infections, one scenario dominated and excluded the second one. Electronic supplementary material The online version of this article (10.1007/s00249-018-1338-7) contains supplementary material, which is available to authorized users.

Objective The aim of this study was to demonstrate safety and efficacy of ZSI 475 hydraulic penile prosthesis three components. Preparation, procedure and functional results are similar to AMS 700 and Coloplast Titan. This study was conducted from September 2012 to December 2016. Patients and Method From September 2012 to December 2016, 29 ZSI 475 hydraulic penile prostheses three components were implanted by six surgeons in 28 patients in five European centres. Mean age of patients was 60 years old (44-75). Standard peno-scrotal incision procedure was performed for the 28 patients. Erectile function was assessed by IIEF-5 self-administered questionnaire. Results Median follow-up was 35.11 months (8-47). Postoperative complications were limited to scrotal pump torsion that required a revision, an armed tubing breakage and a scrotal haematoma. At the end of follow-up, 100% of patients had a functional prosthesis and 92.86% were satisfied. Conclusions Implantation, risks of complications, functional outcome and patient satisfaction with penile implant ZSI 475 are similar to standard hydraulic penile implants three components as AMS 700 and Coloplast Titan.

The aim of the present study was to determine the roles of the WWOX tumor suppressor and cancer-related genes in bladder tumor carcinogenesis. Reverse transcription-quantitative polymerase chain reaction was used to analyze the status of WWOX promoter methylation (using MethylScreen™ technology) and loss of heterozygosity (LOH) in papillary urothelial cancer tissues. The associations between the expression levels of the following tumorigenesis-related genes were also assessed: The WWOX tumor suppressor gene, the MKI67 proliferation gene, the BAX, BCL2 and BIRC5 apoptotic genes, the EGFR signal transduction gene, the VEGF vascular endothelial growth factor gene, and the CCND1 and CCNE1 cell cycle genes. The results reveal a high frequency of LOH in intron 1 in the WWOX gene, as well as an association between reduced WWOX expression levels and increased promoter methylation. In addition, the present study demonstrates that in bladder tumors, apoptosis is inhibited by increased expression levels of the BCL2 gene. A correlation between the proliferation indices of the MKI67 and the BIRC5 genes was also revealed. Furthermore, the expression levels of VEGF were identified to be positively associated with those of the EGFR gene.

Introduction Stress urinary incontinence (SUI) is a condition of social dimension which generally pertains to women of various age. The only effective treatments of SUI are surgical procedures. The use of tension-free vaginal tape (TVT) ensures low invasiveness but also carries the risk of complications. One of the complications may be migration of the tape into the urinary bladder creating conditions for urinary stones. There is a number of treatment methods for cystolithiasis, among them the optical lithotripter, ultrasound and pneumatic probes, and recently, the holmium laser. Material and methods From January 2009 to February 2010, six women suffering from bladder stones were treated at our department. All patients had previously undergone SUI procedures and over time, thread or tape had penetrated into the urinary bladder. The stone diameters were in the range of 1.6 cm–3.5 cm. Lithotripsy was performed with the use of an 80 W holmium YAG laser as an endoscopic procedure: beam frequency length of 2100 nm and applied energy was in the range of 0.2–3.5 J. Results The urinary bladder stones were disintegrated and suctioned out. During the same pro- cedure, the threads or tape from the SUI procedure were excised from the bladder. All patients were discharged from the hospital in good general condition after two days. Conclusions The holmium laser is an effective treatment for patients with bladder stone complications after SUI procedures when threads or tape have migrated and penetrated the bladder wall. The procedure is straightforward and safe for patients.

Several single nucleotide polymorphisms (SNPs) have been associated with an elevated risk of prostate cancer risk. It is not established if they are useful in predicting the presence of prostate cancer at biopsy or if they can be used to define a low-risk group of men. In this study, 4,548 men underwent a prostate biopsy because of an elevated prostate specific antigen (PSA; ≥4 ng/mL) or an abnormal digital rectal examination (DRE). All men were genotyped for 11 selected SNPs. The effect of each SNP, alone and in combination, on prostate cancer prevalence was studied. Of 4,548 men: 1,834 (40.3%) were found to have cancer. A positive association with prostate cancer was seen for 5 of 11 SNPs studied (rs1800629, rs1859962, rs1447295, rs4430796, rs11228565). The cancer detection rate rose with the number of SNP risk alleles from 29% for men with no variant to 63% for men who carried seven or more risk alleles (OR = 4.2; p = 0.002). The SNP data did not improve the predictive power of clinical factors (age, PSA and DRE) for detecting prostate cancer (AUC: 0.726 vs. 0.735; p = 0.4). We were unable to define a group of men with a sufficiently low prevalence of prostate cancer that a biopsy might have been avoided. In conclusion, our data do not support the routine use of SNP polymorphisms as an adjunct test to be used on the context of prostate biopsy for Polish men with an abnormal screening test.

Introduction The aim of the study is to evaluate the number of years of life lost in inhabitants of Poland due to bladder cancer (BC), identify trends of the mortality and calculate the pace of change which has happened over the period of the first fifteen years of the 21st century. Material and methods The study material was a database including 44,283 death certificates of Polish inhabitants who died due to bladder cancer in the period 2000–2014. The number of years of life lost were calculated using the SEYLL indices: SEYLLp (Standard Expected Years of Life Lost per living person) and SEYLLd (Standard Expected Years of Life Lost per death). Results The crude death rates (CDR) index increased from 10.79 per 100,000 males in 2000 to 14.30 in 2014 (Annual Percentage Change [APC] = 2.1%, p 0.05) in men, but rose from 3.54 in 2000 to 3.83 in 2014 (APC = 0.4%, p

BACKGROUND The G84E mutation in the HOXB13 gene has been associated with a high lifetime risk of prostate cancer in North America (about 20-fold). The geographical and ethnic extent of this recurrent allele has not yet been determined. METHODS We assayed for the presence of the G84E mutation in 3,515 prostate cancer patients and 2,604 controls from Poland and estimated the odds ratio for prostate cancer associated with the allele. RESULTS The G84E mutation was detected in 3 of 2,604 (0.1%) individuals from the general population in Poland and in 20 of 3,515 (0.6%) men with prostate cancer (Odds ratio [OR] = 5.0; 95% CI: 1.5–16.7; P = 0.008). The allele was present in 4 of 416 (1.0%) men with familial prostate cancer (OR = 8.4, 95% CI: 1.9–37.7; P = 0.005). CONCLUSIONS The G84E mutation predisposes to prostate cancer in Poland, but accounts for only a small proportion of cases. We expect that the G84E founder mutation might be present in other Slavic populations. Prostate 73: 542–548, 2013. © 2013 Wiley Periodicals, Inc.

Topoisomerase IIb binding protein 1 (TopBP1) is involved in cell survival, DNA replication, DNA damage repair and cell cycle checkpoint control. The biological function of TopBP1 and its close relation with BRCA1 prompted us to investigate whether alterations in the TopBP1 gene can influence the risk of breast cancer. The aim of this study was to examine the association between five polymorphisms (rs185903567, rs116645643, rs115160714, rs116195487, and rs112843513) located in the 30UTR region of the TopBP1 gene and breast cancer risk as well as allele-specific gene expression. Five hundred thirty-four breast cancer patients and 556 population controls were genotyped for these SNPs. Allele-specific Top- BP1 mRNA and protein expressions were determined by using real time PCR and western blotting methods, respectively. Only one SNP (rs115160714) showed an association with breast cancer. Compared to homozygous common allele carriers, heterozygous and homozygous for the T variant had significantly increased risk of breast cancer (adjusted odds ratio = 3.81, 95 % confidence interval: 1.63–8.34, p = 0.001). Mean TopBP1 mRNA and protein expression were higher in the individuals with the CT or TT genotype. There was a significant association between the rs115160714 and tumor grade and stage. Most carriers of minor allele had a high grade (G3) tumors classified as T2-T4N1M0. Our study raises a possibility that a genetic variation of TopBP1 may be implicated in the etiology of breast cancer.

Background: To establish the contribution of eight founder alleles in three DNA damage repair genes (BRCA1, CHEK2 and NBS1) to prostate cancer in Poland, and to measure the impact of these variants on survival among patients. Methods: Three thousand seven hundred fifty men with prostate cancer and 3956 cancer-free controls were genotyped for three founder alleles in BRCA1 (5382insC, 4153delA, C61G), four alleles in CHEK2 (1100delC, IVS2+1G>A, del5395, I157T), and one allele in NBS1 (657del5). Results: The NBS1 mutation was detected in 53 of 3750 unselected cases compared with 23 of 3956 (0.6%) controls (odds ratio (OR)=2.5; P=0.0003). A CHEK2 mutation was seen in 383 (10.2%) unselected cases and in 228 (5.8%) controls (OR=1.9; P

Metallothioneins (MTs) are a family of metal binding proteins that play an important role in cellular processes such as proliferation and apoptosis. Metallothionein 2A is the most expressed MT isoform in the breast cells. A number of studies have demonstrated increased MT2A expression in various human tumors, including breast cancer. We carried out an association study to examine whether MT2A gene polymorphisms are associated with risk of breast cancer. Information on lifestyle risk factors was collected via a self-administered questionnaire. Genotyping was conducted using polymerase chain reaction–restriction fragment length polymorphism technique. Three single nucleotide polymorphisms (SNP) rs28366003, rs1610216 and rs10636 were genotyped in 534 breast cancer cases and 556 population controls. One SNP in MT2A (rs28366003) showed a positive association with breast cancer. Compared with homozygous common allele carriers, heterozygous for the G variant [odds ratio (OR) = 1.92, 95 % confidence interval (CI):1.28–2.81, p trend

To estimate the oxidative stress in patients with prostate cancer and in a control group, we used the biomarker of lipid peroxidation–isoprostanes (8-isoPGF2) and the level of selected antioxidants (glucose and uric acid [UA]). The level of urinary isoprostanes was determined in patients and controls using an immunoassay kit according to the manufacturer’s instruction. The levels of UA and glucose were also determined in serum by the use of UA Assay Kit and Glucose Assay Kit. We observed a statistically increased the level of isoprostanes in urine of patients with prostate cancer in compared with a control group. The concentration of tested antioxidants in blood from patients with prostate cancer was also higher than in healthy subjects. Moreover, our experiments indicate that the correlation between the increased amount of UA and the lipid peroxidation exists in prostate cancer patients (in all tested groups). Prostate cancer risk by urinary isoprostanes level was analyzed, and a positive association was found (relative risk for highest vs. lowest quartile of urinary isoprostanes = 1.6; 95 % confidence interval 1.2–2.4; p for trend = 0.03). We suggest that reactive oxygen species induce peroxidation of unsaturated fatty acid in patients with prostate cancer, and the level of isoprostanes may be used as a non-invasive marker for determination of oxidative stress. We also propose that UA may enhance the oxidative stress in patients with prostate cancer. This study was supported by the Grant 506/810(KBO) from University of Lodz, Poland

Metallothionein 2A (MT2A) is the most expressed metallothionein (MT) isoform in prostate cells. A number of studies have demonstrated altered MT2A expression in various human tumors, including prostate cancer. We conducted an association study to examine whether MT2A gene polymorphisms are associated with a risk of prostate cancer. Genotyping was conducted using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Three single nucleotide polymorphisms (SNPs), rs28366003, rs1610216, and rs10636, were genotyped in 358 prostate cancer cases and 406 population controls. One SNP in MT2A (rs28366003) showed a positive association with prostate cancer. Compared to homozygous common allele carriers, heterozygosity for the G variant (odds ratio (OR)=2.30, 95% confidence interval (CI): 1.50-3.47, P-trend

Introduction The first decade of XXI century it is a time of the thulium laser implementation to a benign prostatic hyperplasia treatment. Objective The objective of this paper is a comparative assessment of early results thulium laser enucleation of the prostate (TmLEP) versus transurethral resection of the prostate (TURP) in 3-months observation. Materials and methods Patients were randomized to BPH surgical treatment: research group (TmLEP – 54 men) or control group (TURP – 52 men). Between 02.2007-09.2009 non-consecutive patients were examined before, one month, and 3-months after surgery. Perioperative data (age, PV, time of surgery, use of laser, morcellation, catheterization, hospitalization, used energy, Hgb loss and removed tissue weight) were assessed. Before and after surgery IPSS, QoL, Qmax and PVR were controlled. Results Hemoglobin loss was twice lower during TmLEP than TURP [0.95 ±0.77 (0-3.2) vs. 1.81 ±0.97 (0.1-4.7) g/dl, p

In recent years urologists have concentrated on the intense introduction of minimally invasive methods for the treatment of urinary tract diseases with major progress noted in the treatment of urolithiasis. Nowadays extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and ureteroscopic lithotripsy (URSL) are widely used in the treatment of urinary tract lithiasis. The aim of this study is to present examples of urinary tract lithiasis as the complication after minimally invasive methods used in the treatment of urolithiasis. One should remember that even minimally invasive medical procedures using the instruments retained in long-term contact with urine may be the cause of incrustation and stone formation.

Introduction. Bladder cancer (BC) is a serious medical problem. The high rate of recurrence and progression demands the development of new methods, such as genetic markers, which allow diagnosis and patient follow-up. objectives. The aim of this study was to compare expression of HIF-1, GLUT1, endoglin, and BRIC5 in patients without and those with BC. The second group was divided into sub-groups: those without a history of PDD (photodynamic diagnosis) in the diagnostic process and those after PDD. Methods. Patients with BC were diagnosed using the PDD method using hexaminolevulinate (Hexvix®). The expressions of HIF-1, GLUT1, endoglin, and BRIC5 genes were established in urine specimens by real-time quantitative polymerase chain reaction (PCR). results. The expressions of all tested genes were higher in the group of patients with BC than in the group without BC. In the group after PDD, a statistically significant overexpression of HIF-1 was observed. In this group, changes were not observed in cases of the other three tested genes. Conclusions. The differences between the group with PDD and the group without it can be connected with the direct influence of PDD on malignant tissue, which can cause overexpression of HIF-1 only. This is, however, only a hypothesis and needs further study.

INTRODUCTION: Holmium lasers and ultrasound probes are widely used in urinary stone lithotripsy. The authors present a comparison of both methods in urinary stones lithotripsy. MATERIALS AND METHODS: We analyzed 164-patients who underwent endoscopic lithotripsy. Ninety-eight of them (group I) were treated with the holmium laser Omni-Pulse Max 80 and were compared to the other 66-patients (group II) who were operated on with an ultrasound probe (sonotrode). Prior to the procedures, all patients were exposed to urological ultrasound and radiological imaging in order to localize the stone. The state where the stones were invisible in the radiological and renal ultrasound imaging that was performed after the operation was considered to be effective. Patients were operated under intravenous general or subepidural anesthesia. RESULTS: The effectiveness of laser lithotripsy in the bladder amounted to 100% (25 of 25 patients). In the case of stones localized in the ureter it reached 89%. The total effectiveness of the procedure reached 92% (90 out of 98 procedures). In group II, the total effectiveness of the procedure reached 79% (52 out of 66 procedures). In group I, two cases the inflammatory changes of the ureter made the endoscopy impossible. These two patients were operated with open surgery. In one case, the laser lithotripsy was complicated with a perforation of the ureter. CONCLUSION: The results prove that laser lithotripsy is a method of high effectiveness with a low risk of complication. It might surpass sonotrode and become its alternative. Both methods have both advantages and disadvantages.

The semen analysis is the main diagnostic tool for evaluating the male fertility potential. The standard semen analysis includes evaluation of the sperm concentration, motility, and their morphology. The most important question is whether the results from semen analysis may be accurate markers for male fertility. Therefore, we retrospectively studied sperm quality among men attending the infertility clinic due to reproductive problems consistent with the WHO manual from 1999, which were reassessed according to the manual from 2010. Semen results from 571 males from couples undergoing fertility investigation were analyzed. All subjects included in the study had no abnormalities during examination. In 64 samples (11.2%), a leukocyte count above 1 x 10(6)/ml was found and their semen volume (median 3.2 ml) was significantly lower in comparison with the group without leukocytes (3.6 ml; p0.001). Normal semen parameters were found in 290 subjects (50.8%) according to the 1999 manual and in 362 men (63.4%) according to the 2010 manual. The normozoospermia group, according to the 2010 manual, had a significantly lower percentage of sperm with progressive motility, motile sperm concentration, and total number of motile sperm in comparison with the normozoospermia group according to the manual from 1999. It seems that routine semen analysis is not sufficient to estimate male fertility potential and some men with normal semen parameters may be subfertile. Further investigations are needed.

Introduction. Testicular lesions are an indication for testis removal; 95% are testicular germ cells tumors (TGCT). The aim of the work was to present the conditions leading to castration and the clinical stages of the disease. Material and method. Case histories and subsequently treated patients were retrospectively analyzed. The type and size of the testicular lesion as well as pT and clinical stage (in cases of TGCT) were analyzed. results. Non-seminomas (NSGCT) were found in 51.9%, seminomas (SEM) in 35.8%, and non-TGCT lesions in 12.3% of cases. Bilateral TGCT was found in 4.3%. The mean TGCT diameter was 41.4 mm. The incidence of tumors

The extent of Nd-YAG laser fiber damage due to inappropriate handling during a common surgical procedure was assessed.Nd:YAG laser and Urolase noncontact fibers with 7.5 F gold reflective surface tips have been used to treat benign prostatic hyperplasia since 1995. Nine gold Urolase fiber tips damaged during the procedure and one tip not used for the surgical procedure were analyzed. The surfaces and cross-sections of gold fiber tips used with an Nd:YAG laser were observed under a scanning electron microscope. In order to improve imaging quality, mirror cross-sections embedded in resin were analyzed.The observations, both on the macro and micro scales, revealed a high degree of damage to the gold reflective tip surfaces. In order to observe changes taking place in the reflective surface structure, atomic maps of the studied fiber tips were obtained. Mixing of the atoms of the various elements present in the reflective surface structure was observed. The extent of this phenomenon was dependent on the energy applied during the surgery and on the duration of the procedure.The gold reflective surface tip of a Urolase fiber becomes damaged with inappropriate handling during visual laser ablation procedures. The amount of energy accumulated in the fiber tip leads to a considerable rise in temperature, which can be dangerous for living tissue and may lead to accidental damage of the urinary bladder wall or the urethra.

In the course of cirrhosis, a variety of disturbances of endocrine glands occur. Degenerative changes in the testes with atrophia and fibrosis of the glandular tissue are often found in men. Twenty-one males with compensated alcoholic liver cirrhosis were studied. The age ranged from 29 to 61 years (mean 47,1). Efficiency of the liver was evaluated according to Child classification. HBC (this needs to be spelled out in parenthesis) or HBV (Hepatitis B Virus) infections were excluded. Levels of serum testosterone were determined and the volume size of the testes was measured using 7,5 MHz sector probe, B&K Medical ultrasonograph, 3535 model. Volume size of the testes was measured in 22 healthy control volunteers, as well; age ranged from 25 to 66 years (mean-46,6). All patients were interviewed about sexual function, particularly possible erectile dysfunction using IIEF-5 questionnaire. The mean testosterone level was 8,89 umol/l (ranged: 7,4–10,9 umol/l) in the study patients [the normal range interval: 8,2–34,6 umol/l]. The level was below the normal range in 4 patients, and low but within the normal range in the remaining patients. Statistically significant lower values of both testes volumes were estimated in patients with compensated alcoholic liver cirrhosis in comparison to healthy controls (p

Long-term ureteral stenting is associated with bacterial colonization of both catheter surface and urine. The aim of the study was to evaluate the correlation between the type of bacteria cultured from the Double-J catheter, removed from urinary tract, and cultured from urine. Relationship of the Double-J catheter and urine culture with the duration of Double-J stenting, gender, the presence of diabetes mellitus, as well as the reason for stenting and manner of catheter insertion was also evaluated.Sixty-five patients were enrolled in the study. Urine specimens were cultured before stent insertion and removal. The stent was sent immediately for culture. Data such as age, sex, presence of diabetes mellitus, reason for stenting, and manner of catheterization were recorded.Urine cultures were positive in 17 cases, while catheter cultures were positive in 64 cases. In 10 cases, the same bacterial species were colonized from urine and stent surface, while in one case, both cultures were negative. In seven patients, both cultures showed different bacterial species, and in 47 cases, urine cultures were negative while the catheters were colonized.The only significant correlation was noted between urine culture and stenting duration (P0.05). Double-J catheter retention in the urinary tract is associated with a high risk of bacterial colonization, while the risk of urine infection is about fourfold lower. There is a great discrepancy between urine and catheter cultures.

Carcinoma in situ (CIS) of the urinary bladder is extremely hard to diagnose. The symptoms are highly unspecific and the small, flat CIS lesions can easily be missed, thus remaining unseen in standard white light cystoscopy. Photodynamic diagnosis (PDD) is recommended by the European Association of Urology (EAU) as a diagnostic procedure in cases of suspected CIS [1]. A 58-year-old man visited the outpatient clinic complaining of symptoms of dysuria and occasional pain during micturition. The patient had been a smoker for 20 years, with no risk of exposure to chemical substances. The medical history did not indicate any haematuria or fever. Digital rectal examination found the prostate to be of proper density, with little enlargement and no other pathological findings. The preliminary diagnosis was set as lower urinary tract syndrome secondary to prostate enlargement. The patient was sent for creatinine assay, prostate specific antigen (PSA) assay, a urine test, and ultrasound examination of the kidneys, bladder, and prostate. He received a prescription for diclofenac, tamsulosin, and ciprofloxacin. The next appointment in the outpatient clinic was set for two months later as a follow-up. During that visit, the patient reported two episodes of painless bleeding in his urine. The serum levels of creatinine and PSA were 0.9 and 1.2 ng/ml, respectively, and no abnormalities were observed in the results of the urine test. No pathological changes were observed by ultrasonography. After the treatment, the symptoms of dysuria were diminished. In response to the presence of bleeding in the urine, the patient was sent for urethrocystoscopy, performed with short intravenous anaesthesia, and urinary cytology, which revealed the presence of pathological cells. On the basis of this result and that of the earlier ultrasonography, which indicated no bladder tumour symptoms, the patient was qualified for PDD. Photodynamic diagnosis was performed after intravesical instillation of a photosensitiser (Hexvix®) 60 minutes before the procedure. A Wolf PDD system was used to observe the photodynamic effect. Although the white light cystoscopy revealed only one pathological lesion, 4 mm in diameter, on the front wall of the urinary bladder, the urinary bladder mucosa seemed otherwise unaffected by any pathological changes. After switching to PDD mode, three independent points were indicated by red flashes: one on the back wall (8 mm in diameter), one on the right wall (5 mm in diameter), and one on the left wall of the urinary bladder (5 mm in diameter) (photo). Tissue samples were taken from each of the suspicious lesions. Both the papillary tumour and the three lesions visible only in PDD were treated by transurethral resection of the bladder tumour (TURBT). After the operation, instillation of mitomycin C was performed. The histopathological report revealed the papillary tumour from the front wall to be a high-grade non-muscle-invasive bladder cancer (G2) without lamina propria infiltration, the lesions on the back and left walls were found to be carcinoma in situ, and the one on the right wall was a high-grade dysplasia. The patient was immediately qualified to immunotherapy with BCG. In common practice, the diagnosis of urinary bladder CIS with non-specific symptoms often presents a problem [2]. Although urinary cytology has high sensitivity for CIS in cases such as specific and non-specific inflammatory processes in the urinary bladder, it can give false positive results. In addition, the result is highly dependent on the experience of the pathologist [3, 4]. Although CIS can appear to be a flat lesion in white light cystoscopy, with oedema of the urothelium and with abnormal blood vessel patterns, there is, generally speaking, no single standard picture of CIS. Hence, there is a strong need for diagnostic tools that can be used to visualise CIS when it is presented in the urinary bladder. Photodynamic diagnosis is a tool that can be used in the diagnosis of CIS as part of the TURBT (Transurethral Reaction of Bladder Tumour) procedure and re-TURBT, particularly in combination with Hexvix [5]. In a multicentre study on 286 patients, PDD examination identified CIS lesions in 80 patients (96%), and white light cystoscopy allowed for identification of CIS in 64 patients (80%) [6]. Another multicentre study conducted in the USA also compared standard white light cystoscopy and PDD in a group of 311 patients. Statistical analysis was performed on 196 patients. CIS was diagnosed in 56 cases. Solitary lesions were identified in 18 cases, and carcinoma in situ coexisting with papillary tumours in 36 cases. While PDD identified 92% of the CIS cases, white light cystoscopy identified 68% [7, 8] (Fig. 1). Fig. 1 Image of Cis lesion in white light cystoscopy Image of Cis lesion in PDD mode A disadvantage of PDD is its rather low specificity, ranging from 35% to 66%, which is often due to a lack of experience on the part of the operator or the presence of scars after previous TURBT or intravesical instillation [9]. Nevertheless, PDD is recommended as a diagnostic tool in follow-up examinations of patients with CIS after BCG immunotherapy [10]. In a study of 49 patients with CIS examined after BCG therapy, 18 cases of recurrence were noted. Of these 18 cases, white light cystoscopy revealed no CIS lesions, while PDD diagnosed 14. Overall, while nine of the PDD results were found to be false positives (33.3%), only one positively identified by white light cystoscopy was false (7.1%) [10]. PDD represents a great enhancement of the urological diagnosis of CIS of the urinary bladder and is a superior method to standard white light cystoscopy in cases where CIS is suspected. This efficiency is even more important when considering that a diagnosis of CIS demands the quick implementation of appropriate therapy.

Although prostate cancer is one of the most common cancers in men, the genetic defects underlying its pathogenesis remain poorly understood. DNA damage repair mechanisms have been implicated in human cancer. Accumulating evidence indicates that the fidelity of the response to DNA double-strand breaks is critical for maintaining genome integrity. RAD51 is a central player in double-strand break repair via homologous recombination, and its alterations may confer and increase the risk of cancer. RAD51 functioning depends on the indirect or direct interactions with BRCA1 and BRCA2. To evaluate the contribution of RAD51 to sporadic prostate cancer, loss of heterozygosity (LOH) for chromosomal region 15q14-21.1 (RAD51 locus) was determined and compared to LOH in 17q21.31 (BRCA1 locus) and 13q12.3-13.1 (BRCA2 region). DNA was isolated from prostate biopsies and matched peripheral blood of 50 patients. The regions 15q14-21.1, 17q21.31, and 13q12.3-13.1 were examined using microsatellite markers on chromosome 15 (D15S118, D15S214, D15S1006), chromosome 17 (D17S855, D17S1323), and chromosome 13 (D13S260, D13S290), respectively. The LOH in tumors was analyzed by PCR with fluorescently labeled primers and an ABI PRISM 377 DNA Sequencer. Allele sizing was determined by GeneScan version 3.1.2 and Genotyper version 2.5 software (Applied Biosystems, USA). LOH was identified in 57.5, 23, and 40 % for chromosomal regions 15q14-21.1, 17q21.31, and 13q12.3-13.1, respectively. Twenty-six percent of studied cases manifested LOH for at least one marker in 15q14-21.1 exclusively. A significant correlation was found between LOH for studied region and PSAD (prostate-specific antigen density). The findings suggest that RAD51 may be considered as a prostate cancer susceptibility gene.

Malignant tumors of the kidney, which the most common is renal cell carcinoma (RCC) is diagnosed in Poland in more than 5,000 patients each year. Most cases of kidney cancer occurs after the age of 55 years. In men, the risk is 2 times higher than in women. Among the various histological subtypes of RCC, 5% of cases of chromophobe renal cell carcinoma (chRCC). The 1% is in combination with oncocytoma, creating a hybrid chromophobe renal cell carcinoma. The paper presents a case report of a patient operated on because of a kidney tumor - eosinophilic type of chromophobe cancer. During subsequent care of patients experienced a rare complication of this type of tumor, ie. metastasized to the paraaortic lymph nodes. Another surgery and radiotherapy were later stages of treatment. Discussed in the paper example of a patient with type eosinophilic chRCC indicate the variable nature and mileage as compared with typical of the tumor, thus requiring increased surveillance oncology. This requires a careful approach clinicians at the stage of diagnosis and then treatment and aftercare.

Introduction A PROSTATE BIOPSY CAN RESULT IN SUCH COMPLICATIONS AS: hematuria, rectal bleeding, pain in hypogastrium, perineum or urethra, fever, nausea, vomiting, retention of urine or other adverse events. The aim of this research was to estimate complication rates after a prostate biopsy based on the number of cores. Material and methods The complication rate was evaluated on the basis of questionnaires filled out by patients. Questions were related to the occurrence of mentioned complications on the first and second day after prostate biopsy. Patients were divided into two groups: 1(st) group (41 patients) 5-8 cores and 2(nd) group (73 patients) 12 or more cores. Results There was no significant statistical difference in the occurrence of complications mentioned in the questionnaires in both groups. The biggest difference was recorded for hematuria - 1(st) day: 39% in the 1st and 53% in the 2nd group (p = 0.1398); 2(nd) day: 15% in the 1(st) and 30% in the 2(nd) group (p = 0.0650). Rectal bleeding on the 1(st) day also seems to vary: 12% in the 1st and 26% in the 2(nd) group (p = 0.0835). Other complications occurred in 3-8% of patients. 32% of patients in the 1(st) and 29% in the 2(nd) group (p = 0.7419) had no complications at all. Conclusions The most common complications after a prostate biopsy are hematuria and rectal bleeding. Other complication rates are low. In general, complication rates after a prostate biopsy procedure are not related to the number of sampled cores.

We present a rare case of ureteral cysts in the left ureter treated by an endoscopic holmium laser. These cysts caused asymptomatic hydronephrosis in the left kidney. Complete cyst removal was performed by a ureteroscopically applied holmium laser. Six months post-procedure, the patient had no recurrence, which suggests that endoscopic excision is an optimal treatment for this disorder. Periodic ureteroscopic examination is indicated for further observation.

Introduction Stress urinary incontinence (SUI) is a social disease caused by numerous contributing factors such as natural childbirth, obesity, hormonal deficiencies and changes in collagen fibers, to name a few. Currently, mini–slings, among all the surgical treatment methods, have gained significance. The aim of this study was to establish the effectiveness of this method. Material and methods From 2008 to 2012, one hundred sixty women suffering from SUI underwent surgical procedures to implant mini–slings under the middle part of the urethra and 140 (87.5%) of them remained under observation. In 65 cases, Johnson & Johnson's TVT–Secur was used; in 70 cases, BARD's Adjust mini–sling was used; and in 5 cases, AMS Mini–Arc mini–sling was used. The average period of hospitalization was 3 days per admission, operation and discharge day. Results In 82 cases, patients urinated well after the removal of the catheter, and had full urine continence. Fourteen patients showed great improvement, and in four cases temporary urine retention was observed. In two cases vaginal bleeding was observed, yet there was no need for wound revision. Evaluation of the ‘quality of life improvement’ was done using the Visual Analog Scale (VAS). Conclusions The obtained results allowed the conclusion that the implantation of mini–slings is a low invasive, relatively safe and effective procedure for the treatment of SUI even in cases of recurrence. Almost full recovery was achieved in all the cases of this study. The mini–sling has become an important element in modern urogynecology.