Introduction The COVID-19 outbreak has become the dominant issue throughout the world whilst the governments, nations and health services are trying to deal with its impact. The aim of our study is to assess the impact of COVID-19 on patients treated with radical prostatectomy (RP) for prostate cancer (PCa) at European referral centers in terms of surgical volume (SV), waiting list meant as time from biopsy to surgery (WL) and risk of adverse pathologic findings at RP due to the selection of men with more adverse disease characteristics at final pathology. Material and methods Consecutive patients with a diagnosis of histologically proven PCa treated with RP between March 2020 (WHO declaration of pandemic) and December 2020 were identified. Patients with metastatic disease not eligible to local treatment and recurrent prostate cancer after RP or RT were excluded. Patients treated at the same institutions between March 2019 and December 2019 were considered as the control group. Multivariable logistic regression analysis tested the impact of the COVID-19 outbreak on the risk of adverse pathologic findings at RP after adjusting for confounders. The percentage change of SV and WL was assessed comparing the months of pandemic with the equivalent timespan of the previous year. Results A total of 2,574 patients treated with RP (927 cases and 1647 controls) were identified in 8 European tertiary referral centers. At multivariable analysis patients who were treated during the pandemic had higher risk of extra prostatic disease (OR:1.35, p = 0.038) and lymph node invasion (LNI) (OR:1.72, p = 0.048). An average 23% reduction of the SV with the equivalent timespan of the previous year allowed an illusory reduction of the WL after the peak gained during the first wave of COVID-19. Conclusions Our results showed that the COVID-19 outbreak resulted in a delay in the administration of curative-intent therapies in patients with localized PCa. This, in turn, resulted in a stage migration phenomenon with a potential impact on oncologic control.
Retroperitoneal liposarcoma is among the most common primary retroperitoneal tumors, along with malignant fibrous histiocytoma and leiomyosarcoma. It is slow-growing and has the propensity to displace rather than invade adjacent structures. Histologic subtypes include well-differentiated, myxoid (the most common form), and pleomorphic. Liposarcoma is most often seen in the fifth to seventh decades and is more common in men. We report the case of a patient who presented with a well-differentiated giant retroperitoneal liposarcoma.
Introduction. Ischemia due to arterial occlusion, shock, or organ transplantation is a common cause of cell death and organ failure. This study was designed to assess the possible protective effects of leptin in ischemia/reperfusion (I/R) injury of renal tissue.Material and methods. Twenty-four male Sprague-Dawley rats were used. The animals were divided into 3 groups. Control, I/R, and I/R+Leptin group. Rats were subjected to renal ischemia for 60 min. The I/R+Leptin group was pretreated with leptin (10 mu l, i.p), which was administered 2 hours prior to the ischemia process. Then the clamps were removed and reperfusion was applied for 60 min. After reperfusion the kidneys were removed. Samples were collected and stained with hematoxylin and eosin (H&E) as well as immunohistochemically with p53. Apoptosis kits were used and positive cells were counted with an image analysis program and analyzed statistically. Also, in routine staining, the degree of edema, vascularization, and infiltrative cell migration was semiquantitatively evaluated.Results. The number of p53 positive and apoptotic cells was smaller in the leptin treated group than the I/R group (respectively p=0.004 and p=0.016). At the same time, the scores obtained from the I/R+Leptin group were smaller than from the I/R group (for edema p=0.002, for vascularization p=0.004, and for infiltration p=0.009).Conclusions. These results suggest that leptin reduces renal oxidative injury and facilitates repair. Leptin may have a role as a renoprotective agent by inhibiting p53 positive cells and apoptosis.
Introduction. An evaluation of prostate cancer progression in group 1 (n - 30) with simultaneous prostate cancer (PCa) and premalignant lesions (PL) in comparison with group 2 (n - 159) with prostate cancer alone was carried out.Materials and methods. All patients underwent radical prostatectomy (RP). The assessment consisted of PSA levels, Gleason score (Gs), clinical staging, percentage of multifocal tumors, and tumor volume in both groups. Postoperative follow-up was evaluated: including clinical recurrence and biochemical recurrence (BCR) rate, metastases, and cancer specific deaths.Results. Sixty percent of patients in group 1 had clinically insignificant prostate cancer. Although in this group PSA levels, Gs, and tumor staging were statistically lower. Tumor progression was similar to group 2. A considerably prevalent presence of multifocal tumors in group 1 did not result in their greater volume.
The occurrence of mucinous cystadenocarcinoma of the testis, which histologically resembles an epithelial tumor of the ovary, is extremely rare. We report a case of a 54-year-old man with mucinous cystadenocarcinoma of the testis who underwent orchidectomy. A review of the literature focuses on histogenesis, differential diagnosis, and the role of adjuvant therapy.
Tissue factor (TF) is a substance of great biological relevance. TF activates the extrinsic coagulation cascade and takes part in the mechanisms of inflammation and atheromatosis. TF, through its influence on neoangiogenesis, plays a great, but not exactly recognized, role in the origin and spread of neoplasms, including prostate cancer.
Introduction. Laparoscopic pyeloplasty has been proven to be an effective and minimally-invasive technique in the treatment of ureteropelvic junction (UPJ) obstruction. However, only case-reports are available about the use of this technique in patients with duplicated collecting systems.Material and methods. Between September 2002 and June 2005, 5 patients with duplicated collecting systems underwent laparoscopic pyeloplasty at our institution. In all cases, UPJ-obstruction was observed in the lower pole moiety. The cause of obstruction was a crossing vessel (3 cases) or an intrinsic stenosis (1 case). These patients were treated with Anderson-Hynes pyeloplasty. One individual presented with a 1 cm stenotic connection between the hydronephrotic lower pole system and a solitary ureter coming from the upper pole. An end-to-side anastomosis between the renal pelvis and the ureter was performed. All intraoperatively placed double pigtail ureteral stents were removed 6 weeks postoperatively.Results. All operations were performed successfully without complications or conversion to open surgery. Mean operative time including preoperative transurethral ureteral stenting was 175 +/- 15 min. No urinary leakage was observed. Average hospitalization was 4.5 days. Renal scintigrams, performed 3 months postoperatively, demonstrated improvement of renal function with disappearance of obstruction in all cases. Durable clinical and radiographic success was observed during a follow-up of 4 to 26 months.Conclusions. The present data demonstrates that laparoscopic pyeloplasty is an applicable tool in patients with upper urinary tract anomalies like duplicated collecting systems. This technique provides excellent clinical results and can be performed in an acceptable operative time without complications.
Inflammatory myofibroblastic tumor (IMT) is an uncommon tumor believed to be benign and can arise in various organs. We report a case of renal IMT in a 74-year old female with right upper quadrant abdominal pain. Computerized tomography showed a 4.5 cm upper pole renal mass, consistent with a renal cell carcinoma. Subsequently a laparoscopic right radical nephrectomy was performed. Pathology revealed an unusual lesion consisting of spindle cells having prominent nucleoli, with plasma cells and lymphocytes throughout the lesion. Staining was positive for anaplastic lymphoma kinase (ALK), vimentin, CK 18, CK-AE 1/3, and CAM 5.2 consistent with an IMT.
Introduction. The increasing number of benign and non-cancerous tumors has resulted in the common use of NSS for the treatment of pT1 tumors. However, this kind of treatment did not reduce the number of unnecessary operations.Material and methods. Two-hundred nineteen patients with pT1 tumors treated with NSS were analyzed retrospectively. The mean time of observation was 77.9 months. The patients were divided into groups depending on tumor size and the degree of cellular differentiation of the tumor - DCTD (according to Fuhrman).Results. Statistical analysis revealed that an increase in tumor diameter accompanied a decrease in the percentage of patients with tumors staged pT1 as well as those graded G1 and G0 (according to Fuhrmann). Mean survival time also decreases. While the percentage of tumors graded G3, those staged pT3, unconventional varieties of renal cell carcinoma (RCC), local recurrence, as well as renal insufficiency all increase together with increases in tumor diameter.Conclusions. In patients with tumors up to 3 cm, the risk of surgical overtreatment increases. In patients with pT1 increases: the risk of unconventional varieties of RCC, cancerous progression, and death along with the increase in the size of the tumor and DCTD. Along with the size of pT1 tumors, a decrease in the number of benign and non-cancerous tumors as well as 5-years survival after NSS is observed. The dynamics of cancerous changes in the tumors up to 2 cm is similar to the dynamics observed in the tumors up to 3 cm, whereas those of 4 cm act similarly as the tumors of 5 cm diameter.
Introduction. Prostate specific antigen (PSA) is an acknowledged marker in various conditions of the prostate including prostatic cancer. The PSA value depends on a given ailment of the prostate gland. It is commonly known that the serum PSA concentration changes under the influence of various drugs, prostate conditions, and urological surgical procedures as well as following ejaculation. Until now it was not clear whether pre-analytical external factors, such as the time and temperature at which the samples are stored from the moment of blood collection, had an influence on the final PSA value. The purpose of this study was to establish the influence of pre-analytical external factors (temperature and duration of storage before analysis) on the serum level of total PSA (tPSA).Material and methods. Forty-seven subsequent patients with prostate cancer were included and routine blood samples were collected. The tPSA was determined using the MEIA (Microparticle Enzyme Immunoassay) immunoenzymatic method with Abbott Diagnostics kits. Four measurement series of PSA levels were carried out in each patient dividing them into the following groups: series 1 - following coagulation (about 30 min), measurement after centrifugation - in serum series 2 - after incubating blood sample for 4 hours at 30 degrees C; series 3 - after incubating blood sample for 4 hours at room temperature; series 4 - after incubating blood sample for 24 hours at 4 degrees C.Results. The tPSA median and range for series 1 were: 0.656 ng/ml (0.0008 - 152.1 ng/ml). The percentage difference of PSA values between series 2, 3, and 4 and series 1 were analyzed. One-sample T-test was used with H0: assuming zero difference. No statistically significant difference was found between the series. The minimal detectable difference, at 0.9 test power level was 2.8% for all tests.Conclusions. In the present study, the external factors of blood sample storage had no effect on tPSA concentration.
Scrotal elephantiasis is both emotionally distressing and physically disabling, caused by chronic lymphedema created by obstruction, aplasia, or hypoplasia of lymphatic vessels. We present a case of a patient with massive scrotal, penile, and perineal elephantiasis of unexplained origin and discuss the diagnostic and therapeutic approach. The patient underwent four-stage repair: subtotal scrotectomy saving penis, testes, and spermatic cords followed by scrotal and penile reconstruction with adequate cosmetic and functional outcome.
Authors present a case of an 83 year old man with angiofibroma of the scrotum treated by total excision of the tumor. The presented case was first diagnosed as a hydrocele of the testis. However, during the surgical procedure, it was recognized as the very rare condition of angiofibroma of the scrotum [1, 2]. Hydrocele of the testis is a frequently observed pathology in men. Differential diagnosis should consider scrotal hernia, tumor of the testis, and post-traumatic hematoma among others
Introduction. A major interest in human genetics is to distinguish functionally neutral mutations and polymorphisms from those that contribute to disease. Polymorphic variants of the P53 gene at codon 72 are associated with cancer susceptibility. The aim of our study was to characterize P53 polymorphism at codons 72 and 213 in bladder cancer patients and in a control group. Materials and methods. Ninety-five patients with clinically diagnosed urinary bladder tumors were included in the study. Pathology classified 36 tumors as low grade and 59 as high grade. Tumor stage was pTa or lower in 30 patients and at least pT1 in 65 patients. The control included DNA samples from the blood of 84 cancer-free individuals. The demonstration of codon 72 and codon 213 P53 polymorphisms was performed using PCR and MSSCP techniques. results. In the group of healthy patients we found the following distribution of polymorphism: ARG/ARG – 58.3%, ARG/PRO – 40.5%, and PRO/PRO – 1.2%. In the group of patients suffering from urinary bladder cancer it was 56.8%, 43.2%, and 0.0%, respectively. Statistical analysis of the distributions by the G-test did not reveal any significant difference (table 2x2 G = 0.433) Conclusions. Our study did not reveal that one of the polymorphic variants of the P53 gene codon 72 is a factor increasing the risk of urinary bladder cancer development in the Polish population. It needs to be mentioned, however, that the ARG/ARG genotype (leading to this kind of cancer, according to other researchers) is dominant in the tested population.
Introduction. Data suggest that not only alpha-adrenergic factors contribute to contractility of smooth muscles of the prostate. The authors determined the influence of doxazosin mesylate on localization of endothelin-1 in prostatic tissue in treated and non-treated patients.Material and methods. Seventy patients with symptoms of prostate enlargement: 40 patients preliminary treated with doxazosin mesylate and 30 non-treated patients. All underwent prostate biopsy due to elevated PSA level (mean 5.85 ng/ml). Specimens were H&E stained for histopathology which confirmed diagnosis of benign hyperplasia and immunohistochemically stained for ET-1 in epithelium and prostate stroma. Authors calculated ET-1 mean optical density ratios (epithelial ET-1/stromal ET-1) for treated and non-treated patients. Statistical analysis was performed. Ratios of ET-1 in epithelium and stroma of both groups differed statistically.Conclusions. Obtained data indicate that relocation of endothelin-1 from prostate epithelium to stroma is altered in the treated group in comparison with the non-treated group. Doxazosin mesylate might have an influence on ET-1 redistribution from the epithelial compartment to the non-epithelial environment. This could be an additional mechanism of action of alpha-adrenergic blockers in BPH patients.
