A high fluid intake is still the most evidence-based measure for the prevention of idiopathic stone disease. The recommendation of current guidelines on urolithiasis to increase diuresis to 2–2.5 L/day is mainly based on a single clinical study. The present paper shows the influence of diuresis on calcium oxalate (CaOx) crystallization and especially aggregation (AGN) which can explain the initial development of Ca stones on papillary calcifications as well as stone growth in the renal pelvic system. Diuresis determines the urinary transit time (UT) through the kidney and together with the afflux of Ca and Ox the state of urinary saturation with respect to CaOx being the most frequent stone mineral. High supersaturation inducing crystallization during UT and a high urinary ion concentration interfering with the inhibition of crystal AGN by urinary macromolecules seem to be critical parameters for stone formation. Using data from the literature the influence of diuresis on these parameters is evaluated for short-term recurrent stone formers (RSF), idiopathic stone patients, and healthy controls, the latter two collectives with and without excessive oxalate ingestion. This investigation suggests that a diuresis of 2 L/day may protect from stone formation even after dietary Ox excesses and in RSF. However, in RSF with a continuously high Ca and Ox afflux into urine a permanent high diuresis is required which is difficult to sustain over 24 hours.

Molecular markers reliably predicting failure or success of Bacillus Calmette‐Guérin (BCG) in the treatment of nonmuscle‐invasive urothelial bladder cancer (NMIBC) are lacking. The aim of our study was to evaluate the value of cytology and chromosomal aberrations detected by fluorescence in situ hybridization (FISH) in predicting failure to BCG therapy. Sixty‐eight patients with NMIBC were prospectively recruited. Bladder washings collected before and after BCG instillation were analyzed by conventional cytology and by multitarget FISH assay (UroVysion®, Abbott/Vysis, Des Plaines, IL) for aberrations of chromosomes 3, 7, 17 and 9p21. Persistent and recurrent bladder cancers were defined as positive events during follow‐up. Twenty‐six of 68 (38%) NMIBC failed to BCG. Both positive post‐BCG cytology and positive post‐BCG FISH were significantly associated with failure of BCG (hazard ratio (HR)= 5.1 and HR= 5.6, respectively; p < 0.001 each) when compared to those with negative results. In the subgroup of nondefinitive cytology (all except those with unequivocally positive cytology), FISH was superior to cytology as a marker of relapse (HR= 6.2 and 1.4, respectively). Cytology and FISH in post‐BCG bladder washings are highly interrelated and a positive result predicts failure to BCG therapy in patients with NMIBC equally well. FISH is most useful in the diagnostically less certain cytology categories but does not provide additional information in clearly malignant cytology. © 2009 UICC

You have accessJournal of Urology1 Apr 2008EARLY RECOVERY OF ERECTILE FUNCTION PREDICTS LONG- TERM OUTCOME AFTER RADICAL PROSTATECTOMY Kurt Lehmann, Marcus Zahner, Brunello Mazzola, and Roberto Casella Kurt LehmannKurt Lehmann More articles by this author , Marcus ZahnerMarcus Zahner More articles by this author , Brunello MazzolaBrunello Mazzola More articles by this author , and Roberto CasellaRoberto Casella More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61183-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "EARLY RECOVERY OF ERECTILE FUNCTION PREDICTS LONG- TERM OUTCOME AFTER RADICAL PROSTATECTOMY." The Journal of Urology, 179(4S), p. 404 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 404 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Kurt Lehmann More articles by this author Marcus Zahner More articles by this author Brunello Mazzola More articles by this author Roberto Casella More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE:To assess the value of nuclear matrix protein-22 (NMP22), compared with urinary cytology, in predicting the recurrence of bladder cancer that is not transitional cell carcinoma (non-TCC).PATIENTS AND METHODS:We tested the sensitivity, specificity and the predictive accuracy of NMP22 in the context of non-TCC bladder cancer recurrence, and compared it to the performance of urinary cytology. The study group comprised 2687 patients with history of non-muscle-invasive bladder cancer from 10 centres across four continents.RESULTS:The mean patient age was 64.8 years and 75.4% were men; of all patients, 513 (19.1%) had positive urinary cytology, 906 (33.7%) had a positive NMP22 test (>or=10 units/mL) and 80 (3.0%) had non-TCC recurrence. Most of these, i.e. 60 (75%), were stage >or=T2. The sensitivity and specificity of urinary cytology were, respectively, 20.0% and 94.8%, vs 77.5% and 81.8% for NMP22 of >or=10 units/mL. The predictive accuracy of urinary cytology was 57.5%, vs 87.1% for NMP22 >or= 10 units/mL. A combined model that included dichotomized NMP22 and urinary cytology was 85.3% accurate.CONCLUSION:The ability of a NMP22 level of >or=10 units/mL to predict non-TCC recurrence was better than that of urinary cytology, suggesting that NMP22 might have a role in the surveillance of patients at risk of non-TCC recurrence.

Purpose: We tested the hypothesis that urinary cathepsin B and L are associated with bladder cancer recurrence and invasiveness in patients with a history of nonmuscle invasive urothelial carcinoma of the bladder.Materials and Methods: Cathepsin B and L, and NMP22 (R) were determined in the urine specimens of 188 consecutive subjects with a history of treated urothelial carcinoma of the bladder, 31 with noncancerous urological conditions and 10 healthy subjects. Cathepsin B and L were analyzed as continuous and categorical variables based on their quartile distribution.Results: Urinary cathepsin L was higher in the 122 patients with cystoscopic evidence of bladder tumor compared with levels in 107 with normal cystoscopy (median 5.9, IQR 4.4 vs 3.0, IQR 3.2, p <0.001). Higher levels of cathepsin L were associated with positive cytology assay results, higher NMP22 and T1 or greater pathological stage (each p <0.001). Area under the ROC curves of NMP22 and cathepsin L for bladder cancer detection were 0.704 (95% CI 0.637-0.772) and 0.793 (95% CI 0.736-0.850), respectively. On multivariate analysis cathepsin L, NMP22 and cytology were associated with invasive pathological stage (OR 1.29, 2.42 and 2.76, respectively, p <= 0.002). Urinary cathepsin B was not associated with any outcome variables.Conclusions: Urinary cathepsin L is an independent predictor of bladder cancer presence and invasiveness in patients with a history of urothelial carcinoma of the bladder. Further evaluation of this marker is necessary before its use as an adjunct to cystoscopy for urothelial carcinoma of the bladder.

We report an uncommon sequel of a renal artery occlusion after a complicated abdominal aortic aneurysm repair. During 2 years following the operation the kidney underwent a complete liquefaction wh

You have accessJournal of UrologyDiscussed Poster, Monday, May 22, 2006, 9:00 am - 12:00 pm1 Apr 2006682: No Pad or One Pad: The Patient's Perspective Kurt Lehmann, Urs Straumann, Leander Schürch, Marcus Zahner, and Roberto Casella Kurt LehmannKurt Lehmann More articles by this author , Urs StraumannUrs Straumann More articles by this author , Leander SchürchLeander Schürch More articles by this author , Marcus ZahnerMarcus Zahner More articles by this author , and Roberto CasellaRoberto Casella More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)32928-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "682: No Pad or One Pad: The Patient's Perspective." The Journal of Urology, 175(4S), p. 221 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 221 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Kurt Lehmann More articles by this author Urs Straumann More articles by this author Leander Schürch More articles by this author Marcus Zahner More articles by this author Roberto Casella More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE:To assess the contemporary inter-institutional accuracy of urinary cytology in predicting the recurrence of transitional cell carcinoma (TCC) of the bladder, in a large multi-institutional cohort from four continents, as cystoscopy and urinary cytology represent the 'gold standards' for surveillance of TCC recurrences, but the ability of cytology to predict recurrence varies. PATIENTS AND METHODS:Ten institutions contributed 2542 patients with a history of superficial TCC, of whom 898 had TCC recurrence. Age- and gender-adjusted logistic regression models were used to evaluate the association between urine cytology and TCC recurrence. The predictive accuracy derived from the logistic regression model was tested using the area under the receiver operating characteristic curve. The resulting predictive accuracy estimates were internally validated with 200 bootstrap re-samples. RESULTS:The mean (range across institutions) age of the patients was 65 (48-69) years and 75 (67-87)% were men. Cytology was positive in 19 (10-38)% of patients; recurrence was identified in 35 (27-54)% of patients. The sensitivity was 38-65% across institutions. Urinary cytology varied significantly in its ability to predict recurrence of bladder cancer. Institution-specific predictive accuracy adjusted for gender and age was 0.627-0.893. Stratifying by grade and stage only partly attenuated the discrepancies between centres. CONCLUSIONS:The variability of urinary cytology results was very appreciable among the 10 centres and ranged from poor (63%) to excellent (89%).

You have accessJournal of UrologyPodium, Monday, May 22, 2006, 3:30 - 5:30 pm1 Apr 2006984: Variability in the Performance of Nuclear Matrix Protein 22 in the Detection of Bladder Cancer Shahrokh F. Shariat, Michael Marberger, Yair Lotan, Marta Sanchez-Carbayo, Craig D. Zippe, Gerson Lüdecke, Hans Boman, Kämsjukhuset Skövde, Ihor S. Sawczuk, Martin G. Friedrich, Roberto Casella, Christine Mian, Sanaa Eissa, Hideyuki Akaza, Vincenzo Serretta, Hartwig Huland, Hans Hedelin, Kärnsjukhuset Skövde, Rupesh Raina, Naoto Miyanaga, Arthur I. Sagalowsky, Claus G. Roehrborn, and Pierre I. Karakiewicz Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Michael MarbergerMichael Marberger More articles by this author , Yair LotanYair Lotan More articles by this author , Marta Sanchez-CarbayoMarta Sanchez-Carbayo More articles by this author , Craig D. ZippeCraig D. Zippe More articles by this author , Gerson LüdeckeGerson Lüdecke More articles by this author , Hans BomanHans Boman More articles by this author , Kämsjukhuset SkövdeKämsjukhuset Skövde More articles by this author , Ihor S. SawczukIhor S. Sawczuk More articles by this author , Martin G. FriedrichMartin G. Friedrich More articles by this author , Roberto CasellaRoberto Casella More articles by this author , Christine MianChristine Mian More articles by this author , Sanaa EissaSanaa Eissa More articles by this author , Hideyuki AkazaHideyuki Akaza More articles by this author , Vincenzo SerrettaVincenzo Serretta More articles by this author , Hartwig HulandHartwig Huland More articles by this author , Hans HedelinHans Hedelin More articles by this author , Kärnsjukhuset SkövdeKärnsjukhuset Skövde More articles by this author , Rupesh RainaRupesh Raina More articles by this author , Naoto MiyanagaNaoto Miyanaga More articles by this author , Arthur I. SagalowskyArthur I. Sagalowsky More articles by this author , Claus G. RoehrbornClaus G. Roehrborn More articles by this author , and Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33209-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "984: Variability in the Performance of Nuclear Matrix Protein 22 in the Detection of Bladder Cancer." The Journal of Urology, 175(4S), p. 317 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 317 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Shahrokh F. Shariat More articles by this author Michael Marberger More articles by this author Yair Lotan More articles by this author Marta Sanchez-Carbayo More articles by this author Craig D. Zippe More articles by this author Gerson Lüdecke More articles by this author Hans Boman More articles by this author Kämsjukhuset Skövde More articles by this author Ihor S. Sawczuk More articles by this author Martin G. Friedrich More articles by this author Roberto Casella More articles by this author Christine Mian More articles by this author Sanaa Eissa More articles by this author Hideyuki Akaza More articles by this author Vincenzo Serretta More articles by this author Hartwig Huland More articles by this author Hans Hedelin More articles by this author Kärnsjukhuset Skövde More articles by this author Rupesh Raina More articles by this author Naoto Miyanaga More articles by this author Arthur I. Sagalowsky More articles by this author Claus G. Roehrborn More articles by this author Pierre I. Karakiewicz More articles by this author Expand All Advertisement PDF DownloadLoading ...

Objective: To assess whether urinary levels of tumor-associated trypsin inhibitor (TATI) would aid in the detection of bladder transitional cell carcinoma (TCC); and to compare diagnostic performance of urinary TATI with that of nuclear matrix protein 22 (NMP22) and barbotage cytology.Methods: We determined TATI and NMP22 levels in voided urine from 181 subjects: 153 with previous bladder cancer, 20 with urologic pathology other than bladder cancer, and eight healthy volunteers. TATI was analyzed continuously and categorically on the basis of its quartile distribution. We also measured urinary creatinine and barbotage cytology in 173 and 154 patients, respectively.Results: Urinary TATI levels were significantly higher in TCC patients with evidence of tumor on cystoscopic evaluation (n = 96) than in control subjects (n = 85; p < 0.001). Higher levels of TATI were associated with positive cytology assay results (p = 0.018), higher NMP22 levels (p < 0.001), and invasive tumor stage (p = 0.026). The area under the receiver operating characteristics (ROC) curve (AUC) of TATI for the detection of TCC was 0.712 (95%CI: 0.637-0.786). The overall AUCs for TATI and NMP22 were not statistically different from each other (p = 0.174). In the > 75% sensitivity region of the ROC curves, TATI was consistently more specific than NMP22. TATI, NMP22, and cytology were independently associated with bladder cancer (p = 0.049, p = 0.040, and p < 0.001, respectively). Adjustment of TATI for urinary creatinine levels did not affect any of the outcomes.Conclusions: Urinary level of TATI may add independent information to urinary cytology and NMP22 in the detection of bladder TCC. TATI seems to outperform NMP22 for bladder TCC detection. (c) 2005 Published by Elsevier B.V.

Nachdem der Entscheid gefallen ist, bei einem Patienten einen Hormonersatz einzuleiten, sollte diese Therapie bezüglich klinische und laborchemische Wirkung und mögliche Nebenwirkungen überwacht werden. Diese Kontrollen sollten 3, 6, und 12 Monate nach Beginn der Therapie durchgeführt werden, in der Folge in jährlichen Abständen. Die uns zur Verfügung stehende Evidenz unterstützt nicht die Hypothese, dass der Androgenersatz hypogonader älterer Männer einen kausalen Zusammenhang mit dem Prostatakarzinom hat. Was die benigne Prostathyperplasie betrifft, stellen fehlende oder leichte obstruktive Symptome eine relative, schwere obstruktive Symptome eine absolute Kontraindikation dar.

INTRODUCTION:The management of caliceal diverticular calculi has changed from an open surgical approach to endoscopic management. TECHNICAL CONSIDERATIONS:Different minimally invasive treatment modalities, such as extracorporeal shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, laparoscopy, and retroperitoneoscopy, can be offered to the patient. We report on a retroperitoneoscopic operative technique using endosonography for location and performing nephrotomy with complete excision of the caliceal diverticulum and ligation of the diverticular neck with an Endo-loop. CONCLUSIONS:The advantages of this minimally invasive technique include total excision of the diverticulum with no risk of recurrence and easy and complete closure of the diverticular neck.

No AccessJournal of UrologyCLINICAL UROLOGY: Letters to the Editor1 Jun 2004RE: TUMOR MARKERS IN THE DIAGNOSIS OF PRIMARY BLADDER CANCER. A SYSTEMATIC REVIEW R. Casella R. CasellaR. Casella More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000124332.57014.29AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "RE: TUMOR MARKERS IN THE DIAGNOSIS OF PRIMARY BLADDER CANCER. A SYSTEMATIC REVIEW." The Journal of Urology, 171(6 Part 1), pp. 2383–2384 References 1 : Further study of fibrinogen degradation products in bladder cancer detection. Urology1978; 12: 659. Google Scholar 2 : A multicenter trial evaluation of the fibrin/fibrinogen degradation products test for detection and monitoring of bladder cancer. J Urol1997; 158: 801. Link, Google Scholar 3 : Rapid detection of bladder cancer: a comparative study of point of care tests. J Urol1997; 158: 2098. Link, Google Scholar 4 : Current bladder tumor tests: does their projected utility fulfill clinical necessity?. J Urol2001; 165: 1067. Link, Google Scholar 5 : Current concepts in biomarker technology for bladder cancers. Clin Chem2000; 46: 595. Google Scholar Department of Urology, University Hospital, Basel, Switzerland© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 171Issue 6 Part 1June 2004Page: 2383-2384 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.MetricsAuthor Information R. Casella More articles by this author Expand All Advertisement PDF DownloadLoading ...

Objectives: A modern baseline assessment of erectile dysfunction (ED) should be individualized, reliable, noninvasive and cost-efficient. Appraisal based on the patient’s self-evaluation may be the method of choice. Methods: Using a self-report method, 63 consecutive ED patients were prospectively investigated. Semiquantitative parameters on 7 criteria were assessed, and an intracavernous injection test with alprostadil was performed. Performances of self-reporting and intracavernous testing in predicting penetrative ability were compared. Results: Twenty-three (37%) men had erection insufficient for penetration even with manual assistance, 26 (41%) men needed manual assistance and 14 (22%) could penetrate without manual assistance but erection was not sufficient for satisfaction. In addition to impaired penetrative ability, 6 criteria (intercourse frequency, patient’s and partner’s satisfaction, penile rigidity, duration of erection and need for extra stimulation) deteriorated over time (p < 0.006). Patient self-evaluation criteria such as intercourse per week, patient satisfaction, penile rigidity, duration of erection and time between consultation and last satisfactory intercourse showed discriminating differences in accordance with the 3 subgroups of penetrative ability (p < 0.02). Intracavernous testing could not reproduce the degree of erectile deficit as experienced during intercourse (p = 0.21). In a logistic regression model, criteria best characterizing penetrative ability were penile rigidity, time between consultation and last unsuccessful intercourse, and degree of satisfaction (p < 0.0001). Conclusions: The patient’s self-evaluation by semiquantitative parameters on criteria characterizing sexual erections better predicts the penetrative ability than the response to an intracavernous injection. These criteria quantify both the objective degree of ED and the patient’s apprehension. Consequently, patients may undergo immediate treatment without further testing.

PURPOSE:To test the hypothesis that voided urinary levels of nuclear matrix protein 22 (NMP22) would add to the predictive ability of urine cytology in the diagnosis, staging and grading of bladder transitional cell carcinoma (TCC), and to evaluate the diagnostic performance of different NMP22 cut-points.MATERIALS:NMP22 level and barbotage cytology were evaluated in voided urine specimens collected before cystoscopy from 302 subjects with a history of TCC, 32 subjects with benign urologic pathologies, and 10 healthy volunteers.RESULTS:180 patients (52%) had bladder TCC. Higher levels of NMP22 and positive cytology were independently associated with an increased risk of TCC, invasive stage, and high grade. The NMP22 value with equal sensitivity and specificity for prediction of bladder cancer was 6.5U/ml; for prediction of grade 3 TCC it was 13.5U/ml; and for prediction of invasive tumor stage it was 17.4U/ml. The NMP22 cut-point of 6.5U/ml outperformed the 10U/ml cut-point in all pathologic stages and grades. The diagnostic sensitivity of the cytology and NMP22 combined was superior across all pathologic stages and grades to that of either marker alone. NMP22 and cytology stratified patients into groups with significantly different risk for TCC presence, invasive stage, and high grade.CONCLUSIONS:6.5U/ml is a robust NMP22 cut-point for bladder cancer surveillance. The diagnostic sensitivities of the combined NMP22 and cytology for TCC presence, stage, and grade were significantly higher than those of single marker alone. The combination of urine cytology and NMP22 could be used to tailor the frequency of cystoscopic follow up.

PURPOSE:Androgens and a functioning androgen receptor are required for normal spermatogenesis. The androgen receptor gene (AR) has a repetitive DNA sequence in exon 1 that encodes a polyglutamine tract. Within the normal polymorphic range this (CAG)(n) tract length is inversely related to the transcriptional activity of the androgen receptor. In a prospective analysis we determined the association of AR (CAG)(n) tract length with testicular histology in infertile males.MATERIALS AND METHODS:Blood DNA from 70 severely infertile patients without obstruction who were undergoing testicular biopsy was amplified by polymerase chain reaction targeting the AR (CAG)(n) tract. A total of 37, 15 and 18 men presented with the Sertoli-cell-only syndrome, maturation arrest and hypospermatogenesis, respectively. Blood DNA from 55 fertile men served as the control. Polymerase chain reaction amplified DNA was direct sequenced using a genetic analyzer.RESULTS:Median CAG repeat length was 22 (range 17 to 33) in infertile patients and 21 (range 8 to 27) in controls (p = 0.009), including 22 (range 17 to 30) in patients with the Sertoli-cell-only syndrome, 22 (range 18 to 28) in those with maturation arrest and 23 (19 to 33) in those with hypospermatogenesis. Statistical significance was noted for the hypospermatogenesis versus control groups (p = 0.039) but not for the groups with the Sertoli-cell-only syndrome or maturation arrest versus the control group (p = 0.054 and 0.591, respectively).CONCLUSIONS:Infertile males with testicular failure, particularly those with hypospermatogenesis, are more likely to have a longer androgen receptor polyglutamine tract than controls. Polymorphisms of the AR (CAG)(n) tract may contribute to spermatogenesis efficiency through a subtle modulatory effect on androgen receptor function.

Microsatellite instability is characteristic of certain types of cancer, and is present in rodents lacking specific DNA-mismatch repair proteins. These azoospermic mice exhibit spermatogenic defects similar to some human testicular failure patients. Therefore, we hypothesized that microsatellite instability due to deficiencies in mismatch repair genes might be an unrecognized aetiology of human testicular failure. Because these azoospermic patients are candidates for testicular sperm extraction and ICSI, transmission of mismatch repair defects to the offspring is possible. Seven microsatellite loci were analysed for instability in specimens from 41 testicular failure patients and 20 controls. Blood and testicular DNA were extracted from patient and control specimens, and amplified by PCR targeting seven microsatellite loci. DNA fragment length was analysed with an ABI Prism 310 Genotyping Machine and GeneScan software. Immunohistochemistry was performed on paraffinized testis biopsy sections and cultured testicular fibroblasts from each patient to determine if expression of the mismatch repair proteins hMSH2 and hMLH1 was normal in both somatic and germline cells. Results demonstrate that microsatellite instability and DNA mismatch repair protein defects are present in some azoospermic men, predominantly in Sertoli cell-only patients (P < 0.01 and P < 0.05 respectively). This provides evidence of a previously unrecognized aetiology of testicular failure that may be associated with cancer predisposition.