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PURPOSE: Various targeted disease-specific therapeutics are currently approved, demonstrating a survival benefit over therapy with interferon-alpha (IFN-α) in patients with metastatic renal cell carcinoma (mRCC). Temsirolimus, a highly specific inhibitor of the mammalian target of rapamycin (mTOR), improves the overall and progression-free survival of high-risk patients with mRCC. The purpose of this study was to estimate the effects of temsirolimus on several laboratory parameters and to report the potential adverse events (AEs) in patients with mRCC. METHODS: This research was a controlled, open, prospective and partly retrospective randomized study that included 60 patients up to 65 years of age, divided into the experimental and control group, each containing 30 patients. Patients in the experimental group were treated with temsirolimus. The control group comprised patients in the same stage of disease, treated with IFN-α. The effect of therapy in both groups was monitored during the first year of administration. RESULTS: The overall incidence of AEs was 40% in both groups. Sixteen laboratory parameters were analyzed and the total number of deviations from the reference range was 263 in the experimental group and 229 in the control group. The total number of AEs regarding patient general clinical condition in the experimental group was 193 (asthenia 53.3%, urinary infection 43.3% and pyrexia 40%) and 175 in the control group (pyrexia 76.7%, asthenia 50% and tremor 50%). CONCLUSION: Monitoring the renal function parameters during the temsirolimus administration has proved that the therapy had no significant influence on the remaining kidney function. By evaluating the AEs we concluded that there was no significant difference in the number of AEs of all grades between the groups, while the laboratory parameters and physical status deterioration differed qualitatively.
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Antineoplásicos/uso terapéutico , Carcinoma de Células Renales/tratamiento farmacológico , Interferón-alfa/uso terapéutico , Neoplasias Renales/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/uso terapéutico , Sirolimus/análogos & derivados , Antineoplásicos/efectos adversos , Carcinoma de Células Renales/secundario , Humanos , Interferón alfa-2 , Interferón-alfa/efectos adversos , Neoplasias Renales/patología , Estudios Prospectivos , Inhibidores de Proteínas Quinasas/efectos adversos , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Estudios Retrospectivos , Serbia , Sirolimus/efectos adversos , Sirolimus/uso terapéutico , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCTION: In males the ectopic ureter usually drains into the prostate (50%). During ureteric developement a thin membrane (Chawalla's membrane) separates the lumen of the ureter and the urogenital sinus at the point where the ureter joins the urogenital sinus. This membrane ruptures allowing urin to drain from the ureter to the urogenital sinus. The authors reported a case of renal dysplasia associated with ipsilateral uretral ectopia mimicking prostatic abscess. CASE REPORT: A subfebrile (37.3 degrees C), 23-year-old patient, otherwise healthy, presented with persistent ascending perineal pain non-responsive to antibiotics and analgetics. Digitorectal examination (DRE) showed asymmetric prostate with a soft, tender, buldging left lobe suggestive of prostatic abscess. The diagnosis was suspected using transrectal ultrasonography (TRUS), but the picture of the anechoic tubular structure in the left lobe of the prostate with a proximal undefined extraprostatic extension and a caudal intraprostatic blind end was incoclusive for the definitive diagnosis of prostatic abscess. Magnetic resonance imaging (MRI) was ordered and definitive diagnosis of renal dysplasia associated with the ipsilateral ectopic ureter filled with inflamed content mimicking prostatic abscess was made. Transurethral incision/minimal resection of the distal, blindly closed end of left ectopic ureter was done. Endoscopic surgical treatment was sufficient for relief of clinical symptoms. The patient's recovery was uneventful. CONCLUSION: To the best of our knowledge, a case of renal dysplasia with the ipsilateral ectopic ureter mimicking prostate abscess has not been reported so far. Cystic pelvic malformations in males may result from too cranial sprouting of the ureteral bud, with delayed absorption and ectopic opening of the distal end of the ureter.
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Absceso/diagnóstico , Coristoma/diagnóstico , Riñón/anomalías , Enfermedades de la Próstata/diagnóstico , Uréter , Adulto , Coristoma/cirugía , Diagnóstico Diferencial , Endoscopía , Humanos , Masculino , Enfermedades de la Próstata/cirugía , Uréter/cirugía , Adulto JovenRESUMEN
INTRODUCTION: Renal Cell Cancer ( RCC) is third most frequent urological cancer behind Prostate cancer and Bladder cancer. It represents 2-3 % of all cancers with annual increase in incidence of 2% in Europe (except Denmark and Sweden) and worldwide. Surgery is the only curative procedure, performed as radical nephrectomy (RN) or partial nephrectomy (nephron sparing surgery-NSS). Radical nephrectomy consists of nephrectomy with ipsilateral adrenalectomy and lymphadenetomy, but partial nephrectomy means resection of the tumor only with 1-3 mm of healthy surrounding tissue and preservation of the rest of the kidney as well as ipsilateral adrenal gland and lymph nodes. NSS is a method of conservation of attacked kidney and preservation of kidney's function with previous radical resection of localized RCC, respecting of all oncological principles. The aim of this study is to describe NSS procedure in details and present results of its 13 year use at Clinic of Urology in Novi Sad. MATERIAL AND METHODS: In the last 13 years there were 868 patients (pts) with RCC. NSS has been performed in 242 pts (27.88%). Bilateral tumors: synchronous 8 pts, asynchronous 3 pts. Better kidney has been operated, first. Indications for NSS were: absolute--34 pts (15.0%), relative--58 pts (23.1%) and elective--150 pts (61.9%).Surgery was performed according to esta- blished protocol for this procedure based on recommendation of Prof. A. Novick, Cleveland, USA. RESULTS: All patients underwent surgery under general anesthesia through lumbothomy, mostly.Tumor size was between 2.5-4.5 cm: over 4.5 cm (4-7 cm): 4 pts. Average age of pts--63.5 years (37-84), male: 148 (61.1%), female: 94 (38.9%). From 2001-2005, 2006-2010 i 2011-2013, 39,111 i 92 NSS has been done, respectively. It represented 13.5%, 36.6% , 50.54% of all pts with RCC underwent surgery in that period, respectively. There was an increase of NSS in that period compared to RN for localized RCC. There were no death outcomes inpts underwent NSS, local recurrence was seen in 1 patient (0.6%), urine leakage > 2 weeks 5 pts (5/242 = 2.06%),severe hemorrhage: 3 pts (1.23%), nephrectomy has been done. We do not have patients with von Hippel Landau (VHL) disease. CONCLUSION: Nephron sparing surgery Is the first choice of surgery for patients with low grade kidney tumors (up to 4.5 cm, even 7 cm), has excellent onco- logical results-comparable with radical nephrectomy, but with preservation of renal function and should be done by an experienced urological team in specialized urological centers with good anesteziological support.
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Neoplasias Renales , Recurrencia Local de Neoplasia/patología , Nefrectomía , Nefronas , Tratamientos Conservadores del Órgano , Complicaciones Posoperatorias/diagnóstico , Adulto , Anciano , Femenino , Humanos , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Nefrectomía/efectos adversos , Nefrectomía/métodos , Nefronas/patología , Nefronas/cirugía , Tratamientos Conservadores del Órgano/efectos adversos , Tratamientos Conservadores del Órgano/métodos , Estudios Retrospectivos , Serbia , Carga TumoralRESUMEN
UNLABELLED: In addition to the metabolic role of vitamin D, which is well known and clearly defined, there have been many hypotheses regarding its anti-proliferative and pro-apoptotic role. EPIDEMIOLOGY AND SIGNIFICANCE OF PROSTATE CANCER: Prostate cancer is the second most common malignancy in men. Long period of cancerogenesis, available tumor markers and high incidence make this cancer ideal for preventive measures. PHYSIOLOGICAL ROLE OF VITAMIN D AND ITS EFFECT ON PROSTATE CANCER CELLS. In vitro and in vivo studies have shown the anti-proliferative and pro-apoptopic role of vitamin D. Disorders of vitamin D metabolism are noted in vitamin D gene level, vitamin D receptor, vitamin D responsive elements and androgen receptors. We present the most important effect of those changes on vitamin D metabolism. CONCLUSION: Available studies on vitamin D level in serum, prostate tissue, observed activity of vitamin D enzymes and genetic changes give us only a slight insight into the basic mechanisms of vitamin D action in the development of prostate cancer; therefore, further investigations are needed.
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Próstata/metabolismo , Neoplasias de la Próstata/fisiopatología , Vitamina D/metabolismo , Apoptosis , Proliferación Celular , Humanos , Masculino , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/metabolismo , Vitamina D/sangreRESUMEN
BACKGROUND/AIM: Hormone suppression therapy is used in men with advanced prostate cancer improving chances of longer survival. The aim of this study was to investigate the influence of androgen blockades on testosterone and luteinizing hormone (LH) values in patients with locally advanced and metastatic prostatic cancer. METHODS: The study included a total of 60 patients out of which 45 with prostatic cancer divided into 3 subgroups based on the type of the applied treatment protocol: 15 patients on monotherapy with luteinizing-releasing hormone (LH-RH) agonists (group I), 15 patients on total androgen blockade (group II) and 15 patients on monotherapy with antiandrogen (group III)). The control group consisted of 15 patients with benign prostatic hyperplasia. In all the patients, values of testosteron, LH and prostate-specific antigen (PSA) were monitored initially, as well as 3 and 6 months after the treatment protocol introduction. RESULTS: In the patients of the groups I, II and III, values of testosterone decreased after three months by 95.58%, 95.72%, and 67%, respectively. The difference was significant (p < 0.01). Between the values after three and six months there was no significant difference in these groups of participants. Testosterone values were significantly higher in the patients of the group III in both analyses. Comparing the values between the groups III and I, as well as those of the groups III and II, a significant difference was found after three and six months of the therapy (p < 0.01). There was a difference in testosterone values between the groups I and II after 3 and 6 months, but not significant. All types of the applied treatment protocols in the therapy of prostatic cancer significantly decreased the values of LH compared to the basal ones. CONCLUSION: Total androgen blockade and LH-RH agonists are more effective in lowering testosterone values (to castration values) compared to the antiandrogen monotherapy, where testosterone values stay above the castration level. This therapy approach has advantages, since it decreases testosterone values providing better therapy response. There is a difference in testosterone values, but not significant, when total androgen blockade and monotherapy with LH-RH agonists are administered. Registered lower basal values of LH in all patients with prostatic cancer open the possibility to introduce LH as a new additional, significant marker in diagnosis of this neoplasm.
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Antagonistas de Andrógenos/uso terapéutico , Antineoplásicos Hormonales/uso terapéutico , Hormona Luteinizante/sangre , Neoplasias de la Próstata/tratamiento farmacológico , Testosterona/sangre , Hormona Liberadora de Gonadotropina/agonistas , Humanos , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangreRESUMEN
BACKGROUND/AIM: Radical cystectomy is a method of choice in the therapy of infiltrative bladder cancer. The aim of this research was to analyze postoperative course after radical cystectomy (length of hospitalization, most frequent complications and utilization of antibiotics and transfusions). METHODS: We analyzed the records of 82 patients operated on in the Department of Urology, Clinical Center of Vojvodina, in a three-year period. In order to aquire data World Health Organization (WHO) has developed Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. Defined daily dose (DDD) is the assumed average maintenance dose per day for a drug use for its main indication. RESULTS: Continent urinary derivation was preformed in 23.15% cases. Postoperative complications occurred in 18.29% of patients. Average blood utilization was 2.19 units. Blood utilization for continent derivations (n=48) was 4.6 units, and incontinent ones 3.36 units. Totally 159.33 DDD/100 bed days were used. CONCLUSION: When preforming continent derivation there is a significant increase in blood utilization. Frequency of postoperative complications correlates to those reported in the literature.
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Cistectomía , Complicaciones Posoperatorias , Neoplasias de la Vejiga Urinaria/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Profilaxis Antibiótica , Transfusión Sanguínea , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Reservorios Urinarios ContinentesRESUMEN
INTRODUCTION: A locally advanced prostate cancer is defined as a malignant process spreading beyond the prostate capsule or in seminal vesicles but without distant metastasis or regional lymph nodes invasion. CLINICAL CLASSIFICATION, PREDICTION AND TREATMENT OF PROSTATE CANCER: An exact staging of clinical T3 stadium is usually difficult because of the frequent over and under staging. The risk prognostic stratification is performed through nomograms and ANN (artificial neural networks). The options for treatment are: radical prostatectomy, external radiotherapy and interstitial implantation of radioisotopes, hormonal therapy by androgen blockade. Radical prostatectomy is considered in patients with T3 stage but extensive dissection of lymph nodes, dissection of neurovascular bundle (on tumor side), total removal of seminal vesicle and sometimes resection of bladder neck are obligatory. Postoperative radiotherapy is performed in patients with invasion of seminal vesicles and capsular penetration or with prostate specific antigen value over 0.1 ng/ml, one month after the surgical treatment. Definitive radiotherapy could be used as the best treatment option considering clinical stage, Gleason score, age, starting prostate specific antigen (PSA) value, concomitant diseases, life expectancy, quality of life, through multidisciplinary approach (combined with androgen deprivation). Hormonal therapy in intended for patients who are not eligible for surgical treatment or radiotherapy. Conclusion Management of locally advanced prostate cancer is still controversial and studies fbr better diagnosis and new treatment modalities are ongoing.
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Neoplasias de la Próstata/terapia , Humanos , Masculino , Neoplasias de la Próstata/patologíaRESUMEN
INTRODUCTION: The aim of this study was to investigate the influence of androgen blockades on prostate specific antigen (PSA) values in patients with locally advanced and metastatic prostatic cancer. MATERIAL AND METHODS: The research was conducted on 60 patients. The group of 45 patients with prostatic cancer was divided into 3 subgroups, based on the type of the applied treatment protocol (15 patients on monotherapy with luteinizing hormone-releasing hormone agonists, 15 patients on total androgen blockade and 15 patients on monotherapy with antiandrogen). The control group consisted of 15 patients with benign prostatic hyperplasia. For all patients, the values of testosterone, luteinizing hormone and prostate specific antigen were monitored before as well as after 3 and 6 months during the treatment protocol. RESULTS: All types of the applied treatment protocols in the therapy of prostatic cancer decreased the values of prostate specific antigen significantly. The application of total androgen blockade and monotherapy with luteinizing hormone-releasing hormone agonists decreased the levels of prostate specific antigen significantly in comparison with monotherapy with antiandrogen. CONCLUSION: Although prostate specific antigen is not a prostatic cancer specific parameter; the dynamics of its decrease during the therapy of androgen blockade represents a significant marker of the therapy effect.
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Antagonistas de Andrógenos/uso terapéutico , Antineoplásicos Hormonales/uso terapéutico , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/tratamiento farmacológico , Anciano , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/sangreRESUMEN
INTRODUCTION: The number of male patients with clinical presentation of infertility, especially secondary infertility after infections, is increasing every day. Contemporary urological standards in defining male infertility include ultrasound examination. Ultrasound examination of the scrotum using color doppler is of great importance. DIAGNOSIS OF MALE INFERTILITY: Testicular atrophy, microlithiasis and varicocele are the most common causes of male infertility. Microlithiasis and classical testicular microlithiasis are not directly associated with infertility. Gray scale sonography is used in evaluation of the dilatation of the testicular veins, but color Doppler made a real contribution in revealing subclinical varicocele. Transrectal ultrasound is used in a number of pathological conditions of prostate, seminal vesicles and ducts. In cases of obstructive azoospermia it is important to find out the cause, such as focal prostatitis, cysts, ejaculatory ducts obstruction or absence of vas deferens. CONCLUSION: Ulltrasound is a noninvasive method easy to perform, which provides information without postexamination consequences such as strictures or obstructions, which are possible after invasive deferentography. Ultrasound guided biopsy, provides a new minimally invasive diagnostic tool in current urology.
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Enfermedades de los Genitales Masculinos/diagnóstico por imagen , Infertilidad Masculina/diagnóstico por imagen , Epidídimo/diagnóstico por imagen , Humanos , Infertilidad Masculina/etiología , Masculino , Escroto/diagnóstico por imagen , UltrasonografíaRESUMEN
INTRODUCTION: Exracorporeal shockwave lithotripsy (ESWL) is the first choice for patients with urolithiasis. Increased use of endoscopic techniques provided increased use of ureteroscopic lithotripsy in the treatment of stones located in distal ureter, as well as ESWL. Rigid ureteroscope is usually used in the management of distal ureter stones, while middle and upper ureter stones should be treated by flexible ureteroscope or ESWL. At Urology Clinic in Novi Sad, ureteroscopy has been used since 1986, and more than 1000 procedures have been performed with success rate of over 95% (100% when we were able to reach the stone). The aim of this report is to show the destruction of stone along the ureter, using a rigid ureteroscope, shortly after the ESWL treatment of kidney stones. CASE REPORT: A 46-year-old woman was admitted to the Clinic with "steinstrasse" along the ureter, two weeks following ESWL of kidney stones. Primarily, she underwent ESWL without J-J stenting, at another urologic department. On admission to our Clinic, she complained of pain, nausea, mild temperature. An urgent diagnosis was carried out and left sided "steinstrasse" with hydronephrosis was confirmed by ultrasound, plain X-ray, laboratory findings. Ureteroscopy was performed under spinal anesthesia by rigid ureteroscope and the stone was destroyed along the ureter, even the pyelon was explored at the end of the procedure. The patient was advised to take a lot of fluids with diuretics and 80% of stones were eliminated in the first week after the procedure. At the first control, a month later, the patient was stone free. CONCLUSION: Rigid ureteroscope is a therapeutic option for distal ureteral stones, just as ESWL with comparable and reproducible results. This case confirms the fact that in strictly selected cases, and careful work of skilled urologists, rigid ureteroscope can be used for successful stone destruction in the middle and upper ureter.
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Cálculos Renales/terapia , Litotricia , Cálculos Ureterales/terapia , Ureteroscopios , Ureteroscopía , Adulto , Femenino , HumanosRESUMEN
INTRODUCTION AND OBJECTIVE: A prerequisite for successful outcome of exatracorporeal shock wave lithotripsy (ESWL) is effective stone fragmentation. Despite successful stone fragmentation, complete clearance of stone fragments cannot be achieved in every patient, due to various factors. The aim of this prospective study was to determine morphological factors that affect clearance following successful stone fragmentation by ESWL. MATERIAL AND METHODS: In the period October 1999 and January 2001, 60 patients (45 male and 15 female) with single lower pole kidney stones have been treated using lithotripter Lithostar 2000TM. Parameters of radiographic anatomy, measured on intravenous pyelography, included infundibular width and length, infundibuloureteral infundibulopelvic angles. After the follow-up period of 3 months, patients were divided into two groups regarding clearance status: Group I consisted of stone free patients, and group II of those with residual fragments. RESULTS: Average values of measured parameters in group I vs group II were as follows: infundibular length 27.70 +/- 5.48 mm vs 30.25 +/- 3.95 mm (p = 0.045, Mann-Whitney test); infundibular width 5.98 +/- 3.28 mm vs 4.70 +/- 1.30 mm (p = 0.018, Mann-Whitney test); infundibulopelvic angle 52.92 +/- 20.76 degrees vs 34.10 +/- 8.19 degrees (p = 0.00001, Mann-Whitney test); infundibuloureteral angle 48.00 +/- 21.13 degrees vs 30.70 +/- 7.49 degrees (p = 0.00001, Mann-Whitney test). CONCLUSION: This study revealed that parameters of infundibulopelvic anatomy were significantly different in the examined groups. The success of clearance of fragments following ESWL procedure can be predicted using these morphologic parameters.
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Cálculos Renales/terapia , Litotricia , Adulto , Anciano , Femenino , Humanos , Cálculos Renales/patología , Pelvis Renal/patología , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
INTRODUCTION: The treatment of T1G3 bladder cancer is still a controversial issue. Nowadays, intravesical bacillus Calmette-Guérin (BCG) instillation is considered to be the treatment of choice for patients with high-grade superficial bladder tumour after transurethral resection of all visible tumour. The aim of this retrospective study was to determine the effects and results of this approach, recurrence and progression rates in patients with T1G3 superficial bladder tumours. MATERIALS AND METHODS: 43 patients (28 male, 15 female; mean age 65.5 years, range 21-82) with T1G3 TCC (transitional cell carcinoma) bladder tumour underwent transurethral resection and subsequent intravesical BCG according to Morales protocol, in the period 1993-1998 at our institution. The mean follow-up period was 52.5 (range 30-96) months. RESULTS: After one or more initial courses of therapy, 33 patients were disease-free. Twelve patients (27.90%) had recurrent tumour after a median of 7 (range 3-46) months. After a second course of BCG treatment, 6 patients had no evidence of disease, 3 patients had progression and 3 had recurrence. Progression occurred in 7 (16.27%) patients after a median of 19 (range 3-43) months. Five patients underwent radical cystectomy and the remaining 2 underwent bladder-preserving therapies. Two patients died of TCC and 3 due to disease-unrelated conditions. CONCLUSION: Intravesical BCG instillation can be recommended as treatment modality for responders with T1G3 TCC bladder tumour. The benefit of the second course of intravesical BCG therapy has to be confirmed in further investigations.