Assessment of cryopreserved human tunica albuginea for the surgical treatment of penile defects

Peyronie’s disease, a connective tissue disorder of penile tunica albuginea (TA) associated with penile deformity, curvature, pain and erectile dysfunction, is best managed surgically, but suitable graft biomaterials are not available. To establish whether cryopreservation affects human TA in view of its use in allotransplants. The effects on TA samples of the two most widely used tissue cryopreservation methods were investigated using an ad hoc panel of histochemical, immunohistochemical and ultrastructural tests. Apoptotic cells were evaluated using the TUNEL assay. Assessment of tissue integrity and arrangement of collagen and elastic fibers in thawed TA. Both cryofixation methods provided TA tissue suitable for use as graft material. Significant ultrastructural changes, namely a greater diameter of collagen fibrils, were detected in sections preserved in liquid nitrogen; nonetheless, such increase never exceeded the normal range. The comprehensive panel of assays used proved suitable to characterize the thawed tissue. Human TA is suitable for cryopreservation; freezing at -80 °C provides better results than preservation in liquid nitrogen

The role of intrinsic pathway in apoptosis activation and progression in Peyronie’s disease

Peyronie’s disease (PD) is a connective tissue disorder where formation of fibrous plaques in tunica albuginea (TA) and erectile tissue can result in penile deformity, pain, and erectile dysfunction. Fibrosis, its major pathological manifestation, arises from fibroblast proliferation and accumulation of extracellular matrix; PD progresses with formation of plaques or even ectopic calcification having the appearance of scar tissue, which prevent TA expansion during erections. The mechanisms underpinning PD are unclear, and relatively little is known about the disease itself. To date corrective surgery is the sole effective treatment. A greater understanding of PD pathophysiology at the molecular level has the potential to help develop novel medical therapeutic approaches. The aim of this study was to investigate the activation of the apoptotic intrinsic apoptotic pathway in plaques from PD patients. Tunica albuginea from either PD and control patients were assessed for the expression of bax, bcl-2, caspase 9 and 3 using immunohistochemistry, and by measurement of apoptotic cells using TUNEL assay. Bax overexpression was observed in metaplasic bone tissue, in fibroblasts and in myofibroblast of plaques from PD patients. Little or no bcl-2 immunostaining was detected in samples from either patients or controls. Caspase 3 immunostaining was very strong in fibrous tissue, in metaplasic bone osteocytes and in primary ossification center osteoblasts. Moderate caspase 9 immunostaining was seen in fibrous cells plaques and in osteocytes and osteoblasts of primary ossification centers from PD patients. Control samples were negative for caspase 9 immunostaining. In PD patients the TUNEL immunoassay showed intense immunostaining of fibroblasts and myofibroblasts, the absence of apoptotic cells in metaplasic bone tissue and on the border between fibrous and metaplasic bone tissue. Apoptotic cell death occurs in stabilized PD plaques and is partly induced by the intrinsic mitochondrial pathway. The present findings can have clinical implications and may help devise improved treatment strategies. A therapeutic approach aimed at enhancing apoptosis-inducing molecules would at least help delay the progression of PD. Identification of target molecules for gene construct or biological or chemical reagent delivery to target sites could contribute to induce PD plaque stabilization

Radiation exposure of patients during endourological procedures: IAEA-SEGUR study

Fluoroscopy is increasingly used to guide minimally invasive endourological procedures and optimised protocols are needed to minimise radiation exposure while achieving best treatment results. This multi-center study of radiation exposure of patients was conducted by the South-Eastern European Group for Urolithiasis Research (SEGUR), in cooperation with the International Atomic Energy Agency. Seven clinical centers from the SEGUR group collected data for 325 procedures performed within a three-months period, including standard percutaneous nephrolithotomy (PCNL), mini PCNL, retrograde intrarenal surgery (RIRS), semirigid ureterorenoscopy (URS) and flexible URS. Data included: air kerma area product (PKA), air kerma at the patient entrance reference point (Ka,r), fluoroscopy time (FT), number of radiographic images (N) and fluoroscopy pulse rate, as well as total procedure duration, size and location of stones. Data were centrally analysed and statistically compared. Median PKA values per center varied 2-fold for RIRS (0.80–1.79 Gy cm2 ), 7.1 fold for mini-PCNL (1.39–9.90 Gy cm2 ), 7.3 fold for PCNL (2.40–17.50 Gy cm2 ), 19 fold (0.13–2.51 Gy cm2 ) for semi-rigid URS and 29-fold for flexible URS (0.10–2.90 Gy cm2 ). Lower PKA and Ka,r were associated with use of lower FT, N and lower fluoroscopy pulse rate. FT varied from 0.1 to 14 min, a small fraction of the total procedure time, ranging from 10 to 225 min. Higher N was associated with higher PKA and Ka,r. Higher median PKA in PCNL was associated with the use of supine compared to prone position. No correlation was found between the concrement size and procedure duration, FT, PKA or Ka,r. Dose values for RIRS were significantly lower compared to PCNL. The maximum Ka,r value of 377 mGy was under the threshold for radiation induced skin erythema. The study demonstrated a potential for patient dose reduction by lowering FT and N, using pulsed fluoroscopy and beam collimation

The Role of Intrinsic Pathway in Apoptosis Activation and Progression in Peyronie’s Disease

Peyronie’s disease (PD) is characterized with formation of fibrous plaques which result in penile deformity, pain, and erectile dysfunction. The aim of this study was to investigate the activation of the intrinsic apoptotic pathway in plaques from PD patients. Tunica albuginea from either PD or control patients was assessed for the expression of bax, bcl-2 and caspases 9 and 3 using immunohistochemistry and by measurement of apoptotic cells using TUNEL assay. Bax overexpression was observed in metaplastic bone tissue, in fibroblasts, and in myofibroblast of plaques from PD patients. Little or no bcl-2 immunostaining was detected in samples from either patients or controls. Caspase 3 immunostaining was very strong in fibrous tissue, in metaplasic bone osteocytes, and in primary ossification center osteoblasts. Moderate caspase 9 immunostaining was seen in fibrous cells plaques and in osteocytes and osteoblasts of primary ossification centers from PD patients. Control samples were negative for caspase 9 immunostaining. In PD patients the TUNEL immunoassay showed intense immunostaining of fibroblasts and myofibroblasts, the absence of apoptotic cells in metaplasic bone tissue and on the border between fibrous and metaplastic bone tissue. Apoptosis occurs in stabilized PD plaques and is partly induced by the intrinsic pathway.</jats:p

Tension free vaginal tape (TVT) vs transobturator tape(TOT) complications and outcomes

Background: Stress urinary incontinence (SUI) is managed with both TVT and TOT. The TVT route of placement could result in a higher complication rate. The aim of this study is to analyze and compare outcomes and complications of TVT and TOT in SUI treatment. Methods: Prospective study in 64 women with isolated SUI was validated through Urogenital Distress Inventory (UDI-6), Incontinence Impact questionnaire (IIQ-7) and International Continence Impact Questionnaire (ICIQ5-SF). Intraoperative and postoperative complications were noted. Patients were considered cured when negative on stress test and with no need for additional surgery during follow up, after one and three months. Results: The cure rates for both TVT 26/30 (86,6%) and TOT 30/34 (88,2) were comparable. Higher rates of bleeding, bladder perforations, pain and dyspareunia are recorded in TVT group. Quality of life graded on the questionnaire basis proved significant improvement in both procedures. Conclusion: Both TVT and TOT have comparable cure results in the treatment of SUI. The TOT is equally effective in the SUI treatment with significantly lower complication incidence.</jats:p

Results of the modification of antireflux subserosal and submucosal implantation of the ureter into the rectosigmoid urinary reservoir after total cystectomy

Introduction. Uretero-intestinal anastomisis has a large influence on derivation quality. Objective. The aim of the study was to present the modified serous lined extramural Abol-Enein method of implantation of low quality ureter into the sigma-rectum pouch and comparison of the results with Le Duc implantation. Methods. From 1995 to 2009, 62 dilated ureter units were implanted in the detubularized rectosigmoid urinary reservoir. In 28 units Le Duc, and in 34 Abol-Enein method was done. Urinary fistula and ileus were considered as early complications, while late complications included stenosis and reflux pyelonephritis. Frequency of urination was considered as a parameter of functionality. Results. Transitory urine fistulae occurred only in the ureters implanted according to Le Duc technique in 4/28 (14.2%); the difference between the examined groups was close but still below the level of statistical significance (p=0.07). Ileus occurred with nearly equal frequency in both groups. Stenosis on the ureteral implantation place was significantly more frequent (p=0.04) in the Le Duc group 5/28 (21.7%) than in the Abol-Enein group 0/34 (0%). Refluxive pyelonephritis occurred in 3/34 (8.8%) of the Abol-Enein group, and in 5/28 (21.7%) of patients in the Le Duc group. Concerning the daily frequency, there was no difference between the examined groups. Conclusion. Uretero-intestinal anastomisis of dilated ureters through a serous-lined extramural tunnel decreases the risk of reflux in a considerable number of patients, with an acceptable level of complications. There are several advantages in comparison with Le Duc method

Complications of Camey-Le Duck ureteral reimplantation technique in modified ureterosigmoidostomy (Mainz pouch II) urinary diversion

Objective: to analyze complications and clinical outcome of Camey-Le Duck ureteral reimplantation technique in modified Mainz pouch II urinary diversion. Patients and methods: this retrospective study included a total of 110 patients (101 male and 9 female, mean age 59,2 years, SD=10,2), who had underwent a modified Mainz pouch II urinary diversion with Camey-Le Duck ureteral reimplantation technique, following total cystectomy, during the period 1995-2014. The mean follow-up, available for 90 (82%) patients period was 19 (1-74) months. Early and late postoperative complications were analyzed. Results: early complications developed in 22 (20%) patients as follow: unilateral ureterohydronephrosis in 8 (7%) patients, bilateral ureterohydronephrosis in one (1%)- two RU (renoureteral units), urinary leakage in 8 (7%), and pyelonephritis in 5 (5%) patients. Late complications developed in 28 (25%) patients: pyelonephritis in 17 (15%), and ureteral reimplantation site stenosis in 11 (10%) patients with 12 RU. Balloon dilatation procedure was applied in all 12 RU, with additional metallic Strecker stent insertion in 5 RU. At 24-month follow-up, all patients with metallic Strecker stent had normal results of serum biochemistry, blood gas analysis and renal ultrasound. In the rest of six patients with 7RU, balloon dilatation has failed and restenosis of ureteral reimplantation site with consequent ipsilateral hydronephrosis was verified. In these patients, permanent percutaneous nephrostomy catheter was applied. Conclusion: Camey-Le Duck ureteral reimplantation technique following Mainz pouch II urinary diversion is simple, reliable and durable. It enables well upper urinary tract protection and is associated with relatively low major complication rates.</jats:p