Testosterone supplementation and prostate cancer, controversies still exist

Late onset hypogonadism is a common condition in aging males. The population of men who can be potentially treated with testosterone supplementation is growing. Controversy that surrounds testosterone replacement therapy is due to generally undefined lower limits of normal testosterone level and high prevalence of hypogonadal symptoms in elderly population and the non-specific nature of these symptoms. Incidence of prostate hyperplasia and occult prostate cancer in elderly are both high. The risk that testosterone treatment would trigger prostate cancer was not fully recognized. The aim of this mini review is to present a risk of carcinogenesis within the prostate related to testosterone treatment

Radiofrequency ablation of small renal masses as an alternative to nephron-sparing surgery : preliminary results

INTRODUCTION: Radical endoscopic minimal-invasive treatment methods, such as thermal ablation, are sought as an alternative to standard radical surgical treatment of kidney neoplasms. We analysed patients who could be qualified for radical treatment due to T1a renal tumour. MATERIAL AND METHODS: Twenty-three patients out of 129 who underwent radiofrequency thermal ablation of kidney tumours in the years 2003-2010 were analysed. The inclusion criteria were age below 70 years, lack of major comorbidities (ASA score 1, 2), and competent contralateral kidney. In all cases tumour size was below 4 cm. All patients were followed up with computed tomography (CT) and ultrasonography (USG) every 6 months for 3 years. RESULTS: In 20 patients kidney tumour was biopsied before radiofrequency ablation (RFA) and 10 of these biopsies were positive and revealed cancer. Six patients required additional treatment due to recurrence visible in CT – 3 with a positive biopsy result, 1 with negative and 2 without biopsy. Three of them were treated with a second session of RFA, 1 with radical nephrectomy and 2 with partial nephrectomy. No disease dissemination was observed and all patients who received additional treatment remain disease free. CONCLUSIONS: The RFA can be safely used in selected patients with T1a tumour as an alternative to partial nephrectomy. Careful follow-up is required after thermal ablation and allows early detection and successful treatment of recurrences

Bladder neck preservation during classic laparoscopic radical prostatectomy : point of technique and preliminary results

INTRODUCTION: Stress urinary incontinence after radical prostatectomy for prostate cancer organ-confined patients can significantly affect quality of life. The article presents a technique of bladder neck preservation, because it is believed that this point is one of many crucial points responsible for fast recovery of continence after laparoscopic radical prostatectomy (LRP). MATERIAL AND METHODS: Laparoscopic radical prostatectomy with the intention of bladder neck preservation was performed in 194 patients of clinically organ-confined prostate cancer (cT2 ≤ N0M0). The working space was done by tissues-fingers dissections and insufflation of the cavity under full visual control, without the Gaur-balloon device. We insert two 10 mm trocars, three trocars of 5 mm and both 0° and 30° laparoscopes. The most important points of technique include: identification of landmarks of bladder neck and prostate base; dissection of muscle fibres of the very superficial bladder wall; mobilization of the posterior part of the urethra and simultaneous seminal vesicles release; neuro-vascular bundles preservation. This procedure resulted in a long bladder neck which can be easily anastomosed with the urethra. Tension-free and end-to-end (bladder neck-urethra) anastomosis are the results. RESULTS: In all cases radical prostatectomy was performed laparoscopically in the extraperitoneal space. There were no complications of bladder neck preservation during laparoscopic radical prostatectomy (LRP) apart from 22 cases with a large medium lobe. The mean time of operation was 150 min (110-210 min). The mean blood loss during LRP was 150 ml (110-350 ml). Blood transfusion was not necessary. There were no postoperative complications. Mean hospitalization time was 5 days. Pathological result of the postoperative specimens was pT2a in 30%, pT2b in 60%, pT3a in 6%, and pT3b in 4% of patients. In 7% of patients a positive surgical margin was affirmed, but the bladder neck was not affected in any case. Full continence after 3, 6, and 12 months was observed in 75%, 85%, and 92% of analysed patients, respectively. CONCLUSIONS: Bladder neck preservation during LRP is an effective, safe procedure that offers good functional results based on fast recovery of continence. Bladder neck preservation offers full tight anastomosis, especially in cases with no large median lobe of prostatic adenoma. Continence of patients who underwent bladder neck preservation was improved during short-term follow-up. Long-term results are still not conclusive. We think that this technique applied to laparoscopy will finally result in real progress of continence preservation after radical prostatectomy, but larger groups of patients have to be compared

Effect of four fluoroquinolones on the viability of bladder cancer cells in 2D and 3D cultures

IntroductionThe anticancer properties of fluoroquinolones and the high concentrations they achieve in urine may help in bladder cancer therapy. This study aimed to analyze the properties of 4 fluoroquinolones as potential candidates for supportive treatment of bladder cancer. MethodsComparative analyses were performed on the cytotoxic effects of norfloxacin, enrofloxacin, moxifloxacin, and ofloxacin on normal and cancer urothelial cell lines. In 2D culture, the cytotoxic properties of fluoroquinolones were evaluated using MTT assay, real-time cell growth analysis, fluorescence and light microscopy, flow cytometry, and molecular analysis. In 3D culture, the properties of fluoroquinolones were tested using luminescence assays and confocal microscopy.Results and DiscussionAll tested fluoroquinolones in 2D culture decreased the viability of both tested cell lines in a dose- and timedependent manner. Lower concentrations did not influence cell morphology and cytoskeletal organization. In higher concentrations, destruction of the actin cytoskeleton and shrinkage of the nucleus was visible. Flow cytometry analysis showed cell cycle inhibition of bladder cancer cell lines in the G2/M phase. This influence was minimal in the case of normal urothelium cells. In both tested cell lines, increases in the number of late apoptotic cells were observed. Molecular analysis showed variable expression of studied genes depending on the drug and concentration. In 3D culture, tested drugs were effective only in the highest tested concentrations which was accompanied by caspase 3/7 activation and cytoskeleton degradation. This effect was hardly visible in non-cancer cell lines. According to the data, norfloxacin and enrofloxacin had the most promising properties. These two fluoroquinolones exhibited the highest cytotoxic properties against both tested cell lines. In the case of norfloxacin, almost all calculated LC values for bladder cancer cell lines were achievable in the urine. Enrofloxacin and norfloxacin can be used to support chemotherapy in bladder cancer patients

Severe calcification of forgotten Double-J ureteral stent in a patient with undiagnosed hyperparathyroidism

Background Double J stent (DJ) is widely used in urological practice in patients with renal stones. However, its application is related to the risk of incrustation. We present a case of severe calcification of forgotten DJ in a patient with previously undiagnosed hyperparathyroidism (HPT). Case presentation A 30-year-old female was admitted to the Urology Department with renal colic. An initial kidney, ureter, and bladder X-ray revealed a completely calcified DJ catheter placed twelve months earlier. Unfortunately, the patient did not show up for a follow-up visit, and stent removal was not performed.  Due to the extent of the disease, the patient was qualified for multistage endoscopic treatment. Total treatment lasted six months and consisted of five urereroscopies and one hybrid procedure. Simultaneously, diagnostics of a metabolic cause of the advanced stone disease suggested primary hyperparathyroidism, confirmed during parathyroid scintigraphy. After urological treatment had been completed, parathyroidectomy was performed. During a further 7-year follow-up, only one episode of renal colic occurred within the first year after treatment. The patient is stone-free until the present day. Conclusions Stents are designed to last usually up to six months, but they should be removed as quickly as possible after finishing treatment. Also, other causes such as a metabolic or hormonal imbalance should be considered. In our patient combination of forgotten DJ and HPT was the reason for excessive stone formation. Selective removal of the parathyroid gland was effective in the presented patient, with no stone recurrence observed