Comparison of 10-year overall survival between patients with G1 and G2 grade Ta bladder tumors

To compare long-term overall survival (OS) in patients with G1 and G2 grade Ta bladder cancer after transurethral resection of bladder tumors (TURBTs). Secondary aim was to investigate clinical and pathologic prognostic factors for OS of Ta patients, except G3/high grade (HG). A total of 243 patients, retrospectively selected, with Ta nonmuscle invasive bladder cancer (NMIBC) underwent TURBT between January 2006 and December 2008 (median follow-up 109 months). Inclusion criteria were: Ta at first manifestation, G1 or G2 grade with no associated carcinoma in situ (CIS). Seventy-nine patients were excluded due to concomitant CIS (1), G3/HG tumors (47), and lost to follow-up (31). Ethical approval was obtained from the Ethical Committee of the Mures County Hospital. Statistical analysis was performed using STATA 11.0. Following inclusion criteria, 164 patients with primary G1 or G2 Ta tumors, were enrolled. Recurrence was observed in 26 (15.8%) and progression in 5 (3%) patients. Ten-year survival in G1 patients was 67.8% (CI 54.3-78.1) and in G2 patients 59% (CI 49-67.3) (P=.31). Univariable and multivariable logistic regression analysis underlined that advanced age at diagnosis (hazard ratio [HR] 1.10) and no Bacillus Calmette-Guerin (BCG) treatment (HR 0.24 and 0.29) were independent predictors for death at 10 years after diagnosis. Long-term analysis confirms that patients with well differentiated (G1) and moderately well differentiated (G2) Ta tumors have similar OS. A longer OS was even reported in those who underwent BCG adjuvant therapy

Leiomiom al vezicii urinare (prezentare de caz)

Abstract Bladder leiomyoma is a benign tumour, with a rather low incidence, 0,43%, at about 200 cases presented in the literature. The authors present a case of a female patient aged 70 years, who was treated in the Clinic of Urology Târgu-Mureş presenting dysuria and polakysuria. The abdominal ultrasound examination, IVU, cystoscopy revealed a tumour (5x5 cm dimension) localised near the bladder neck on the left lateral wall of the bladder. This tumour had an omogenous structure, produced bladder outlet obstruction, the residual urine was about 150 ml. A transurethral resection was performed for the tumour (weight 50 gr). The endoscopic control revealed a tumour covered with normal urothelium, localised on the left lateral bladder wall near neck. The macroscopic aspect of the tumour was like the adenomatous tissue of the prostate in man. The histopathological finding (hematoxilin eosing dying, imunohistochemical ex.) revealed leiomyoma of the bladder (no signs of malignancy). The patient had no bladder obstruction after the endoscopic procedure. Bladder leiomyoma is a very rare, benign tumour. The one presented is an endovezical one causing bladder obstruction. The endoscopia procedure solved the case, the 3 month follow up revealed a normal bladder. Introducere. Leiomiomul vezicii urinare este o tumoră benignă mezenchimală cu incidenţă scăzută sub 0,43%, în literatura de specialitate raportându-se aproximativ 200 de cazuri. Localizarea leiomiomului poate fi endovezicală, intramurală şi extravezicală. Materiale şi metode. Prezentăm cazul unei bolnave U.V. în vârstă de 70 ani, internată în clinica noastră între 15.11.- 21.11.2005 pentru acuze urinare de tip obstructiv (disurie, polakiurie). Examinările paraclinice (ecografie, urografie în faza cistografică, cistoscopie) pun în evidenţă o formaţiune tumorală de 5/5 cm situată în vecinătatea colului vezical ataşat peretelui stîng al vezicii urinare. Investigaţiile efectuate sugerau existenţa unei tumori bine delimitate, cu structură omogenă şi cu caracter obstructiv tip clapetă pe colul vezical, pacienta având un reziduu urinar de 150 ml. Sunt prezentate imagini radiologice, ecografice, endoscopice şi histologice ale tumorii vezicale benigne. Bolnava a fost supusă unei intervenţii transuretrale cu rezecţia în totalitate a tumorii, în greutate de 50 gr. Rezultate şi discuţii. Intervenţia endoscopică a pus în evidenţă formaţiunea tumorală descrisă, acoperită de un uroteliu normal, având baza de inserţie pe peretele stîng în imediata vecinătate a colului, cu caracterele obstructive amintite. Rezecţia transuretrală a dus la îndepărtarea tumorii în totalitate. Aspectul macroscopic al ţesutului rezecat fiind asemănător cu cel al adenomului de prostată de la bărbat. Ex. histopatologic (coloraţiile hematoxilinăeozină, imunohistochimice) pun diagnosticul de leiomiom al vezicii urinare fără elemente atipice. După îndepărtarea sondei uretrovezicale, fenomenele obstructive semnalate de pacientă au dispărut. Concluzii. Leiomiomul vezical este o tumoră benignă extrem de rară. Forma prezentată în poster este endovezicală obstructivă. Intervenţia endoscopică a dus la îndepărtarea tumorii în totalitate, cu dispariţia simptomatologiei. Controlul endoscopic la 3 luni a relevat o vezică urinară normală

Cistita necrotică - dificultăţi diagnostice şi terapeutice

Abstract Necrotic cystitis, also called incrustation cystitis, raises etiopathological and therapeutical problems, with relapse of the necrosis after removal of pathological tissue. Between 01.01.1999 and 31.12.2005 there have been 55 patients institutionalized in our Clinic, presenting lower urinary tract symptoms (LUTS). Instrumental investigations have demonstrated the thickening of the bladder wall, more frequently in the trigonum area. Ultrasound examination and cystography couldn’t exclude an infiltrative bladder tumor. Cystoscopy which showed necrotic bladder tissue, with calcareous incrustations, followed by the resection of the pathologic tissue. In 45 cases the histopathological result was necrotic cystitis and in 10 cases infiltrative urothelial bladder tumor or epidermoid metaplasia. In order to clarify the etiology of the necrosis an investigation protocol have been used, consisting of laboratory tests for autoimmune diseases, vascular or local causes that initiate the necrosis (previous surgery in the area, endoscopic interventions). In 5 cases with autoimmune disease, the treatment was transurethral resection and plasmapheresis. The evolution was favorable in 4 cases. Failure: 1 patient. In 12 cases the cause of the necrosis appears to be a diabetic vasculitis, judging by the deep necrosis, dispersed over several small areas. The posttherapeutic evolution depends on the correct treatment of diabetes. In 10 patients with previous endoscopic surgery, the necrosis has been induced by inadequate electrical currents or mechanical lesions. In 18 patients the causing factor remained unknown. The limited necrosis of the bladder can be caused by autoimmune diseases, vascular diseases (diabetes) and endo-urethral maneuvers. The endoscopic resection of the necrotic bladder wall to the healthy, well vascularised tissue beneath is an important therapeutic procedure. The treatment of the causing factors (autoimmune, vascular) will consolidate the healing. Not knowing the other causes will lead to failure, and repeated endoscopic treatment will result in short term ameliorations. Introducere. Cistita necrotică, denumită în literatură şi “cistita de incrustaţie”, ridică probleme de etiopatogenie, prezentând dificultăţi terapeutice, cu recidiva necrozei după îndepărtarea ţesuturilor patologice. Materiale şi metode. Între 01.01.1999-31.12.2005 au fost internaţi în clinica noastră 55 de pacienţi cu fenomene urinare joase de tip iritativ. Investigaţiile paraclinice au pus în evidenţă peretele vezical îngroşat, situaţie frecventă în trigon. Ecografia şi cistografia nu puteau exclude aspectul unei tumori vezicale infiltrative.Cistoscopia a evidenţiat un ţesut vezical necrozat, cu incrustaţii calcare, fiind urmată de rezecţia ţesutului patologic. La 45 de pacienţi rezultatul histopatologic a fost de cistită necrotică, iar la 10 bolnavi s-a depistat tumoră vezicală urotelială infiltrativă sau metaplazie epidermoidă. Pentru a elucida etiopatogenia necrozei, s-a aplicat un protocol de investigare care include teste de laborator pentru depistarea unui proces autoimun, a unor cauze vasculare sau a unor cauze locale de declanşare a necrozei (intervenţii în antecedente, manevre endoscopice, etc.). Rezultate şi discuţii. La 5 bolnavi cu proces autoimun, tratamentul a constat din rezecţie transuretrală şi din plasmafereză. Evoluţie favorabilă, cu vindecare - la 4 bolnavi. Eşec: 1 pacientă. La 12 bolnavi cauza necrozei este sugerată a fi o vasculită diabetică, după aspectul profund al necrozei în puncte dispersate, evoluţia postterapeutică este influenţată de tratamentul corect al diabetului. La 10 pacienţi cu manevre chirurgicale endoscopice în antecedente, inducţia procesului necrotic a fost provocat de curenţi electrici inadecuaţi sau de leziuni mecanice. La 18 bolnavi cauza a fost necunoscută. Concluzii. Necroza limitată a vezicii urinare poate avea cauze autoimune, vasculare (diabet), manevre endouretrale. Rezecţia endoscopică a peretelui vezical necrozat până în ţesut bine vascularizat este un gest terapeutic important. Tratamentul cauzal (autoimun, vascular, etc.) consolidează vindecarea. Necunoaşterea şi a altor cauze duce la eşec, iar tratamentul endoscopic repetat - la ameliorări pasagere

The correlation between histopathological results post-prostate biopsy and after radical prostatectomy

Clinica Urologie, Spitalul Clinic Județean Mureș, Universitatea de Medicină, Farmacie, Științe și Tehnologie, Târgu Mureș, Al VII-lea Congres de Urologie, Dializã si Transplant Renal din Republica Moldova cu participare internațională 19-21 iunie 2019Introducere: Adenocarcinomul de prostată este cel mai frecvent cancer în rândul bărbaților, fiind a doua cauză de deces, după cancerul de plămâni, de aceea interesul pentru studierea acestei afecțiuni este tot mai mare. Sistemul de grading pentru carcinoamele prostatice este sistemul Gleason, care se bazează pe gradul de diferențiere glandulară si pe pattern-ul de crestere al tumorii (1-5). Scopul: Scopul studiului este de a compara rezultatele EHP de la puncția biopsie prostatică si prostatectomia totală. Materiale și metode: Studiul este unul retrospectiv, pe o perioadă de trei ani, cuprinzând un număr de 42 pacienti internați în Clinica Urologie Tg. Mures în perioada 1 Ianuarie 2016 – 31 decembrie 2018. Au fost incluși în studiu toți pacienții cu cancer de prostată confirmat prin puncție biopsie prostatică, care au beneficiat de prostatectomie totală. Au fost excluși pacienții cu cancer de prostată dovedit prin PBP care au beneficiat de alt tip de tratament. Rezultate: Din cei 42 de pacienți, 25 (59.52%) au fost operați clasic, iar 17 (40.48%) au fost operați laparoscopic. Preoperator, 11 pacienți au avut scorul Gleason 6 (3+3) – 26.19%, 19 pacienți 7 (3+4) – 45.23%, 9 pacienți au avut 7 (4+3) – 21.43%, 2 pacienți au avut Gleason 8 (4+4) – 4.76% si 1 pacient a avut scorul 9 (4+5) – 2.39%. Postoperator, la 21 de pacienți – 50%, scorul Gleason a ramas nemodificat, la 16 pacienți – 38.09, a fost mai mare, la 3 pacienți – 7.15%, a fost mai mic, iar la 2 pacienți – 4.76 – cancerul de prostată nu a mai fost pus în evidență pe piesa de prostatectomie. Concluzii: În ansamblu, fiabilitatea rezultatele EHP a biopsiilor transrectale în prognosticul diagnosticului a fost una bună. Cu toate acestea, limitările clasificării Gleason bazate pe biopsie trebuie luate în considerare atunci când se indică modalitatea terapeutică.Introduction: Prostate adenocarcinoma is the most common type of cancer among men, being the second cause of death, after lung cancer, therefore the interest in studying this disease is increasing. Grading system of prostate carcinoma is Gleason Score, which is based on the degree of glandular differentiation and the tumor growth pattern. Aim: The aim of the study is compare the histopathological results from prostate biopsy and radical prostatectomy. Materials and methods: The study is a retrospective one which included 42 patients admitted in Urology Clinic of Mures County Clinica Hospital between 1 January 2016 – 31 Decembre 2018. The including criteria were patients with prostate cancer confirmed by prostate biopsy, who underwent radical prostatectomy. The excluding criteria were patients with prostate cancer confirmed by prostate biopsy, who received another type of treatment. Results: Out of the 42 patients included in the study, 25 (59.52%) of them were classically operated and 17 (40.48%) were operated laparoscopically.Preoperatively, 11 patients had Gleson score 6 (3+3) – 26.19%, 19 patients had it 7 (3+4) – 45.23%, 9 patients had Gleason score 7 (4+3) – 21.43%, 2 patients hat it 8 (4+4) – 4.76% and 1 had it 9 (4+5) – 2.39%. Postoperatively, 21 patients – 50% had the Gleason score unchanged, 16 patients – 38.09% had a higher Gleason score, 3 patients – 7.16% and in 2 patients the prostate cancer couldn’t be revealed on prostatectomy pieces. Conclusions: Overall, the reliability of histopathological results of transrectal biopsies in prognosis of diagnostic was good. However, the limitations of Gleason score established on prostate biopsies should be considered when indicating the therapeutic mode

Factors influencing recurrent reflux acute pyelonephritis in patients with JJ ureteral stent after discharge

The vesicoureteral reflux (VUR) after the insertion of a JJ stent is a pathological entity characterized by the impossibility of the vesicoureteric junction (VUJ) to exhibit its sphincterian functioning that allows the unidirectional flow of urine from the ureter to the bladder. This happens as long as the catheter is in place, and after its suppression due to traumatization of the ureterovesical junction, which loses its tonicity and ability to ensure urinary unidirectional flow. Reflux acute pyelonephritis is the acute inflammation of the renal tract and parenchyma resulting from stagnation of infected urine for long periods of time due to vesicoureteral reflux. We have noted multiple cases which, after the insertion of a JJ stent, presented reflux acute pyelonephritis due VUR, we considered the causes favoring these aspects. We focused on the frequency of reflux acute pyelonephritis and identified factors that could be used to advise patients with JJ stents

Extracorporeal shock waves lithotripsy versus retrograde ureteroscopy: is radiation exposure a criterion when we choose which modern treatment to apply for ureteric stones?

The aim of this study is to compare two major urological procedures in terms of patient exposure to radiation. We evaluated 175 patients, that were subjected to retrograde ureteroscopy (URS) and extracorporeal shock waves lithotripsy (ESWL) for lumbar or pelvic ureteral lithiasis, at two urological departments. The C-arm Siemens (produced in 2010 by Siemens AG, Germany) was used for ureteroscopy. The radiological devices of the lithotripters used in this study in the two clinical centers had similar characteristics. We evaluated patient exposure to ionizing radiation by using a relevant parameter, the air kerma-area product (PKA; all values in cGy cm2), calculated from the radiation dose values recorded by the fluoroscopy device. PKA depends on technical parameters that change due to anatomical characteristics of each case examined, such as body mass index (BMI), waist circumference, and stone location. For the patients subjected to ESWL for lumbar ureteral lithiasis the mean of PKA (cGy cm2) was 509 (SD=180), while for those treated for pelvic ureteral lithiasis the mean of PKA was 342 (SD=201). In the URS group for lumbar ureteral lithiasis, the mean of PKA (cGy cm2) was 892 (SD=436), while for patients with pelvic ureteral lithiasis, the mean of PKA was 601 (SD=429). The patients treated by URS had higher exposure to ionizing radiation dose than patients treated by ESWL. The risk factors of higher radiation doses were obesity, exposure time, and localization of the stones