Rare and Challenging Tumor Entity: Phyllodes Tumor of the Prostate

Cystic epithelial-stromal tumors of the prostate are rare, with 82 cases reported in literature. These cases have been published under a variety of diagnoses, including phyllodes tumor and prostatic stromal proliferation of uncertain malignant potential as well as a malignant tumor called “prostatic stromal sarcoma”. We report a case of a 60-year-old man with the histological diagnosis of phyllodes tumor of the prostate in transurethral resection specimen

Ensuring Consistent European-Wide Urological Care by the Use of Evidence-Based Clinical Practice Guidelines : Can We Do Better

This study was supported by the European Association of Urology.Peer reviewedPublisher PD

Expression of human beta-defensins 1 and 2 in kidneys with chronic bacterial infection

BACKGROUND: Constitutive expression and localization of antimicrobial human β-defensin-1 (HBD-1) in human kidneys as a potential mechanism of antimicrobial defense has been previously reported. Inducible expression of human β-defensin-2 (HBD-2) has been described in various epithelial organs but not for the urogenital tract. METHODS: We investigated the gene- and protein expression of HBD-1 and HBD-2 by reverse transcriptase-polymerase chain reaction, and immunohistochemistry in 15 normal human kidney samples and 15 renal tissues with chronic bacterial infection. Additionally, cell culture experiments were performed to study HBD gene expression by real-time RT-PCR in response to inflammatory cytokines TNFα and IL-1β as well as lipopolysaccharide from Gram-negative bacteria. RESULTS: Constitutive HBD-1 gene- and protein expression was detected in normal renal tissue and kidneys with chronic infection. As a novel finding, inducible HBD-2 gene- and protein expression was demonstrated in tubulus epithelia with chronic infection but not in normal renal tissue. In pyelonephritic kidneys HBD-1 and HBD-2 expression showed a similar pattern of localizaton in distal tubules, loops of Henle and in collecting ducts of the kidney. Furthermore, real-time RT-PCR of kidney derived cell lines stimulated with inflammatory agents TNF-α, IL-1β and LPS revealed a strong increase in relative HBD-2 transcription level and also a slight increase in relative HBD-1 transcription level. CONCLUSIONS: Upregulated HBD-2 expression in renal tubulus epithelium indicates a role of a wider range of human defensins for antimicrobial host defense in the urogenital tract than previously recognized

Cannabinoid type-1 receptor signaling in central serotonergic neurons regulates anxiety-like behavior and sociability

The endocannabinoid system possesses neuromodulatory functions by influencing the release of various neurotransmitters, including γ-aminobutyric acid (GABA) and glutamate. A functional interaction between endocannabinoids and the serotonergic system has already been suggested. Previously, we showed that cannabinoid type 1 (CB1) receptor mRNA and protein are localized in serotonergic neurons of the raphe nuclei, implying that the endocannabinoid system can modulate serotonergic functions. In order to substantiate the physiological role of the CB1 receptor in serotonergic neurons of the raphe nuclei, we generated serotonergic (5-HT) neuron-specific CB1 receptor-deficient mice, using the Cre/loxP system with a tamoxifen-inducible Cre recombinase under the control of the regulatory sequences of the tryptophan hydroxylase 2 gene (TPH2-CreERT2), thus, restricting the recombination to 5-HT neurons of the central nervous system. Applying several different behavioral paradigms, we revealed that mice lacking the CB1 receptor in serotonergic neurons are more anxious and less sociable than control littermates. Thus, we were able to show that functional CB1 receptor signaling in central serotonergic neurons modulates distinct behaviors in mice

GEC/ESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localised prostate cancer

Background and purpose: The aim of this paper is to present the GEC/ESTRO-EAU recommendations for template and transrectal ultrasound (TRUS) guided transperineal temporary interstitial prostate brachytherapy using a high dose rate iridium-192 stepping source and a remote afterloading technique. Experts in prostate brachytherapy developed these recommendations on behalf of the GEC/ESTRO and of the EAU. The paper has been approved by both GEC/ESTRO steering committee members and EAU committee members. Patients and methods: Interstitial brachytherapy (BT) to organ confined prostate cancer can be applied as a boost treatment in combination with external beam radiation therapy (EBRT) using a proper number of BT fractions in curative intent. Temporary transperineal BT alone or in combination with EBRT are feasible as a palliative/salvage treatment modality because of local recurrence, however, without large clinical experience. The use of temporary BT as a monotherapy is subject of ongoing clinical research. Results: Recommendations for pre-treatment investigations, patient selection, equipment and facilities, the clinical team, the implant procedure (treatment planning and needle implantation) dose and fractionation, reporting, management of side effects and follow-up are given. Conclusions: These recommendations are intended to be technically and advisory in nature, but the ultimate responsibility for the medical decision rests with the treating physician. Although, this paper represents the consensus of an interdisciplinary group of experts, TRUS and template guided temporary transperineal interstitial implants in prostate cancer are a constantly evolving field and the recommendations are subject to modifications as new data become available. (c) 2004 Elsevier Ireland Ltd. All rights reserve

Innovative endoscopic enucleations of the prostate – Xie's Prostate Enucleations

In the past 2 decades, endoscopic enucleation of the prostate has become a safe and effective surgical treatment for benign prostatic hyperplasia (BPH), with comparable outcomes to traditional surgeries. Transurethral vapor enucleation and resection of the prostate (TVERP), transurethral vapor enucleation of the prostate (TVEP), and ultrasound-navigated TVEP (US-TVEP) are new, innovative endoscopic enucleation procedures. These procedures are named Xie's Prostate Enucleations (Xie's Procedures for short). Current clinical data indicate that Xie's Procedures are safe and effective treatment options for patients with BPH, especially for patients with larger prostates. Further prospective, randomized clinical trials compared with traditional transurethral resection of prostate (TURP) are still needed

The European Association of Urology (EAU) Guidelines Methodology: A Critical Evaluation

Objectives: Guidelines can be produced and written in numerous ways. The aim of the present article is to describe and evaluate the method currently used to produce the European Association of Urology (EAU) guidelines. Design, setting, and participants: The methodology is described in detail, compared to other urologic guidelines by members of the EAU Guidelines Office Board. Measurements: The new methodology is evaluated by the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Results and limitations: The currently used methodology is adapted to the aims and objectives as established by the EAU for their guidelines; wide coverage (essentially all fields of urology) and useful to urologists all over Europe. The frequent updates are easily accessible in a printed and electronic format. The AGREE instrument supports these strong points, but also identifies potentially weak points, such as no patient involvement, no formal validation of the guidelines texts prior to publication, and lack of discussion of organisational barriers and cost implications. Conclusion: The currently used methodology for the production of EAU guidelines fulfils the association’s main objectives related to their guidelines, but the texts will benefit from the inclusion of country-specific cost and organisational data. For the practising clinician, these guidelines will help to take science into clinical practice. (C) 2008 European Association of Urology. Published by Elsevier B. V. All rights reserved