Urologia Journal

In this study, we used a new experimental model, proposed by our group, based on in vitro reconstitution of the human neo-bladder to improve pharmacological studies targeted at optimizing endocavity therapy of superficial bladder cancer. In the light of this, we evaluated the antiproliferative activity on neoplastic and normal origin human urothelium of two psoralen derivatives, 4-methyl-11-dimethilaminopropoxy-benzopsoralen (G50-E) and 8-methoxypsoralen (8-MOP), which are photosensitized by UVA radiation (photochemotherapy PUVA). The pharmacological treatment effects were evaluated by cytotoxic assay based on intramitochondrial capture of MTT, and by using scanning electron microscopy (SEM). Moreover, the cytotoxic effects exerted by the two psoralen derivatives on the neo-bladders were compared to those of mytomicin C, a reference drug for the treatment and prophylaxis of superficial carcinoma bladder relapse. Qualitatively, these investigations confirmed the cytotoxic activity of both psoralen derivatives tested, but, nevertheless, they did not allow a quantitative evaluation of cellular damage.

Idiopathic varicocele is a one of the all too often organic causes of male infertility and may can affect hormonal and spermatogenic function of the testis. We demonstrated relationships of hormonal parameters to sperm production on follicle-stimulating hormone (FSH), (LH) and testosterone blood concentrations to sperm production. The investigations involved a total of 329 patients with varicocele, at aged from 20 to 48 years, mean age 28.76 ± 0.66 years, divided into three groups: group I – patients with varicocele dextra; group II – patients with varicocele sinistra; and group III – patients with varicocele bilateralis. We established in our investigations that in 65.35% of cases the varicocele was attended coupled by with some disorders in the fertilizing ability, included including oligospermia Gr I-II (groups I and II) in 41.33% of cases, oligospermia (Gr.II-IIIgroups II and III) in 15.5% of cases and azoospermia in 8.52% of cases. In 56.83% of cases, the low sperm concentration was attended by decreasedcoupled with reduced sperm motility and velocity. Our data did not demonstrated a statistically significant increase in blood plasma T testosterone and we noted no significant correlation between the magnitude of the change in serum androgen and improvements in sperm concentration or total sperm motility per ejaculate in patients with varicocele. No significant correlations were noted in mean blood LH and FSH concentrations in patients with varicocele and in controls group.

Subclinical infections of the prostate can increase the prostate-specific antigen (PSA) values in patients with normal digital rectal examination. This study aimed to evaluate the role of short-term antimicrobial therapy in reducing the PSA value in patients as candidates for transrectal biopsy. Fifty-eight patients with negative digital rectal examination and PSA values between 4 and 20 ng/mL were included in the study. Antibiotics were administered to all patients for 3 weeks, and the PSA was reassessed 10 days after the end of the treatment. Patients were subsequently submitted to prostate biopsy.

A reduction in PSA was detected in 34 patients (59%). Mean percentage reduction was 32%. In only six patients (10%) did the PSA return to normal levels. Prostate biopsy revealed prostate cancer in 26 patients (45%). Prostate cancer was not detected in patients with PSA levels above 4 ng/mL. Prostate biopsy can be avoided only in a small number of patients showing the normalization of PSA levels after short-term antimicrobial therapy. These patients should be strictly monitored with frequent PSA determinations.

The efficacy and local toxicity of the intravesical combination of microwave-induced hyperthermia with a cytostatic agent in patients affected by superficial bladder cancer is presented. Between 1994 and 2002, two studies were performed on ablative and adjuvant intravesical thermo-chemotherapy. The ablative study demonstrated complete tumor eradication in 88% of patients who should have undergone cystectomy due to diffuse multiple papillary tumors non-responsive TUR and intravescical adjuvant therapy. In a randomized study, comparing adjuvant thermo-chemotherapy vs. standard chemotherapy with mitomycin C, recurrence-free survival analysis at 24 months revealed a significant difference in favor of thermo-chemotherapy. Our preliminary experience confirmed that local side effects, mainly cystitis, suprapubic pain and thermal reaction of the posterior bladder wall, were transitory and did not require treatment interruption.

Contrast media-induced nephropathy (CN) is an important cause of hospital-acquired acute renal failure. Patients with both diabetes mellitus and renal impairment are at high risk. CN pathophysiology involves activation of the tubulo-glomerular feedback and vasoactive mediators such as renin-angiotensin 2, endothelin, adenosine, ADH, etc. The risk of CN can be minimized by the use of non-ionic, low or isoosmolar, contrast material, adequate hydration and prophylactic pharmacological measures. In patients with chronic renal failure who are undergoing arteriography (e.g. coronary angiography and angioplasty), periprocedural hemofiltration appears effective in preventing further renal damage due to contrast agents.

We evaluated the sensitivity and specificity of fluorescence in situ hybridization (FISH) performed on the urine specimens of patients under follow-up for superficial bladder cancer. Thirty-seven patients were enrolled and underwent cystoscopy, urinary cytology or biopsy and FISH examination. Urinary cytology and FISH were evaluated in exfoliated urothelial cells from bladder washings. A mixture of fluorescent labeled probes to the centromere of chromosomes 3, 7 and 17, and locus 9p21 was used to assess urinary cells for chromosomal abnormalities indicative of malignancy. Nine patients (24.3%) showed an abnormal cystoscopy, but only five patients showed transitional cell carcinoma at histology. Eighteen patients (48.6%) showed an abnormal FISH: one patient (2.7%) had a positive cytology, and three patients (8.1%) showed an atypical cytology. Patients with both positive cystoscopy and histological examination had a positive FISH, while only one patient had a positive cytology. Patients with positive cystoscopy and negative histological examination had a negative FISH. Three patients with negative cystoscopy and suspicious cytology had a positive FISH.

Ten patients (27%) with both negative cystoscopy and cytology had a positive FISH. The sensitivity of the FISH assay was 100%, 50% for the cytology and 62% for the cystoscopy. The specificity of the FISH assay, cytology and cystoscopy were 66%, 100% and 86%, respectively. The sensitivity of the FISH assay in detecting non-invasive urothelial tumors is worth further studies.

In this study, we established the values for cadmium, chromium, nickel, manganese and lead in seminal plasma of normal and in different infertile conditions. Except for manganese, the other elements were not present in all normal samples. The value of nickel differed significantly from normal in all pathological conditions except azoospermia. Chromium showed a statistical difference in azoospermia when compared to that of normozoospermia. The presence of these elements in semen could have different roles to play in the survival and function of spermatozoa.

We present a case of retroperitoneal splenosis simulating a relapsing renal carcinoma. A 75-year-old male had undergone a left radical nephrectomy for a clear cell neoplasm, pT4 N0; during the operation a splenectomy for an unreparable spleen laceration had been performed. After 1 yr, the patient was asymptomatic; an abdominal CT evidenced a solid 24 mm diameter nodular formation of the left lumbar region, a suspected recurrence of renal carcinoma. This nodule was removed, it was capsulated and violaceous; the histologic examination demonstrated that it was typical splenic tissue. Splenosis nodules are generally due to “insemination” of splenic pulp after trauma or splenectomy, probably more frequent with laparoscopic surgery. The splenosis localizations can be either single or multiple, round in form, a few centimeters at its greatest diameter; the favorite seats are the peripancreatic region, the gastrocolic ligament and the great omentum. The splenosis is generally asymptomatic, but it can simulate tumors of various organs. The echotomographic and CT scan remarks can be aspecific. MRI can be more precise, with the ferumoxide-enhancement effect. The most reliable examination is the “heat damaged” Tc-99 labeled erythrocyte scintigraphy: 1 cm nodules appear evident. We recommend that the diagnosis of suspected neoplasm in splenectomized patients should include the heat damaged red cell scintigraphy.