Percutaneous nephrostomy versus indwelling ureteral stents in the management of extrinsic ureteral obstruction in advanced malignancies: are there differences?

OBJECTIVES

To compare the complications and morbidities after placement of a percutaneous nephrostomy (PCN) tube or an internal ureteral stent (IUS) in the management of malignant ureteral obstruction in patients with advanced malignancy.

METHODS

A retrospective analysis was performed on a total of 148 patients (80 women and 68 men, mean age 57.3 years, range 20 to 84) with malignant ureteral obstruction, who underwent PCN tube placement (n = 80) or IUS placement (n = 68) between January 2000 and December 2002. The incidence of fever and acute pyelonephritis was expressed as the number of episodes per 100 person-days.

RESULTS

The accumulated incidence of fever and acute pyelonephritis was not different in the two groups. The accumulated incidence and the incidence of febrile episodes in the IUS group was 10.3% and 0.0004/100 person-days; the corresponding values for the PCN group were 15.0% and 0.2154/100 person-days. The incidence of acute pyelonephritis in the IUS and PCN groups was 0.0002/100 person-days and 0.0005/100 person-days, respectively. These patients were treated conservatively and recovered uneventfully. The difference in overall stent-related or catheter-related complications between the IUS and PCN groups was not statistically significant. The accumulated incidence of failed diversion due to obstruction was 11% (8 of 68) and 1.3% (1 of 80) in the IUS and PCN groups, respectively (P = 0.012).

CONCLUSIONS

Our results have demonstrated that morbidities after internal or external diversion were minimal in cases of malignant obstruction. However, patients scheduled to receive an IUS should be more carefully monitored for ongoing obstruction than patients scheduled for PCN tube placement.

Voiding diary for the evaluation of urinary incontinence and lower urinary tract symptoms: prospective assessment of patient compliance and burden

AIMS

Voiding diary duration may be related to patient compliance and burden. To test this hypothesis, we evaluated patient compliance and burden.

METHODS

Between January and July 2002, we prospectively evaluated 162 patients (57 males and 105 females, mean age 53.0, range 20-81 years) with stress urinary incontinence or lower urinary tract symptoms. At the initial visit, all patients underwent a detailed clinical evaluation including an International Prostate Symptom Score (I-PSS) assessment and were randomly requested to complete 2-day, 3-day, or 7-day voiding diaries (the three study groups). At the second visit, a simple self-administered questionnaire was completed by all patients. The questionnaire included 11 items on subject demographics and voiding diary-keeping.

RESULTS

No significant differences were found in either the accuracy of diary-keeping or the daily average number of omissions when the three groups were compared. However, as the diary duration increased, the mean burden scores increased (P = 0.005), and the mean preferred duration of the diary in the 7-day group was significantly higher than that of the 2-day or 3-day groups (P < 0.001). After categorizing patients into two groups according to the degree of patient burden, members of the group with a greater perceived burden were found to have a significantly higher I-PSS quality of life score (P = 0.045) and to have kept a diary for a longer time (P = 0.038).

CONCLUSIONS

Our results suggest that keeping a diary for 7 days may increase patient burden and thus, we recommend that the 7-day diary should be reduced to cover fewer days.

The prognostic value of pretreatment of systemic inflammatory responses in patients with urothelial carcinoma undergoing radical cystectomy

BACKGROUND

Systemic inflammatory response (SIR) is important in the relationship between the tumour, the host, and outcome in cancer patients. However, limited data exist regarding the prognostic significance of SIR in bladder cancer. We investigate the utility of pretreatment SIR in patients with urothelial carcinoma undergoing radical cystectomy.

METHODS

The study cohort consisted of 419 patients with a median follow-up of 37.7 months. The SIRs used for each described prognostic nomogram are consistent with previously published data: C-reactive protein, albumin, white cell count, neutrophil count, lymphocyte count, and platelet count. Primary end point was disease-specific survival (DSS) and overall survival (OS) after surgery. Cox regression models were used to determine the time to disease-specific and overall mortality. Multivariate regression coefficients of the predictors were used to develop nomograms for predicting 5-year DSS and OS probability.

RESULTS

Multivariate Cox regression analyses revealed that albumin, lymphocyte count, and platelet count were significantly associated with a significantly increased risk for death from bladder cancer. The nomograms including each index were developed to predict the probability of 5-year DSS and OS after radical cystectomy. The C statistics were 77.8% and 77.3%, respectively, and exceeded the 2002 AJCC (72.0% and 70.3%, respectively). In the decision curve analyses, the nomograms including SIR demonstrated higher net benefit gains compared with the models without SIR.

CONCLUSIONS

Cellular components of SIR have better prognostic values compared with acute-phase protein in patients undergoing radical cystectomy for bladder cancer.

Expression of survivin, a novel inhibitor of apoptosis, in superficial transitional cell carcinoma of the bladder

PURPOSE

We investigated whether the over expression of survivin, a new antiapoptotic protein, might provide prognostic information in patients with superficial bladder cancer.

MATERIALS AND METHODS

Immunohistochemical staining of paraffin sections using a monoclonal antibody for survivin was performed in 88 cases of superficial bladder cancer using the standard avidin-biotin-peroxidase technique. The relationships between the expression of survivin, clinicopathological characteristics and clinical outcome were analyzed.

RESULTS

Survivin expression was found in tumor cells but not in nonneoplastic bladder tissues. High expressions (greater than 20%) of survivin were observed in 51 cases (58.0%) and low expression in 37 cases. No statistically significant association was observed between survivin expression and tumor grade (p = 0.052) or pathological stage (p = 0.131). When clinical data such as sex, age, tumor number, size or shape were examined in conjunction with survivin status no statistically significant relationship was noted. Patients with a high expression of survivin had worse disease-free survival rates than those with low survivin expression (log rank test p = 0.0004). Multivariate Cox proportional hazards model analysis identified survivin expression as an independent prognostic factor of disease-free survival (p = 0.009, relative risk = 3.17).

CONCLUSIONS

Our findings suggest that high survivin expression may be considered a new unfavorable prognostic factor in superficial bladder cancer.

The preventive effect of systemic treatment with interferon-alpha2B for infertility from mumps orchitis

OBJECTIVE

To evaluate the effect of interferon-alpha2B on mumps orchitis, often caused by postpubertal mumps and which can result in permanent testicular atrophy.

PATIENTS AND METHODS

The study included 21 patients with mumps orchitis, treated between May 1990 and June 1997. Patients were randomly assigned into two groups: in group 1, 13 patients received therapy with interferon-alpha2B (3 x 10(6) IU per day) and group 2 did not, acting as controls. All were evaluated by measurements of testis size, mumps virus titre, hormone level and semen analysis.

RESULTS

In group 1, the patients' symptoms resolved within 2-3 days and the volume of the testes returned to normal within 11 days; there was no testicular atrophy in any patient during the follow-up. However, asthenospermia continued to be detected in four patients (unilateral in two, bilateral in two). In group 2, the patients' symptoms resolved within 5-6 days and the volume of the testes returned to normal within 10 days; testes atrophied in three patients (unilateral in two, bilateral in one) during the follow-up. Asthenospermia continued in four patients (unilateral in two, bilateral in two).

CONCLUSION

These results suggest that treatment with systemic interferon-alpha2B is effective in preventing testicular atrophy when combined with standard symptomatic treatment.

Comparison of retroperitoneal laparoscopic and open nephrectomy for benign renal diseases in children

OBJECTIVES

To compare the results of retroperitoneal laparoscopic versus open nephrectomy for benign renal diseases in children.

METHODS

From January 1999 to February 2003, retroperitoneal nephrectomy or nephroureterectomy was performed in 23 consecutive children (7 girls and 16 boys). The median patient age was 4 years (range 1 to 13). The disease was on the right side in 9 children and on the left side in 14. Operative and convalescence parameters, including operative time, blood loss, transfusion rate, resumption of oral intake, hospital stay, and complication rate, were evaluated in both groups.

RESULTS

All laparoscopic cases were completed successfully without conversion to open surgery. The median operative time and estimated blood loss were not statistically different between the two groups. No major perioperative complications occurred in any child, but a wound site complication occurred in 1 child who had undergone open surgery. The median hospital stay of the open group was 4 days (range 3 to 14), significantly longer than that of the laparoscopic group (median 2.5 days, range 2 to 6; P = 0.018). The cosmetic results of the laparoscopic group were excellent; the scars from the trocar sites were barely discernible at the initial postoperative visit. Convalescence was uneventful in all patients.

CONCLUSIONS

Retroperitoneal laparoscopic nephrectomy and nephroureterectomy may be performed for benign disease in children with minimal morbidity, improved cosmetic results, and a short hospital stay. Our findings indicate that retroperitoneal laparoscopic nephrectomy is appropriate in children and superior, in some instances, to open surgery.

Complications of the upper urinary tract in patients with spinal cord injury: a long-term follow-up study

The aim of this study was to establish hazard ratios for the risk of complications of the upper urinary tract in relation to bladder management methods in patients with spinal cord injury. A total of 179 male patients were eligible for this investigation which was followed-up on a yearly basis until 2003. The average age at which the lesion occurred was 25.2 years (range 18-57). The average duration of follow-up since SCI was 29.3 years (range 10-53). During follow-up, the incidence of vesicoureteral reflux (VUR) was 15.1%. A total of 61 (34.1%) and 44 (24.6%) patients were diagnosed with pyelonephritis and renal stones, respectively. There were no significant differences in these complications among groups. Upper tract deterioration (UTD) was observed in 58 patients (32.4%). The incidence of UTD in the urethral catheter group (51.7%) was higher than that in other groups (P=0.008). Using multivariate analysis, patients with VUR were shown to have a higher risk of pyelonephritis (odds ratio 2.78; 95% confidence interval 1.16-6.68), and UTD (odds ratio 22.10; 95% confidence interval 6.92-70.56). We also found that UTD was more common for patients with an indwelling urethral catheter than for patients using other methods. For other variables, no positive association was observed. In cases which cannot undergo intermittent catheterization, or when the bladder cannot empty spontaneously, a suprapubic catheter is better than a urethral catheter for reducing UTD in this population. These findings suggest that even at a late stage post injury, bladder management methods are still important.

Lymph node density as a prognostic variable in node-positive bladder cancer: a meta-analysis

BACKGROUND

Although lymph node (LN) status and the LN burden determine the outcome of bladder cancer patients treated with cystectomy, compelling arguments have been made for the incorporation of LN density into the current staging system. Here, we investigate the relationship between LN density and clinical outcome in patients with LN-positive disease, following radical cystectomy for bladder cancer.

METHODS

PubMed, SCOPUS, the Institute for Scientific Information Web of Science, and the Cochrane Library were searched to identify relevant published literature.

RESULTS

Fourteen studies were included in the meta-analysis, with a total number of 3311 patients. Of these 14 publications, 6 studies, (533 patients), 10 studies (2966 patients), and 5 studies (1108 patients) investigated the prognostic association of LN density with disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS), respectively. The pooled hazard ratio (HR) for DFS was 1.45 (95% confidence interval [CI], 1.10-1.91) without heterogeneity (I2=0%, p=0.52). Higher LN density was significantly associated with poor DSS (pooled HR, 1.53; 95% CI, 1.23-1.89). However, significant heterogeneity was found between studies (I2=66%, p=0.002). The pooled HR for OS was statistically significant (pooled HR, 1.45; 95% CI, 1.11-1.90) without heterogeneity (I2=42%, p=0.14). The results of the Begg and Egger tests suggested that publication bias was not evident in this meta-analysis.

CONCLUSIONS

The data from this meta-analysis indicate that LN density is an independent predictor of clinical outcome in LN-positive patients. LN density may be useful in future staging systems, thus allowing better prognostic classification of LN-positive bladder cancer.

Health-related quality of life of living kidney donors: review of the short form 36-health questionnaire survey

Kidney transplantation is the ultimate goal and the best treatment for most patients with end-stage renal disease. Organ shortage and steadily growing waiting time for a cadaver kidney transplant have forced the medical community to look for alternatives, such as living kidney donation. However, available data examining health-related quality of life (QOL) issues of living donors are currently limited. In addition, little information regarding factors associated with health-related QOL in living kidney donors is currently available and this issue remains controversial. This review article aims to summarize the data regarding health-related QOL of living kidney donors by using the Medical Outcomes Study Short Form.

Patient experience with a urodynamic study: a prospective study in 208 patients

PURPOSE

We assessed several emotional variables, including anxiety, pain, shame and morbidity, in patients who underwent a urodynamic study.

MATERIALS AND METHODS

A total of 208 patients of 20 to 81 years old (mean age 54.3) were included in the study. Of the patients 71 (34.1%) were male and 137 (65.9%) were female. Prior to and immediately after the procedure each patient completed a self-administered questionnaire. Answers were given on a visual analog scale. All patients received an antibiotic for 3 days after the investigation and urine was collected for culture 7 days after the investigation.

RESULTS

Patient initial anxiety did not significantly depend on demographics. The mean degree of pain +/- SEM experienced by patients was higher in males than in females (3.1+/- 0.2 vs 2.4 +/- 0.2, p = 0.012). Pain scores correlated with pre-procedure anxiety scores but the relationship was weak ([pain] = 0.283[anxiety] + 1.766, r = 0.157, p = 0.024). On the other hand, female patients showed a significantly higher mean level of shame than males (3.6 +/- 0.3 vs 1.8 +/- 0.3, p <0.001). In general patients cooperated extremely well during the examination. By the stepwise method only bother was associated with tolerance ([tolerance] = 0.182[bother] + 2.753, r = 0.275, p <0.001). Seven patients (3.4%) had significant bacteriuria and received antibiotic treatment.

CONCLUSIONS

The study demonstrates that urodynamic studies are well tolerated by male and female patients in all age groups. However, emotional support depending on gender prior to the urodynamic procedure might enhance the level of patient cooperation.

Preoperative serum albumin as a prognostic factor in patients with upper urinary tract urothelial carcinoma

PURPOSE

The study evaluated whether preoperative measures of the C-reactive protein-systemic inflammatory response may predict cancer survival independent of tumor stage in patients with upper urinary tract urothelial carcinoma (UTUC).

MATERIALS AND METHODS

Between September 1999 and October 2010, 181 patients submitted to radical nephroureterectomy were available for evaluation. Multivariate survival analyses were performed using Cox's proportional hazards model and the coefficient for each factor was divided by the highest coefficient, multiplied by 4, and rounded to the nearest integer.

RESULTS

Multivariate analyses showed that tumor location, pathologic T stage, lymphovascular invasion, margin status, and albumin level were independent contributors. The bootstrap-corrected C statistics of the model were 0.813 for disease-specific survival and 0.755 for overall survival, respectively. For time to disease-specific and overall mortality for patients, integrated area under the curve values were 0.792 and 0.739, respectively. When patients were clustered into three groups according to their model-predicted survival, the 5-year disease-specific survival in the low-, intermediate- and high-risk group was 95.4%, 76.2%, and 36.9%, respectively (p<0.001), and were 87.8%, 54.4%, and 31.8%, respectively, for overall survival (p<0.001). Decision curve analysis revealed that the use of model was associated with net benefit gains relative to the treat-all strategy.

CONCLUSIONS

Pretreatment albumin is a simple biomarker based on routinely available well-standardized measures, and is not an expensive and time-consuming process. Hypoalbuminemia is an independent marker of poor prognosis in patients with upper urinary tract urothelial carcinoma.

Health-related quality of life in patients with spinal cord injury: review of the short form 36-health questionnaire survey

Advances in medical and rehabilitative care have increased interest in studying how different factors may affect the health-related quality of life (HRQOL) of individuals with spinal cord injury (SCI). There has been a large increase in the number of studies assessing HRQOL among persons with SCI. However, despite these advances, numerous issues remain unanswered because these studies have used a variety of methodologic approaches and assessment tools to examine how different factors have a role in predicting HRQOL in SCI populations. Therefore, standardized instruments should be used as part of this process. The Medical Outcomes Study Short Form (SF-36) was developed in order to survey health status of the general population. However, the available data on the HRQOL of individuals with SCI are currently limited. In addition, there is little information currently available on the factors that are associated with HRQOL in the SCI population and this issue remains controversial. The findings from several individual studies that used the SF-36 to assess the HRQOL of patients suffering from SCI were reviewed, and the results were interpreted with disability in mind. This review article aims to summarize the data regarding the HRQOL of individuals with SCI by using the SF-36.

Correlation between prostatic urethral angle and bladder outlet obstruction index in patients with lower urinary tract symptoms

OBJECTIVES

To evaluate the association of prostatic urethral angle (PUA) with bladder outlet obstruction (BOO) index in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).

METHODS

A retrospective analysis was made of 260 men with LUTS and/or BPH aged>50 years (median: 65.9, range: 50-87). Patients underwent an evaluation including the International Prostatic Symptom Score, serum prostate-specific antigen levels, transrectal ultrasonography, frequency-volume chart, uroflowmetry, and measurement of postvoid residual, and multichannel video urodynamic study with a pressure-flow study.

RESULTS

Patients with higher PUA (PUA>or=35 degrees) had higher prostate-specific antigen levels (P=.043), larger prostate volume (P<.001), higher maximal urethral closure pressure (P=.004), higher detrusor pressure at maximum flow rate (P=.008), and higher BOO index (P=.032), in comparison with those who had lower PUA (PUA<35 degrees). There was no significant difference of PUA values according to the degree of intravesical prostatic protrusion. When we compared BOO index according to PUA, patients with higher PUA had higher BOO index than those with lower PUA (30.6+/-1.8 vs 23.6+/-1.8, P=.006). The area under the curve of PUA was significant for BOO (area, 63.0%; 95% confidence interval, 55.1%-70.9%; P=.002).

CONCLUSIONS

PUA may be one method to asses the presence of BOO in men with LUTS and/or BPH. Our findings suggest that PUA may help in the treatment of individuals by better predicting their likely classification from a pressure-flow study.

Urine survivin as a diagnostic biomarker for bladder cancer: a systematic review

What's known on the subject? and What does the study add? Although many tests for identifying patients with new or recurrent bladder cancer have been used, a reliable method has yet to be established. Recently, increasing attention has focused on the role of survivin in bladder cancer detection. Because urine survivin tests have better sensitivity than cytology, urine survivin could potentially replace routine cytology and might be used as an adjunct method for cystoscopy. However, the clinical utility of urine survivin as a bladder tumour marker identified in the present study remains to be elucidated. To determine the clinical utility of urine survivin as a bladder tumour marker we systematically reviewed the available evidence. A comprehensive literature review was performed, from August 1997 to March 2011, using three search engines in English including PubMed, Cochrane Library, and SCOPUS. Two reviewers independently evaluated both trial eligibility and methodological quality and data extraction. We included studies that evaluated urine survivin, used cystoscopy and/or histopathology as the reference standard, and allowed the construction of a 2 × 2 contingency table. Bivariate random effect meta-analyses were used to calculate the summary estimated of sensitivity and specificity and to construct a summary receiver-operating characteristics curve of urine survivin tests. In all, 14 studies were included in the present review; two studies had two subsets of data. There were 2051 subjects, including 1038 in the case group and 1013 in the control group, and heterogeneity was present among diagnostic studies. The pooled sensitivity and specificity for urine survivin tests were 0.772 (95% confidence interval [CI] 0.745-0.797) and 0.918 (95% CI 0.899-0.934), respectively. The area under the curve of urine survivin tests was 0.9392. When a subgroup analysis with six studies was performed, urine survivin tests had better sensitivity than cytology, but did not match cytology for specificity. The clinical utility of urine survivin as a bladder tumour marker identified in the present study remains to be elucidated.

Minimally invasive management of ureteral injuries recognized late after obstetric and gynaecologic surgery

We evaluated whether iatrogenic ureteral injuries recognized late after obstetric and gynaecological surgery were likely to resolve with minimally invasive strategies. We reviewed our records of 30 patients with surgical ureteral injuries diagnosed after obstetric and gynaecological operations. From collected data, the outcome of minimally invasive strategies and operative repair was evaluated and compared. Thirteen patients were treated primarily by operative repair and 17 were treated by minimally invasive strategies including percutaneous nephrostomy drainage, ureteral stent placement, or both. All patients treated by operative repair obtained primary healing. Of 17 patients treated by minimally invasive strategies, 11 had recovery of injured ureters but additional procedures were needed in six. We conclude that minimally invasive strategies are not always successful in the management of ureteral injuries recognized late after obstetric and gynaecological surgery.

Bladder cancer after nephroureterectomy in patients with urothelial carcinoma of the upper urinary tract

OBJECTIVES

To determine the independent risk factors of bladder recurrence in patients with upper urinary tract (UUT) urothelial carcinoma (UC).

MATERIALS AND METHODS

A total of 181 patients with UUT-UC were enrolled in this study. Their median age was 63 years (range 36-90), and median follow-up after total nephroureterectomy was 37.5 months (range 1.0-174.0). The end-point of this study was defined as the initial intravesical recurrence of UC.

RESULTS

Of the 181 patients, 64 (35.4%) developed subsequent bladder tumors at a median interval of 6.3 months (range 1.7-50.1) after initial treatment. By univariate analysis, a previous bladder tumor history (P = 0.046) and tumor necrosis (P < 0.001) were found to have a significant prognostic impact on bladder tumor-free survival in patients with superficial UUT-UC, whereas surgical margin status (P = 0.045) and the use of adjuvant chemotherapy (P = 0.003) were found to be prognostic factors for bladder tumor-free survival in those with invasive UUT-UC. However, by multivariate analysis, only tumor necrosis (P = 0.012, relative risk = 6.512) was found to have a significant impact on intravesical recurrence in patients with superficial UUT-UC. However, surgical margin status (P = 0.007, relative risk = 5.846) and the use of adjuvant chemotherapy (P = 0.001, relative risk = 0.223) were retained as independent predictors of bladder tumor survival in those with invasive UUT-UC.

CONCLUSIONS

Our findings may be useful in patients with UUT-UC who may require more stringent follow-up by cystoscopy to detect bladder tumors.

Influence of environmental factors on chronic prostatitis-like symptoms in young men: results of a community-based survey

OBJECTIVES

To investigate the influence of environmental factors on chronic prostatitis-like symptoms among young men in a community.

METHODS

Of 28,841 men aged 20 years dwelling in the community, a total of 16,321 men (response rate 56.6%) were included in this study. The National Institutes of Health Chronic Prostatitis Symptom Index was used to identify men with chronic prostatitis-like symptoms. The questionnaire also queried sociodemographic characteristics. The Korean Meteorological Administration provided information on the weather of the community. We determined the risk factors of chronic prostatitis-like symptoms among these environmental factors using univariate and multivariate analyses.

RESULTS

Six percent of the men were identified as having significant prostatitis-like symptoms (perineal and/or ejaculatory pain and a total pain score of 4 or greater). The univariate logistic regression analysis indicated that education level, average duration of sunlight, and average temperature were risk factors for chronic prostatitis-like symptoms. As these variables increased, the scores of chronic prostatitis-like symptoms decreased. In the multivariate model used, the likelihood of chronic prostatitis-like symptoms varied by the final educational level, with middle school and high school graduates having 1.8 and 1.4-fold higher odds, respectively, than men attending college. In the same model, the average duration of sunlight was also an independent risk factor of chronic prostatitis-like symptoms (odds ratio 0.85; 95% confidence interval 0.77 to 0.95; P = 0.003), but the average temperature lost statistical significance.

CONCLUSIONS

Our findings suggest that the community-based prevalence of chronic prostatitis-like symptoms may be high in young men. Higher education and a longer time in sunlight were associated with a decreased likelihood of chronic prostatitis-like symptoms.

Lymphovascular invasion as a prognostic factor in the upper urinary tract urothelial carcinoma: a systematic review and meta-analysis

BACKGROUND

The objective of the present study was to conduct a systematic review and meta-analysis of the published literature investigating lymphovascular invasion (LVI) and its effects on upper urinary tract urothelial carcinoma (UTUC) prognosis.

METHODS

To identify relevant studies, PubMed, Cochrane Library, OVID and SCOPUS database were searched from the inception until June 2012.

RESULTS

A total of 17 trials met the eligibility criteria for the meta-analysis. The total number of patients included was 4896, ranging from 60 to 2492 per study. None of the 17 included studies was based on the data of prospective analysis of survival. In 13 of 17 studies, patients had received adjuvant chemotherapy. Despite our attempts to limit the between-study heterogeneity through a strict inclusion criteria, there was a between-study heterogeneity in the effect of LVI on all of the meta-analyses, with a p value of <0.05 and I(2) generally greater than 50%. Thus, the hazard ratio (HR) was calculated using the random-effect model. The pooled HRs were statistically significant for disease-free survival (pooled HR, 1.91; 95% confidence interval [CI], 1.40-2.41), cancer-specific survival (CSS) (pooled HR, 1.72; 95% CI, 1.28-2.71) and overall survival (pooled HR, 4.05; 95% CI, -0.44-8.53). There was no clear evidence of funnel plot asymmetry, and thus, no evidence of publication bias was found.

CONCLUSIONS

Our meta-analysis showed that LVI is predictive of mortality in UTUC. However, these findings should be interpreted with caution due to the heterogeneity in the series. These results need to be further confirmed by an adequately designed prospective study to provide a better conclusion on the relationship between LVI and the outcome of patients with UTUC.

External validation of an online nomogram in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma

BACKGROUND

The objective was to validate an online nomogram developed based on the French collaborative national database on upper urinary tract urothelial carcinoma (UUT-UC) using a different cohort.

METHODS

The study comprised 328 patients with UUT-UC who underwent radical nephroureterectomy. The discrimination of models was quantified using Harrell's concordance index. The relationship between the model-derived and actuarial cancer-specific mortality was graphically explored within calibration plots. Calibration was also assessed using the quartiles of the predicted survival at 3 and 5 years and calculation of the corresponding observed Kaplan-Meier estimates. Clinical net benefit was evaluated constructing decision curve analysis.

RESULTS

The discrimination accuracy of the nomograms at 3 and 5 years was 71.6% and 71.8%, respectively. Although nomograms discriminated well by Kaplan-Meier curves, and log-rank tests were all highly significant, the calibration plots tended to exaggerate the overestimation of mortality between predicted and observed probabilities at 3 and 5 years for survival. When compared with the AJCC/UICC staging system, the nomograms performed well across a wide range of threshold probabilities using decision curve analysis.

CONCLUSION

The online nomogram is a highly accurate prognostic tool for patients with UUT-UC treated with radical nephroureterectomy. The model can provide an accurate estimate of the individual risk of cancer-specific mortality. Further improvement and implementation of novel molecular marker is needed.

Psychological problems in young men with chronic prostatitis-like symptoms

OBJECTIVE

To take a different perspective in assessing young men with chronic prostatitis-like symptoms, this study was designed since few prospective studies are available to survey a population of young men.

MATERIAL AND METHODS

One hundred and fifty men aged 20 years dwelling in the community were randomly selected. Chronic prostatitis-like symptoms were measured by the National Institutes of Health-Chronic Prostatitis Symptom Index and the selfreported scores for pain and urinary symptoms were used to identify chronic prostatitis-like symptoms. The psychological methods used were the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Bem Sex Role Inventory. A total of 87 men (a response rate 58%) completed self-administered questionnaires.

RESULTS

As the scores for pain and urinary symptoms increased, those for depression increased (p < 0.001 and p = 0.01, respectively). However, the mean scores for state and trait anxiety were not different according to the scores for pain and urinary symptoms. The mean masculinity scores were not different according to the scores for pain but those were significantly different according to the scores of urinary symptoms (p = 0.042). The mean femininity scores were not different according to the scores of pain and urinary symptoms.

CONCLUSIONS

Our findings suggest that psychological factors, especially depression and weak masculine identity may be associated with an early stage of chronic prostatitis-like symptoms. Young men with chronic prostatitis-like symptoms also have psychological problems.

The excisional, plication and internal drainage techniques: a comparison of the results for idiopathic hydrocele

OBJECTIVE

To assess the results of the excision, plication and internal drainage techniques for hydrocele repair.

PATIENTS AND METHODS

Between January 1990 and June 1998, 132 patients (mean age 54.36 years, range 16-83) underwent repair for idiopathic hydrocele using one of three techniques (excision, eversion/plication or internal drainage); the complication and recurrence rates of each technique were evaluated.

RESULTS

The excisional technique resulted in the highest complication rate (81%) and the internal drainage technique the lowest (7%). Postoperative scrotal oedema occurred in 74% of patients after plication and this was the highest rate among the techniques (P < 0.001). Differences in the rates of wound infection and haematoma among the three techniques were not statistically significant. The internal drainage technique had the highest recurrence rate (85%) and the excisional technique the lowest (1.3%; P < 0.001).

CONCLUSIONS

Although useful, the internal drainage technique has a high recurrence rate and we suggest abandoning its use for hydrocele repair. The present results suggest that plication is better than excision, causing fewer complications, and better than internal drainage, as the results are more favourable.

The role of survivin and Bcl-2 in zinc-induced apoptosis in prostate cancer cells

OBJECTIVES

To study the effects of zinc treatment on the gene expression levels of survivin and Bcl-2 in prostate cancer cells.

MATERIALS AND METHODS

The effects of zinc exposure on apoptosis were assessed using two human prostate cancer cell lines, LNCaP and PC-3. Zinc-induced apoptosis was measured by Annexin V staining. The direct effect of zinc on the expression levels of zinc transporters (ZnT-1 and ZnT-4) and apoptosis-related genes (Bax, Bcl-2, and survivin) was determined by RT-PCR analysis.

RESULTS

When LNCaP and PC-3 cells were exposed to various concentrations of zinc sulfate for 48 hors, their growth was inhibited in a dose-dependent manner. The levels of zinc in both cell lines treated with zinc sulfate for 24 hours were higher than in untreated cells. Exposure to zinc induced apoptosis and necrosis in LNCaP and PC-3 cells. Apoptosis became more extensive as the treatment time with zinc increased. There was a significant increase in the gene expression levels of ZnT-1 and ZnT-4 in both cell lines treated with zinc sulfate compared with untreated cells. The expression of Bax mRNA was up-regulated, while the expression of Bcl-2 and survivin were decreased in both cell lines following zinc treatment.

CONCLUSIONS

Exposure to zinc sulfate in human prostate cancer cells increased intracellular levels of zinc, which resulted in increased apoptosis. The apoptogenic effect of elevated concentration of zinc could be due either to increased expression of zinc transporters and increased levels of Bax or decreased Bcl-2 and survivin expression.