The Italian version of the National Institutes of Health Chronic Prostatitis Symptom Index

OBJECTIVES

To perform the Italian version of the National Institutes of Health Chronic Prostatitis Symptom Index (NHI-CPSI), and to study its linguistic validity and its correlations with the Visual Analogue Scale for pain (VAS) and the Italian version of International Prostatic Symptom Score (I-PSS) in men with chronic pelvic pain syndrome (CPPS) and healthy controls.

METHODS

A rigorous double-back translation of the original English NHI-CPSI was performed by a staff composed of 3 professional bilingual experts and 3 urologists. The study population consisted of 160 male CPPS patients and 125 healthy controls, who were asked to self complete the Italian version of the NHI-CPSI together with the VAS and the Italian I-PSS. The discriminatory power, psychometric properties, internal correlations and convergent validity of the questionnaire were tested.

RESULTS

Of the 285 enrolled patients, 223 patients (142 with CPPS and 81 healthy patients) were definitively considered for the study. The overall Italian NIH-CPSI scores and each subscale differed significantly (p<0.001) between the two groups, and so that the index proved a good discriminant validity. High correlations were found between the VAS and the pain domain (0.88) and between I-PSS and void domain (0.94), suggesting a good convergent validity of the Italian version of the NIH-CPSI. The questionnaire proved to have a high internal consistency.

CONCLUSIONS

The Italian NIH-CPSI is a reliable symptom index that can be self-administrated in about 5 minutes in daily clinical practice for the follow-up of the Italian patients with chronic prostatitis.

Weekly paclitaxel and epirubicin in the treatment of symptomatic hormone-refractory advanced prostate carcinoma: report of a phase II trial

The efficacy of weekly paclitaxel in androgen-independent prostate cancer and its addictive cytotoxicity with anthracycline derivatives led us to determine the safety and efficacy of a weekly schedule of paclitaxel and epirubicin. Between October 2000 and November 2002, 32 patients were enrolled in this study. Patients characteristics included a median age of 72 years (range 68-77), adequate hepatic, cardiac, renal and bone marrow functions, ECOG performance status of 1-2, and no prior chemotherapy. All patients had received hormonal manipulation and seven patients (22%) had received prior palliative radiation therapy. The regimen consisted of paclitaxel 70 mg/m2 i.v. infusion for 2 h and epirubicin 30 mg/m2 in bolus every week. Treatment was continued for 3 months or until disease progression or unacceptable toxicity were observed. During the study, prostate-specific antigen (PSA) was monitored and response was defined as a 50% reduction in PSA levels, to be confirmed 4 weeks later. Thirty-one patients were evaluable for toxicity and 21 for objective response. Seventeen patients (57%) had a decline above 50% in PSA level that lasted more than 4 weeks with a median time to PSA progression and a median duration of PSA response of approximately 5.5 months. Ten of the 21 patients with measurable disease (47%) had a confirmed objective response (one complete response and 20 partial responses). Thirteen of 25 symptomatic patients (56 %) had improvement in pain. The median time to disease progression was 7.6 months and the median survival was 12.9. The most prominent grade 3 toxicities were reversible myelosuppression and fatigue. Nausea, vomiting, diarrhea and peripheral edema were minimal. No evidence of cardiac toxicity was recorded. Alopecia was frequent, but reversible, in all patients. We conclude that despite the small sample size, this study demonstrates that the combination of weekly paclitaxel and epirubicin is a well-tolerated regimen for androgen-independent prostate cancer. The results imply that a combination of these agents in a weekly schedule may have clinical potential in prostate cancer treatment.

Nephrogenic adenoma of bladder after ibuprofen abuse

Nephrogenic adenoma is an infrequent benign lesion of the urinary system that occurs in patients with a history of genitourinary surgery, stone disease, trauma, chronic urinary tract infection, or renal transplantation. We report the first case of nephrogenic adenoma of the bladder in a 53-year-old man with a 5-year history of ibuprofen abuse for chronic arthritis. We stress the importance of investigating the analgesic abuser for nephrogenic adenoma if microhematuria and/or irritative lower urinary tract symptoms are present.

Pathophysiology of Reno-Ureteral Colic

INTRODUCTION

Reno-ureteral colic presents with a complex of acute symptoms that usually indicate the presence of a stone in the collecting system, The aim of any treatment is pain relief, stone removal and preservation of kidney function. We focused our review on the pathophysiological aspects of reno-ureteral colic and, briefly, on its treatment.

MATERIALS AND METHODS

A complete overview of contemporary literature regarding reno-ureteral colic was performed by using MEDLINE and website on-line publications like EAU Guidelines.

RESULTS

Clinical presentation of reno-ureteral colic, of mechanisms of ureteral peristalsis and pathophysiology of renal colic is described. An overview of the available medical treatments is presented.

CONCLUSIONS

An accurate comprehension of the pathophysiology of reno-ureteral colic allows the physician to tailor the best treatment for each patient.

Molecular urinary sediment analysis in patients with transitional cell bladder carcinoma

BACKGROUND

Nowadays urinary cytology methods in early diagnosis of superficial bladder transitional carcinoma (TCC) allow the identification of about 35-50% of tumors. Cytoscopy and biopsy are reliable but invasive. It has been recently shown that allelic abnormalities detected by microsatellite analysis of DNA extracted from urine sediment can be successfully used in TCC. We performed a comparative study between urinary cytology and microsatellite sequence alterations in patients affected by TCC.

MATERIALS AND METHODS

Fifty-eight patients were recruited for the study. Of these, 45 had cystoscopic diagnosis of TCC, while 7 were without apparent lesions after TUR but presented urinary irritative symptoms after BCG endocavitary administration, and 6 who underwent open surgery for benign prostatic hypertrophy represented the control groups. DNA extraction and PCR analysis were performed by using 13 different primers, while urinary cytology was performed by using an Autocyte Preparation System.

RESULTS

Urinary cytology confirmed the presence of TCC in 22% of patients while in 15.5% of them a displastic/inflammatory status was found. Microsatellite analysis allowed the identification of 82% of tumors with a 100% specificity. A high sensitivity was obtained in patients affected by superficial (79%) or G1(80%) tumors.

CONCLUSION

Microsatellite analysis represents a highly sensitive and specific marker in TCC diagnosis and monitoring.

Urinary symptoms, quality of life and sexual function in patients with benign prostatic hypertrophy before and after prostatectomy: a prospective study

OBJECTIVE

To evaluate urinary symptoms, sexual dysfunction and quality of life in patients with benign prostatic hypertrophy (BPH) before and after open prostatectomy, using the International Prostate Symptom Score (IPSS), the International Continence Society (ICS)-"BPH" (ICS-male, ICS-sex and ICS-QoL) and International Index of Erectile Function (IIEF) questionnaires.

PATIENTS AND METHODS

Sixty men with BPH (mean age 68 years) underwent a digital rectal examination, transurethral ultrasonography, measurement of total prostatic specific antigen serum level and uroflowmetry. Their urinary symptoms, sexual function and quality of life were fully evaluated using the IPSS, ICS-"BPH" and IIEF before and 6 months after suprapubic prostatectomy. The body mass index (BMI) was also calculated for each patient. Univariate analysis was used to examine the relationship between symptom scores and age, tobacco use, alcohol intake and BMI.

RESULTS

In a univariate analysis, age was the most important prognostic factor for both urinary and sexual symptoms. Prostatectomy resulted in a significant improvement in obstructive (mean 9.68 to 3.38) and irritative symptom (6.70 to 3.06), and quality-of-life scores (3.41 to 1.34). ICS-male scores were both significantly decreased, the mean voiding score from 13.72 to 10.28 and the incontinence score from 10.43 to 7.81. There was also a significant decrease in the ICS-QoL symptom score (from 9.20 to 7.27). Comparative results between IIEF and ICS-sex showed no improvement in sexual scores after open surgery, but there was a significant increase in sexual desire and overall satisfaction (both P = 0.035).

CONCLUSIONS

The combined use of the IPSS, ICS-"BPH" and IIEF allows an evaluation of the relationship between age, prostatic symptoms and sexual dysfunction. Age may be considered both a direct and indirect (BPH-related) prognostic factor for sexual activity. Suprapubic prostatectomy resolves obstructive symptoms, and maintains sexual desire, overall sexual satisfaction and an improvement in quality of life. However, irritative symptoms, erection, orgasm and sexual intercourse satisfaction are not significantly altered.

Relationship of flow rate with symptoms, quality of life and other clinical parameters in patients with LUTS suggestive of BPH

AIM

The uroflowmetry data of a selected number of patients who took part to the QUIBUS study (366 traces selected after quality control by a central panel of reviewer) were evaluated for their relationships with age, prostate volume, and IPSS and ICS-BPH scores. Waiting time, flow time, voided volume, maximum flow rate (Q(max)) and average flow rate (Q(ave)) were the flow variables considered for analysis. Only measurements with total voided volume exceeding 100 ml were included.

RESULTS

An increasing percentage of subjects with voided volume <200 ml was observed over 65 years of age. Age did not affect neither Q(ave) nor Q(max )(p = n.s. at correlation analysis). In particular, Q(max)was <15 ml/s in about 70% of patients independently of age. Prostate enlargement was inversely associated with voided volume, Q(max) and Q(ave), showing a worsening of urinary function for increasing values of prostate volume Q(max) was negatively correlated with IPSS total score and with most single items with the exception of two storage symptoms such as repeated urination and nocturia). Accordingly, Q(max) was inversely associated with the total score ICS-BPH for voiding symptoms to a higher extent (r = -0.31, p < 0.01) than with the one for storage symptoms (r = -0.22, p < 0.01). Flow variables were inversely correlated with IPSS-QoL.

CONCLUSION

Uroflowmetry and IPSS, although not allowing a definitive diagnosis of obstruction, may nonetheless satisfy the clinical need of a rapid, easy and accurate tool for the noninvasive screening of LUTS patients.

Leiomyoma of the corona glans penis

A 42-year-old man presented with an 8-mm elliptical indolent solid mass on the superior surface of the corona glandis at our institution 3 months after its appearance. The lesion was excised by using a wedge resection performed by a cool blade knife. The subsequent pathologic evaluation defined the lesion as a leiomyoma. Immunohistochemical analysis using the streptavidin-biotin peroxidase technique and immunoreactivity for cytokeratin, S100 protein, and the proliferative marker MIB1 was performed, confirming the pathologic diagnosis. Early local excision of these tumors is indicated because of the trend toward their dimensions increasing quickly, with subsequent difficulties for cosmetic glandis reconstruction.

Molecular genetic alterations of c-myc oncogene in superficial and locally advanced bladder cancer

OBJECTIVE

Gene activation and altered expression of cellular proto-oncogene are important mechanisms implicated in initiation and development processes of human cancer. It has already been shown that c-myc oncogene is implicated in the control of cell proliferation, apoptosis and differentiation.

METHODS

We have determined the methylation status, the presence of genetic amplification and the presence of m-RNA overexpression of c-myc gene in 31 samples from patients with bladder carcinomas.

RESULTS

Our data demonstrated the presence of c-myc gene amplification only in 5 of 15 superficial bladder carcinomas (p < 0.05). On the other hand, we did not find statistical significant correlation between the methylation, expression of c-myc gene and the clinical-histopathological parameters. A significant correlation (p < 0.05) was found between the methylation pattern and m-RNA overexpression of c-myc oncogene.

CONCLUSION

We demonstrate aberrant c-myc gene status in human bladder cancer. This oncogene is altered at different levels in bladder carcinoma genesis and progression.

Intravesical migration of AMS 800 artificial urinary sphincter and stone formation in a patient who underwent radical prostatectomy

A patient who underwent placement of AMS 800 urinary sphincter for incontinence after salvage prostatectomy after radiation therapy failure, experienced urethral erosion of the cuff after 54 months. He was treated with cuff removal and prosthesis deactivation. Thirteen months later, a large bladder stone was removed transvesically, and it contained the reservoir. The remaining sphincter components were also removed. Patients with previous radiotherapy are particularly at risk for sphincter erosion, but intravesical displacement of the reservoir is a very uncommon complication.

Molecular alterations of E-cadherin gene: possible role in human bladder carcinogenesis

E-cadherin is a transmembrane glycoprotein which mediates a calcium dependent homophilic interaction among epithelial cells. The altered expression and gene mutations of E-cadherin adhesion molecule have been frequently observed in various tumors. Several invasive carcinomas showed cell-cell adhesion loss although the tumor cells expressed considerable amounts of E-cadherin protein. The purpose of this study was to evaluate the role of E-cadherin gene alterations in genesis and progression of bladder carcinoma by mutation analysis of coding region, expression analysis and microsatellite instability at E-cadherin chromosome locus. We analyzed 30 bladder carcinoma (28 transitional and 2 squamous cell carcinoma) at different stage and grade. The mutation analysis showed that in one case there was a presence of a point mutation at codon 846 that consisted of a G (AGC) to C (ACC) transversion resulting in the replacement of R to T. In another sample the sequence analysis revealed a same-sense mutation at the codon 785 (AAC - AAT). The study of E-cadherin mRNA by Northern blot analysis showed that there were no differences of mRNA levels between tumor and normal mucosa samples. We noted that invasive and anaplastic tumors showed a trend to loss of expression, even if we did not find any statistically significant differences. The microsatellite analysis showed the presence of genomic instability in proximity of the E-cadherin gene. Nine out of 30 (30%) specimens presented molecular alterations in at least one out of 2 loci (D16S260 and D16S301) analyzed. The comparison between microsatellite mutations and clinical-histopathological parameters revealed a higher number of alterations in invasive respect to superficial tumors (p=0.014). On the other hand, there were no statistical differences regarding the correlation with pathological grade. These observations, which, nevertheless, need to be confirmed in a larger number of patients, suggest that alterations of E-cadherin gene may be related to pathobiology of bladder cancer development and clinical progression.

Focal xanthogranulomatous pyelonephritis with associated bone metaplasia

Focal xanthogranulomatous pyelonephritis of the left lower pole was accidentally discovered in a 34-year-old woman at sonography. The patient had no history of stones and urinary tract infection and both conventional radiology and CT scan revealed radiated calcifications within a well-circumscribed mass. Surgical treatment consisted of enucleoresection of the lesion, and histopathology revealed a nucleus of bone metaplasia. To the best of our knowledge, metaplastic bone formation has never been documented before with xanthogranulomatous pyelonephritis.

Urethral carcinoma recurrence in ileal orthotopic neobladder: urethrectomy and conversion in a continent pouch with abdominal stoma

A patient who had previously undergone ileal neobladder with Studer technique presented an urethral recurrence of a transitional cell carcinoma. Further surgical treatment consisted of urethrectomy and creation of an intussuscepted ileal loop which was anastomosed to the pouch and provided a continence mechanism allowing self-catheterization.

Microsatellite alterations in superficial and locally advanced transitional cell carcinoma of the bladder

Recent studies described the existence of genetic instability associated with bladder carcinogenesis. Alterations at microsatellite loci constitute a recognized tumor marker of genome instability. A series of 21 transitional cell carcinomas of the bladder (10 superficial and 11 invasive carcinomas) was analyzed for the presence of alteration in 12 microsatellite loci, in order to detect the role of microsatellite instability in genesis and progression of human bladder cancer. Our preliminary results indicate a trend to presence of microsatellite instability (MI) in invasive and undifferentiated tumors compared to superficial and differentiated forms. Eight out of 11 T2-T4 tumors presented a number of altered microsatellite >/=2 compared to one out of 10 Ta-T1 bladder carcinomas (p=0.008). Moreover, 9 out of 15 (60%) G2-G3 tumors had significantly more unstable microsatellites than those differentiated (0 out of 6) (p=0.019). Our results provide an insight into the potential usefulness of microsatellite analysis of bladder carcinoma to better understand which neoplastic forms will evolve to invasive progression and indicate that pronounced MI may be associated with more aggressive bladder carcinomas.

Long-term results of anterior and posterior urethroplasty with actuarial evaluation of the success rates

PURPOSE

We analyzed the long-term results of different urethroplasty techniques.

MATERIALS AND METHODS

We performed a retrospective review of 98 patients who underwent different procedures for anterior (78) and posterior (20) urethral strictures. Mean followup was 53 months. A total of 20 patients underwent end-to-end anastomosis (group 1), 30 underwent 1-stage procedures (group 2), 28 underwent 2-stage procedures (group 3), and 20 underwent bulboprostatic anastomosis (group 4). The results were analyzed using Kaplan-Meier curves and log rank test.

RESULTS

The success rate was 95% for group 1, 93.4% for group 2, 78.6% for group 3, and 70% for group 4. Statistical evaluation of the actuarial success rates failed to show significant differences among the 4 groups.

CONCLUSIONS

The stricture recurrences were uniformly distributed over time. Urethroplasty patients must be followed for the rest of their lives.

Retrospective evaluation of c-erbB-2 oncogene amplification using competitive PCR in collecting duct carcinoma of the kidney

PURPOSE

To evaluate retrospectively c-erbB-2 oncogene amplification in paraffin embedded specimens of collecting duct carcinoma of the kidney (CDC) with competitive polymerase chain reaction (PCR).

MATERIALS AND METHODS

Eleven CDC specimens were evaluated with a novel PCR procedure for oncogene amplification measurement, which provides sensitive and accurate results even in presence of low-quality DNA, unsuitable for Southern blot techniques.

RESULTS

c-erbB-2 oncogene amplification was present in 5 out of 11 cases (45%) with a number of copies ranging from 4 to 12. All patients presenting oncogene amplification decreased within one year, while 50% (3/6) of those without amplification are alive with a mean follow-up of 42 months.

CONCLUSIONS

The high incidence of c-erbB-2 oncogene amplification in CDC further characterizes this tumor as a separate entity from renal cell carcinoma, and shows some genetic characteristics in common with transitional cell carcinoma.

Cowper's gland duct cyst in an adult male. Radiological and clinical aspects

A 48-year-old man presenting with perineal pain, weak stream and dysuria was found to have a Cowper's gland duct cyst measuring 1.8 x 3.5 cm, which was investigated with retrograde and voiding urethrography, cavernosography and perineal MRI, which was the single most useful imaging technique. Treatment consisted in complete surgical excision, which allowed an anatomical reconstruction of the urethra. This condition is typical of the pediatric age group, and seldom diagnosed in adults.

Surgical treatment of bilateral large seminal vesicle cysts associated with unilateral renoureteral agenesis

A 26-year-old man presented bilateral cysts of the vesicles, larger on the right side, associated with agenesis of right kidney and ureter. Surgical treatment consisted of removal of the right cyst and volume reduction of the left one. The embryological aspects are discussed, together with the clinical findings and the treatment options.

Abnormal c-myc oncogene DNA methylation in human bladder cancer: possible role in tumor progression

OBJECTIVE

It has been suggested that the hypermethylation of normally unmethylated DNA sequences plays a critical role in the genesis and progression of human tumors. Although the molecular bases of this mechanism have not been completely explained, the altered methylation pattern of the c-myc oncogene is supposed to represent an important step in tumor development.

METHODS

We have analyzed tissue samples from 47 urinary bladder tumors (43 primary transitional and 4 squamous cell carcinomas) and the respective blood with HpaII methyl-sensitive endonuclease digestion and the Southern blotting technique to detect the methylation pattern in a widespread area in and around the c-myc oncogene.

RESULTS

Data presented in this study showed significant differences between the c-myc methylation pattern and pathological grade (p < 0.05). On the other hand, we did not find a significant correlation between the c-myc methylation pattern and clinical stage. However, a variable covalent alteration of c-myc DNA existed in bladder cancer as compared to normal tissue.

CONCLUSION

Although the correlation between superficial and infiltrating forms was not statistically significant, we did, however, find differences in aggressive neoplastic behavior. This suggested that local hypermethylation may be considered as one potential mechanism for increasing genetic alterations in bladder cancer formation.

Cytofluorometric and cytogenetic evaluation of renal cell carcinoma: correlations with the clinical course

The tumor specimens of 20 patients who underwent radical nephrectomy for nonfamiliar unifocal renal cell carcinoma were evaluated with conventional histopathology, cytogenetic analysis and evaluation of nuclear ploidy with cytofluorometry. The pathological stages were 1 T1N0M0, 10 T2N0M0, 1 T2N + M0, 6 T3N0M0 and 2 T3N + M0. Eleven tumors presented clonal chromosomal abnormalities, 2 had chromosomal instability and 7 normal karyotype. Rearrangement of chromosome 3 was documented in 2 cases only, in contrast with previous observations in the literature. Ten patients had a diploid or peridiploid DNA tumor content, 1 tetraploid, 4 triploid and 5 multiclonal. No correlation was found between nuclear ploidy and karyotype. Chromosomal abnormalities did not impact on survival, while a statistically significant correlation was found with diploid nuclear DNA content, since with a mean follow-up of 45.7 months, 9 out of 10 patients with diploid and peridiploid tumors are alive (p < 0.02), while 8 out of 10 nondiploid died of disease progression.