Oncological Outcomes of Patients with Non-Clear Cell Renal Cell Cancers: Subtypes of Unclassified and Translocation Renal Cell Cancers

PURPOSE

We aimed to compare oncological outcomes in the two rare subtypes, unclassified renal cell cancer (unRCC) and translocation RCC (tRCC), vs clear cell RCC (ccRCC).

MATERIALS AND METHODS

Between 2004 and 2019, from Turkish Urooncology Society Database, we identified 2324 patients for histological subtypes including 80 unRCC (3.4%), 19 tRCC (0.8%) and 2225 ccRCC (95.8%).

RESULTS

The overall (15.8%) and cancer-specific mortalities (11.1%) were found to be higher in tRCC group and the recurrence free mortality (13.8%) was found to be higher in unRCC group. Larger pathological tumor size (p = 0.012) and advanced pathological T stage (p = 0.042) were independent predictive factors on overall mortality in patients with unRCC tumors.

CONCLUSION

The oncological outcomes of the unRCC and tRCC are worse than ccRCC and pathological tumor size and pathological stage are predictive factors for mortality in the unRCC.

What Is Your Choice for Androgen Deprivation Therapy in Metastatic Prostate Carcinoma: Surgical or Medical?

OBJECTIVE

At the time of diagnosis, approximately 16.5% of prostate cancer patients are metastatic. The main framework of metastatic prostate cancer treatment is androgen deprivation therapy, which is performed surgically or medically. The aim of this study is to evaluate the attitudes of medical oncologists and urologists about orchiectomy as androgen deprivation therapy.

MATERIAL AND METHODS

A total of 387 physicians working in the Departments of Urology (n=217) and Medical Oncology (n=170) were included in this descriptive study. Data were collected through an electronic survey.

RESULTS

Only 7.5% of participants indicated that they offered surgical castration to their patients. Urologists preferred surgical castration more than oncologists for the treatment of metastatic castration-sensitive prostate carcinoma (P=.003). The reasons why medical oncologists preferred surgical castration less are that it is an invasive procedure, has risk of morbidity and mortality, high cost of hospitalization, and may cause deterioration of the patient's body image (P < .05).

CONCLUSION

This study showed that physicians were less likely to perform orchiectomy as an androgen deprivation therapy. Although the most important reason for this is the patient preference, the biased presentation of treatment options to patients, the lack of knowledge of physicians about orchiectomy, and the effect of the pharmaceutical industry should also be kept in mind.

What Is Your Choice for Androgen Deprivation Therapy in Metastatic Prostate Carcinoma: Surgical or Medical?

OBJECTIVE

At the time of diagnosis, approximately 16.5% of prostate cancer patients are metastatic. The main framework of metastatic prostate cancer treatment is androgen deprivation therapy, which is performed surgically or medically. The aim of this study is to evaluate the attitudes of medical oncologists and urologists about orchiectomy as androgen deprivation therapy.

MATERIAL AND METHODS

A total of 387 physicians working in the Departments of Urology (n=217) and Medical Oncology (n=170) were included in this descriptive study. Data were collected through an electronic survey.

RESULTS

Only 7.5% of participants indicated that they offered surgical castration to their patients. Urologists preferred surgical castration more than oncologists for the treatment of metastatic castration-sensitive prostate carcinoma (P=.003). The reasons why medical oncologists preferred surgical castration less are that it is an invasive procedure, has risk of morbidity and mortality, high cost of hospitalization, and may cause deterioration of the patient's body image (P < .05).

CONCLUSION

This study showed that physicians were less likely to perform orchiectomy as an androgen deprivation therapy. Although the most important reason for this is the patient preference, the biased presentation of treatment options to patients, the lack of knowledge of physicians about orchiectomy, and the effect of the pharmaceutical industry should also be kept in mind.

Effect of pelvic lymph node dissection and its extent on oncological outcomes in intermediate-risk prostate cancer patients: A multicenter study of the Turkish Uro-oncology Association

BACKGROUND

Pelvic lymph node dissection (PLND) is the gold standard method for lymph node staging in prostate cancer. We aimed to evaluate the effect of PLND combined with radical prostatectomy (RP) on oncological outcomes in D'Amico intermediate-risk prostate cancer (IRPC) patients.

METHODS

Patients with D'Amico IRPC were included in the study. In the overall cohort and subgroups (biopsy International Society of Urological Pathology [ISUP] grade group 2 and 3), patients were divided into two groups as PLND and no-PLND. More extensive PLND, defined as a number of removed nodes (NRN) ≥ 75th percentile.

RESULTS

After exclusion, a total of 631 patients were included: 351 (55.6%) had PLND and 280 (44.4%) had no-PLND. The mean age was 63.1 ± 3.60 years. The median NRN was 8.0 (1.0-40.0). The mean follow-up period was 47.7 ± 37.5 months. The lymph node involvement (LNI) rate was 5.7% in the overall cohort, 3.9% in ISUP grade 2, and 10.8% in ISUP grade 3. Patients with PLND were associated with more aggressive clinicopathologic characteristics but no significant difference in biochemical recurrence-free survival (BCRFS) was found between patients with PLND and no-PLND (p = 0.642). In the subgroup analysis for ISUP grades 2 and 3, no significant difference in BCRFS outcomes was found in patients with PLND and No-PLND (p = 0.680 and p = 0.922). Also, PLND extent had no effect on BCRFS (p = 0.569). The multivariable Cox regression model adjusted for preoperative tumor characteristics revealed that prostate specific antigen (PSA) (HR: 1.18, 95% CI: 1.01-1.25; p = 0.048) was an independent predictor of biochemical recurrence (BCR). The optimum cut-off value for PSA, which can predict BCRFS, was assigned to be 7.81 ng/ml, with an AUC of 0.63 (95% CI: 0.571-0.688). The highest sensitivity and specificity were 0.667 and 0.549.

CONCLUSION

Overall and cancer-specific survival analyzes were not evaluated because not enough events were observed. Neither PLND nor its extent improved BCRFS outcomes in IRPC. The LNI rate is low in patients with biopsy ISUP grade 2 and the BCR rate is low in those with PSA < 7.81 ng/dl so PLND can be omitted in these IRPC patients.

How accurate is radiological imaging for perirenal fat and renal vein invasion in renal cell carcinoma?

OBJECTIVE

To evaluate the accuracy of radiological staging, especially renal venous and perirenal fat invasion, in renal cell carcinoma (RCC).

MATERIAL AND METHODS

Data of 4823 renal tumour patients from Renal Tumor Database of Association of Uro-oncology in Turkey were evaluated. Of 4823 patients, 3309 RCC patients had complete radiological, and histopathological data were included to this study. The Pearson chi-squared test (χ² ) was used to compare radiological and histopathological stages.

RESULTS

The mean (SD) age of 3309 patients was 58 (12.3). Preoperative radiological imaging was performed using computed tomography (CT) (n = 2510, 75.8%) or magnetic resonance imaging (MRI) (n = 799, 24.2%). There was a substantial concordance between radiological and pathological staging (к = 0.52, P < .001). Sensitivities of radiological staging in stages I, II, III and IV were 90.7%, 67.3%, 27.7% and 64.2%, respectively. The sensitivity in stage III was lower than the other stages. Subanalysis of stage IIIa cases revealed that, for perirenal fat invasion and renal vein invasion, sensitivity values were 15.4% and 11.3%, respectively.

CONCLUSIONS

There was a substantial concordance between radiological (CT and/or MRI) and pathological T staging in RCC. However, this is not true for T3 cases. Sensitivity of preoperative radiological imaging in patients with pT3a tumours is insufficient and lower than the other stages. Consequently, preoperative imaging in patients with T3 RCC has to be improved, in order to better inform the patients regarding prognosis of their disease.

Sextant Biopsy-Based Criteria for Clinically Insignificant Prostate Cancer Are Also Valid for the 12-Core Prostate Biopsy Scheme: A Multicenter Study of Urooncology Association, Turkey

BACKGROUND

Epstein criteria based on sextant biopsy are assumed to be valid for 12-core biopsies. However, very scarce information is present in the current literature to support this view.

OBJECTIVES

To investigate the validity of Epstein criteria for clinically insignificant prostate cancer (PCa) in a cohort of the currently utilized 12-core prostate biopsy (TRUS-Bx) scheme in patients with low-risk and intermediate-risk PCa.

METHOD

Pathological findings were separately evaluated in the areas matching the sextant biopsy (6-core paramedian) scheme and in all 12-core schemes. Patients were divided into 2 groups according to the final pathology report of RP as true clinically significant PCa (sPCa) and insignificant PCa (insPCa) groups. Predictive factors (including Epstein criteria) and cutoff values for the presence of insPCa were separately evaluated for 6- and 12-core TRUS-Bx schemes. Then, different predictive models based on Epstein criteria with or without additional biopsy findings were created.

RESULTS

A total of 442 patients were evaluated. PSA density, biopsy GS, percentage of tumor and number of positive cores, PNI, and HG-PIN were independent predictive factors for insPCa in both TRUS-Bx schemes. For the 12-core scheme, the best cutoff values of tumor percentage and number of positive cores were found to be ≤50% (OR: 3.662) and 1.5 cores (OR: 2.194), respectively. The best predictive model was found to be that which added 3 additional factors (PNI and HG-PIN absence and number of positive cores) to Epstein criteria (OR: 6.041).

CONCLUSIONS

Using a cutoff value of "1" for the number of positive biopsy cores and absence of biopsy PNI and HG-PIN findings can be more useful for improving the prediction model of the Epstein criteria in the 12-core biopsy scheme.

Factors affecting long-term renal functions after partial vs radical nephrectomy for clinical T1 renal masses: A Multicentre Study of the Urooncology Association, Turkey

PURPOSE

To compare the functional outcomes of patients who underwent partial (PN) or radical nephrectomy (RN) for clinical T1 (cT1) renal tumours using the Kidney Cancer Database of the Urooncology Association, Turkey.

METHODS

We retrospectively reviewed 1004 patients who underwent PN and RN for cT1 renal tumours at multiple academic tertiary centres between 2000 and 2018. Patients with preoperative end-stage chronic kidney disease and/or metastatic disease were excluded.

RESULTS

There were 452 patients in the PN group and 552 patients in the RN group. The median follow-ups were 74.9 and 83.7 months in RN and PN cohort. The eGFR was significantly reduced in both groups on postoperative day 1 (PN = 13.7 vs RN = 19.1 mL/min/1.73 m² : P < .001). In the PN group, eGFR showed a tendency to recover according to a quadratic pattern and reached preoperative levels in the first and third years (95.6 ± 28.8 mL/min/1.73 m² and 96.9 ± 28.9 mL/min/1.73 m² , respectively), with no significant difference between the eGFRs in the 1st and 3rd years (P = .710). To define groups at risk, different cut-off values for the GFR were considered. Among patients with a baseline GFR < 90, the RN cohort had significantly lower eGFRs in the first and third years than the PN cohort (P = .02). Logistic regression showed that comorbidities, coronary artery disease, diabetes and hypertension had no adverse impacts on the changes in the eGFR (P = .60, P = .13, and P = .13, respectively).

CONCLUSION

For the treatment of stage T1 kidney tumours, open or laparoscopic partial nephrectomy has the benefit to preserve renal function.

Comparison of pain, quality of life, lower urinary tract symptoms and sexual function between flexible and rigid cystoscopy in follow-up male patients with non muscle invasive bladder cancer: A randomized controlled cross section single blind study

OBJECTIVES

To compare pain, quality of life (QoL), sexual function and lower urinary tract symptoms (LUTS) between rigid (RC) and flexible cystoscopy (FC).

METHODS

Forty-one patients who were planned control cystoscopies were enrolled the study. At the first cystoscopy, 20 patients (Group 1) and other 21 patients (Group 2) were performed by flexible (15.5 Fr) and rigid cystoscope (15.5 Fr), respectively. At the second cystoscopies, the patients in group 1 and group 2 were performed by rigid and flexible cystosacope, respectively. In all the patients, pain was measured with visual pain scale (VPS) shortly after cystoscopy. Also, SF, QoL and LUTS were assessed by IIEF, SF-36 and MLUTS forms, respectively.

RESULTS

While 22 of the patients preferred FC, the other 19 preferred RC (P > 0.05). There were no statistical differences between VPS, IIEF, SF-36 and MLUTS scores of the two groups. In multivariate analysis regarding the quality of life, although sexual function, pain and cystoscopy type did not affect QoL, voiding symptoms affected independently QoL. After both cystoscopy type, IIEF, SF-36 and MLUTS scores did not change statistically.

CONCLUSION

The results showed that the effects on pain, sexual function, QoL and LUTS of RC and FC were similar. In general, cystoscopy did not affect negatively on QoL, sexual function and LUTS of the patients.

MEDİTERRANEAN DİET AND OVERACTİVE BLADDER.. [DOI: 10.22541/au.161570491.19107369/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Aims The relationship between nutrition and overactive bladder (OAB) is known. This study investigates the relationship between Mediterranean type diet and OAB. Methods 14-Item Mediterranean Diet Adherence Screener(MeDAS) and OAB-V8 Bladder Inquiry Form, validated in Turkish, were presented to 500 patients over the age of 18 who applied to outpatient clinics other than urology outpatient clinics. Those with chronic diseases and urinary tract infections (by urinalysis and detailed medical history) were excluded. Results There was a negative correlation between the MeDAS and OAB-V8 scores. High OAB-V8 scoring was associated with obesity (BMI ≥ 30), being single and low education level. Conclusions Dietary patterns represent a broader perspective of food and nutrient consumption and may therefore be more predictive of disease risk. Mediterranean type diet should be recommended in the first-line treatment of patients with OAB symptoms. It is easily possible to determine the compliance of patients with this diet by using 14-Item MeDAS. Keywords: Mediterranean Diet , Overactive bladder, Nutrition

The effect of postoperative early mobilization on healing process and quality of life following radical cystectomy and ileal conduit: A randomized prospective controlled trial.. [DOI: 10.22541/au.161545934.45040085/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Aim: This study was conducted to evaluate the effect of postoperative early mobilization in patients who underwent radical cystectomy (RC) and ileal conduit in terms of healing process and QOL. Methods: This multicenter prospective randomized controlled study was conducted with 40 patients who were randomly divided into two groups. The intervention group was mobilized within the first 16 hours postoperatively in accordance with the mobilization procedure which determined according to literature. Data were collected using the case report form, HADS and SF-36 QoL scale. Results: Postoperative hospitalization, duration of narcotic analgesic administration, first oral food intake, flatus, defecation and NG tube termination time were shorter in the intervention group. In the control group blood glucose and pulse values were higher after mobilization. SF-36 physical function, physical role difficulty and general perception of health were higher in intervention group at the postoperative first and third month (p <0.05). Conclusion: Our study showed that early mobilization contributed to the healing process positively and improved the quality of life in the patients who underwent radical cystectomy (RC) and ileal conduit surgery. Keywords: Early Mobilization, Radical Cystectomy, Ileal conduit, Quality of Life, Convalescence

Long Term Follow-up Results of Ablation Treatment for Patients with Small Renal Mass.. [DOI: 10.22541/au.160831267.75170095/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Objective: The aim of this study is to evaluate the outcome of ablation therapy in our clinic for the treatment of patients with small renal mass Materials and Methods: We retrospectively evaluated the technic and follow-up data of 30 patients with 36 tumors who underwent Radiofrequency Ablation (RFA) and Microwave Ablation (MWA) in our clinic. Demographic data, ablation type, tumor characteristics, peroperative and postoperative complications and treatment success of the patients were evaluated. Results: A total of 36 tumors who underwent ablation treatments, 23 were treated with RFA, 13 with MWA. The mean tumor size was 28.9 ± 6.92 mm in RFA and 29.3 ± 7.70 mm in MWA. 12 (52.1%) of the RFA procedures were applied to the right kidney while 11 (47.8%) were applied to the left kidney. 6 (46.1%) of the MWA procedures were performed on the right kidney and 7 (53.8%) on the left kidney. Of the 36 tumors, 4 (11.1%) were located central and 32 (88.8%) were peripheral. Complications occurred in 2 patients. In one of these patients, acute renal failure and urea creatinine were found to be elevated. In the other patient, local pain was found in the ablation side and minor bleeding was detected at the ablation site in USG. The mean follow-up period was 49.6 ± 24.7 months in patients with RFA and mean follow-up was 16 ± 8,05 months in MWA treatments. The overall success in MWA administration was calculated as 76.9%, while the overall success in RFA was 80%. Conclusion: Long-term oncologic efficacy of RFA appears to be successful in the treatment of T1a renal carcinomas. Further studies can be conducted to elucidate the influence of MWA on long-term oncological outcomes.

THE EFFECT OF TREATMENT ON CYTOKINE LEVELS IN NON MUSCLE INVASIVE BLADDER CANCER.. [DOI: 10.22541/au.160666762.21229852/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Objectives The aim of the present study was to investigate the effect of treatment on IL-1, IL-6, IL-8 and neopterin levels in patients with non-muscle invasive bladder cancer (NMIBC). Methods Thirty patients with NMIBC and 30 age-matched controls were included in the study. Preoperative, postoperative first control (at two weeks after second transurethral resection of bladder tumor (TURBT)) and second control (at the end of intravesical immunotherapy) blood samples were analyzed by ELISA to determine IL-1, IL-6, IL-8 and neopterin levels. The mean cytokine levels of the patients were statistically compared as well as comparing the patients’ and controls’ levels. Results There were no statistically significant differences between the mean IL-1, IL-6, IL-8 and neopterin levels of the patient and control group before initial TURBT. In the patient group, there were no statistically significant differences in the IL-6 and IL-8 levels after both TURBT and intravesical BCG therapy. The mean of preoperative IL-1 and neopterin levels significantly decrease after TURBT (p<0.05=). However this reduction do not continue after intravesical BCG instillations. Conclusions The finding of this study showed that the IL-1, IL-6, IL-8 and neopterin levels of the patients with NMIBC were similar to the levels of healthy controls. The IL-1 and neopterin levels significantly decreased after TURBT. But this reductions did not continue after intravesical BCG instillation. These findings demonstrate that IL-1 and neopterin levels decrease after TURBT due to the reduction of tumor weight or tumor removal.

The long-term results of temporary urethral stent placement for the treatment of recurrent bulbar urethral stricture disease?

Aim:

To evaluate the long term outcomes of temporary urethral stent placement for the treatment of recurrent bulbar urethral stricture.

Materials and Methods:

Twenty-eight patients who underwent temporary polymer coated urethral stent placement due to recurrent bulbar urethral stricture between 2010 and 2014 were enrolled in the study. The long term outcomes of the patients were analyzed.

Results:

The mean age of the patients was 62.3±6.4 (44–81). The overall clinical success was achieved in 18 (64.2%) of the 28 patients at a median (range) follow-up of 29 (7–46) months. No patient reported discomfort at the stent site. Stone formation was observed at the urethral stent implantation area only in one patient. Stenosis occurred in the distal end of the stents in two patients and took place in bulbar urethra in seven patients after removed the stents. The mean maximum urine flow rates were 6.24±2.81mL/sec and 19.12±4.31mL/sec before and at 3 months after the procedure, respectively.

Conclusion:

In this study, the success rate of temporary urethral stent placement has remained at 64.2% at a median follow-up of 29 months. Therefore, our outcomes have not achieved desired success rate for the standard treatment of recurrent bulbar urethral stricture.

Pure Yolk sac presenting with inferior vena cava thrombus extending from bilateral external iliac veins to hepatic vein

Introduction:

Vena cava thrombus is an extremely rare complication of testicular tumors. We report on an unusual case of testicular tumor presenting with inferior vena cava thrombus extending from the left spermatic and bilateral external iliac veins to the hepatic vein.

Case report:

A-35-year old man presented with a 6-month history of left scrotal mass and a 1-day history of bilateral lower extremity edema. Computed tomography (CT) revealed the presence of thrombus extending from the left spermatic vein and bilateral external iliac veins to the hepatic vein, and multiple lymph node and lung metastases. 3 cycles of chemotherapy were given after the left high inguinal orchiectomy. Pathological examination demonstrated a pure yolk sac carcinoma with lymphovascular invasion and direct tumor extension into the left spermatic cord. CT and positron emission tompgraphy-CT obtained no findings of metastasis or recurrence at 3 months after the chemotherapy.

Conclusion:

We review this seldom case and discuss the literature with regard to its diagnosis and treatment.

The Rate of Neoadjuvant Chemotherapy Use in Muscle Invasive Bladder Cancer and The Approach of Urologists in Turkey

PURPOSE

To investigate the proportion of neoadjuvant chemotherapy (NAC) use in patients with muscle invasive bladder cancer before radical cystectomy and the approach of urologists to this subject.

MATERIALS AND METHODS

We invited 242 urologists during the 12th International Urooncology Congress in Turkey to answer a self-administered questionnaire. The questionnaire included questions related to radical cystectomy, lymph node dissection and neoadjuvant chemotherapy that had been performed in patients with muscle invasive bladder cancer by the urologist.

RESULTS

The median number of radical cystectomy operations was 20 per year. 122 (50.5 %) of 242 urologists had used neoadjuvant chemotherapy for the treatment of muscle invasive bladder cancer before radical cystectomy. The mean rate of neoadjuvant chemotherapy use by these urologists (n=122) was 28.46 %. The most common reasons for not using neoadjuvant chemotherapy by urologists in Turkey were as follows: (i) neoadjuvant chemotherapy might lead to a decrease in the cure rate of radical cystectomy due to delayed surgery (ii) complication rate of radical cystectomy might be elevated and the surgery might be complicated by NAC use.

CONCLUSION

Although the European Association of Urology (EAU) guidelines panel on muscle invasive bladder cancer recommends using NAC in T2-T4a bladder, the rate of neoadjuvant chemotherapy use was still found to be low in our country because urologists have concerns about adverse effects NAC on radical cystectomy.&nbsp.

Predictive value of cyclooxygenase-2 over expression for identifying prostate cancer from benign prostatic hyperplasia in prostate biopsy specimens

BACKGROUND

We studied cyclooxygenase-2 (COX-2) immunohistochemical staining intensity both in prostatic biopsy and surgical samples of patients with prostate cancer to determine if it might provide prognostic information for the decision of re-biopsy indication.

METHODS

Twenty-eight patients undergone radical prostatectomy whose final pathologic examination revealed prostatic adenocarcinoma were included in the study. Twelve patients with BPH in their pathological examination of both prostatic biopsy and open prostatectomy were considered as a control group. Intensity of COX-2 receptor was examined with immunohistochemical staining according to standard techniques.

RESULTS

Positive COX-2 receptor staining was obtained 89.3% of biopsy samples and 93% of surgical samples in all cancer patients. The rate of agreement in COX-2 receptor staining of biopsy samples and radical prostatectomy samples was 76% in same patients (P=0.54). Similarly, the COX-2 receptor levels in biopsy specimens of patients with BPH open surgery compared with samples of the agreement still rate was 41% (P=0.41). Prostate cancer exchanging COX-2 receptor levels in patients with biopsy specimens in patients with BPH were found significantly more (P=0.008).

CONCLUSIONS

In this study the feasibility of presence of COX-2 receptor staining in biopsy samples was shown. We have also demonstrated that COX-2 staining intensity was higher in prostatic biopsy samples of patients with prostatic cancer than patients with BPH. This leads a conclusion that, higher COX-2 expression levels in biopsy specimens may be used to decide re-biopsy in borderline preoperative PSA levels as well as in the cases with suspicious pathological findings for cancer.

Effect of anxiety and pain on success of shockwave lithotripsy (SWL) for treatment of proximal ureteral and renal pelvic stones

The aim of this study is to evaluate the impact of anxiety and pain on success of shockwave lithotripsy (SWL) for treatment of proximal ureteral and renal pelvic stones smaller than 15 mm. One hundred thirty-two patients with proximal ureteral or renal pelvic stones <15 mm who were treated by a SWL and forty controls were enrolled in the study. State-trait anxiety inventory (STAI) was used to assess anxiety of the controls and patients (before every SWL session). Pains of the patients were measured by a visual analog scale (VAS) at three times (T) of the sessions (T11 at 11 kV, T15 at 15 kV and T end of treatment). The mean STAI scores of the patients at the first SWL session and controls were 40.61 ± 8.71 and 36.11 ± 8.18, respectively (p < 0.05). There was statistically positive moderate relationship between STAI and VAS scores at the first SWL session. The mean size of stone in men and women were 11.16 ± 2.88 and 11.00 ± 3.41, respectively (p = 0.88). In the first session, the mean STAI and VAS scores of the men were significantly lower than the women. The stone-free rate (SFR) of SWL was 72.7 % in this study. The SFR of SWL in the men and women were 78 and 64 %, respectively (p < 0.05). Our data showed that the severity of anxiety and pain in the women were higher than the men. SFR of SWL in the men was higher than the women. The severity of anxiety and pain in the patients may affect SFR of SWL.

Sorafenib in metastatic renal cell carcinoma with sarcomatoid differentiation

Targeted therapy in the management of metastatic renal cell cancer has been recently introduced to urology practice. The drugs used for management are used in a very limited number of patients and only for clear cell histology. We present a case where we administered sorafenib, a multikinase inhibitor of tumor-cell proliferation and angiogenesis, to a patient with metastatic renal cell carcinoma of clear cell histology. We found that our results were different from those of previously reported studies, because sarcomatoid differentiation was evident in a histological examination of this case. There was an excellent response to sorafenib. This case report might provide evidence that antiangiogenic agents may be active in any histological type of renal cell carcinoma. However, there are no available data to demonstrate the duration of response and survival benefit.

SEXUAL DYSFUNCTION IN FEMALE SUBJECTS WITH FIBROMYALGIA

PURPOSE

We investigated sexual function in females with fibromyalgia (FM) and evaluate whether coexistent major depression (MD) has an additional negative effect on sexual function.

MATERIALS AND METHODS

A total of 100 female subjects were enrolled in the study, including 40 with FM only, 27 with FM plus MD and 33 healthy volunteers as a control group. The diagnosis of MD was made according to Structured Clinical Interview for Diagnostic and Statistical Manual-IV interview and the Hamilton Depression Rate Scale was used to grade depression. Widespread pain and quality of life were assessed with the Lattinen Pain Scale and Fibromyalgia Impact Questionnaire, respectively. The Female Sexual Function Index (FSFI) was used to assess sexual dysfunction.

RESULTS

All subjects were comparable in age, occupation and education. Mean FSFI total score +/- SD was significantly decreased in the FM and FM plus MD groups compared with that in healthy controls (21.83 +/- 5.84 and 22.43 +/- 7.0 vs 28.10 +/- 6.52, respectively, p = 0.001). However, the FSFI score was not significantly different between patients with FM only and FM plus MD (p >0.05). Correlation analysis revealed a negative moderate correlation between total Lattinen pain score and FSFI score in the FM only and FM plus MD groups (r = -0.366, p = 0.047 and r = -0.403, p = 0.018, respectively). FSFI score did not correlate with FIQ and HDRS scores (p >0.05).

CONCLUSIONS

This study demonstrates that female patients with FM have distinct sexual dysfunction compared with healthy controls and coexistent MD has no additional negative effect on sexual function. Thus, female subjects with FM should be evaluated in terms of sexual function to provide better quality of life.