Urology Journal

Purpose: To investigate the epidemiologic and clinical characteristics of renal colic in Korea.

Materials and Methods: Forty-six participating emergency departments provide their essential informa­tion to the National Emergency Medical Center. We extracted the National Emergency Department Informa­tion System data from January to December 2010. We analyzed data on demographics, visit time, chief com­plaints, mode of arrival, outcome, and length of stay. A total of 23,653 patients with renal colic visited the 46 emergency departments, and this patient population comprised 1.8% of all emergency department visits.

Results: The median patient age was 45 years, and the male-to-female ratio was 2:1. The peak time of inci­dence for patients with renal colic occurred between 06:00 and 10:00 h. The peak incidence occurred in Au­gust, whereas the lowest incidence occurred in winter. The most common chief complaint was flank pain, followed by abdominal pain and hematuria. The median length of stay in the emergency department was 171 min, and female patients stayed longer in the emergency department relative to male patients. The medi­an length of stay was shorter for weekend visits than for weekday visits. Most patients were discharged from the emergency department; only 6% of patients were admitted. Monday was the day with the highest ad­mission rate. The length of stay did not correlate with age, whereas the admission rate increased with age.

Conclusion: The epidemiologic and clinical features derived from this study may facilitate further investigations aimed at understanding the etiology of renal colic.

Purpose: To investigate the expression alteration of miR-886-5p in bladder tumors and evaluating its expression level as a potential biomarker in this type of cancer.

Materials and Methods: Formalin-fixed paraffin-embedded (FFPE) samples of bladder tumors belonging to 70 patients whom had been referred to the Shahid Labbafi-Nejad medical center were obtained from the archival collection of pathology department. After RNA extraction and cDNA synthesis, expression levels of miR-886-5p were quantified by a real-time reverse transcription polymerase chain reaction (RT-PCR) approach.

Results: Our data revealed a significant upregulation (~3 times) of miR-886-5p in high grade bladder tumors, compared to the low grade ones (P < .05). Moreover, its expression level could significantly discriminate noninvasive (Ta, T1) from invasive (T2-T4) tumor stages.

Conclusion: Our data suggests a potential role for miR-886-5p in progression of bladder cancer.

 Purpose: We investigated the clinical significance of chromogranin A (CgA) expression as a neuroendocrine (NE) marker during prostate cancer (PCa) progression, especially as a potential predictor of chemotherapeutic response in castration-resistant PCa (CRPC) patients based on immunohistochemical findings.

Materials and Methods: Sixteen CRPC patients who underwent combination (docetaxel/estramustine/ carboplatin; DEC) chemotherapy were retrospectively studied. Immunostaining of CgA was performed using prostate biopsy samples obtained at the initial PCa diagnosis, during androgen deprivation therapy, at the time of CRPC diagnosis, and after 2 cycles of DEC therapy. The positive rate was expressed as the mean percentage of positively stained tumor cells against the total number of tumor cells. Differences in positive rates among the treatment courses were compared using a Mann-Whitney test.

Results: The mean percentage of CgA-positive PCa cells increased in a stepwise manner until CRPC development and then significantly decreased after DEC therapy. Subanalysis of CgA at CRPC diagnosis showed a more evident reduction of CgA expression after DEC therapy in patients who also had a high level of CgA as compared to those with a low CgA level (P = .003). Likewise, longer prostate-specific antigen progression-free survival was related to CRPC and high CgA (P = .028).

Conclusion: NE differentiation of PCa cells is accelerated despite androgen deprivation and reaches a peak at the time of CRPC diagnosis. Although further studies using larger samples are needed, CgA expression in CRPC may be a candidate tissue biomarker to reflect the chemotherapy sensitivity of individual PCa cells.

Purpose: Contrast-enhanced ultrasound (CEUS) allows for real-time examination of signal intensity changes in a region of interest (ROI) and quantification of contrast agent kinetics. This study assessed the predictive ability of time-intensity curve (TIC) parameters for local tumor invasion and T stage of renal cell carcinoma (RCC).

Materials and Methods: Renal tumors in 41 patients were examined by CEUS. Thirty-two met the inclusion criteria, with a total of 33 tumors (27 clear cell, 4 chromophobe, and 2 papillary type I). Nineteen (57.6%) tumors were included in group A (stages pT1 and pT2) and 14 (42.4%) in group B (stage pT3). ROIs were established as: whole tumor (TuW); tumor area with the highest signal intensity (TuMAX) and renal cortex (Ref). The TIC param­eters for each ROI were calculated as below: peak signal intensity, time to peak (TTP), rise time (RT), and mean transit time (MTT). They were analyzed as a whole value for each ROI and as a ratio between the different ROIs.

Results: There were significant differences between the tumors invading and not invading the renal sinus fat for TTP (TuW/Ref) [0.98 (0.67-1.25) vs. 1.18 (1.08-1.3), P < .05]. For differentiation between groups A and B, the following ratios were proven as predictors by univariate regression analysis: TTP (TuMAX/TuW); MTT (Tu­MAX/TuW); RT (TuMAX/TuW) (P = .03, P = .01 and P = .02, respectively). The value derived from the Receiver Operating Characteristic (ROC) curve for RT (TuMAX/TuW) was 0.8 with sensitivity = 78.6%, specificity = 89.5%, and cutoff value of > 0.91.

Conclusion: TIC parameters were predictors of locally noninvasive and invasive RCC.

Purpose: To analyze and compare surgical, oncological and functional outcomes of laparoscopic radi­cal prostatectomy (LRP) in patients with and without previous transurethral resection of the prostate (TURP).

Materials and Methods: In total, 785 men underwent LRP at our institution from January 2002 to December 2012. TURP had been performed previously in 35 of these patients (TURP group). A matched-pair analysis iden­tified 35 additional men without previous TURP who exhibited equivalent clinicopathological characteristics to serve as a control group. Perioperative complications and surgical, functional, and oncological outcomes were compared between the two groups.

Results: The groups were similar in age, body mass index, serum prostate-specific antigen level, and pre- and post-operative Gleason scores. Patients in the TURP group had greater blood loss (231 vs. 139 mL), longer opera­tive times (262 vs. 213 min), a greater probability of transfusion (8.6% vs. 0%), and a higher rate of complications (37.1% vs. 11.4%) compared with the control group. The positive surgical margin rate was higher in the TURP group, but this difference was not statistically significant (P = .179). The continence rates at one year after surgery were similar, but a lower continence rate was identified in the TURP group (42.9% vs. 68.6%) at 3 months. Bio­chemical recurrence developed in 17.1% and 11.4% of the patients in the TURP and control groups, respectively, after a mean follow-up of 57.6 months.

Conclusion: LRP is feasible but challenging after TURP. LRP entails longer operating times, greater blood loss, higher complication rates and worse short-term continence outcomes. However, the radical nature of this cancer surgery is not compromised.

Purpose: To investigate the risk factors in women with urodynamic stress urinary incontinence (USTIC) at a Turkish tertiary referral center.

Materials and Methods: The urodynamic records of 3038 consecutive women were analyzed between 1990 and 2011. The patients who had etiological factor of neurologic disease were excluded. There were 1187 women who had USTIC after urodynamic investigation and 274 women who had no incontinence symptoms were included in the study. Multivariate analyses were done using logistic regression test to determine the risk factors for USTIC.

Results: The mean age was 50.1 years (range, 86-18). Increased age, vaginal delivery, cesarean section, anterior prolapse existence in physical examination, previous anti-incontinence surgery, and previous pelvic organ prolapse surgery was found to be significant risk factors for USTIC at multivariate analyses.

Conclusion: There are risk factors for women to have USTIC. Increased age, having vaginal delivery, having cesarean section, anterior prolapse, previous anti-incontinence surgery and previous prolapse surgery were found to be risk factors for women to have USTIC at this study.

Purpose: To determine serum fetuin-A pattern after renal transplantation and its association with graft outcome.

Materials and Methods: In 41 renal transplant recipients, serum pretransplant fetuin-A levels and serum fetuin-A concentrations on days 7 and 30 after transplantation were measured using the enzyme-linked immunosorbent as­say (ELISA) method. Also, the association between serum fetuin-A levels with clinical and laboratory parameters was evaluated.

Results: A significant decrease in serum fetuin-A levels was noted in the first week after transplantation (P < .001). Subsequently, it started to increase and surpass pretransplant values during the first month (P < .001). Pretransplant fetuin-A levels did not differ among patients with different diethylenetriamine pentaacetic acid (DTPA) results. In addition, serum fetuin-A levels did not significantly correlate with metabolic parameters.

Conclusion: In this prospective study there was no increase in serum fetuin-A levels during the first month and pretransplant fetuin-A levels are not predictive for allograft outcome in renal transplant recipients.

Purpose: To evaluate the results of intravesical instillations of hyaluronic acid (HA) in the treatment of recurrent bacterial cystitis (RBC), and to assess the rate of tolerability, the rate of recurrence of RBC and side effects of treatment.

Materials and Methods: The study included 23 female patients from September 2012 to May 2013, aged 28-42 years. Twenty three women with a history of RBC, received intravesical instillations of HA once weekly for 6 weeks then once monthly for 8 months.

Results: In 16 (69.6%) of patients, symptoms of RBC resolved after 8 months. In 5 (21.7%) patients after 8 months of HA treatment, urgency was reduced only by 30%. Therefore, it was decided to use combined therapy of HA and alpha blockers in this cohort group. There was a specific reduction (75%) in frequent urination at day and at night without urgency. Despite the use of above mentioned treatment, in 2 (8.7%) patients, RBC was still present and therefore the treatment was discontinued.

Conclusion: The use of HA protects mucosa of urinary bladder and alleviates symptoms of infection. The intra­vesical instillations of HA and combination of HA + alpha blockers seems to be an effective therapeutic alternative in patients with RBC.

Introduction: Impact of lower urinary tract symptoms on health-related quality of life in Serbian population considering socio-demographic characteristics, habits and health status.

Methods: The study was conducted in the Primary Healthcare Center Novi Beograd. The study included 1424 male participants, aged 40 and above. The quality of life was measured by using the SF-36 questionnaire, while voiding and incontinence symptoms were measured by using the International Continence Society Male Short Form (ICS male SF) questionnaire.

Results: Voiding and incontinence symptoms significantly correlate with all dimensions of life quality. Voiding and incontinence symptoms have a higher influence on some dimensions like general health, social functioning, physical functioning and body pain while they have a low but still statistically significant impact on physical, emotional and mental health. After adjusting for age and education, voiding and incontinence symptoms had a similar influence on life quality but lower than before. In a multivariate model, life threatening morbidities and income had an influence on life quality lower than voiding and incontinence symptoms.

Conclusion: Voiding and incontinence symptoms affect life quality dimensions differently. Incontinence symptoms have impact on life quality higher than voiding symptoms.

Purpose: Prostate cancer (PCa) is one of the most commonly diagnosed male malignancies. Nu­merous studies have investigated the role of genetic variants in PCa risk. However, the results re­main unclear. The purpose of this study was to evaluate the relationship between single-nucleo­tide polymorphism (SNP) rs2228001 in xeroderma pigmentosum group C (XPC), SNP rs4073 in interleukin 8 (IL8), and SNP rs2279744 in mouse double minute 2 (MDM2) homolog gene with PCa susceptibility.

Materials and Methods: Electronic database of PubMed, Medline, and Embase were searched for eligible articles published between January 2000 and April 2014. The odd ra­tio (OR) with its 95% confidence interval (CI) were calculated to estimate the strength of association.

Results: A total 18 case-control studies, including 5725 PCa cases and 5900 healthy controls, were screened out. Six studies were eligible for each SNP. For XPC 939A/C polymorphism, no significant association was found with PCa risk in the whole population (P > .05). No relationship in subgroup analysis was found by ethnicity. For IL8 -251T/A variant, the A allele was not related with PCa risk in any genetic models when compared with those individuals without A allele. For MDM2 -309T/G mutation, the G allele was not as­sociated with the increased risk of PCa in total population and subgroup analysis by ethnicity as well.

Conclusion: Our study demonstrated that all these three genetic polymorphisms were not associated with an in­creased risk of developing PCa, which might also provide an insight into the future research. Further large-scale studies with concerning the gene-gene and gene-environment interactions are needed to elucidate final conclusion.