DOI: 10.22591/magyurol.2016.4.szegedik.183

Authors:
¹Szabó Zsuzsanna dr., Halmos Gábor dr. (Debreceni Egyetem, Gyógyszerésztudományi Kar, Biofarmácia Tanszék, Debrecen (director: Halmos Gábor dr.))
²Szegedi Krisztián dr., Flaskó Tibor dr. (Debreceni Egyetem, Klinikai Központ, Urológiai Klinika, Debrecen (director: Flaskó Tibor dr.))

Summary
Renal cell carcinoma accounts for approximately 3% of cancers in adults as well as 85% of all primary malignant kidney tumours. It is the third most common urological cancer after prostate and bladder cancer, but it has the highest mortality rate of more than 40%. Apart from surgery, it is both chemotherapy and radiotherapy resistant. Early detection and appropriate follow-up of the patients may influence the prognosis of the disease. It is necessary, therefore, to improve our understanding of renal cell carcinoma pathogenesis, identify new biomarkers enabling prediction of early metastasis after nephrectomy, and develop new targeted therapies.
MicroRNAs are small, non-coding RNAs that have an important role in the regulation of carcinogenesis pathways. Tumour tissue expresses miRNAs differentially compared to corresponding normal tissue, and they regulate important breakpoints during carcinogenesis. There is increasing evidence in the literature suggesting that they might be associated with the development of renal cell carcinoma, and the expression profiles of miRNAs are believed to be more informative and accurate for classifying kidney cancer. In the future some of them can be potential novel biomarker candidates for the diagnosis and treatment of human cancers including renal cell carcinoma. In this paper we aimed to summarize the information about the functional role of miRNAs in the development of renal cell carcinoma.

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DOI: 10.22591/magyurol.2016.4.hajdue.199

Authors:
Hajdú Erzsébet dr., Bajory Zoltán dr., Fehér Ádám dr., Pajor László dr. ( Szegedi Tudományegyetem, Urológiai Klinika, Szeged ((director: Bajory Zoltán dr.))

SUMMARY
Objective: The authors present a case history of the late complications of an obsolote, nearly unforgotten surgical operation method, the Tuffier fistula procedure.
Case report: The 41-year-old woman was born with congeni­tal urogynecological malformations, pseudohermaphroditism, atresia of vagina and urethra. The penis-like clitoris was resected in early childhood and the fistula artificially widened bet­ween the bladder and rectum with Tuffier method. The mixture of urine and faces was passed through anal sphincter and this secured the continence. In 1991 a coloplastic vaginal substitution was performed without connection with the uterus. She was admitted to the Department of Urology as an adult for febrile episodes, abdominal pain – especially during menstruation – and elevation of serum creatinine level. The MR scan revealed a shrunken left kidney, communication between the uterus, the small bladder and the rectum. In 2013 a Bricker-bladder was created and this operation decreased temporarily the creatinine level, but through the persistant Tuffier fistula faces was passed into the uterine cavity. At a second session, the bladder remnant and the uterus were removed and the fistula closed. This intervention stopped the febrile episodes and the painful menstruation.
Conclusion: The Tuffier fistula procedure now is an obsolete surgical method with predictable late consequences. The remodelling of these is a surgical challenge, needs complex and multiple surgical operations in most cases.

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DOI: 10.22591/magyurol.2016.4.fehera.196

Authors:
Fehér Ádám dr., Bajory Zoltán dr., Hajdú Erzsébet dr., Pajor László dr. (Szegedi Tudományegyetem, Urológiai Klinika, Szeged (director: Bajory Zoltán dr.))

SUMMARY
Objective: The authors present the history of a patient suffering multiple scrotal skin inflammation and pump perforation following artificial sphincter implantation.
Case report: The presented case – a 76 year-old patient – was operated because of prostate cancer. The dissection revealed positive surgical margin and for this reason irradiation was performed. Just after the operation the patient noticed total incontinence and the conservative treatment was unsuccessful. In 2013 after the right evaluation an artificial sphincter (AMS 800) was implanted and the patient became continent. Half a year later, scrotal skin inflammation developed around the pump and within a few days the pump perforated here. Two options emerged for elimination of the disease, to remove or to reimplant the perforated component. Operation was performed: proper local desinfection, resection of the surrounding skin and the pump was reinserted. The wound healed and the equipment functioned in a normal way. After two years, in the same manner as previously, scrotal skin erosion developed. Once more reimplantation happened and activation of the artificial sphincter. During the last half a year it is still working and the patient remained continent.
Conclusion: In selected cases of skin perforation of artificial sphincter pump urgent reimplantation can be performed.

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DOI: 10.22591/magyurol.2016.4.oroszim.193

Authors:
Oroszi Márton dr., Rosecker Ágnes dr., Pajor László dr., Papos István dr., Bajory Zoltán dr. (Szegedi Tudományegyetem, Urológiai Klinika, Szeged (director: Bajory Zoltán dr.))

Summary

Objective: The authors present a successful operative solution for incurable combined urethral stricture.
Patients and method: Between 2005 and 2015 vesico-ileocutaneo-stomy was performed in four patients. Urethral stricture, irradiation, radical prostatectomy and small pelvic trauma were the basic cause of developing the dense scarification around the bladder neck. A 10-15 cm long ileum was isolated for the connection of the bladder and the skin surface. The patient passes the urine through a stoma. The preservation of the bladder and the ureteral orifices avoid the patient from the stricture formation at the level of the ureterointestinal anastomosis as it is a usual complication in the Bricker-bladder.
Results: The patients are satisfied with the urine stoma as they get rid of the danger of total retention. Early complication was not obsessed, the late complications – perineal fistula, stoma stricture and parastomal hernia – were successfully repaired.
Conclusion: As „ultimum refugium” vesicoileocutaneostomy can be performed in patient with dense urethral stricture.

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DOI: 10.22591/magyurol.2016.4.bajoryz.189

Authors:
Bajory Zoltán dr., Oroszi Márton dr., Pajor László dr. (Szegedi Tudományegyetem, Urológiai Klinika, Szeged (director: Bajory Zoltán dr.))

SUMMARY

Objective: The short-term outcome of specific laser vaporisation was evaluated in high risk patients.
Material and method: In 2015 a diode pumped Nd:Yag laser equipment was applied at our department. A retrospective review of the patient’s database and phone interview were done about the complications and efficacy. We analysed the complications, PSA value, prostate size, duration of the operation and I-PSS score.
Results: The mean operative time was 95 minutes, significantly higher than a usual TUR. The hospital stay was observed more than the prostatic average. The decrease in PSA level and in prostate volume demonstrated the effectivity of the procedure. The extended I-PSS score indicated the release in the complaints. Most importantly no side effects or complications were registered among this high risk population.
Conclusion: Diode pumped Nd:Yag laser vaporisation seems to be effective, safe surgical treatment option for high risk prostatic patients.

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