DOI: 10.22591/magyurol.2017.2.szendroia.69

Authors:
Szendrői Attila dr. (Semmelweis Egyetem, Urológiai Klinika, Budapest (igazgató: Nyirády Péter dr.))

Summary

Sclerosis Tuberosa (TSC) is an autosomal dominantly inherited, various organs such as kidney in 80%, brain in 75%, skin in 70%, and heart in 50% affecting disease. In the patient’s kidney next to multiple cysts angiomyolipomas (AML) also appear, both tend to ruin the renal function on long-term. In case of sclerosis tuberose the clinical appearance of the angiomyolipomas differ from the sporadic AML: they appear in younger age, show progressive growing, with several centre and both kidneys are involved. Treatment of AML in urology is performed due to the high risk of heavy bleeding or blood shock and means in most of the cases kidney resection or nephrectomy. On the other hand surgery is not ideal on TS based AML, because we have to count on further manifestations of the illness and repeated surgeries cause damage to the renal parenchyma and even without surgery complications this increases the development of renal insufficiency. This enhances the importance of the minimal invasive radiological interventions, such as the selective embolization and radiofrequency ablation the importance of the medical treatment. Per os applying the mTOR inhibitor everolimus on regular basis, the size of the AML’s decrease, preventing the shock of bleeding. On the systematic therapy the other organ’s lesions react also well, there will be less epileptic attacks; cognitive functions will be better, etc. The treatment of TS patients is a multidisciplinary task, where the patient’s quality of life and the expected lifetime can be supported by the efficient cooperation of the different professions.

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DOI: 10.22591/magyurol.2017.2.kubika.52

Authors:
Mosonyi Péter dr., Szepesváry Zsolt dr., Kerényi Gábor dr., Lacó László dr. (Petz Aladár Megyei Oktató Kórház, Urológiai Osztály, Győr (osztályvezető: Szepesváry Zsolt dr.))

Summary

Objective: A high percentage of recurrent tumours can be obtained during the follow up of non-muscle invasive bladder tumours (NMIBT). In order to reduce this number, a lot of newly developed procedures have been introduced in the clinical practice. These are either biomarkers, and have a role in the follow up, or make the visualisation of bladder tumors more accurate. In the following article we discuss the most common methods and emphasize more importance to Narrow Band Imaging (NBI).

Patients and method: A total of 26 patients were retrospectively examined (female: 10 – male: 16). The light source of Olympus’s Visera Elite (C-190) type with special filters was used for endoscopic examinations. Conventional cystoscopy white light was performed, followed by NBI technique procedure.

Results: Atipical malformations were detected in two cases during NBI examination that was not detectable with white light cystoscopy.

Conclusion: The authors also highlight that the results can be improved by combining these new procedures.

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DOI: 10.22591/magyurol.2017.2.kubika.52

Authors:
Kubik András dr., Szarvas Tibor dr., Módos Orsolya dr., Keresztes Dávid dr., Horváth András dr., Nyirády Péter dr. (Semmelweis Egyetem, Urológiai Klinika, Budapest (igazgató: Nyirády Péter dr.))

Summary

The upper tract urothelial carcinoma (UTUC) and urothelial bladder carcinoma (UBC) were considered as one tumour entity with different anatomical locations. The aim of this review was to discuss current progress in UTUC research and to highlight the molecular, histopathological and clinical differences and similarities between UTUC and UBC. UBC and UTUC sharing common risk factors including smoking and aromatic amines, while aristolochic acid exposure or familiar Lynch syndrome are rather specific for UTUC. The grading of UBC and UTUC are identical, but inherent from their different anatomical locations, there are some differences between their stage classifications.

The primary treatment for both UBC and UTUC is surgery. Because of the inaccurate preoperative or transurethral staging of UTUC, many patients are overtreated by nephroureterectomy. Therefore, combined predictive tools including molecular, pathological and imaging parameters are needed in order to improve the prediction of tumor stage. Currently, the clinical benfit of lymph node dissection (LND) as well as the optimal number and sequence of lymph node removal is unclear. Systemic neoadjuvant and adjuvant chemotherapies may be considered, however their benefit has to be confirmed by large prospective studies.

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DOI: 10.22591/magyurol.2017.2.kerenyig.64

Authors:
Kerényi Gábor dr., Szepesváry Zsolt dr., Mosonyi Péter dr., Törzsök Ferenc dr. (Petz Aladár Megyei Oktató Kórház, Urológiai Osztály, Győr (osztályvezető: Szepesváry Zsolt dr.))

Summary

Objective: Investigation of erectile function of penis by administration of avanafil in patients operated with laparoscopic nervesparing radical prostatectomy, its impact on quality of life, furthermore compare the same parameters of data with a group of patients not received medication.
Patients and methods: Authors investigated patients operated with laparoscopic radical prostatectomy on Urology Department of Petz Aladár County Teaching Hospital between 2012 and 2016. Preoperative erectile function was appointed by score of „Questionnaire on quality of erection” (MMM) – a shortened form of IIEF used in Hungary. 26 patients met criteria (MMM score 17 at least) in group of penile rehabilitation (2015– 2016) and 25 men was included in control group (2012–2015). In „patients with medicine” group next catheter removal 100 mg avanafil was administered once daily for 60 days, and 200 mg casually after that. For measuring efficacy (satisfying erection for sexual intercourse) “MMM” questionnaire was also used in addition a specially compiled list of questions. Postoperatively quality of life score was determined by EQ-5D and VAS questionnaire 6-9 months after the operation.
Results: Differences in all of the endpoints of this survey (satisfying erection for vaginal insertion, successful sexual intercourse, increase in postoperative MMM score, improvement in Quality of Life parameters) was proven statistically significant in favour of avanafil medication group.
Authors remark that data processed during this study were neither prospective nor randomized, but was a comparison of parameters between metachronous groups.
Conclusion: There are several studies for penile rehabilitation with PDE-5 inhibitors attainable in international literature. Pharmaceutical agent in most studies is sildenafil, as well as tadalafil and vardenafil. On the score of present survey the newest phosphodiesterase type-5 inhibitor, avanafil seems to have its place among methods of early correction of circulation of penis after nervesparing radical prostatectomy.

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