2017-4 — Summary
The life quality of patients with benign prostate hyperlasia treated medically in Hungary: a cross-sectional survey in six urological departments
DOI: 10.22591/magyurol.2017.4.kovacsa.173
Authors:
Kovács Ágnes dr.1,2,3
1Budapesti Corvinus Egyetem, Gazdálkodástani Doktori Iskola, Budapest (igazgató: Michalkó Gábor dr.)
2Budapesti Corvinus Egyetem, Egészségügyi Közgazdaságtan Tanszék, Budapest (tanszékvezeto: Gulácsi lászló dr.)
3Boehringer-Ingelheim RCV, Magyarország (igazgató: Francesco Banchi dr.)
Summary
Objective: The aim of the study was to assess the quality of life of BPH patients receiving medication in urological care.
Patients and methods: A cross sectional survey was conducted in 2014 in 6 urological departments in Hungary. A total number of 246 medically treated males aged 18 years or over participated who had been diagnosed with benign prostatic hyperplasia. Patients’ mean age was 70,6 (SD 8,1) years and the average disease duration was 6,5 (SD 6,2) years.
Results: The average of International prostate Symptom Score was 12.8 (SD 6.3). Based on the total score 52 (23%), 136 (61%), and 35 (16%) patients belonged to the mild, moderate and severe benign prostatic hyperplasia subgroups. Health status of the patients measured with EQ-5D index and EQ VAS scores were 0.85 (SD 0.19) and 68.4 (SD 15.5), respectively and the difference between severity subgroups was significant for both.
Conclusion: Patients’ average EQ-5D index score was similar to the gender and age-matched population norm, except in age-groups 45–49 and 55–59 where patients’ scores were significantly lower and higher, respectively.
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Preliminary experiences with sacral neuromodulation in the treatment of non-obstructive urinary retention
DOI: 10.22591/magyurol.2017.4.romicsm.167
Authors:
Romics Miklós dr.1, Kiss Gusztáv dr.2, Eross Lóránd dr.3, Nyirády Péter dr.1, Majoros Attila dr.1
1Semmelweis Egyetem, Urológiai Klinika és Uroonkológiai Centrum, Budapest (igazgató: Nyirády Péter dr.)
2Innsbrucki Orvostudományi Egyetem, Neuro-urológiai Ambulancia, Innsbruck, Ausztria
3Országos Klinikai Idegtudományi Intézet, Funkcionális idegsebészet, Budapest (igazgató: Eross Lóránd dr.)
Summary
Introduction and aims: In our study we proudly present our initial experiences with sacral neuromodulation (SNM) in the treatment of non-obstructive urinary retention trough detrusor hypocontractility.
Patients and methods: Three of our patients, diagnosed with non-obstructive detrusor hypocontractility, have been chosen for the implantation of Interstim neuromodulators (Medtronic, USA) after a thorough urological, neurological and gynecological examination. The male patient (41) received surgery for a spinal herniation before he developed the condition, the two female patients (26 and 42) had no past history to explain their voiding inability: the cause could be interpreted as idiopathic or symptom of Fowler’s syndrome. All our patients were doing intermittent selfcatheterisation 4-5 times a day before the neuromodulation, the conservative treatment methods all failed to improve their situation. After we have demonstrated solid evidence for the indication of SNM, we performed it in two steps: at first – after the bilateral implantation of the sacral electrodes through the sacral 3-4 foramen – we have performed a 2-3 weeks long testmodulation to analyse the effects of the stimuli. The modulation kick started the spontaneous miction for each patient therefore the implantation of the definitive subcutaneous neuromodulator could be performed.
Results: After the implantation of the stimulating devices, the youngest patient could discontinue self-catheterisation, and the others did not need to do it more than 3 times a day (from the initial 5-6). After the operations we did not experience any complications or pain symptoms.
Conclusion: SNM is an effective and minimal invasive alternative solution for non-obstructive urinary retention. After a thorough examination and careful patient selection it can be successfully applied for treating hypocontractile detrusor function.
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Laparoscopic partial nephrectomy in warm ischemia: impact of parenchymal loss on kidney function
DOI: 10.22591/magyurol.2017.4.bagherif.158
Authors:
Fariborz Bagheri MD1,2, Csaba Pusztai MD1, László Farkas MD1, István Buzogány MD3, Zsuzsanna Szabó MD4, János Lantos MD5, Marianna Imre MD6, Nelli Farkas MD7, Árpád Szántó MD1
1University of Pécs Medical School, Department of Urology, Pécs, Hungary (director: Árpád Szántó MD)
2Dubai Health Authority, Dubai Hospital, Department of Urology, Dubai, UAE
3Péterfy Sándor Street Hospital, Department of Urology, Budapest, Hungary (director: István Buzogány MD)
4University of Pécs Medical School, Department of Nuclear Medicine, Pécs, Hungary (director: Katalin Zámbó MD)
5University of Pécs Medical School, Department of Research and Techniques, Pécs, Hungary (director: Gábor Jancsó MD)
6Diagnostic Center of Pécs, Hungary (director: Ferenc Kövér MD)
7University of Pécs Medical School, Institute of Bioanalysis, Pécs, Hungary (director: Ferenc Kilár MD)
Summary
Objective: To evaluate impact of deliberate renal parenchymal loss on renal function, distinguished from ischemic reperfusion (I-R) injury after laparoscopic partial nephrectomy (LPN) under warm ischemia (WI).
Patients and methods: Thirty five patients with a single polar renal mass £4 cm with normal contralateral kidney planned for transperitoneal laparoscopic partial nephrectomy (LPN) under WI using en-bloc hilar occlusion in a prospective study. Total differential renal function (T-DRF) using 99TTc-Dimercaptosuccinic acid (99TTc-DMSA) was evaluated preoperatively and postoperatively in different intervals over one year. In all isotope assessments, a special region of interest (ROI) was selected on the non-tumorous pole of the involved kidney and it was compared with the same ROI in the contralateral kidney. This was named as partial DRF (P-DRF). Any postoperative decline in the P-DRF of the operated kidney was contributed to I-R injury unrelated to parenchymal loss. Subtraction of the P-DRF decline from the T-DRF decline was attributed to the parenchymal loss caused by deliberate resection and suturing of the normal parenchyma. Other than DRF, serum creatinine (sCr), estimated glomerular filtration rate (eGFR) using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, warm ischemia time (WIT), and weight of the resected specimen were also measured.
Results: The mean WIT was 22 minutes, and the mean weight of resected specimen was 18 grams. The mean postoperative eGFR declined to 87 from its baseline mean value of 97 (p-value = 0.0757). Mean postoperative T-DRF and P-DRF of the operated kidney, declined by 7% and 3% respectively.
Conclusion: After LPN of small renal mass, decline in renal function is primarily contributed to parenchymal loss caused by deliberate resection and suturing of the normal parenchyma rather than the I-R injury.
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New biomarkers to predict the prognostic pattern of patients with conventional renal cell carcinoma
DOI: 10.22591/magyurol.2017.4.javorhazya.149
Authors:
Jávorházy András dr., Farkas László dr., Szántó Árpád dr., Kovács Gyula dr.
Pécsi Tudományegyetem, Urológiai Klinika, Pécs (igazgató: Szántó Árpád dr.)
Summary
Purpose: In spite of early detection of conventional renal cell carcinoma (RCC) by widespread use of abdominal imaging approximately 10-15% of patients will die due to disease. The aim of this study was to identify new biomarkers predicting the postoperative progression of conventional RCC.
Methods: Tissue multi arrays (TMA) of conventional RCC patients were analysed by immunohistochemistry for expression of the acute phase protein serum amyloid A1 (SAA1), the matrix metalloproteinase 12 (MMP12) and the transmembrane protein 27 (TMEM27) which were identified as candidate biomarkers formerly by global gene expression analysis (Affymetrix array). Univariate and multivariate Cox-regression models were addressed to assess cancer specific survival in association of protein expression. Cancer specific survival time was estimated with Kaplan-Meier analysis, the comparison of survival curves was made with the Log rank test.
Results: The Kaplan-Meier survival analysis indicated a poor disease specific survival rates for tumours with SAA1 and MMP12 staining. The lack of TMEM27 staining was also associated with poor disease specific survival rates. Cox-regression analysis revealed significant association of patient survival with SAA1, MMP12 and TMEM27 expression. All the three biomarkers proved to be independent prognostic factors in the cohort of patients without metastatic disease at the time of operation.
Conclusions: Our results suggest that SAA1, MMP12 and TMEM27 immunochemistry in localised conventional RCC is a promising method to define a group of patients at high risk for postoperative progression.