DOI: 10.22591/magyurol.2018.2.damasdim.69

Authors:
Damásdi Miklós dr., Pytel Ákos dr., Kovács Gyula dr., Szántó Árpád dr.
Pécsi Tudományegyetem Klinikai Központ Urológiai Klinika, Pécs (igazgató: Szántó Árpád dr.)

Summary

Objective: Based on our present knowledge and evidence, phimosis, chronic inflammation (balanoposthitis, balanitis xerotica obliterans), penile lesions, UVA radiation, smoking, promiscuity, prior condyloma and HPV infection are considered a clear risk factor. The question arises whether the HPV affected primary tumor, an advanced process, clinically positive or possibly the involvement of the lymph nodes of the lymph nodes affected by HPV involvement, or the presence of the same subtypes, oncogenic HPV types in both tissue environments.
Patients, methods: Between 2002 and 2012, during operations of malignant penile cancers in the Department of Urology, University of Pécs, tissue samples were taken from both the primer tumour and the regional lymph nodes. The collection and processing of tissue samples was carried out with the permission of the PTE ÁOK Ethics Committee (Ethical Approval Number: 4828).
In our clinical studies we studied the HPV expression is issue samples and biological markers that correlated with the progression of penile tumors, and we investigated the protective role of toll-like receptor 4 (TLR4) in the formation of penile tumors.
Results: In our clinical study 16/31(51.61%) patients were isolated high malignant HPV DNA from the primary tumor, and in 3/31 cases were detected HPV from its regional (inguinal) lymph nodes. In further molecular biological studies and typing processes, in 13 of the 16 high-malignant HPV positive primary tumors, the high sensitivity test method was used to characterize. Types of HPV 16 in all 10 patients (76.92%) and 3 (23.07%) HPV 51, 82, 59 types were confirmed. In the 3 patients with HPV analysis of both primary and lymph node positive HPV 16 types were positive. In the clinical and pathological studies associated with molecular biology, 47% pTa-pT1 and 53% pT2-pT4 localized HPV positive cases were confirmed. A reverse correlation between HPV infection / TLR4 expression in penile cancer can be observed (compared to cervical cancer). TLR4 expression can be used as a biological marker to detect Of the biological markers involved in the clinical trial, the mTOR, EZH2 and RARRES1 immunohistological expression have a significant correlation with the progression of the penile tumors.
Conclusions: Both HPV-associated and HPV-independent mechanisms can lead to malignant processes (different pathways). We first introduced the difference between HPV infection and TLR4 expression in the penile tumor. Increased TLR4 expression indicates HPV negative tumors, and p16INK4a expression increases in HPV positive penile cancer. Our data suggest that TLR4 receptor expression protects the long-term presence of viral infection. We identified three new prognostic markers. Patient vaccination in the light of this clinical study would be absolutely justified, as the incidence of HPV 16/18 types in our region is far more common with other non-HPV 16-18 types. In the case of mTOR positivity (66%) the possibility of therapeutic use of mTOR inhibitors may be included.

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DOI: 10.22591/magyurol.2018.2.pytela.65

Authors:
Pytel Ákos dr.
Pécsi Tudományegyetem, Klinikai Központ, Urológiai Klinika, Pécs (igazgató: Szántó Árpád dr.)

Summary

Introduction: Overactive bladder is a syndrome of multiple etiological origins. Regarding relevant guidelines second (third) line invasive treatment are indicated in cases, refractory to standard medical treatment. Percutaneous tibial nerve stimulation among the different neuromodulations is one of the treatments of choice as second line therapy. Regarding recent literature data, the procedure is effective in the treatment of overactive bladder. The aim of this current paper is to introduce the technique, and – first in Hungarian literature – to demonstrate the preliminary own data gained with it.
Material and method: Three patients with symptoms of overactive bladder, refractory to standard medical treatment were treated. Pre-treatment bladder diaries were obtained, basic urological investigations, and urodynamics were performed. With Urgent®PC Neuromodulation System 30 minutes’ treatments on weekly basis for 12 weeks were performed. After the fulfilled treatment urine test, ultrasound control was done and repeated bladder diary was asked. By the patient with pathological urodynamic findings prior the treatment, a control urodynamics was performed as well.
Results: Based on the bladder diaries all patients had an improvement regarding incontinent episodes, frequency and urgency. The control urodynamics could not prove significant change compared the findings seen prior the treatment. The treatments were well tolerated, no complication was observed.
Conclusion: Based on relevant literature data and based on our limited own experience, the percutaneous tibial nerve stimulation is an effective, minimally invasive safe treatment of the overactive bladder

LAPSZÁM: MAGYAR UROLÓGIA | 2018 | 30. ÉVFOLYAM, 2. SZÁM

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DOI: 10.22591/magyurol.2018.2.pusztaics.60

Authors:
Pusztai Csaba dr., Sarlós Donát Péter dr.,Horváth Anna Csenge dr., Szántó Árpád dr.
Pécsi Tudományegyetem, Klinikai Központ, Urológiai Klinika, Pécs (igazgató: Szántó Árpád dr.)

Summary

Objectives: Partial nephrectomy has become the gold standard of surgical care for T1N0M0 stage renal tumours. Functional outcome of surgery depends on many factors, of which ischaemia time is the only fully modifiable factor. In this sense, zero ischemia represents the reachable technical optimum.
Materials and methods: Patient, tumour, operative and follow-up data related to laparoscopic partial nephrectomies were recorded prospectively in an institute database. The study group was formed by patients without hilar compression. For each case of the study group, a computer algorithm was used to select a control case from non-zero ischaemia surgeries that fitted as good as possible in the significant attributes (control group).
Results: There was no significant difference between the study and control groups in terms of transfusion rate, length of hospital stay, positive surgical margins, and frequency of complications. In the zero ischaemia group, the operative time was significantly shorter. Mean postoperative renal function loss was not significantly lower than in the control group, but there was a fewer number of patients with significant renal function deterioration (>30%).
Conclusion: Our study proved that zero ischemia is a feasible and safe method for laparoscopic partial nephrectomies. The operative time is shorter and a slightly more intraoperative blood loss is compensated by the low incidence of postoperative haemorrhage. Using this technique, the proportion of patients with surgically induced severe renal impairment can be reduced.

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DOI: 10.22591/magyurol.2018.2.berczics.55

Authors:
Berczi Csaba dr., Kiss Zoltán dr., Flaskó Tibor dr.
Debreceni Egyetem Általános Orvostudományi Kar, Urológiai Klinika, Debrecen (igazgató: Dr. Flaskó Tibor)

Summary

Objective: At present there is no consensus regarding the optimal treatment of patients with high-risk prostate cancer. The authors measured the efficacy of radical prostatectomies for high-risk tumors at their institute.
Material and method: From January 1996 to January 2016, 2022 patients underwent radical prostatectomy and they were involved into the study. The mean age of the patients was 63.5±6.4 years. In their cases the mean preoperative PSA level was 12.3 ng/ml. High-risk prostate cancer was present in 356 cases (17.6%). The mean age of these patients was 63.7±7.2 years and their mean preoperative PSA level was 29.4 ng/ml.
Preoperative CT examination was performed in 174 cases and it showed locally advanced tumor in 15 patients with high-risk tumors. MRI and MRI with endorectal coil were carried out in 123 and 36 occasions and they detected locally advanced tumor in 29 and in 16 patients.
Observation, adjuvant or salvage irradiation or/and hormonal therapy were administered in the follow-up period regarding to the actual guideline and the patient’s condition.
Results: The histology showed locally advanced tumor (pT3) in 169 of the 356 patients (47.4%). Margin positivity occurred in 88 cases (28.7%). Biochemical progression was detected in 42 (11.7%) cases, while local recurrency and distant metastases were diagnosed in 12 (3.3%) and in 7 (1.9%) patients with high-risk tumor during the 5 year follow-up period. Irradiation and hormonal treatment were performed in 22.7% and in 30.8% of the patients after the radical prostatectomy.
Conclusion: The presence of locally advanced tumor and margin positive status are common in patients with high-risk prostate cancer. However, the radical prostatectomy as a part of multimodal treatment provides reasonable oncological outcome.

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