2019-2 — Summary
Platinum-based chemotherapy in urinary bladder cancer – 10 years clinical experiences
DOI: 10.22591/magyurol.2019.2.modoso.58
Authors:
Módos Orsolya dr.1, Bozsaki Ákos1, Nagy Cintia1, Nagy Nikolett1, Csizmarik Anita1, Keresztes Dávid1, Oláh Csilla1, Váradi Melinda1, Horváth András dr.1, Szendrői Attila dr.1, Szűcs Miklós dr.1, Keszthelyi Attila dr.1, Nyirády Péter dr.1, Szarvas Tibor dr.1,2
1Semmelweis Egyetem ÁOK, Urológiai Klinika és Uroonkológiai Centrum, Budapest (igazgató: Nyirády Péter dr.);
2Duisburg-Esseni Egyetem, Urológiai Klinika, Essen
Summary
Objective: Cisplatin-based chemotherapy is the first-line treatment for locally advanced and metastatic bladder cancer. Novel checkpoint inhibitor therapies are approaching and are currently approved for second-line treatment. In this retrospective study, we report our 10-years single institution experiences with cisplatin-based chemotherapy.
Patients and methods: We collected clinicopathological and follow-up data of bladder cancer patients treated with platinum-based chemotherapy in our clinic between 2007 and 2017. Correlations between clinicopathological and follow-up data have been evaluated and compared to those published in the literature.
Results: Our internal database search identified 135 bladder cancer patients with sufficient data who received cisplatin-based chemotherapy. Of these patients 97 were men (72%) and 38 were women (28%). At the time of diagnosis, the median age was 63 years (40-82 years). We grouped patients based on the indication of chemotherapy: 1) Adjuvant chemotherapy was performed in patients with locally advanced (pT3/T4, N0; n=42/135; 31.1%) and/or with lymph node metastatic cases (pT1/T2, N+, n=19/135; 14.1% or pT3/pT4 and N+, n=28/135; 20,7%). 2) Induction chemotherapy was performed in those patients who had tumor progression after surgical treatment (local recurrence n=5/135; 3.7%, distant organ metastases n=7/135; 5.2% and distant lymph node metastases n=1/135; 0.8%). 3) Patients who were unfit for radical cystectomy received palliative chemotherapy (n=33/135; 24.4%).
Patients who received induction chemotherapy had the most unfavourable survival (p<0.001). In the induction chemotherapy group patients with lymph node metastasis had a significant better prognosis compared to those with local recurrence or distant metastasis (p=0.036). Diabetes mellitus proved to be a significant risk factor for patients’ survival (p=0.027). Patients who showed a radiographic response to chemotherapy had a significant better survival (p=0.047).
Conclusions: Our analysis demonstrated that the indication of chemotherapy, the progression site and diabetes mellitus have a significant impact on survival of platinum-treated bladder cancer patients. Therapy predictive models for cisplatin-based chemotherapy implementing molecular features of bladder cancer are needed to improve therapeutic decision making.
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Epidemiology and susceptibility patters of Staphylococcus aureus isolates from STI samples of male patients (2008–2017)
DOI: 10.22591/magyurol.2019.2.gajdacsm.66
Authors:
Gajdács Márió dr.1,2
1Szegedi Tudományegyetem Gyógyszerésztudományi Kar, Gyógyszerhatástani és Biofarmáciai Intézet, Szeged (intézetvezető: Zupkó István dr.);
2Szegedi Tudományegyetem Általános Orvostudományi Kar, Klinikai Mikrobiológiai Diagnosztikai Intézet, Szeged (igazgató: Burián Katalin dr.)
Summary
Introduction: Bacterial infections of reproductive organs are a major factor of morbidity, and one of the most common causes of infertility in men. More and more studies report the growing importance of Staphylococcus aureus in urological diseases, but little data is available on the sensitivity of the isolates.
Materials and methods: During this study, the retrospective characterization of S. aureus isolates from STI samples of male patients was performed regarding a 10-year (01. 01. 2008. – 31. 12. 2017.) study period.
Results: 85 S. aureus isolates were detected during the study period; the average age of the affected patents was 37±14 years (range 17–90). During the 10-year period, 2 MRSA isolates were detected. The sensitivity of the isolates was close to 100% for most tested antibiotics, except for fluoroquinolones (90%) and macrolides (~75-80%).
Conclusions: S. aureus is a relatively rare isolate in male STI samples; however its significance must not be neglected, due to its high pathogenicity.
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Primary renal solitary fibrous tumour: case report and literature review
DOI: 10.22591/magyurol.2019.2.vrecenarl.69
Authors:
Vrecenár László dr.1, Galambos Csilla dr.2, Diczházi János Csaba dr.2, Buzogány István dr.1
1Péterfy Kórház-Rendelőintézet és Manninger Jenő Országos Traumatológiai Intézet, Urológiai osztály, Budapest (osztályvezető: Buzogány István dr.);
2Péterfy Kórház-Rendelőintézet és Manninger Jenő Országos Traumatológiai Intézet, Patológiai osztály, Budapest (osztályvezető: Diczházi János Csaba dr.)
Summary
Objective: The authors present a rare case of fibrotic tumour originating from the kidney and provide the literature review background.
Case report: The solitary fibrous tumour (SFT) is a rare mesenchymal neoplasm most frequently originating from the pleura. Renal occurrence is very uncommon. We report a 21-year-old male patient presenting with recurrent episodes of hypoglycaemia causing altered level of consciousness. Subsequent investigations revealed a tumour in the right kidney. The initial results of the core biopsy caused a diagnostic dilemma, but the immunohistochemical analysis of the radical nephrectomy specimen confirmed the primary renal solitary fibrous tumour. Our patient was doing well at the 3-month follow-up with no evidence of recurrence or metastasis.
Conclusion: The basis of its treatment is primarily surgical, which includes metastasectomy in metastatic cases. Considering the possibility of recurrence and distant metastasis formation, careful follow-up is recommended.
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Glans reconstruction with split-thickness skin graft
DOI: 10.22591/magyurol.2019.2.muranyim.73
Authors:
Murányi Mihály dr.1, Juhász István dr.2, Drabik Gyula dr.1, Kiss Zoltán dr.1, Flaskó Tibor dr.1
1Debreceni Egyetem Általános Orvostudományi Kar, Urológiai Tanszék, Debrecen (tanszékvezető: Flaskó Tibor dr.);
2Debreceni Egyetem Általános Orvostudományi Kar, Bőrgyógyászati Tanszék, Debrecen (tanszékvezető: Remenyik Éva dr.)
Summary
Objective: A patient with penile cancer located on the glans penis is reported. The authors performed glansectomy and glans reconstruction with meshed split-thickness skin graft. To our knowledge, this is the first report of glans reconstruction with split-thickness skin graft in Hungarian literature.
Case report: The 73-year-old patient had a biopsy-proven verrucous carcinoma of the penis. Glansectomy and glans reconstruction was performed. A subcoronal incision was carried out and then the glans and prepuce was removed en block. The penile skin was fixed to the corporal bodies 3 cm from the tip of the corpora, creating the neosulcus. Urethra was sutured to the corporal tips. Area between the neosulcus and meatus was covered by meshed unexpanded split thickness skin graft. Postoperative period was uneventful. 14 months after surgery follow up examination did not revealed local recurrence or metastasis.
Conclusion: Besides complete primary tumour removal, organ preservation is major issue in penile cancer treatment. Small T1/T2 localised glandular and preputial tumours are ideal for penile-sparing surgery. The aims of organ preservation are ability of voiding in standing position, preserving sexual health and better cosmetic result.
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The role of Uro-Vaxom in the treatment and prevention of acute cystitis
DOI: 10.22591/magyurol.2019.2.magyara.78
Authors:
Magyar András dr., Tenke Péter dr.
Jahn Ferenc Dél-pesti Kórház és Rendelőintézet, Urológiai Osztály, Budapest (osztályvezető: Tenke Péter dr.)
Summary
Introduction: Non-antibiotic approaches are of high priority in the prevention of recurrent cystitis, due to the global emergence of bacterial resistance to antibiotics. Uro-vaxom (OM-89), a lyophilized extract of Escherichia coli, is one of the most important drugs for non-antibiotic prophylaxis of recurrent cystitis. Its efficacy for reducing recurrent cystitis episodes has been investigated in several studies. Our objective was to review available publications on this immunoprophylactic drug.
Methods: A PubMed search was performed and references from available systematic reviews were summarised. The main outcomes of interest were: 1) the effects of the drug, 2) its efficacy in the prevention of recurrent cystitis episodes, 3) development of immunity versus several pathogens, 4) time of the initiation of the treatment 5) drug administration schemes and scheduling. Results: prophylaxis with Uro-Vaxom decreases the episodes of recurrent cystitis by 36% for at least 6 months therefore the administration of antibiotics may be reduced. Its efficiency is not influenced by the causative pathogen.
Conclusions: Out of all agents for non-antibiotic prophylaxis of acute cystitis Uro-Vaxom has the strongest evidence of its efficiency, which may be further amplified by its intermittent use.