Urodynamic evaluation of patients with lower urinary tract symptoms and small prostate volume

Introduction: The relevance of prostate size in the pathophysiology of lower urinary tract symptoms (LUTS) is controversial. We evaluated the urodynamic findings in patients with LUTS and small prostate volumes. Materials and Methods: 84 patients aged >= 50 years with LUTS and prostates < 40 ml were evaluated. All had an International Prostate Symptom Score (IPSS) >= 8. Average age was 62.0 +/- 8.1 years. We evaluated the impact of bladder outlet obstruction (BOO) and detrusor overactivity (DO) on the voiding symptoms and urodynamic findings. Results: Mean prostate volume was 29.2 +/- 7.2 ml and mean IPSS was 13.5 +/- 4.6. BOO was the main finding, affecting 42 (50.0%) patients, followed by detrusor underactivity (DU) in 41 (48.8%) and DO in 28 (33.3%) patients. Patients without BOO were significantly older than the obstructed (64.0 +/- 8.8 and 60.1 +/- 6.9 years, respectively; p = 0.026) and had an increased prevalence of DU (76.2 and 21.4%, respectively; p < 0.001). Comparison of patients with and without DO showed reduced bladder capacity and compliance in the DO group (p < 0.001). No other comparisons were significant. Conclusion: Half of the patients with LUTS and small prostates are not obstructed and may have DO or decreased detrusor contractility as the basis for their voiding symptoms. Our results emphasize the value of urodynamics in this population, especially when invasive treatments are being considered. Copyright (c) 2008 S. Karger AG, Basel.

Complicações em idosos submetidos a cirurgia de correcção de de hérnias da parede abdominal

RESUMO: O envelhecimento da população é um fenómeno à escala mundial, com tendência a aumentar, sendo cada vez mais os idosos e mais velhos. Esta propensão é notória nos utentes que recorrem aos cuidados de saúde. À medida que se envelhece maior vai sen-do a vulnerabilidade e riscos para a saúde, bem como a prevalência para doenças croni-cas, que se traduz num aumento de hospitalizações e consumo. As complicações ocorri-das em idosos aquando submetidos a intervenções cirúrgicas estão descritas na literatu-ra, havendo uma escassez de publicações nacionais relacionadas com o tema. O presente estudo teve por objectivo caracterizar idosos submetidos a correcção cirúrgi-ca de hérnias da parede abdominal, os procedimentos e as complicações ocorridas. O estudo, transversal e de natureza quantitativa, foi realizado no Centro Hospitalar de Lisboa Norte – Hospital Pulido Valente, e teve como critério de inclusão os indivíduos com 65 ou mais anos submetidos a correcção cirúrgica de hérnias da parede abdominal, realizadas em 2009-2010, que tiveram um período de recobro na Unidade de Cuidados Anestésicos Pós-operatórios. Para a obtenção dos dados, foram analisados os processos clínicos do Arquivo Clínico da Instituição e registada informação sobre variáveis de caracterização sócio demográfi-ca, de saúde pré, intra e pós-operatória imediata e descritivas da cirurgia. Foram avaliadas as situações de 164 indivíduos, 78.7% eram homens e 21.3% mulheres e a média de idades era de 72.4 anos e desvio padrão 5.46. Em termos de hábitos de Vida, foi possível constatar um predomínio de baixo consumo de tabaco (13.4%) e álcool (6.7%). O valor médio de co-morbilidades foi de 2.6 e desvio padrão de 1.34 sendo a maior prevalência de 3-4 co-morbilidades com 48.8%. Salienta-se que todas as mulheres da amostra apresentaram doenças. As patologias mais prevalentes são as do foro cardiovascular: Hipertensão Arterial (75.0%), Dislipidémia (35.4%) e Insuficiência Venosa Periférica (14.6%), de forma menos expressiva, mas igualmente relevante a Diabetes Mellitus (23.8%). Nos mais idosos [75 ou mais], verificou-se uma expressivi-dade Hipertrofia benigna da próstata (18.2%). Das cirurgias ocorridas predominou a correcção cirúrgica de Hérnia Inguinal.Das complicações identificadas prevaleceu a dor (97.6%). A hipotermia (34.8%), HTA (24.4%) e bradicárdia (14.6%) encontram-se entre as complicações mais determinantes. Verificaram-se diferenças com significado estatístico entre os dois grupos etários consi-derados nas complicações bradicárdia (p=0.021) e a saturação de oxigénio <90% (p = 0.006), hemorragia (p=0.036) e retenção urinária (p = 0.038). Neste estudo constata-se que a cirúrgica de hérnias da parede abdominal em idosos é uma realidade prevalente. Dos factores que possam estar associados a propensão para complicações pós-cirúrgicas, a idade e a presença de co-morbilidade controlada não revelaram ter influência. Também os tempos de cirurgia e de anestesia não revelaram influências no surgimento de complicações. A monitorização dos sinais vitais deve ser constante, desde o período pré-operatório imediato de forma a permitir aos profissionais de saúde identificar uma propensão para vulnerabilidade, com vantagem em ser apre-sentado sob a forma de score. Este manifestou diferenças significativas a nível dos dois grupos etários considerados (p=0.001). Este score, vai possibilitar sinalizar quais os idosos com maior susceptibilidade de ocorrência de complicações.------------------ABSTRACT:Population aging has become a worldwide phenomenon with tendency to increase. This is particularly evident due to the amount of elderly that attend the medical services. As one gets older, more vulnerable and more risks to one’s health. Also chronic diseas-es are more likely to exist which lead to more hospitalizations and increase of consuma-bles. The complications after a surgery in older people are well documented in international scientific studies, however national studies are still lacking. The present study aims to characterize elderly patients after abdominal hernia surgical correction, the procedures and complications detected. This transversal and quantitative nature like study, was held in the Centro Hospitalar Lisboa-Norte – Hospital Pulido Valente, and as inclusive criteria where patients with more than 65 or more years old, who undergone abdominal hernia surgical correction surgery in 2009-2010 and had the post-operation on the Unidade de Cuidados Anestésicos Pós-Operatorios. Data from the clinical files from the archive of the hospital where analyzed. Information was taken regarding social demographic variables; before, during and immediately after surgery variables and also descriptive of the surgery itself. Were evaluated 164 individuals, 78, 7% of which were men and 21, 3% women with an average age of 72, 4 years and standard deviation 5.46. Life habits analyzed detected low consumption of tobacco (13, 4%) and alcohol (6, 7%). The average of co-morblity was 2, 6 and standard deviation 1.34. The biggest prevalence of 3-4 co-morbilities was 48, 8%. Important to notice that, all women from the study presented illnesses. The illnesses more frequent were cardiovascular: High Blood Pressure (75%), Dyslipidemia (35, 4%), Deep Venous Insufficiency (14, 6%), less significant but also relevant, Diabetes Melli-tus (23, 8%). In the older (75 or more), was noticed Benign Prostatic (18, 2%). In the surgeries verified, the abdominal hernia correction was more frequent. From all thecomplications identified, pain was 97, 6%, Hypothermia 34, 8%, high Blood Pressure 24, 4% and Bradycardia 14, 6%, were higher prevalence. Was seen differences in the statistic meaning of the two groups in the Bradycardia com-plications (p=0.021), and the oxygen saturation < 90% (p=0.006), bleeding (p=0,036) and urine retention (p=0,038). In the present study it is evident that the abdominal hernia surgical correction in older population is a common procedure. Of all the factors that might be related with post-operatory complications, age and the presence of controlled co-morbility didn’t reveal relevant. Also, surgical times and duration of anesthesia didn´t seem to be related to complications incidence. Monitoring the vital signs must be constant since the immedi-ate post-operatory to ensure that the professionals can identify any possible vulnerabil-ity, presenting it in a score like way. The score has shown meaningful differences be-tween the two age groups analyzed (p=0,001). This score allows identifying which pa-tients are more likely to suffer complications.

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins.

The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed that tumor extending close to the 'capsular' margin, yet not to it, should be reported as a negative margin, and that locations of positive margins should be indicated as either posterior, posterolateral, lateral, anterior at the prostatic apex, mid-prostate or base. Other items of consensus included specifying the extent of any positive margin as millimeters of involvement; tumor in skeletal muscle at the apical perpendicular margin section, in the absence of accompanying benign glands, to be considered organ confined; and that proximal and distal margins be uniformly referred to as bladder neck and prostatic apex, respectively. Grading of tumor at positive margins was to be left to the discretion of the reporting pathologists. There was no consensus as to how the surgical margin should be regarded when tumor is present at the inked edge of the tissue, in the absence of transected benign glands at the apical margin. Pathologists also did not achieve agreement on the reporting approach to benign prostatic glands at an inked surgical margin in which no carcinoma is present.

Urologie [Urology in 2010].

In 2010, therapeutic acquisitions in urology mainly allowed optimizing the management of benign prostatic hypertrophy, overactive bladder, localized and metastatic prostate and renal cancers.

Reaktive Thymushyperplasie infolge der Therapie ACTH-produzierender Tumoren [Reactive thymus dysplasia following therapy for ACTH-producing tumors]

Surgical or conservative treatment of ACTH-producing tumors results in acute drop of the previously excessively high cortisol levels. The following associated pathophysiological changes also occur in the organism's recovery from stress, such as trauma, operation or chemotherapy of tumors. Both cases result in a regeneration of the immune system, which might even be exalted. The corresponding radiographic feature is the "rebound" enlargement of the thymus occurring about six months after remission of hypercortisolism. Histological examination reveals benign thymus hyperplasia. Especially in cases of still unknown primary tumor the appearance of this anterior mediastinal mass can lead to misdiagnosis. We present the cases of two patients with diffuse thymic hyperplasia following surgical and medical correction of hypercortisolism. One patient suffered from classic Cushing's disease responding to transsphenoidal resection of an ACTH-secreting pituitary microadenoma. Six months later CT of the chest incidentally demonstrated an anterior mediastinal mass known as thymic hyperplasia. The second patient presented with an ectopic, still unkown source of ACTH-production. Six months after medical correction of hypercortisolism CT of the thorax showed an enlargement of the anterior mediastinum. Thymectomy was performed in order to exclude thymus carcinoid. Histological examination revealed benign thymus hyperplasia with negative immunostaining. CONCLUSION: Radiologists and clinicians should be familiar with the pathophysiological changes resulting from precipitously dropping cortisol levels in order to prevent diagnostic errors and unnecessary operations.

Relación entre síntomas urinarios bajos y calidad de vida antes y después de la RTUP

Determinar el impacto en la calidad de vida de los pacientes con STUB dados por HPB en el Hospital de la Samaritana y Hospital universitario mayor MEDERI, que son llevados a resección transuretral de próstata y definir cual es la relación de dicho impacto con la severidad de los síntomas antes y después del tratamiento. Métodos: Se incluyeron 72 pacientes con síntomas de tracto urinario bajo dados por crecimiento prostático que fueron llevados a resección transuretral de próstata. Se realizo medición de síntomas urinarios según el IPSS y medición de calidad de vida según el cuestionario índice de impacto BPH (BII) antes de la cirugía y 3 meses luego de la misma. Resultados: Se realizó análisis de correlación entre los síntomas del IPSS y el BII antes de la resección transuretral de próstata y 3 meses después de la misma, encontrándose una correlación significativa entre las dos escalas en ambos momentos. Se realizó un modelo de regresión con las variables de las 2 escalas utilizadas, encontrando que antes de la cirugía los síntomas que deterioran más la calidad de vida son chorro débil, nicturia y frecuencia y los síntomas que al mejorar luego de la cirugía, mejoran la calidad de vida son intermitencia, chorro débil y pujo. Conclusión: Existe una correlación entre la escala IPSS y el índice de calidad de vida BII en los pacientes con STUB que van a ser llevados a RTUP antes y después de la intervención; por lo que el BII podría ser una herramienta para la evaluación inicial y para el seguimiento de los pacientes que son llevados a resección transuretral de próstata .

Amitriptyline aggravates the fibrosis process in a rat model of infravesical obstruction

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Age-related histopathological lesions in the Mongolian gerbil ventral prostate as a good model for studies of spontaneous hormone-related disorders

The Meriones unguiculatus (Mongolian) gerbil has demonstrated significant prostatic responses to hormonal treatments, and to drugs against human prostatic hyperplasia Spontaneous neoplasia develops in the older animals. Thirty gerbils (age 18 months) were divided into non-affected and prostatic lesion bearers and the prostate lesions were evaluated morphologically, immunohistochemically and quantitatively. The most frequent changes were in epithelial sites and, namely prostatic intraepithelial neoplasias, microinvasive carcinomas and adenocarcinomas. In the stromal compartment, cellular hyperplasia, when verified, was always associated with the sites of anomalous epithelium. Additionally, larger deposition of collagen fibrils, generating stromal fibrosis, was found in all the old gerbils analysed. The quantitative analysis showed that prostatic tissue proportions differed in altered areas, being specific for each lesion type. Isolated nuclear and nucleolar parameters were not effective in diagnosing the malign potential of lesions. However, the cellular proliferation and death indexes indicated larger cellular turnover in invasive lesions such as carcinomas. With these analyses, it could be verified that old gerbils present high propensity to develop spontaneous prostate changes and this may aid in a better understanding of the biological behaviour of human prostate cancer.

Chronic Ethanol Consumption Alters All-Trans-Retinoic Acid Concentration and Expression of Their Receptors on the Prostate: A Possible Link Between Alcoholism and Prostate Damage

Background: Ethanol (EtOH) alters the all-trans-retinoic acid (ATRA) levels in some tissues. Retinol and ATRA are essential for cell proliferation, differentiation, and maintenance of prostate homeostasis. It has been suggested that disturbances in retinol/ATRA concentration as well as in the expression of retinoic acid receptors (RARs) contribute to benign prostate hyperplasia and prostate cancer. This study aimed to evaluate whether EtOH consumption is able to alter retinol and ATRA levels in the plasma and prostate tissue as well as the expression of RARs, cell proliferation, and apoptosis index. Methods: All animals were divided into 4 groups (n = 10/group). UChA: rats fed 10% (v/v) EtOH ad libitum; UChACo: EtOH-naïve rats without access to EtOH; UChB: rats fed 10% (v/v) EtOH ad libitum; UChBCo: EtOH-naïve rats without access to EtOH. Animals were euthanized by decapitation after 60 days of EtOH consumption for high-performance liquid chromatography and light microscopy analysis. Results: EtOH reduced plasma retinol concentration in both UChA and UChB groups, while the retinol concentration was not significantly different in prostate tissue. Conversely, plasma and prostate ATRA levels increased in UChB group compared with controls, beyond the up-regulation of RARβ and -γ in dorsal prostate lobe. Additionally, no alteration was found in cell proliferation and apoptosis index involving dorsal and lateral prostate lobe. Conclusions: We conclude that EtOH alters the plasma retinol concentrations proportionally to the amount of EtOH consumed. Moreover, high EtOH consumption increases the concentration of ATRA in plasma/prostate tissue and especially induces the RARβ and RARγ in the dorsal prostate lobe. EtOH consumption and increased ATRA levels were not associated with cell proliferation and apoptosis in the prostate. © 2012 by the Research Society on Alcoholism.

Óxido nítrico, GSTP-1 e P53: qual o papel desses biomarcadores e suas correlações com as afecções prostática no cão?

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Exposição crônica ao cádmio e/ou à cafeína: alterações estruturais, ultraestruturais e bioquímicas na próstata do rato

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Mecanismo de transdução de sinal na próstata de cão: avaliação nas vias da p-ERK1/2 e da CYR61

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

In situ melanoma of the nail unit in children: report of two cases in fair-skinned Caucasian children

Nail melanoma in children is rarely reported in the literature, and all of the published cases were diagnosed in dark-skinned phototypes or in Asians. We report two cases of in situ nail matrix melanoma presenting as longitudinal melanonychia (LM) in fair-skinned children of Italian origin. Nail plate dermatoscopy revealed a brown background with lines of irregular color, spacing, and thickness in both cases. Histopathology of the excised lesions showed melanoma in situ. Clinical, dermatoscopic, and pathological criteria that permit clear differentiation of benign melanocytic activation or proliferation from nail matrix melanoma are not established for children. The presence of a pigmented band of a single nail in a child usually represents a problem for clinicians, because the clinical and dermatoscopic features that are considered possible indicators of nail unit melanoma in adults are frequently observed in benign melanocytic hyperplasia and nevi in children. There is therefore the need to find parameters useful for clinical and dermatoscopic diagnosis in childhood nail pigmentation and to reach a consensus on management of children with a band of LM.

Early development of human lymphomas in a prostate cancer xenograft program using triple knock-out immunocompromised mice

BACKGROUND There is an urgent need for preclinical models of prostate cancer; however, clinically relevant patient-derived prostate cancer xenografts (PDXs) are demanding to establish. METHODS Sixty-seven patients who were undergoing palliative transurethral surgery or radical prostatectomy for histologically confirmed, clinically relevant prostate cancer were included in the study. Fresh prostate cancer tissue was identified by frozen analysis in 48 patients. The cancer tissue was transplanted subcutaneously and under the renal capsule of NSG and NOG mice supplemented with human testosterone. All growing PDXs were evaluated by histology and immunohistochemistry. RESULTS Early assessment of the animals at least three months after transplantation included 27/48 (56.3%) eligible PDX cohorts. PDX growth was detected in 10/27 (37%) mouse cohorts. Eight of the ten PDXs were identified as human donor derived lymphomas, including seven Epstein Barr virus (EBV)-positive diffuse large B-cell lymphomas and one EBV-negative peripheral T-cell lymphoma. One sample consisted of benign prostatic tissue, and one sample comprised a benign epithelial cyst. Prostate cancer was not detected in any of the samples. CONCLUSIONS Tumors that arise within the first three months after prostate cancer xenografting may represent patient-derived EBV-positive lymphomas in up to 80% of the early growing PDXs when using triple knockout NSG immunocompromised mice. Therefore, lymphoma should be excluded in prostate cancer xenografts that do not resemble typical prostatic adenocarcinoma. Prostate 9999: XX-XX, 2014. © 2015 Wiley Periodicals, Inc.