125 research outputs found
Does hexaminolevulinate detect chromosmal aberrations in the false-positive bladder biopsies?
No full textIntroduction:With the introduction of photosensitizing drugs allowing photodynamic diagnostic (PDD) for the bladder cancer, diagnosis has become more accurate. The main limitation of the procedure is the false-positive detection rate, which ranges from 12% to 60%. The onset of multifocal transitional cell carcinoma has been described as a panurothelial disease as it evolves because of genetic defects that are present also in histological negative urothelial tissue. Objective:We analyzed chromosomal patterns of false-positive lesions in the PDD and compared them with the findings of random biopsies with the intent to observe if hexaminolevulinate detects chromosomal aberrations in histological healthy tissue. Patients and Methods:Included in the study were 18 patient,16 men and 2 women, with a mean age of 70.5 (range=47-83) years. All had false-positive PDD confirmed in the histology. A random sample was taken from all patients. The chromosomal patterns of all samples were analyzed with fluorescence in situ hybridization (FISH). Results: From January 2012 until November 2014, a total of 266 bladder biopsies were performed in 30 patients with a positive PDD finding. Eighteen patients had false-positive biopsies in a total of 40 biopsies. In these patients, a total of 25 random biopsies were also performed. Seven out of 18 patients showed chromosomal aberration in 10 (25%) of the false-positive biopsies. All 10 biopsies showed aneusomy of the Locus 9p21 (p16), 6 (13%) aneusomy of chromosome 3 and 5 biopsies (12,5%) aneusomy of chromosome 7 and chromosome 17. In 4 patients, the FISH of
the control random biopsy was positive. One had an aneusomy of Locus 9p21 (p16), the other three had anuesomy also for chromosomes 3, 7 and 17. Conclusion:In our trial, over a third of the patients with a false-positive PDD finding already express chromosomal aberrations in these lesions
Renal stones composition in vivo determination: comparison between 100/Sn140 kV dual-energy CT and 120 kV single-energy CT
No full textThe objective of this study is to compare in vivo, the accuracy of single-energy CT (SECT) and dual-energy CT (DECT) in renal stone characterization. Retrospective study approved by the IRB. 30 patients with symptomatic urolithiasis who underwent CT on a second-generation dual-source scanner with a protocol that included low-dose 120 kV scan followed by 100/Sn140 kV dual-energy scan have been included. Stone composition was classified as uric acid, cystine or calcium oxalates, and phosphates according to attenuation values at 120 kV and to 100/Sn140 kV attenuation ratios and compared with the infrared spectroscopy analysis. 50 stones were detected in 30 patients. SECT correctly assessed stone composition in 52 % of the cases, DECT in 90 %. Sensitivity, specificity, positive predictive value, and negative predictive value in differentiating uric acid vs. non-uric acid stones were 0.94, 0.72, 0.64, and 0.96 for SECT and 1.00, 0.94, 1.00, and 0.96 for DECT, respectively. DECT significantly performs better than SECT in characterising renal stones in vivo, and may represent a useful tool for treatment planning
Evaluation of the M371-Test Under Real-life Conditions for Diagnosis and Follow Up of Testicular Germ Cell Tumors.
No full textBACKGROUND/AIM
The aim of the study was to establish the performance of the M371-Test on the Thermocycler Rotor-GeneQ (Qiagen) platform for diagnosis and follow-up of testicular tumors and to evaluate the test under real-life conditions in comparison to the classical markers alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-HCG) and lactate dehydrogenase (LDH).
PATIENTS AND METHODS
Forty-four patients, of median age 29 years (range=24-84) were included in this prospective study at our institution between March 2021 and September 2022. Of the 44 patients, 23 had a suspicion of testicular cancer (TC) and 21 were under follow-up for TC. In total, 96 M371-Tests were performed and compared with AFP, β-HCG, LDH using histological diagnosis and/or computer tomography (CT) scan as the gold standard.
RESULTS
In the patients with suspicion of TC, the M371-Test showed a sensitivity of 73.7%, AFP of 21%, LDH of 31.6% and β-HCG of 42.1%. In the patients under follow-up for TC, the M371-Test showed a sensitivity of 86.4%, AFP of 50%, LDH of 31.8% and β-HCG of 63.6%. In germ cell tumours (GCT)/non-seminomas, M371-Test had a sensitivity of 83.3%, AFP of 77.8%, LDH of 38.9% and β-HCG of 66.7%. In GCT/seminomas, M371-Test had a sensitivity of 85%, AFP of 5%, LDH of 30% and β-HCG of 50%.
CONCLUSION
Under real life conditions performed on the real-time Thermocycler Rotor-GeneQ (Qiagen) platform, the M371-Test shows an outstanding performance and is far beyond the sensitivity of the classical markers for detecting GCTs and in the follow-up of patients after GCT, especially in seminomas
90-Day Mortality after Radical Cystectomy for Bladder Cancer: Prognostic Factors in a Multicenter Case Series
No full textObjectives: To identify preoperative risk factors for 90-day mortality and to validate existing nomograms in a multicenter series of patients undergoing radical cystectomy (RC). Materials and Methods: We evaluated 90-day mortality in 475 patients following RC and urinary diversion at 2 Italian institutions and validated Aziz and Isbarn nomogram. Univariable logistic models assessed the predictive ability of operative volume, age at intervention, gender, body mass index, carcinoma in situ at transurethral resection of the bladder, American Society of Anesthesiologist (ASA) score, Charlson Comorbidity Index, clinical stage and pathological stage (TNM). Results: Of the total number of patients, 387 of them (81%) were male. The median age at RC was 71.8. The most frequent ASA score was 2 (53%). Twenty-five deaths occurred within 90 days (5.3%), all among patients who had undergone RC and incontinent urinary diversion. Risk was higher in patients with advanced disease (OR 2.4); moreover, 90-day mortality odd in 70-79-year-old patients was 13 times higher than those of younger patients (<70). Predictive accuracy using Isbarn's and Aziz's nomogram were 67 and 71%, respectively. Conclusions: Our multicenter study confirmed the moderate predictive value of the Aziz nomogram. Larger studies are needed to improve on existing nomograms with the aim of enhancing preoperative counseling
Diagnostic value of Xpert® BC Detection, Bladder Epicheck®, Urovysion® FISH and cytology in the detection of upper urinary tract urothelial carcinoma.
No full textPURPOSE
Following the current guidelines, diagnosis and staging for upper urinary tract tumours (UTUC) can be performed with Computed Tomography, urography, ureterorenoscopy (URS) and selective cytology. The aim of the study was to evaluate the performance of the Xpert®-BC-Detection and the Bladder-Epicheck®-test in the detection of UTUC and compare it with cytology and the Urovysion®-FISH test using histology and URS as gold standard.
METHODS
A total of 97 analyses were collected through selective catheterization of the ureter before URS to test for cytology, Xpert®-BC-Detection, Bladder-Epicheck® and Urovysion®-FISH. Sensitivity, specificity, and predictive values were calculated using histology results/URS as reference.
RESULTS
Overall sensitivity was 100% for Xpert®-BC-Detection, 41.9% for cytology, 64.5% for Bladder-Epicheck® and 87.1% for Urovysion®-FISH. The sensitivity of Xpert®-BC-Detection was 100% in both, LG and HG tumours, sensitivity of cytology increased from 30.8% in LG to 100% in HG, for Bladder-Epicheck® from 57.7% in LG to 100% in HG and of Urovysion®-FISH from 84.6% in LG to 100% in HG tumours. Specificity was 4.5% for Xpert®-BC-Detection, 93.9% for cytology, 78.8% for Bladder-Epicheck® and 81.8% for Urovysion®-FISH. PPV was 33% for Xpert®-BC-Detection, 76.5% for cytology, 58.8% for Bladder-Epicheck® and 69.2% for Urovysion®FISH. NPV was 100% for Xpert®-BC-Detection, 77.5% for cytology, 82.5% for Bladder-Epicheck® and 93.1% for Urovysion®FISH.
CONCLUSION
Bladder-Epicheck® and Urovysion®FISH along with cytology could be a helpful ancillary method in the diagnosis and follow-up of UTUC while due to its low specificity Xpert®-BC Detection seems to be of limited usefulness
Kenntnisse von deutschsprachigen Urologen zur Häufigkeit der Assoziation des Peniskarzinoms mit dem Humanen Papillomavirus – Survey-Ergebnisse der European PROspective Penile Cancer Study (E-PROPS)
No full textZusammenfassung
Hintergrund Gemäß einer aktuellen Metaanalyse zeigt in Europa jeder zweite Patient mit einem Peniskarzinom (PeK) eine Assoziation mit dem Humanen Papillomavirus (HPV). Es liegen keine Daten darüber vor, inwieweit UrologInnen die Häufigkeit dieser viralen Karzinogenese kennen.
Methoden Es wurde ein 14-Items umfassender deutschsprachiger Survey erstellt und in Q3/2018 einmalig an UrologInnen von 45 Kliniken in Deutschland (n = 34), Österreich (n = 8), der Schweiz (n = 2) und Italien/Südtirol (n = 1) verschickt. Insgesamt waren nach vorher definiertem Qualitätsstandard 557 Fragebögen auswertbar (mediane Rücklaufquote 85,7 %). In dem Survey wurde u. a. nach der Häufigkeit HPV-assoziierter PeK in Europa gefragt und 4 Antwortmöglichkeiten vorgegeben: (A)-„ 50 – 75 %“, (D)-„kein Wissen über die Häufigkeit des Zusammenhangs“. Es wurde in der Auswertung eine Toleranz von 50 % akzeptiert, sodass B und C (25 – 75 %) als korrekte Antworten gewertet wurden. Mittels eines Bootstrap-korrigierten multivariaten logistischen Regressionsmodells wurden Kriterien identifiziert, die unabhängig eine richtige Antwort der Befragten vorhersagten.
Ergebnisse Die Kategorien A – D wurden von 19,2 % (n = 107), 48,8 % (n = 272), 12,9 % (n = 72) bzw. 19 % (n = 106) als Antwort gewählt, sodass der Endpunkt von 61,8 % (n = 344) der UrologInnen erreicht wurde (B + C). Die selbstständige Durchführung der Chemotherapie durch die Urologische Klinik (OR 1,55; p[Bootstrap] = 0,036) und die Anzahl der urologischen Klinikbetten (OR 1,02; p[Bootstrap] = 0,025) waren die einzigen Studienkriterien, die signifikant das richtige Ergebnis prädizierten. Der Status einer Universitätsklinik (p = 0,143), eine leitende Position der UrologInnen (p = 0,375) bzw. die jährliche Anzahl behandelter PeK-Patienten (p = 0,571) blieben hingegen ohne signifikanten Einfluss auf den Endpunkt.
Schlussfolgerung Unsere Studienergebnisse zeigen, dass sich deutschsprachige Klinik-UrologInnen der Häufigkeit einer gegenwärtigen HPV-Assoziation des PeK nur unzureichend bewusst sind
Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes
No full textPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102130/1/bju12121.pd
How to teach the teacher to teach the TUR-B
No full textAbstractObjectivesWe report on our training program in teaching TUR of bladder tumours to seven trainees in two distinct periods. We analysed their problems and those from teachers and we present our solutions.Material and MethodsBetween April 2000 and April 2004 seven trainees performed 842 TUR of bladder tumours. In a prospective study we assessed intraoperative and immediate postoperative complications of the procedures and analysed their causes.ResultsIn 48 months 842 teaching TUR were performed. Six hundred and thirty-one patients (75%) were male and 211 (25%) were female. The average age was 63.4years (range 32–92) in the males and 67.3years (range 48–91) in the females. There were complications in 81 cases (6.1%). The most common complication was bleeding. It occurred in 47 cases (3.5%). The second most common complication was bladder perforation. It occurred in 18 cases (1.3%). All but one of the patients who experienced a bladder perforation were male and all but one of the perforations were extraperitoneal and could be managed in a conservative fashion.ConclusionThe standard of TUR is video-controlled resection. The procedure has to be standardised following a protocol to avoid incomplete resections. The trainee should start his TUR experience on middle sized prostates and once the first skills have been acquired he can start to resect bladder tumours in so called “safe areas”. The last step is then complete autonomy. To bring a trainee to this goal remains a challenge for each trainer
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