The Journal of Urology
Volume 178, Issue 3 , Pages 739-740, September 2007

This Month in Clinical Urology

Received 15 May 2007 published online 18 July 2007.

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Risk Factors for Mortality in Patients with Emphysematous Pyelonephritis 

Falagas et al (page 880) from Athens, Greece performed a meta-analysis to determine the factors associated with mortality in patients with emphysematous pyelonephritis. They identified 7 study cohorts representing 175 patients. The overall mortality rate was 25%. Type 1 emphysematous pyelonephritis, bilateral disease and thrombocytopenia were all risk factors for fatal outcome. They also identified conservative treatment as a risk factor for mortality, although interestingly, diabetes mellitus was not a risk factor. (CME credit article)

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Pathological Features After Radical Prostatectomy in Potential Candidates for Active Monitoring 

Griffin et al (page 860) from Chicago, Illinois evaluated pathological features in a contemporary radical prostatectomy series. Of 455 patients with biopsy Gleason grade 3+3 cancers, 292 had low volume disease on the basis of 2 or fewer positive cores. Of these men 245 (84%) were proven to have organ confined disease after radical prostatectomy. Gleason score up grading was observed in 27% of patients while 8% had extracapsular extension and 10% had positive surgical margins. The authors concluded that preoperative variables were not reliable predictors of adverse pathological features and that disease in men with low volume Gleason 3+3 prostate cancer is frequently under staged.

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Chromogranin a Expression in Hormone Naïve Prostate Cancer Predicts Development of Hormone Refractory Disease 

Berruti et al (page 838) from Torino, Italy assessed chromogranin A (CgA) as a tissue biomarker in prostate needle biopsies or as a plasma biomarker. They evaluated 211 patients and segregated them by CgA expression in less than 30% or in more than 30% of tumor cells. Higher CgA expression was significantly associated with a shorter time to development of hormone refractory disease on multivariate analysis, and plasma CgA levels were predictive as well. (CME credit article)

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Changes in Levator Ani Anatomical Configuration Following Physiotherapy for Stress Urinary Incontinence 

Dumoulin et al (page 970) from Montreal, Quebec quantified the effect of pelvic floor muscle training on the anatomical configuration of the levator ani muscles. Using magnetic resonance imaging they identified an increase in levator ani surface retraction during a voluntary contraction after physiotherapy as well as a reduction in synthesis pubis movement. The authors concluded that these results provide insight into the possible anatomical mechanisms through which physiotherapy enables the pelvic floor muscles to minimize urine leakage. (CME credit article)

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Radical Radiotherapy for PT1G3 NXM0 Transitional Cell Carcinoma of the Bladder 

In a multicenter, randomized trial in the United Kingdom, Harland et al (page 807) assessed the role of radiotherapy in the treatment of patients with stage T1, grade 3 urothelial carcinoma of the bladder. A total of 210 patients were randomized to radiotherapy plus intravesical bacillus Calmette-Guerin or mitomycin, or to intravesical therapy alone. Of the patients 32% had progression to muscle invasive disease and 15% of the entire group died of bladder cancer. There was no evidence that radiotherapy reduced the rate of progression to muscle invasive disease. Therefore, the authors concluded that radiotherapy is not an appropriate adjuvant treatment for T1 grade 3 bladder cancer.

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Long-Term Followup After Elective Testis Sparing Surgery for Leydig Cell Tumors 

Testis sparing surgery is increasingly being considered for select testis tumors. Giannarini et al (page 872) from Pisa, Italy retrospectively reviewed a series of 14 men who underwent tumor enucleation and testis sparing surgery for Leydig cell tumors. The diagnosis was confirmed intraoperatively by frozen section examination in all patients. With a mean followup of 91 months no patients have experienced local recurrence or distant metastasis. (CME credit article)

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Complications of Laparoscopic Surgery for Urological Cancer 

A total of 1,867 laparoscopic procedures for genitourinary malignancies were reviewed by Colombo et al (page 786) from Cleveland, Ohio. The most common complication was intraoperative (2.3%) or postoperative (2.7%) hemorrhage. The all cause perioperative mortality rate was 0.4%. On multivariate analysis radical cystectomy and partial nephrectomy were independent risk factors for perioperative complications.

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Factors Influencing the Outcome of Mid Urethral Sling Procedures for Female Urinary Incontinence 

Paick et al (page 985) from Seoul, Korea, reported on 464 women undergoing tension-free vaginal tape (TVT) or transobturator tape (TOT) procedures for urinary incontinence. Bladder perforations occurred in 4.8% of the TVT group and in none who underwent the TOT procedure. Urinary retention also occurred significantly more frequently in the TVT group. However, the overall cure rate was significantly higher in the TVT group than the TOT group (92.1% versus 84.9%, p=0.015). On multivariate analysis comorbid disease, urgency, incontinence and severe cystocele grade were independent risk factors for persistent stress incontinence.

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Serum Bone Turnover Markers for the Early Detection of Bone Metastases in Patients With Prostate Cancer 

An increase in bone turnover markers (PINP and ICTP) may predict bone metastasis in men with prostate cancer, but it can also reflect the effects of androgen deprivation treatment. Koopmans et al (page 844) from Groningen, The Netherlands evaluated archived serum samples from 64 patients with prostate cancer. Increased PINP levels were detectable 8 months before the first evidence of metastasis on bone scan. Thus, measurement of serum PINP and ICTP is useful for the early assessment of skeletal metastasis in patients with prostate cancer regardless of the confounding role of androgen deprivation therapy. (CME credit article)

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Effects of 4-Hydroxy-2-Nonenal on Spermatogenesis and p53 Expression in Male Infertility 

The presence of oxidative stress in the human testis was evaluated by Shiraishi and Naito (page 1012) from Yamaguchi, Japan by studying the generation of 4-hydroxy-2-nonenal (4-HNE) modified proteins, and expressions of proliferating cell nuclear antigen and p53. 4-HNE modified proteins were strongly positive in spermatogonia and primary spermatocytes, and inversely correlated with proliferating cell nuclear antigen expression. p53 expression was increased in the presence of varicocele and obstructive azoospermia. The authors concluded that 4-HNE impairs the proliferation of germ cells through the up-regulation of p53, and that modification by 4-HNE might alter the normal function and stabilization of p53.

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Book Reviews 

On page 1126 Lotan reviews Urology and the Law: Lessons from Litigation and Sosa reviews Minimally Invasive Procedures in Urology.

PII: S0022-5347(07)01448-6

doi:10.1016/j.juro.2007.05.177

The Journal of Urology
Volume 178, Issue 3 , Pages 739-740, September 2007

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