Genitourinary Organs Research Articles

Radical Nephrectomy for Renal Cell Carcinoma: Its Contemporary Role Related to Histologic Type, Tumor Size, and Nodal Status: A Retrospective Study.

Staging for renal cell carcinoma (RCC) depends on tumor size and the status of the regional lymph nodes. Although lymph node involvement by tumor yields the most accurate staging and prognostic information in patients with carcinomas of various genitourinary organs, the role of lymph node sampling (LNS) in patients with RCC to definitively establish nodal metastases remains unsettled. In this retrospective study of 399 patients with RCC treated by total nephrectomy, 115 cases were subjected to lymph node dissection. The corresponding primary tumors averaged larger than 8 cm. Twenty-nine showed positive lymph nodes (25%). The present review confirms that primary tumor size is a key indicator of nodal involvement. Clear cell and papillary tumors larger than 4 cm involve lymph nodes more commonly than other types of RCC. Sarcomatoid differentiation occurred in all major cell types and existed in numbers too few to predict the likelihood of nodal metastases. LNS in RCC for staging purposes may be warranted based on tumor size (>4 cm) as determined by imaging as well as histologic cell type, the latter suggesting a selective role for preoperative fine needle aspiration or core biopsy.

Focusing on organ preservation and function: paradigm shifts in the treatment of pediatric genitourinary rhabdomyosarcoma.

Pediatric genitourinary rhabdomyosarcoma (RMS) accounts for 25% of all pediatric soft tissue sarcomas. The treatment of these tumors has shifted over time from debilitating radical exenteration to organ-sparing techniques using multimodal therapy. Our review aims to summarize recent relevant literature regarding the current treatment practices of pediatric genitourinary RMS and how these practices have shifted over time. PubMed database search was utilized to identify relevant literature from 1997 to 2015 relating to the treatment of pediatric genitourinary RMS with emphasis on organ preservation and maintaining organ function. A total of 31 articles from 1997 through 2015 were identified relating to current management concepts in pediatric genitourinary sarcomas. Relevant articles were reviewed in detail and discussed. The treatment of pediatric genitourinary RMS has shifted from debilitating pelvic exenteration to a multimodal treatment approach involving surgery, chemotherapy, and radiation therapy in an effort to preserve genitourinary organs and reduce treatment morbidity. Continued research is required to improve post-treatment organ function. Further studies utilizing objective urodynamic evaluation are necessary to better characterize bladder function after treatment for RMS. Exciting recent developments in RMS research of fusion proteins that induce cell transformation and inhibit apoptosis and myogenic differentiation may result in future management changes to treatment protocols.

SILDENAFIL AND CHRONIC PROSTATITIS

Prostate stands in close anatomical and functional relations with urethra, genital glands and other pelvic organs. Inflammatory process in prostate is almost universally associated with inflammation in other genitourinary organs as well as sexual dysfunction, abnormal spermogram, psycho-emotional disorders and, in elderly men, with benign prostatic hyperplasia. Sildenafil (phosphodiesterase-5 inhibitor) is effective in the treatment of erectile dysfunction, testicular insufficiency and depression which may persist after the standard therapy of chronic prostatitis and is recommended as add-on to rehabilitation procedures after chronic prostatitis therapy.

Symptoms of Lower Urinary Tract Dysfunction Research Network

To address gaps in understanding and treating lower urinary tract symptoms, the NIDDK created the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN). The goals of LURN are to work collaboratively to 1) identify and explain the important subtypes of lower urinary tract symptoms; 2) improve the measurement of patient experiences of lower urinary tract symptoms; 3) disseminate novel findings to researchers, clinicians and patients; and 4) generate data, research tools and biological samples for future studies. As a first step in understanding subtypes of lower urinary tract symptoms, LURN will focus on disorders of urinary sensation (egurgency) and their causes. These are being examined with respect to patient experience, organism or systemic factors, genitourinary organs and tissues, andcellular/molecular factors. This is being achieved via an observational cohortstudy that is currently enrolling patients with lower urinary tract symptoms (target number 1,000) and that will extensively characterize patients with lower urinary tract symptoms. Future studies embedded within the observational cohort study will focus on neuroimaging and sensory testing, biomarkers and organ based factors. To advance the science of measurement of lower urinary tract symptoms, LURN is also developing and evaluating a comprehensive set of self-report questions to provide more granular assessments of lower urinary tract symptoms. LURN has taken its first steps by developing a framework for studying lower urinary tract symptom subtypes. In developing this framework, LURN is choosing an initial domain on which to focus (sensory experiences), and creating and executing protocols designed to improve measurement of self-reported symptoms and identify patient subtypes.

A Nationwide Survey in Japan of Palliative Radiotherapy for Bleeding in Gastrointestinal and Genitourinary Tumor Patients.

BackgroundIn end-stage cancer, bleeding may markedly influence the patient’s quality of life, and radiotherapy plays an important role in the control of the bleeding. In particular, there is no clear evidence of the benefit of palliative radiotherapy for cancers including gastric, rectal, and bladder cancers. A clarification of the current status of palliative radiotherapy for bleeding is needed.MethodsA survey was conducted by the palliative radiotherapy working group of the Japanese Radiation Oncology Study Group (JROSG), focusing on annual cases of radiotherapy for tumors of the upper and lower gastrointestinal tracts and genitourinary organs (excluding the uterus) and applicable fractionated doses for three hypothetical patients.ResultsA total of 54 radiation oncologists at 43 facilities answered. Most of the facilities reported that they conducted hemostatic irradiation for less than one patient per year, though the median annual number of patients treated with radiotherapy in these facilities was 594. The most frequently observed doses per fraction for two of the hypothetical cases were 3.0 and 2.0 Gy. On the other hand, in each case, the numbers of fractions reported varied markedly among the respondents, ranging from 20 Gy in five fractions to over 30 fractions.ConclusionsEspecially in gastric cancer, hemostatic irradiation is rarely performed in most facilities in Japan. An optimal dose fractionation has not been established. Thirty Gy in 10 fractions is one of the most frequently used regimens, but re-bleeding was observed in approximately one-third of the patients.

An Unusual Site of Acute Lymphoblastic Leukaemia Relapse: Challenge for Gynaecologists.

Secondary involvement of female genitourinary system [1, 2] is more common in lymphoma than leukaemia [3, 4]. In leukaemia, acute myeloid leukaemia (AML) is known to have extra medullary involvement (chloroma, granulocytic sarcoma, etc.) [5, 6]. In case of acute lymphoblastic leukaemia (ALL), except for CNS and testis other extra medullary sites are rarely involved [7, 8]. Amongst genitourinary organs, testis is the most common site of involvement in ALL [8]. Cases of ovarian and cervix involvement in ALL are limited to case reports only [9–13].

Self-Insertion of Metal Rods into Urethra

Numerous accounts of foreign objects, which sometimes defy imagination and include all types of objects, inserted into the urethra have been documented. The frequency of such cases renders these an important addition to the diseases of the genitourinary organs. Regardless of the motive for insertion, the extraction, can be challenging and requires creative deployment of the full armamentarium of the specialist. We report a 26 year old male with history of insertion of foreign objects into his urethra for sexual stimulation. Plain X-ray imaging revealed metallic rods within the urethra. The foreign bodies were extracted per-urethra under general anaesthesia with the use of cystoscopes and foreign body forceps. A urethral catheter was placed for 48 hours, and the patient voided well following its removal.

Trihalomethane exposure and biomonitoring for the liver injury indicator, alanine aminotransferase, in the United States population (NHANES 1999–2006)

Exposure to trihalomethanes (or THMs: chloroform, bromoform, bromodichloromethane, and dibromochloromethane [DBCM]) formed via drinking water disinfection has been associated with adverse reproductive outcomes and cancers of the digestive or genitourinary organs. However, few studies have examined potential associations between THMs and liver injury in humans, even though experimental studies suggest that these agents exert hepatotoxic effects, particularly among obese individuals. This study examined participants in the National Health and Nutrition Examination Survey (1999–2006, N=2781) to test the hypothesis that THMs are associated with liver injury as assessed by alanine aminotransferase (ALT) activity in circulation. Effect modification by body mass index (BMI) or alcohol consumption also was examined. Associations between blood THM concentrations and ALT activity were assessed using unconditional multiple logistic regression to calculate prevalence odds ratios (ORs) with 95% confidence intervals (CIs) for exposure among cases with elevated ALT activity (men: >40IU/L, women: >30IU/L) relative to those with normal ALT, after adjustment for variables that may confound the relationship between ALT and THMs. Compared to controls, cases were 1.35 times more likely (95% CI: 1.02, 1.79) to have circulating DBCM concentrations exceeding median values in the study population. There was little evidence for effect modification by BMI, although the association varied by alcohol consumption. Among non-drinkers, cases were more likely than controls to be exposed to DBCM (OR: 3.30, 95% CI: 1.37, 7.90), bromoform (OR: 2.88, 95% CI: 1.21, 6.81), or brominated THMs (OR: 4.00, 95% CI: 1.31, 12.1), but no association was observed among participants with low, or moderate to heavy alcohol consumption. Total THM levels exceeding benchmark exposure limits continue to be reported both in the United States and globally. Results from this study suggest a need for further characterization of ALT activity and possibly other hepatic or metabolic diseases in populations with elevated drinking water THM concentrations.

Penile metastasis of sigmoid colon carcinoma: a rare case report

BackgroundMetastasis to penis usually arises from genitourinary organs, but in rare cases, metastasis comes from the sigmoid colon. Furthermore, very few cases of penile metastasis of primary sigmoid colon carcinoma have been reported.Case presentationWe described a case of a 53-year-old man with penile metastasis of sigmoid colon carcinoma along with a review of the literature. Physical examination revealed two subcutaneous nodules on the glans penis. Biopsy of the nodules showed that penile metastasis of sigmoid colon carcinoma.ConclusionMetastasis of sigmoid colon carcinoma to the penis is extremely rare, which presents an advanced form of sigmoid colon carcinoma, therefore survival is extremely shortened. Although treatment of penile metastasis is almost always palliative, it is important to recognize this unusual manifestation so that timely appropriate treatment can be initiated. Early recognition may enhance survival rate of these patients.

Distinct genetic alterations in small cell carcinoma from different anatomic sites.

Small cell carcinoma (SmCC) is a distinct clinicopathological entity first described in the lung. It represents approximately 15% of all bronchogenic carcinoma. Extrapulmonary small cell carcinoma (EPSmCC) morphologically indistinguishable from small cell lung cancer (SCLC) was first reported in 1930. Since its first description, EPSmCC has been reported in virtually all anatomical sites, including: gynecologic organs (ovary and cervix); genitourinary organs (urinary bladder and prostate); the gastrointestinal tract (esophagus); skin (Merkel cell carcinoma) and head and neck region. Regardless of the anatomic sites, all SmCCs have similar, if not identical, histo-pathology features and immunohistochemical profile. SmCC is one of the most aggressive malignancies. The molecular mechanisms underlying its development and progression remain poorly understood. Herein, we reviewed the literature in SmCC in respect to its site of occurrence, clinical features, immunohistochemical characteristics. SmCCs have heterogeneous molecular mutations. Dinstinct genetic alterations associated with SmCC from different body sites were reviewed. Some genetic alterations such as RB1, TP53 are commonly seen in different origins of SmCC. Other genes with site specificity were also summarized, such as bladder SmCC with TERT promoter mutations; prostate SmCC with ERG translocations; ovarian SmCC with SMARCA4 mutations; Merkel cell carcinoma (skin) and cervical SmCC with Merkel cell polyomavirus (MCV or MCPyV) and human papillomavirus (HPV). Further studies are needed to employ a genetically oriented approach for the diagnosis and therapy of SmCC.

Trauma to the Pelvis: Injuries to the Rectum and Genitourinary Organs

Pelvic trauma is associated with high mortality rates. Blunt pelvic injuries from high-energy mechanisms are often associated with pelvic fractures and injuries to the rectum and genitourinary (GU) tract. In addition, due to close anatomic proximity, penetrating pelvic trauma can injure the bony pelvis, rectum, and GU tract concomitantly. As a result, the assessment and management of pelvic trauma requires a multifaceted approach involving orthopedics, trauma surgery and urology.

Ultrasound diagnosis of lymphoproliferative tumors in urologic oncology

Objective — to study the echographic semiotics of lymphoproliferative tumors in the presence of genitourinary system lesion. Material and methods. Forty-seven patients with non-Hodgkin lymphoma (NHL) and lymphogranulomatosis (LG) who had tumors in the genitourinary organs (kidney (n=30), testicle (n=5), adrenal (n=4), urinary bladder (n=3), ureter (n=2), prostate (n=2), and spermatic cord (n=1) were followed up. Results. The semiotics of the lesion in different genitourinary organs in lymphoproliferative diseases is described in detail. Conclusion. Ultrasound study yields significant information on organ tumor lesion in LG and NHL. The main signs suggesting the organ lesion are its unusual presentation; an inconsistency between significant visible changes and mild clinical manifestations; frequently multiple foci; and a very rapid progression of changes. The greatest difficulties arise in isolated focal organ lesion since the ultrasound image of each single visible nodule is virtually indistinguishable from that of a tumor of another morphological structure.

Syndromes that Link the Endocrine System and Genitourinary Tract.

The endocrine system and genitourinary tract unite in various syndromes. Genitourinary malignancies may cause paraneoplastic endocrine syndromes by secreting hormonal substances. These entities include Cushing`s syndrome, hypercalcemia, hyperglycemia, polycythemia, hypertension, and inappropriate ADH or HCG production. The most important syndromic scenarios that links these two systems are hereditary renal cancer syndromes with specific genotype/phenotype correlation. There are also some very rare entities in which endocrine and genitourinary systems are involved such as Carney complex, congenital adrenal hyperplasia and Beckwith-Wiedemann syndrome. We will review all the syndromes regarding manifestations present in endocrine and genitourinary organs.

Pilar Leiomyoma Located on the Back: A Case Report

Leiomyoma is a benign tumour commonly encountered in the genitourinary and gastrointestinal organs in adults. Cutaneous leiomyomas are rare benign tumors arising from the arrector pili muscle of hair follicles. Cutaneous leiomyomas are more likely to occur in adults than in children. We describe a case of a 30-year-old male who presented with skin-coloured masses on the back. A punch biopsy was performed. Under high-power examination, spindle cells with an eosinophilic cytoplasm were observed and immunohistochemical studies were performed; the cells stained strongly positive for smooth muscle actin (SMA). The patient was subsequently diagnosed with pilar leiomyoma and referred to a plastic surgeon for surgical treatment. A careful clinical assessment led to the correct diagnosis and therapy in the present case.

Pathophysiology of lower urinary tract dysfunction in the older patient

Understanding the pathophysiology of lower urinary tract dysfunction in the elderly is necessary for the adequate management of lower urinary tract dysfunction, as aging causes anatomical and functional changes in the lower urinary tract. While epithelium atrophy of genitourinary organs and detrusor muscle changes occur in elderly women, due to estrogen decline, prostate enlargement may lead to bladder outlet obstruction and wall thickening in elderly men. Urodynamic changes that occur with aging include bladder outlet obstruction, detrusor overactivity and underactivity, decreased bladder compliance, and detrusor hyperactivity with impaired contractility. Moreover, impaired mobility, central nervous system diseases, non-genitourinary comorbidities, and various medications can also influence lower urinary tract function. Among these age-associated multifactorial conditions, adequate differentiation and management of the factors responsible for lower urinary tract dysfunction is of paramount importance in elderly patients.

Sports-related genitourinary injuries presenting to United States emergency departments.

To describe epidemiologic features of sports-related genitourinary (GU) injuries and determine patient cohorts and particular sporting activities associated with increased GU injury risk. The National Electronic Injury Surveillance System, a data set validated to provide a probability sample of injury-related US emergency department (ED) presentations, was analyzed to characterize GU injuries between 2002 and 2010. A total of 13,851 observations were analyzed to derive national estimates. Between 2002 and 2010, an estimated 137,525 individuals (95% confidence interval, 104,490-170,620) presented to US EDs with GU injuries sustained during sporting activities. Nearly three-quarters of injuries occurred in the pediatric population. The most common product involved was a bicycle, representing approximately one-third of injuries in both adult and pediatric populations. Injuries related to team sports such as football, baseball or softball, basketball, and soccer were also common, particularly among boys where they represented a combined third of all injuries. Eighty-nine percent of all patients were evaluated and treated in the ED without inpatient admission. The large majority of injuries involved the external genitalia (60%), and significant injuries of paired GU organs (kidneys and testicles) requiring inpatient admission were rare (8.5%). Sports-related GU injuries are most commonly sustained during the use of a bicycle. However, there are other associated activities with identifiable high-risk cohorts, products, and situations. Consumers, practitioners, and injury-prevention experts can use our epidemiologic data to prioritize and develop strategies aimed at the prevention and limitation of such injuries, particularly when counseling at-risk cohorts, such as those with solitary kidneys or testicles.

Algunos casos de malformaciones congénitas de los órganos genitales de la mujer

Las malformaciones de los órganos genito urinarios de la mujer, objeto de este trabajo, comprenden el estudio de particularidades irregulares que pueden ser consideradas no solamente como separándose de la regla general, sino también como trastornándola y siendo además más o menos peligrosa para la salud de quien las lleva.

Testosterone alters testis function through regulation of piRNA expression in rats.

Piwi-interacting RNAs (piRNAs) play a role in gene silencing of retrotransposons, maintenance of spermatogenesis and maturation in germlines. The piRNA and PIWI protein are essential for fertility. To reveal piRNA function associated with testosterone, we investigated the expression of piRNA and piwi protein in normal male rats and testosterone-treated rats. Normal Sprague-Dawley (SD) rats were randomly selected and sacrificed at neonatal to late adolescence stage stages (2, 9, 16, 20, 24, 28, 35, and 42 days, n = 6 each). Additional SD rats were divided into four groups: group 1 received weekly injections of testosterone enanthate (8 mg/100 g) during 1-3 weeks; group 2 during 3-5 weeks; group 3 during 1-5 weeks; and group 4 was the control (n = 20 each). These animals were sacrificed at an age of 60 days. We investigated piRNA, PIWI, and Ago3 protein levels using real-time PCR, Western blot, and immunohistochemistry in each group. In normal rats, PIWI protein and piRNA were expressed at P24. The expression of PIWI and piRNA gradually increased from adolescence to adulthood on Western blot, real-time PCR and immunohistochemistry. In testosterone-treated rats, the expression of PIWI protein was analyzed by Western blot and shown to be significantly increased in group 1 (neonatal to juvenile injection). In real-time PCR, the expression of piRNA after testosterone treatment was increased in all groups (G1 166.8 ± 2.7; G2 113.3 ± 4.6; G3 70.2 ± 1.5 vs. control, 32.87 ± 2.0, all p < 0.001). The expression of testosterone in adolescence induces the development of male genitourinary organs and spermatogenesis. At the same time, the sexual hormones may activate the piRNA and PIWI protein. Our data demonstrate that patterns of piRNA and PIWI expression are similar to the secretion pattern of testosterone, and that piRNA expression was increased after testosterone treatment. Therefore, testosterone may affect testis function through the regulation of piRNA expression in rats.

PD20-03 TWO-YEAR EXPERIENCE WITH TRANSSCROTAL HIGH SUBMUSCULAR PLACEMENT OF UROLOGIC PROSTHETIC BALLOONS AND RESERVOIRS

INTRODUCTION AND OBJECTIVES: The true reoperation rate of penile prosthetic surgery is unknown due limited data from retrospective, single institution studies. This study aims to evaluate the reoperation rate after virgin penile prosthetic surgery using a large population database METHODS: A longitudinal analysis of California Office of Statewide Health Planning and Development database from 1995 to 2010 was performed. Inclusion criteria were men who underwent their first penile prosthetic surgery. Patients were excluded if they had an explant of a prior prosthesis at the time of their first recorded surgery. Primary outcome was reoperation, specified as the removal or replacement of the prosthesis. Censoring events included penile amputation, surgeries of the genitalia or pelvis, and cancer involving the genitourinary organs. Statistical analysis was performed via KaplanMeier plot, hazard curve, and multivariate analysis adjusting for age, race, gender, comorbidities, insurance status, hospital volume and teaching status RESULTS: 7,666 patients (40,932 patient years) were included in the study. The 5 and 10-year cumulative reoperation rates were 11.2% (CI: 10.5-12.0%) and 15.7% (CI: 14.7-16.8%) respectively. Malfunction and infection accounted for 57% and 27% of reoperations. Reoperation rate was highest at 1 year post-operatively (3.4% per year), and steadily declined until 2 years post-operatively, after which it remained at roughly 1.25% per year. Multivariate analysis showed higher rates of reoperation among younger patients (HR1⁄41.51, CI: 1.122.05 for 75yo), African American patients (HR1⁄41.30, CI: 1.05-1.62), and Hispanic patients (HR1⁄41.32, CI: 1.121.57). 22.9% of the reoperations were performed at a hospital different from the initial implantation CONCLUSIONS: Reoperation rate for penile prosthetic surgery is highest in the first year postoperatively. The patients with highest risk for reoperation are African American, Hispanics, and younger age for unclear reasons that warrant further study. Nearly a quarter of reoperations occur at a hospital different from the initial surgery, suggesting that existing literature does not reflect the true prevalence of penile prosthetic complications

PD20-02 REOPERATION OF PENILE PROTHETIC SURGERY: A LONGITUDINAL ANALYSIS OF CALIFORNIA POPULATION DATABASE

INTRODUCTION AND OBJECTIVES: The true reoperation rate of penile prosthetic surgery is unknown due limited data from retrospective, single institution studies. This study aims to evaluate the reoperation rate after virgin penile prosthetic surgery using a large population database METHODS: A longitudinal analysis of California Office of Statewide Health Planning and Development database from 1995 to 2010 was performed. Inclusion criteria were men who underwent their first penile prosthetic surgery. Patients were excluded if they had an explant of a prior prosthesis at the time of their first recorded surgery. Primary outcome was reoperation, specified as the removal or replacement of the prosthesis. Censoring events included penile amputation, surgeries of the genitalia or pelvis, and cancer involving the genitourinary organs. Statistical analysis was performed via KaplanMeier plot, hazard curve, and multivariate analysis adjusting for age, race, gender, comorbidities, insurance status, hospital volume and teaching status RESULTS: 7,666 patients (40,932 patient years) were included in the study. The 5 and 10-year cumulative reoperation rates were 11.2% (CI: 10.5-12.0%) and 15.7% (CI: 14.7-16.8%) respectively. Malfunction and infection accounted for 57% and 27% of reoperations. Reoperation rate was highest at 1 year post-operatively (3.4% per year), and steadily declined until 2 years post-operatively, after which it remained at roughly 1.25% per year. Multivariate analysis showed higher rates of reoperation among younger patients (HR1⁄41.51, CI: 1.122.05 for 75yo), African American patients (HR1⁄41.30, CI: 1.05-1.62), and Hispanic patients (HR1⁄41.32, CI: 1.121.57). 22.9% of the reoperations were performed at a hospital different from the initial implantation CONCLUSIONS: Reoperation rate for penile prosthetic surgery is highest in the first year postoperatively. The patients with highest risk for reoperation are African American, Hispanics, and younger age for unclear reasons that warrant further study. Nearly a quarter of reoperations occur at a hospital different from the initial surgery, suggesting that existing literature does not reflect the true prevalence of penile prosthetic complications