Mucinous aenocarcinoma is one of the least common variant of prostate cancer. The prognosis of this variant of prostate cancer remains controversial. We report the case of 67-year old men with severe lower urinary tract symptoms (LUTS), bladder outlet obstruction (BOO), and sense of urinary retention. The serum level of prostate specific antigen (PSA) was 10.4ng/mL. Prostate was large (56mL), hard, lobulated, with extraprostatic extension and infiltration of surrounding structures, unsuitable for radical operative treatment. The patient demonstrated poor response to complete androgen blockade (CAB) (bilateral orchiectomy, steroidal antiandrogen) after 6 months of treatment with minimal decline of PSA (7.1ng/mL) and progressive growth of the primary tumor (110mL). The patient is submitted to antiandrogen withdrawal consisted of simultaneous addition of ketoconazole with hydrocortison substitution, resulting in normalisation of PSA (<1.0ng/mL) and diminution of prostate volume (PV) (63 mL) after 2 months, followed by adjunctive radiotherapy. Ketoconazole in reduced doses was stopped 6 months after completion of radiotherapy with PSA level < 0.002ng/mL and PV 16mL. The patient is alive with no evidence of disease more than 9 years after diagnosis of primary tumor. This case demonstrated modest hormonal sensitivity of mucinous adenocarcinoma of the prostate, whereas ketoconazole combined with radiotherapy, resulted in long term survival.

The biological potential of teratoma remains unpredictable, therefore identifying its presence in the retroperitoneum remains important. We evaluated patients undergoing post-chemothe rapy retroperitoneal lymphadenectomy (PC-RPLA) for nonseminomatous testicular tumors (NSTT), to determine predictors of teratomatous elements in the retroperitoneum. We identified 161 patients from 1982 to 2005 who underwent PC-RPLA for metastatic NSTT. Multiple clinical and pathological variables were reviewed from out RPLA database. Of the 161 patients in our series, 112 (70%) received only induction chemotherapy and 49 (30%) required 2nd line chemotherapy. Studies of retroperitoneal pathology demonstrated the presence of fibrosis in 44 (27%), teratoma in 82 (51%) and vital carcinoma in 35(22%).Among 82 patients (51%) with finding of teratomatous elements at PC-RPLA, we revealed the presence ofmature teratoma in 85%, immature teratoma in 12% and teratoma with malignant transformation in 3%. Of the 99 patients (61%) with teratomatous elements in the primary NSTT, 61 (62%) had teratoma at PC-RPLA. Even in the absence of teratoma in the primary NSTT, teratoma was present in the retroperitoneum in 21 of 62 patients (32%)(p<0.0001). All patients had normal values of serum tumor markers (STM) at PC-RPLA. Post-chemotherapy retroperitoneal residual mass measuring <2 cm, from 2.1-5.0 cm and > 5 cm in diameter occured in 30%, 52% and 55%, respectively. By multivariate analysis , teratoma in the orchiectomy specimen (p<0.005), relative change in nodal size before and after chemotherapy (p<0.005), and no requirement for 2nd line chemotherapy (p=0.33) were independent predictors for the presence of the teratoma in the retroperitoneum. Teratoma remains a common histologic finding in the retroperitoneal lymph nodes following chemotherapy. We have identified several pre-RPLA variables that predict the finding of teratoma in the retroperitoneum for men treated with chemotherapy for metastatic NSTT.

Sredovečni muškarac često ima simptome donjih partija urotrakta (SDPU) kao posledice benignog uvećanja prostate (BUP). Korelacija između metaboličkog sindroma (MS) i SDPU ostaje predmet debate. Ova studija ima za cilj da ispita uticaj MS na SDPU kod sredovečnih muškaraca imali opšti lekarski pregled. Svi pacijenti su podeljeni u 2 grupe u zavisnosti od prisustva 3 ili više faktora rizika uključujući povišen krvni pritisak, obim struka, glikemiju,HDL holesterol i trigliceride. Volumen prostate (VP), određen pomoću transrektalnog ultrazvuka, i nivo prostata specifičnog antigena (PSA) su upotrebljeni za podgrupnu analizu, uključujući odredjivanje ukupnog Internacionalnog Prostata Simptom Skora (IPSS), sa iritativnim i opstruktivnim skorom, kao i ocenu kvaliteta života. Tri stotine pedeset četiri muškarca, srednje starosti 55.6 ± 9.71 godina, su uključeni u studiju. U zavisnosti od navedenih kriterijuma za MS, 108 (30.5%) je imalo MS i predstavljalo je studijsku grupu, dok je 246 (69.5%) MS-negativnih muškaraca formiralo kontrolnu grupu. Antropometrijski indeksi, metabolički parametri i učestalost arterijskie hipertenzije su bili veći kod grupe sa MS u odnosu na grupu bez MS (p<0.0001). Grupa sa MS (7.89 ± 6.63 prema 6.85 ± 6.52) je imala manju srednju vrednost ukupnog IPSS, manju slabost mlaza urina pri mokrenju (1.24 ± 1.60 prema 0.95 ± 1.50, p= 0.021) i manji stepen IPSS gradiranja (p=0.014). Kod većeg VP (> 30 mL), ukupni IPSS, iritativni i opstruktivni skor, urgentni pozivi na mokrenje i nepotpuno pražnjenje bešike su bili manje izraženi kod grupe sa MS (p<0.05). U grupi sa višim prostata specifičnim antigenom (PSA) (> 0.93 ng/ mL), muškarac sa MS je imao značajno niži IPSS, opstruktivni skor, nepotpuno pražnjenje mokraćne bešike i slab mlaz. Negativna povezanost izmedju iritativnih i opstruktivnih smetnji, intenzitet SDPU i MS postaje naročito izražena sa povećanjem broja faktora rizika MS (p<0.0001). Odnos šanse (OŠ) za umeren i izražen SDPU je bio signifikantno manji kod muškaraca sa 3 (OŠ 0.61; 95% interval poverenja (IP) 0.40-0.94) ili 5 (OŠ 0.32; 95% IP 0.11-0.95) faktora rizika. Muškarci u grupi sa MS imaju manju verovatnoću da imaju umeren do žestok skor SDPU (OŠ 0.58; 95% IP 0.41-0.83). Studija je pokazala da MS ima povoljan efekt na SDPU, uključujući iritativne i opstruktivne simptome kod zdravih sredovečnih muškaraca. Beneficirajući efekat je bio najizraženiji kod muškaraca sa uvećanom prostatom i/ili višim vrednostima PSA.

Postoji relativno malo podataka u literaturi koji imaju za cilj procenu korelacije između kvaliteta ishrane i simptoma donjih partija urotrakta (SDPU). Cilj ove studije je da proceni povezanost izmedju kvaliteta ishrane i SDPU. Naša hipoteza je bila da je izbalansirana zdrava ishrana udružena sa manjom učestalošću SDPU. Studija obuhvata 852 pacijenata starosti >40 godina od kojih je 724 (85%) kompletiralo urinarni upitnik. Primenjena je bivarijantna analiza da se ispita stepen SDPU kod pacijenata sa dobrom i lošom ishranom. Multivarijantna regresiona analiza je primenjena da se proceni uticaj demografskih faktora kod pacijenata sa ili bez SDPU u zavisnosti odgodina starosti, pušenja, dijabetesa, konzumiranja alkohola, gojaznosti i fizičke aktivnosti. Pošto smo isključili iz analize 31 pacijenta sa karcinomom prostate, naša studija je obuhvatala 693 muškaraca od kojih je 139 (20%) imalo najmanje jedan simptom indikativan za SDPU (63 iritativne, 46 opstruktivne i 30 oba simptoma). Veća verovatnoća za pojavu SDPU je postojala kod seoske populacije (p<0.0001), nepušača (p<0.0001), dijabetičara (P<0.0001), starijih muškaraca (p<0.0001), sa višim PSA (p<0.0001) i dijagnozom uvećanja prostate (p<0.0001). Umerena i intenzivna fizička aktivnost i unos alkohola su bili češće zastupljeni kod muškaraca bez SDPU (p<0.0001). Nadjena je veća učestalost SDPU kod muškaraca sa malim unosom mlečnih proizvoda (22.4%:16.4%) (p=0.0013), oskudnim unosom proteina (24.6%:17.9%)(p=0.012), generalno lošom ishranom (28.2%:17.8%) (p=0.012) i malom raznolikošću ishrane (26.1%:17.6%) (p=0.001). Multivarijantna analiza je pokazala da nezdrava ishrana, seoska populacija i stariji muškarciimaju veći rizik za pojavu SDPU, dok je unos alkohola imao protektivno dejstvo na SDPU.

The histologic finding of teratoma occures in aproximately 40% of all postchemotherapy retroperitoneal lymphadenectomy (PC-RPLA) for disseminated nonseminomatous testicular tumors (NSTT). We evaluated patients undergoing PCRPLA for teratoma to determine risk factors for recurrence and clinical outcome. Among a survey of 193 patients submitted to PC-RPLA due to metastatic NSTT from 1980-2005, we identified 82 patients (42%) who were found to have only teratoma in the retroperitoneum. Sixty-seven patients (82%) received only induction cisplatin-based chemotherapy, and 15 (18%) required 2nd line chemotherapy. PC-RPLA histology revealed mature teratoma (MT) in 86%, immature teratoma (IMT) in 12% and teratoma with malignant transformation (TMT) in 2%. Sixteen patients (19%) relapsed within median free interval of 22 months. Among 13 patients submitted to redoRPLA, discordant histology occurred in 6 patients (46%) (2 TMT, 4 viable germ cell tumors [GCT]), all with worst histology in comparison to primary RPLA. One relapsing patient with only elevated serum tumor markers (STMs) achieved complete response with chemotherapy alone. Two patients relapsed at 21 and 74 months with widespread metastasis and died despite salvage chemotherapy. Seven of 13 patients (54%) who were rendered free of disease (FOD) with redo-RPLA, relapsed again. All but one died despite salvage treatment (2 of chemotherapy related toxicity) within mean survival time (MST) of 86.7+/-26.1 (95% confidence interval [CI], 98.79- 149.21). At mean follow-up (MFU) of 135+/-62.6 months (95% CI, 98.79-149.21), alive and free of disease (AFD) are 90% patients. The probability of being reccurence-free at 5- and 10- year was 87% and 81%, respectively. The 5- and 10- year probability of disease speciphic survival (DSS) were 98% and 89%, respectively. On multivariate analysis residual mass size (p<0.005) and worse IGCCCG risk group (p=0.01) predicted disease recurrence. Patients with residual teratoma after PC-RPLA continue to exibit a 19% risk of recurrence even 10 years after RPLA, with 46% recurrence being with worse histology. These data support that these patients should undergo long-term surveillance of their retroperitoneum in the setting of a large residual mass or elevated IGCCCG classification risk.

This sudy is performed to determine disease related outcome in metastatic nonseminomatous germ cell testicular tumors (NSGCTTs) in patients with absence of viable cancer (VC) in the postchemotherapy retroperitoneal lymphadenectomy (PC-RPLA) specimen and determine wheter clinical variables can help predict disease progression Among a survey of 163 patients submitted to PC-RPLA from 1980-2005, 126 patients (77%) had no VC (44 fibrosis, 82 teratoma). At mean follow-up (MFU) of 158+/-77.7months, 20 patients (16%) developed recurrences within median free interval of 19.3 montha, with complete response (CR) following applied therapy in 9 patients (45%). Eleven patients (8%) diead (8 of disease, 3 of' other causes). Predictors for poorer recurrence free survival (RFS) were advanced clinical stage (CS) (P<0.016), intermediate/ poor IGCCCG group (p<0.004), and PC-RPLA nodal size (p<0.0007), while for disease-speciphic survival (DSS) included recurrences (p<0.0001), PC RP residual mass (RM) diameter ((p<0.006), worse IGCCCG risk (p<0.0003) and increased HCG at PC-RPLA (p<0.0001). A subset analysis of potential predictors of poorer RFS in patients with fibrosis identified only worse IGCCCG risk (p=0.05), whereas in teratoma were worse IGCCCG risk classification (p=0.01), PC RP RM size (p<0.0005) and unfavorable histology (teratoma with malignant transformation [TT] vs. mature teratoma [MT]/immature teratoma [IMT]Xp<0.0001). Adverse impact on DSS in fibrosis had elevated HCG on PC-RPLA (p<0.013) and in teratoma the presence of unfavorable IGCCCG risk (p<0.0001), worse RP histology (p<0.05) and postoperative recurrence (p<0.0001). The 5-year DSS and RFS rates for all patients with no VC at PC-RPLA were 87% and 85%, while at 10-year were 79% and 75%, respectively (Log rank=13.155; p<0.003). Patients with no VC at PC-RPLA remain at risk of recurrence. Several clinical variables, including CS, intermediate/poor IGCCCG group, preoperative HCG level, diameter of RP RM and postoperative recurrence help better to define which patients are at risk of disease recurrence and survival; as such these patients should be followed regularly in the postoperative period.

The aim of this study is to examine how the introduction of medical therapy for symptomatic benign prostatic hyperplasia (BPH) might have changed the indications, patient characteristics and outcome in men undergoing transurethral resection of the prostate (TURP) over two decades (1991.- 2011.). All patients who underwent TURP for symptomatic BPH at our institutions in 1991. (before the introduction of medical therapy for BPH), 2001. (when medical therapy was becoming an important therapy for BPH) and 2011. (when medical therapy was the first line therapy for BPH), were reviewed. We assessed the total number of TURPs, indications for surgery, patient age, health status, weight of resected tissue, and pre and post-operative events/ complications. Our institutions provided primary urological care for 989, 1815 and 2162 men > 50 years of age in 1991., 2001. and 2011., respectively. There was a 60% decrease of TURPs from 1991. to 2011. with a slight increase in number in 2001. Failure of medical therapy was not an indication in 37% and 88% of patients in 2001. and 2011., respectively. There was a substantial rise in the percentage of men at risk presenting with acute or chronic retention (AUR and CUR) at the time of their TURPs ( from 23% in 1991. to 55% in 2001. and from 14% in 1991. to 38% in 2011. for AUR and CUR, respectively) (P<0.05). There was also rise in the percentage of patients presenting with preoperative hydronephrosis (2% in 1991., 13% in 2001. and 6% in 2011.) (P<0.05) and gradual decrease of UTI before TURP overtime (14%, 10% and 12%, respectively).The mean operative time was lower in 2011., compared with either of the two previous cohorts (P<0.05), postoperative stays decreased (from 4.1 days in 1991. to 2.7 days in 2001. and 2.1 days in 2011.)(P<0.05), but the number of patients discharged with catheter increase over two decades (from 3.5% in 1991 to 4.8% in 2001., and to 8.8% in 2011.)(P<0.05). The postoperative complications of our three cohorts differed significantly (14% in 1991., 6.4% in 2001. and 20.6% in 2011.)(P<0.05). The increasing use of medical therapy as a first line treatment for BPH has resulted in a dramatic decrease in TURPs which, in turn, has been associated with an apparent increase in risk of poor pre- and postoperative outcomes seems to be related to earlier catheter removal and hospital discharge, although a causal relationship cannot be established. The present study covering the last two decades would suggest that we are not delaying surgery for patients who will eventually require it. We are now selecting the appropriate patients for TURP, rather than using TURP as our only means of BPH therapy as we did two decades ago.

The aim of the present study is to prospectively investigate the presentation of germ cell testicular tumors (GCCTs) in terms of clinical stage (CS) or histology, as the incidence of this malignancy in increasing. Patients diagnosed with GCTTS between 1976 and 2005 were categorized into 3 period depending on date of diagnosis of GCTTs and presentation characteristics assessed. For purpose of analysis patients were assigned into 1 of 3 similar groups in term of duration (10 years) (1976-1985, 1986-1995, 1996-2005). These 3 periods were compared statistically to identify the possible changes in the presentation of GCTTs. Among 1935 patients, the number diagnosed in each period was 111 (6%), 695 (36%) and 1129 (58%), respectively. There was substantial rise in the percentage of patients with GCTTs during the period of 30 years, particularly in 3rd vs. 2nd and 1st decade (P<0.0001). Overall, 46% of patients were diagnosed with seminoma and 54% with nonseminoma. The greater proportion of the entire cohort of patients presented in CS I (65%). Also, seminoma and nonseminoma occurred more frequently in CS I (78% and 51%, respectively). The median (range) age of the whole cohort of patients was 34 (14-80) years. The median age for developing metastatic seminoma was 4 years more than in CS I disease (38 vs. 42 years, respectively), while the median age for the presentation of CS I and metastatic nonseminoma was identical (31 years). The proportion of seminoma increased significantly in time (40% vs 55%) and this was accompanied by a significant decrease of nonseminoma (60% vs. 45%)(P<0.001). The proportion of patients in CS I disease also increased significantly with time (45% vs. 77%), while the proportion of patients with metastatic disease decreased (55% vs. 23%)(P<0.001). There was a significant rise in proportion of patients with CS I seminoma (27% vs. 47%) (P<0.001) and nonseminoma (18% vs. 30%) (P<0.001), accompanied by a significant decrease in the proportion of patients presenting with metastatic nonseminoma (46% vs. 15%)(P<0.0001). However, the proportion of patients with metastatic seminoma remained largery unchanged (13% vs. 9%). The present study shows a progressive increase of GCTTs during the observation period of 30 years, with increase in the proportion of patients with GCTTs confined to the testis, as opposed to metastatic disease. The other finding is that there has been an increase in the proportion of patients presenting with seminoma rather than nonseminoma. The reason for this remain unclear and require further investigation.

We compared the safety and efficacy of transurethral vapor resection (TUVRP) and transvesical prostatectomy (TVP) for prostate > 50 ml in retrospective study. Ninety patients with urodynamic obstruction and prostate volume (PV) in range between 50 and 100 ml were analyzed according to the mode of operative treatment (TUVRP vs. TVP). Patients were assessed preoperatively and followed-up at 3 and 12 months postoperatively. All patients underwent general and urological standard evaluation before surgery, including urine analysis, urine culture, blood samples tests, with determination of PSA, DRE, abdominal and minor pelvis ultrasound (US), transrectal ultrasound (TRUS), maximal flow rate (Qmax), postvoid residual urine(PVR), and self assessment by International Prostate Symptom Score (IPSS) and Quality of Life Score (QoLS). Urethrocystoscopy was obligatory done before TUVRP. TRUS-guided biopsies of the prostate were performed in patients with PSA > 4 ng/ml, abnormal DRE, and/or suspicious echogenicity on TRUS. IPSS, QoLS, Qmax and PVR were obtained at each follow-up. Of 90 patients eligible to participate, 69 patients completed 12 months of follow-up (TUVRP, n=35; TVP, n=36). TUVRP procedure was not faster than TVP procedure (P=0.41); 43.6% and 84.8% of prostatic tissues were resected after TUVRP and TVP, respectively (P<0.001). In TVP group, IPSS, QoLS, Qmax and PVR volume were significantly better than those in TUVRP group at 3 and 12 months of followup. At 12 months postoperatively, IPSS improved 62.7% and 87.9% (P<0.001), QolS decrease by 41.9% and 71.9% (P<0.001), mean Qmax increased by 6.3 ml/s (102.0%) and 11.4 ml/s (230.2%) (P=0.001) and mean PVR volume decreased by 65.4 ml (70.5%) and 71.2 ml (88.6%) (P=0.001) in TUVRP and TVP group, respectively. Two TUVRP patients developed urethral stricture and 1 bladder neck sclerosis postoperatively, requiring internal urethrotomy and TUIP, respectively. TVP may be more effective and safer than TUVRP for benign prostatic hyperplasia (BPH) patients whose PV is > 50 ml.

We investigated whether finasteride given before transurethral vapor resection (TUVRP) treatment has an impact on intra- and postoperative bleeding. Forty-two patients with diagnosis of benign prostatic hyperplasia (BPH) who had prostate volume (PV) > 30 mL underwent TUVRP: group A (n=21) received preoperatively finasteride 5 mg per day for median time of 7 months and group B (n=21) no finasteride. Preoperative evaluation include assessment of International Prostatic Symptom score (IPSS), Quality of Life (QoL), PV, maximum flow rate (Qmax) and postvoid residual (PVR). Patients mean age was 71.4± 2.1 vs 69.8 vs ± 3.4 years, respectively. Median PV was 55.5 ±21.2 vs 57.1 ±28.8 mL, respectively. Twenty-two (52%) patients had complete retention (29% vs 76%) (p<0.001). At baseline mean IPSS, QoL, Qmax and PVR were 18.1±5.9 vs 19.8±5.04, 3.3±1.7 vs 3.3±1.7, 8.1±4.4 vs 6.9±1.6 mL/s, and 146±106.9 vs 151.6±112.1 mL, respectively. The mean operation time was 59±16.8 vs 64±19.2 min, mean volume of irrigation fluid intraoperatively was 14.1±7.01 vs 15.2±8.1 L and postoperatively 7.0±2.1 vs 8.1 ±1.3 L, respectively. Mean blood loss was 312±85.9 vs 425±68.5 mL, respectively. The mean weight of resected tissue was 31.3±5.8 vs 30.75±8.4 gr, respectively. Mean duration of postoperative irrigation was 6.1 ± 4.7 vs 6.2 ±5.1 h, respectively. Thirty-six (85.7%) patients were discharged within 12 h postoperatively and the catheter is removed on 2.0±0.5 vs 2.5 ± 0.6 days, respectively. No patients received blood transfusion postoperatively. At 3 months postoperatively IPSS was 6.7±4.2 vs 5.2 ±2.01 (p<0.001), QoL 1.1±0.9 vs 1.1±0.7, Qmax 18.1±10.3 vs 17.5±8.1 mL/s (p<0.01) and PVR 41±46.1 vs 45±51.3 mL (p<0.05). The present study failed to demonstrate that preoperative treatment of BPH with finasteride did not have significant impact of perioperative bleeding at TUVRP.