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Objectives: To establish the role of the NKX3.1 gene in the development of benign prostatic hyperplasia by comparing the expression of NKX3.1 in messenger ribonucleic acid (mRNA) and protein levels in young adult prostate and BPH tissues., Methods: Normal prostate tissue samples (n = 4) were obtained from prostate biopsies of patients less than 40 years of age who underwent diagnostic cystoscopy for microscopic hematuria. Benign prostatic hyperplasia tissues (n = 12) were obtained from patients who underwent transurethral prostate resection for bladder outlet obstruction. The RNAs isolated from these tissue samples were analyzed with quantitative reverse transcriptase polymerase chain reaction; the proteins were analyzed with Western blotting and immunohistochemistry., Results: The mean NKX3.1 mRNA transcript expression was 19.17 +/- 3.05 vs 1.24 +/- 1.32 in BPH and normal tissues, respectively, and NKX3.1 protein expression of BPH was approximately 2.4-fold higher than in normal prostate tissue. Reverse transcriptase polymerase chain reaction and Western blot analyses revealed that NKX3.1 gene expression in BPH patient tissues were higher compared with normal prostate tissues. Immunohistochemistry results indicated that most of the BPH tissues stained diffusely, and there was no BPH tissue that lacked NKX3.1 expression., Conclusions: NKX3.1 expression is elevated in BPH tissues when compared with normal tissues, which may be important in the development of BPH.

Objectives: To evaluate the additional analgesic efficacy of the rectal administration of diclofenac suppository compared with placebo in patients undergoing transrectal ultrasound-guided prostate biopsy., Methods: A total of 40 consecutive men undergoing biopsy were enrolled in this study. Patients were randomized equally into two treatment groups. In group 1, patients received an intrarectal 100-mg diclofenac suppository 1 hour before biopsy. In group 2, patients received a glycerin suppository as a placebo intrarectally 1 hour before biopsy. All patients received 10 mL of 2% lidocaine gel intrarectally 10 minutes before biopsy. A self-administrated visual analog scale was used to measure the pain scores at the end of the biopsy and 2 hours and 1 day after the biopsy., Results: The mean patient age was 63.3 +/- 6.8 years and 61.6 +/- 6.7 years in groups 1 and 2, respectively. The mean pain score in groups 1 and 2 was 3.4 +/- 1.3 versus 5.9 +/- 1.7 (P < 0.0001), respectively, at the end of the biopsy. The mean pain score at 2 hours and 1 day after the procedure was 1.2 +/- 1.0 versus 3.6 +/- 1.4 (P < 0.0001) and 0.5 +/- 0.9 versus 1.4 +/- 1.3 (P = 0.017) in groups 1 and 2, respectively., Conclusions: Intrarectal diclofenac suppository administration is a simple, safe, and effective procedure to reduce pain and improve patients' tolerance of transrectal ultrasound-guided prostate biopsy. We recommend intrarectal diclofenac suppository administration, together with intrarectally administered lidocaine gel, in men undergoing transrectal ultrasound-guided prostate biopsy.

Objectives: This study was designed to determine the time interval required for the recovery of the bladder after exposure to soluble virulence factor (SVF) in an animal model. In addition, we aimed to determine the changes in the epithelium during the recovery period., Methods: A total of 46 male New Zealand rabbits were used in this study. Sterile human urine was infected with Escherichia coli type O6 to obtain supernatant, which would contain SVF, but no bacteria. Rabbits were assigned to one of three groups comprising the supernatant urine group (SUG) and controls, respectively. Sterile human urine and supernatant urine were instilled to controls and SUG, respectively. Bacterial inoculation with E. coli was performed 1, 24 and 72 h after initial instillation. Histopathologic and microbiologic analyses were performed on these animals., Results: In SUG bacterial colonization was significantly higher than in controls 1 and 24 h after exposure to supernatant. Histopathologic analysis confirmed this finding. Histologic changes were most pronounced 1 hour after instillation of supernatant. A moderate degree of recovery was noted at 24 h, and complete recovery was seen at 72 h., Conclusion: Bacterial growth is potentiated by SVF-induced impaired bladder mucosa until the repairing process has been completed. During this time interval, SVF enables the colonization and growth of E. coli and other bacterium species that may result in sustained bacterial presence and recurrent infection.

Objectives: The goal of this study was to investigate the relation between serum laminin P1 expression and the grade, stage, size, and multiplicity of the tumors to elucidate the potential role of laminin as a diagnostic and prognostic factor in transitional cell carcinoma (TCC) of the bladder., Methods: Serum concentration of laminin P1 was measured by radioimmunoassay in 38 patients with TCC of the bladder and compared with the serum laminin P1 values obtained from 34 healthy control subjects. Patients were grouped according to their tumor stage, grade, size, and multiplicity to compare the serum laminin P1 values., Results: The mean serum laminin P1 level in the patient group was statistically higher than the controls (P = 1.3 x 10(-8); with the destruction of basement membrane (stages pT1 or greater), a significant increase in the serum value was observed (P = 0.00023). Laminin level was found to be positively related to the tumor size and number; however, no correlation was observed with the grade. In tumors invading the lamina propria and beyond, the sensitivity of laminin P1 was 78.9% and specificity was 97.1%. The positive and negative predictive values of laminin P1 were 93.7% and 89.5%, respectively. The patients whose serum laminin P1 levels were above the upper limit of normal (1.6863 U/mL) were found to have a higher recurrence rate (72%) than the patients who had lower serum values in the control cystoscopies performed 3 months after the first admission (P < 0.01)., Conclusions: Serum laminin P1 seems to be a valuable adjunctive marker to predict tumor invasion and recurrence. This warrants further research.

Bellini duct (collecting duct) carcinoma of the kidney is a rare entity often misinterpreted as renal or transitional cell carcinoma on histologic examination. Immunohistochemical identification of specific antigens is needed for the differential diagnoses. We describe a case of Bellini duct carcinoma that arose from the collecting ducts of Bellini and was treated with aggressive surgery and interferon-based immunochemotherapy.

Objective: Postchemotherapy surgery has become an increasingly important treatment for residual masses in germ cell tumors of the testis. However, it is still a challenge to find the optimal combination of chemotherapy and surgery for better survival and cure rates with lowest morbidity. This study evaluated the effectiveness of extended chemotherapy followed by surgery resecting only the residual masses., Methods: After an extended course (one or two additional courses after there is no decrease in tumor size and/or after the normalization of tumor markers) of combination chemotherapies with cisplatin-based regimens, 32 patients underwent surgery for metastatic germ cell tumors of the testis. Complete excision of radiologically determined residual masses and macroscopically suspicious neighboring nodes was performed rather than a conventional retroperitoneal lymph node dissection., Results: Histopathologic examination of the resected specimens revealed teratoma in 17 (55%), fibrosis and/or necrosis in 9 (26.5%), and active residual tumor in 8 (23.5%) of the patients. The patients with residual tumor have been treated with additional chemotherapy. In the follow-up (mean, 28.5 months) 4 patients have relapsed, and 1 died. None of the patients with residual teratomas have shown relapse. Only 1 of the 32 patients has had retrograde ejaculation., Conclusions: A more conservative approach, such as excision of the residual masses after an extended course of chemotherapy, has given excellent results both in the outcome of the patients in the follow-up and in the rate of retrograde ejaculation. We therefore suggest that this approach would be a good alternative to nerve-sparing surgery following chemotherapy.