Biomedical subjects

D Plastiras

Publications and source records attributed to D Plastiras.

5 recordsLinked to original sources

PubMed1999

Can p53 nuclear over-expression, Bcl-2 accumulation and PCNA status be of prognostic significance in high-risk superficial and invasive bladder tumours?

AIMS: To evaluate p53 and Bcl-2 expression and proliferating status (PCNA) in subgroups of patients with high-risk superficial and invasive bladder cancer, with relation to cancer progression and death, and to correlate the results with established clinical prognostic factors. METHODS: Paraffin-embedded sections from 42 high-risk superficial (T1G2,T1G3) and 33 invasive (T2-T4aG3 N0M0) tumours were investigated immunohistochemically for p53, Bcl-2 and PCNA. The median follow-up was 52 months. RESULTS: In the cohort of superficial tumours, statistical analysis showed that p53 and PCNA positivity were significant prognostic factors (P-values: 0.008 and 0.006, respectively) for disease-specific death (DSD). When life expectancy was evaluated (log-rank test), p53(+) (P = 0.015) and PCNA(+) (P = 0.017) offered the most accurate prognosis compared to grade, tumour size and multiplicity. Bcl-2 status had no significant effect on patient survival. In the subset of muscle-invasive tumours we failed to demonstrate any important role of p53, Bcl-2 or PCNA positivity. CONCLUSIONS: p53 and PCNA over-expression may offer valuable additional prognostic information in high-risk subgroups of superficial bladder tumours. From our results, Bcl-2 does not appear to contribute significantly to the prognosis of these patients. None of the studied markers offered prognostic information in muscle-invading disease.

Adult↗

PubMed1999

Incidence and histological findings of unsuspected prostatic adenocarcinoma in radical cystoprostatectomy for transitional cell carcinoma of the bladder.

OBJECTIVE: The present study is designed to evaluate the incidence, histological features and significance of prostatic adenocarcinoma in patients undergoing cystoprostatectomy for Transitional Cell Carcinoma (TCC) of the bladder. PATIENTS, MATERIAL AND METHODS: From January 1990 to December 1996, 59 male patients (mean age 66.5 years), with no evidence of prostatic malignancy on preoperative clinical and biochemical assessment, underwent cystoprostatectomy for TCC of the bladder. The bladder was adequately sampled and the entire prostate sectioned at 5-mm intervals and examined histologically, in order to identify unsuspected prostatic cancer (PCa). RESULTS: Sixteen out of 59 patients (27%) were found to have PCa, which was multifocal in 5 cases (31.25%). The mean tumor size was 0.24 cm. The tumors were equally distributed in the anterior and posterior parts of the prostate and in the peripheral and transition zones, with uniform distribution in both prostatic lobes. In 5 patients (31.25%), the single focus of the tumor was in the apex. All were grade I tumors except one, and all were organ-confined with no capsular penetration. The follow-up ranged from 12-74 months (mean 39 months). Within this period, 7 patients died from metastatic bladder cancer. One patient with PCa localized in the prostatic apex had recurrent prostatic disease in the urethro-ileal anastomosis of an orthotopic bladder substitute; he is alive and on androgen deprivation. The remaining patients are relapse-free. CONCLUSIONS: Incidental PCa is quite a common finding in cystoprostatectomy specimens of bladder cancer patients. Its tendency to appear in the apex of the prostate demands careful and complete excision of the organ.

Adenocarcinoma↗

PubMed1998

Incontinence after surgery for benign prostatic hypertrophy: the case for complex approach and treatment.

OBJECTIVE: Whether incontinence after surgery for benign prostatic hypertrophy (BPH) requires simple workup and treatment or being a more complex condition and multifactorial in etiology requiring combined surgical techniques should be investigated in more detail. METHODS: We retrospectively reviewed the records of 56 patients referred to us for post-prostatectomy incontinence after surgery for BPH. All patients were subjected to urodynamics. Twenty-three (41.1%) patients required additional ascending urethrogram and/or cystourethroscopy, according to their associated symptomatology and the urodynamic findings, for a definitive diagnosis to be established. RESULTS: Twenty-four patients (42.8%) were found to have complex incontinence (either mixed or any type associated with bladder outlet stenosis), requiring combined treatment. Twenty-three (41.1%) had a simple type of incontinence, i.e., pure sphincter incompetence or unstable detrusor. Three patients had residual adenoma and 1 urethral stricture, while 5 patients (8.9%) remained unclassified. Thirty-seven patients were subjected to treatment, 27 (73%) of them to single-modality treatment (artificial urinary sphincter insertion, oxybutynin chloride, transurethral prostatectomy, optical urethrotomy) and the other 10 (27%) to combined treatment (artificial urinary sphincter insertion plus urethroplasty, ileocystoplasty, permanent urethral stent implantation etc.). The overall socially acceptable continence rate (cured plus significantly improved) of the patients subjected to artificial urinary sphincter insertion reached 85%, being better (90%) for the uncomplicated sphincter incompetence group. CONCLUSIONS: Incontinence after surgery for BPH represents a condition that requires careful evaluation. In a significant proportion of patients, a combination of prosthetic and reconstructive techniques is needed for an optimal result to be achieved.

Aged↗

PubMed1997

Lower urinary tract reconstruction in association with renal transplantation.

Congenital or acquired dysfunction of the lower urinary tract may result in renal failure. In this group of patients urinary diversion or lower urinary tract reconstruction is mandatory prior to renal transplantation. Avoiding creation of an external stoma offers far more better quality of life to these unfortunate patients. We present three patients in end-stage renal disease. Two of them presented with dysfunction of the lower urinary tract and the third with absence of the bladder. Reconstruction or substitution of their bladders has been performed prior to kidney transplantation. In one patient an artificial urinary sphincter was implanted simultaneously in order to achieve continence, while all the patients have to empty their neobladders or augmented bladders by clean intermittent self-catheterization. In conclusion, dysfunction or absence of the lower urinary tract does not preclude renal transplantation and however abnormal the urinary tract, transplantation can still be performed if low-pressure, high-compliance reservoir can be achieved by means of augmentation or substitution cystoplasty.

Adult↗

PubMed1997

Combined reconstructive and prosthetic surgery in complicated lower urinary tract dysfunction.

PURPOSE: The combined use of the appropriate reconstructive technique and available prosthetic material was evaluated to achieve an optimal functional result in complicated lower urinary tract dysfunction. MATERIALS AND METHODS: The study included 16 male and 8 female patients. Urinary dysfunction was classified into 2 main categories: 1) neuropathic and 2) nonneuropathic. Of the patients 22 underwent some form of augmentation (21) or substitution (1) cystoplasty, 24 received an artificial urinary sphincter, 2 underwent abdominoperineal urethroplasty and 2 received a permanent urethral stent. One patient underwent renal transplantation and 1 received a penile prosthesis for concurrent impotence. RESULTS: A total of 20 patients (83.3%) became continent, 10 void spontaneously, while 14 must empty the bladder or pouch by clean intermittent self-catheterization. All patients have stable or improved renal function. CONCLUSIONS: Combined reconstructive and prosthetic surgery has an important role in the treatment of lower urinary tract dysfunction, with a high success rate and good quality of life.

Adolescent↗