Matrix metalloproteinases (MMPs) have been implicated in progression and metastases of different tumours. The balance between the MMPs and their natural inhibitors (tissue inhibitors of matrix metalloproteinases; TIMP) seems to be an important factor related to this role. Here, the expression of MMP-2 and -9 along with TIMP-1 and -2 was examined in prostate cancer tissue. A total of 40 radical prostatectomy specimens were embedded in paraffin and immunohistochemical staining was performed to detect MMP-2 and -9, and TIMP-1 and -2. The immunoreactivity was assessed semiquantitively using routine light microscopy. The intensity of staining was correlated to preoperative PSA, T category, Gleason score and clinical parameters of the specimens. The imbalance of MMPs and TIMPs was recognised as a significant loss of TIMP-1 in malignant epithelium and an upregulation of MMPs. Palpable tumours (T2, T3) expressed significantly more MMP-2 and significantly less MMP-9 than T1c tumours. Our data are in accordance with other literature reports in that an imbalance of MMPs and TIMPs is found in malignant tumours. The observed imbalance of MMP and TIMP is mainly caused by a loss of TIMP-1. Furthermore, palpable tumours demonstrated significantly more MMP-2 and significantly less MMP-9 expression than nonpalpable tumours.

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Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? In this study we observed courses of micturition symptoms and differentiated degrees of symptoms for each point in time while also considering the impact of bothersomeness. Our data show that not only significantly more patients who have undergone BT suffer from OAB than those who have undergone RP, but also that those affected show significantly higher values for severity of OAB symptoms throughout the whole observation period of 36 months. Our data analysis further shows that variability of OAB symptoms as well as fluctuation of severity of OAB symptoms vary to a significantly higher degree after BT than after RP. Looking only at mean figures at a given point in time clearly underestimates the underlying problem. This fact is not reflected in the literature. OBJECTIVE To look at individual courses of postoperative micturition symptoms, especially urgency, in patients treated either with radical prostatectomy (RP) or with brachytherapy (BT). PATIENTS AND METHODS In a prospective longitudinal study we investigated individual changes in micturition symptoms before treatment, and 6, 12, 24 and 36 months after treatment. All patients received the European Organization for the Research and Treatment of Cancer quality‐of‐life questionnaire, QLQ‐C30, and the International Continence Society male questionnaire at each assessment. We looked at long‐term results as well as changes in time using repeated measures analysis of variance. We further analysed fluctuation of symptoms using sum of changes. RESULTS Of the 389 patients treated consecutively in our clinic over the last few years, 99 patients with a mean (sd) age of 65 (6.3) years had completed all five questionnaires and thus were further analysed. Of these, 66 (66.7%) were treated with RP and 33 (33.3%) with BT. With the exception of age, no significant difference was found between the treatment groups either in physical functioning or in prevalence and severity of overactive bladder (OAB) symptoms. Adjusted for age and pretreatment symptoms in analysis of covariance, we found that there were statistically more symptoms of OAB 36 months after BT compared with those patients treated with RP (P < 0.025). Whereas 30% of patients complained about severe symptoms of urgency after BT, only 11% did so after RP. Changes of severity of OAB symptoms over the course of time (P < 0.007) using analysis of repeated measures as well as variability of OAB symptoms (P < 0.033) using the two‐sided Wilcoxon t‐test were significantly higher in patients treated with BT than in patients treated with RP. CONCLUSIONS Independently of age and physical functioning, BT is significantly associated with higher rates of long‐term urgency symptoms, even after 3 years. Repeated measurements show that OAB symptoms are highly fluctuating and that in patients treated with BT, severity of symptoms as well as variability of symptoms was significantly higher than in those patients tre...

Introduction: Tissue engineering is an important and expanding field in reconstructive surgery. The ideal biomaterial for urologic tissue engineering should be biodegradable and support autologous cell growth. We examined different scaffolds to select the ideal material for the reconstruction of the bladder wall by tissue engineering. Materials and Methods: We seeded mouse fibroblasts and human keratinocytes in a co-culture model on 13 different scaffolds. The cell-seeded scaffolds were fixed and processed for electron microscopy, hematoxylin and eosin stain, and immunohistochemistry. Cell density and epithelial cell layers were evaluated utilizing a computer-assisted optical measurement system. Results: Depending on the growth pattern, scaffolds were classified into the following three distinct scaffold types: carrier-type scaffolds with very small pore sizes and no ingrowth of the cells. This scaffold type induces a well-differentiated epithelium. Fleece-type scaffolds with fibers and huge pores. We found cellular growth inside the scaffold but no epithelium on top of it. Sponge-type scaffolds with pores between 20 and 40 µm. Cellular growth was observed inside the scaffold and well-differentiated epithelium on top of it. Conclusion: To our knowledge, this is the first time three distinct scaffold types have been reported. All types supported the cell growth. The structure of the scaffolds affects the pattern of cell growth.

and videos were also analysed by two independent investigators not present at the actual investigation. RESULTS• Using perineal ultrasonography we were able to visualize hypermobility of the proximal urethra, funnelling of the bladder neck, voluntary pelvic floor contraction, urethral and paraurethral fibrosis, and suture or sling material.• Men with and without PPI differed mainly in the degree of hypermobility of the proximal urethra and opening of the bladder neck.• Inter-investigator agreement was 100% in assessing paraurethral tissue and voluntary muscle contraction and 94% in quantifying mobility of the proximal urethra.• We were able to evaluate the bladder neck opening in 85% of the men. There was 82% agreement between the initial investigators in evaluation of the bladder neck and 76% in quantifying mobility of the proximal urethra using retrospective analysis of stored images. CONCLUSIONS• Two-dimensional and 3D/4D perineal ultrasonography provides more insight into the diagnosis of men with PPI • Perineal ultrasonography can be used further as a visual aid for biofeedback to teach correct muscle contraction of men with stress incontinence after radical prostatectomy. We know that perineal ultrasound is a well accepted method for women with stress incontinence. We evaluated feasibility of this method for men with stress incontinence after radical prostatectomy. We find differences between continent and incontinent men in amount of fibrosis, mobility of the proximal urethra, bladder neck opening and ability to contract pelvic floor muscles in a sufficient and correct way. KEYWORDS OBJECTIVE• To investigate the feasibility and interinvestigator reproducibility of perineal ultrasonography in men with and without post-prostatectomy urinary incontinence (PPI). PATIENTS AND METHODS• This clinical pilot study involved 33 male patients, with a mean (range) age of 67.8 (51-76) years, who underwent radical prostatectomy (RP) ≥ 1 year ago.• We investigated 21 men with clinically and urodynamically proven grade ≥ 2 PPI and compared them with 12 men without PPI in objective testing as well as in validated questionnaires.• We used an abdominal 3.5-5 MHz ultrasound probe, which was placed at the perineum between scrotum and anus. With the help of three-/four-dimensional (3D/4D) multislice imaging we obtained good visualization of the bladder neck, the urethra and pelvic floor muscle contraction.• The data from all 33 men was evaluated by two investigators and archived images

The AdVance and AdVanceXP are safe and effective treatment options for male stress urinary incontinence. However, the innovations of the AdVanceXP sling did not demonstrate a superiority over the original AdVance sling regarding functional outcome.

Study Type – Diagnostic (exploratory cohort)
Level of Evidence 2b What’s known on the subject? and What does the study add? The current retrospective study evaluates predictive clinical parameters associated with lymph node metastasis in a homogeneous cohort of 499 men with low‐risk prostate cancer who underwent radical prostatectomy. Low‐risk profile and <50% of biopsies involved with cancer are strong predictors of metastasis‐free lymph nodes so that patients do not have to undergo extended pelvic lymphadenectomy. OBJECTIVE To evaluate preoperative predictive risk factors associated with lymph node metastases (LNM) in a cohort of low‐risk prostate cancer (PCA) patients. PATIENTS AND METHODS The charts of 499 patients were retrospectively reviewed to identify prognostic risk factors for the presence of LNM. Pathohistological data and Gleason score of the radical prostatectomy (RP) specimen, number of removed nodes, number of positive lymph nodes, and anatomical distribution of LNM were tabulated and evaluated. A correlation between clinical stage, preoperative serum prostate‐specific antigen (PSA), biopsy Gleason score, number of biopsies taken, percentage of positive biopsies and the presence of LNM were calculated. All 499 men underwent retropubic RP and extended pelvic lymphadenectomy (EPLND). RESULTS LNM were identified in 29 (5.8%) patients. A prediction model based on clinical stage, PSA, and biopsy Gleason score had a predictive accuracy of 79.2%. The addition of number of positive biopsies and % positive cores improved its predictive accuracy to 81.5% and 87.8%, respectively. The predicted frequency of LNM by the original nomogram was 7.4% and differed by less than 3% with the actual observation of LNM. The predictive accuracy of the nomogram was 81.5% as compared with 87.8% of the prediction model of this study. CONCLUSIONS The percentage of positive cores involved with PCA is the most reliable predictor of LNM and indicates the need for EPLND. The Briganti nomogram has been validated and a general applicability for predicting the presence of LNM was proven.

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