Buccal mucosa is the most reliable graft for repairing anterior urethral strictures in patients with LS. Minimal complications are observed, even in cases of long stenosis completely afflicting anterior urethra.
We examined the status and role of autophagy, a process of lysosomal recycling of cellular material, in clear cell renal cell carcinoma (ccRCC). Paired samples of tumor and adjacent non-malignant tissue were collected from 20 patients with ccRCC after radical nephrectomy. The mRNA levels of apoptosis (BAD, BAX, BCL2, BCLXL, BIM) and autophagy (ATG4, BECN1, GABARAP, p62, UVRAG) regulators were measured by RT-qPCR. The protein levels of autophagosome-associated LC3-II, autophagy receptor p62, apoptotic marker PARP, as well as phosphorylation of autophagy initiator Unc 51-like kinase 1 (ULK1), its activator AMP-activated protein kinase (AMPK) and 4EBP1, the substrate of ULK1 inhibitor mechanistic target of rapamycin (mTOR), were analyzed by immunoblotting. The mRNA levels of pro-apoptotic BAX, anti-apoptotic BCLXL and pro-autophagic ATG4, p62 and UVRAG were higher in ccRCC tumors. Autophagy induction was confirmed by an increase in phospho-ULK1 and degradation of the autophagic target p62, while apoptotic PARP cleavage was unaltered. AMPK phosphorylation was reduced and 4EBP1 phosphorylation was increased in ccRCC tissue. The expression of apoptosis regulators did not correlate with clinicopathological features of ccRCC. Conversely, high mRNA levels of ATG4, GABARAP and p62 were associated with lower tumor stage, as well as with smaller tumor size and better disease-specific 5-year survival (ATG4 and p62). Accordingly, low p62 protein levels, corresponding to increased autophagic flux, were associated with lower tumor stage, reduced metastasis and improved 5-year survival. These data demonstrate that transcriptional induction of autophagy in ccRCC is accompanied by AMPK/mTOR-independent increase in ULK1 activation and autophagic flux, which might slow tumor progression and metastasis independently of apoptosis.
Reporting of complication for PCNL should be uniform, and modified Dindo-Clavien grading system that is validated for PCNL should be accepted to be a standard in urology. Surgeons training and experience are the most important to ensure the efficacy of procedure, therefore we suggest that learning of percutaneous renal access should be mandatory in residents trainee program.
Early recognition of signs and symptoms of RPF is of the utmost importance for the outcome. Surgical procedures including ureteral wrapping with omental flap, or intraperi toneal ureteral displacement, usually represent definitive treatment.
Androgens and prostate functionTestosterone (T) and 5α-dihidrotestosterone (DHT) play a crucial role in the fetal prostate development. These androgens stimulate mesenchyme, while mesenchyme induces the proliferation of the epithelial buds from the urogenital sinus. This process, called "mesenchyme-epithelial interaction", starts in the 10th gestational week and continues in the adult age 1, 2 . Testosterone induces the development of the seminal vesicles and Wolffian ducts, while DHT induces the development of the prostate, penis and scrotum.Prostatic tissue is composed of stroma and epithelium. Prostatic stroma is composed of stromal cells (fibroblasts, endothelial capillary cells, lymph vessels and smooth muscle cells), neuroendocrine (NE) cells, neural cell axons, intercellular liquid and collagen fibers 3 . Prostatic epithelium is composed of secretory, basal, intermediary and NE cells. Secretory cells synthesize and secrete various proteins, like prostate specific antigen (PSA), prostatic acid phosphatase (PAP), androgen receptor (AR) and make the greatest part of the prostatic epithelium. It is believed that NE cells induce growth, differentiation, and secretory functions of the prostatic epithelium 4 .Numerous factors regulate prostatic growth: endocrine, neuroendocrine, paracrine, or growth factors (GF), autocrine and intracrine factors. However, the action of the endocrine factors is the best known. Testosterone is the most important serum androgen in the male, with the average serum concentration of 611 ± 186 ng/dL, while the average DHT serum concentration is 56 ± 20 ng/dL. However, the average concentration of active, free T is only 12.1 ± 3.7 ng/dL, while the rest is bound to the globulins and albumins. The major androgen in the prostatic tissue is DHT, with the average tissue concentration of 2.4-5.1 ng/g. The average tissue concentration of T is 3-5 times lower and measures 0.9 ng/g 5-7 .Only free T molecules can enter the prostatic cell, by diffusion. In the cytosol, one part of T molecules transforms into DHT. Both T and DHT bind to AR and form androgen-AR complexes. Subsequently, those complexes make pairs, entering the nucleus and bind to androgen-responsive elements (ARE) on DNA. After the information was transcripted from DNA to mRNA, mRNA leaves the nucleus and comes on ribosomes, where the information is translated into protein. Enzyme 5-alpha reductase (5αR) performs the conversion of T to DHT. There are two isoforms of 5αR: type 5αR-2 is dominant in the prostatic stroma and accessory genital tissues. Type 5αR-1 is present in the skin and prostate epithelium. Benign prostate hyperplasiaBenign prostate hyperplasia (BPH) denotes progressive prostatic enlargement, associated with the symptoms of impaired emptying of the urinary bladder and followed with gradual progression of the symptoms and complications. The most common BPH-related complications are chronic urinary infection, urinary bladder stones, chronic and acute urinary retention. The prevalence of BPH is very high: BPH is the fourth...
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