Publications by authors named "Tomasz Gołąbek"

66 Publications

The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15): translation, adaptation and validation of the Polish version for patients with multiple sclerosis and spinal cord injury.

BMC Neurol 2021 Mar 8;21(1):103. Epub 2021 Mar 8.

Department of Urology, Jagiellonian University Medical College, ul. Jakubowskiego 2, 30-688, Krakow, Poland.

Background: Polish physicians and researchers lack an extensive and precise instrument in their native language for evaluating sexual dysfunction in individuals with neurogenic disorders. The aim of this study was to create a culturally adapted, validated, Polish language version of the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15) for persons with multiple sclerosis (MS) and spinal cord injury (SCI).

Methods: International recommendations and standardized methods for instrument validation were followed. Sexually active patients with MS and SCI completed the MSISQ-15, International Index of Erection Function (IIEF-15, men), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-31, women). IIEF-15 and PISQ-31 were used as reference questionnaires. Responses were collected at baseline (test) and after 2 weeks (re-test).

Results: We recruited 299 Polish-speaking patients with MS or SCI. Interviews disclosed that the translated questionnaire had optimal content validity/cross-cultural adaptation. MSISQ-15 scores correlated significantly with the severity of sexual dysfunction as evaluated by IIEF-15 (r = - 0.487) and PISQ-31 (r = - 0.709). These correlations substantiated the high quality construct/criterion validity. An analysis of reliability presented good internal consistency (Cronbach's alpha of 0.93 for the total score of MS patients and 0.86 for the total score of SCI patients) and reproducibility (intraclass correlation coefficients of 0.91 for the total score of MS patients and 0.92 for the total score of SCI patients). There were no ceiling or floor effects.

Conclusions: The Polish version of MSISQ-15 exhibited excellent measurement properties. It is a suitable and reliable instrument to assess sexual dysfunction in MS and SCI individuals. The Polish MSISQ-15 will enhance routine clinical practice and assist research for neurogenic patients in Poland.
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http://dx.doi.org/10.1186/s12883-021-02132-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938601PMC
March 2021

Overactive Bladder Symptoms Negatively Affect Sleep Quality of Patients With Depression.

Int Neurourol J 2021 Mar 19;25(1):59-68. Epub 2021 Jan 19.

Department of Urology, Jagiellonian University Medical College, Krakow, Poland.

Purpose: An established link exists between overactive bladder (OAB) syndrome and impaired sleep. However, earlier research on this subject only focused on the general population, and certain patient subgroups have not been examined adequately. Depressed patients constitute a unique population because of a possible bidirectional relationship between OAB and depression. Thus, we investigated the association between OAB symptoms and sleep quality in patients with depression.

Methods: In this prospective, cross-sectional study, we analyzed data on depression, sleep quality, and OAB symptoms from depressed patients treated at our department of adult psychiatry. Data were collected with the Hamilton Rating Scale for Depression, the Holland Sleep Disorders Questionnaire, the Athens Insomnia Scale, and the OAB Module of the International Consultation on Incontinence Questionnaire.

Results: In total, 102 patients treated for depression were enrolled. Thirteen patients (12.7%) met the diagnostic threshold of OAB with the International Consultation on Incontinence Questionnaire OAB Module. Patients with depression and concomitant OAB had significantly higher scores on the Holland Sleep Disorders Questionnaire than patients classified as nonOAB (P<0.01). OAB patients also had a higher risk of insomnia relative to non-OAB individuals (P<0.05). In addition, the relationship between OAB symptoms and sleep quality in patients with depression was independent from age and sex.

Conclusion: In our cohort composed exclusively of individuals treated for depression, OAB symptoms were present in a significant proportion of patients, and OAB negatively affected sleep quality. Therefore, we recommend that OAB symptoms should be assessed collectively in patients with depression.
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http://dx.doi.org/10.5213/inj.2040110.055DOI Listing
March 2021

Relationship between Lower Urinary Tract Symptoms and Treatment-Related Behavior in an Eastern European Country: Findings from the LUTS POLAND Study.

Int J Environ Res Public Health 2021 01 18;18(2). Epub 2021 Jan 18.

Department of Urology, Jagiellonian University Medical College, 30-688 Krakow, Poland.

The aim of this study was to investigate the effect of lower urinary tract symptoms (LUTS) on behavior related to treatment of Polish adults aged ≥ 40 years. We conducted a computer-assisted telephone survey with a study sample stratified by age, sex, and place of residence (type, size, urban versus rural) reflecting the entire Polish population. Participants rated the frequency and symptom-specific bother of individual LUTS and their effects on seeking and receiving treatment, treatment satisfaction, and treatment continuation. We adjusted multiple logistic regression models to analyze the simultaneous effects of predictor variables on each dependent variable. Overall, 6005 participants completed the interview. One third (29.6-33.5%) of participants with LUTS were seeking treatment, and 24.0-26.4% received treatment. There was no difference in treatment seeking and receiving between urban and rural areas. Whereas storage and voiding symptoms were significantly related to treatment seeking by both men and women, treatment receiving correlated only with voiding symptoms in men and only with storage symptoms in women. Most respondents who received treatment were satisfied; treatment dissatisfaction was related to the presence of storage symptoms in both men and women. Only 50% of all participants continued their treatment; discontinuation of treatment was statistically more prevalent for women than for men. This investigation, the first population-representative study performed in Eastern Europe, revealed a low frequency of seeking treatment for LUTS. In addition, symptoms that inclined participants to seek treatment might not have been adequately addressed by the treatment they received. We also found a relatively high rate of treatment discontinuation. Clearly, there is a need for both improved patient education about LUTS treatment and a need for increased clinician awareness of the coexistence of different symptoms in men and women plus proactive evaluation by physicians for all types of LUTS and associated bother.
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http://dx.doi.org/10.3390/ijerph18020785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831922PMC
January 2021

Prevalence and bother of lower urinary tract symptoms and overactive bladder in Poland, an Eastern European Study.

Sci Rep 2020 11 13;10(1):19819. Epub 2020 Nov 13.

Department of Urology, Jagiellonian University Medical College, Krakow, Poland.

The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) has been measured by population-based investigations in many parts of the world. However, data are lacking for Eastern Europe, and there has not been any large population-representative study in any country of this region. Therefore, the aim of this study was to evaluate the prevalence and associated bother of LUTS and OAB in a population-representative sample of persons aged ≥ 40 years in Poland. This investigation was conducted as a computer-assisted telephone interview. The survey sample was stratified by age, sex, and place of residence to reflect the entire Polish population. LUTS and OAB were assessed by a standardized protocol based on the International Continence Society definitions and validated questionnaires. Of 6005 participants, 57% were women, and the mean age (range) was 60.7 (40-93) years. The prevalence of LUTS was 69.8% (men 66.2%; women 72.6%). There was no difference in prevalence between urban and rural areas. LUTS were often bothersome among men and women, but women were more likely to be bothered compared with men. There were also statistically significant correlations between the frequency and the bother intensity of each of the LUTS. The prevalence of OAB was higher in women (39.5%) than in men (26.8%), and OAB increased with age. Lastly, LUTS had detrimental effects on the quality of life because one third of the participants had concerns about their urinary-specific quality of life. This investigation was the first nationwide, population-representative epidemiological study of LUTS and OAB in an Eastern-European country. LUTS were highly prevalent, often bothersome, and had negative effects on the quality of life of men and women aged ≥ 40 years. Our findings are comparable with other epidemiologic studies of LUTS and OAB conducted in different regions of the world.Trial registration: NCT04121936.
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http://dx.doi.org/10.1038/s41598-020-76846-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666180PMC
November 2020

Correlation of urinary incontinence with depression severity of patients treated for depression.

Cent European J Urol 2020 6;73(3):321-327. Epub 2020 Aug 6.

Department of Urology, Jagiellonian University Medical College, Cracow, Poland.

Introduction: Urinary incontinence (UI) is a major public health issue because of the high number of individuals affected, its adverse effects on job-related functioning, and the decline in quality of life. The association between UI and symptoms of depression has been evaluated extensively for the general population. However, relationships between UI and depression have not been adequately assessed for specific patient groups. Thus, we investigated the association between UI and depression severity in patients treated for depression.

Material And Methods: This study was a single-center, prospective, cross-sectional inquiry. We analyzed questionnaire data on UI and depression from depressed patients treated in our Department of Adult Psychiatry. Patients completed the International Consultation on Incontinence Questionnaire Short Form and General Health Questionnaire whereas psychiatrists administered the Hamilton Rating Scale for Depression.

Results: One hundred two patients were enrolled in the study. Most patients had mild depression. Patients who were incontinent mostly reported moderate UI and UI was statistically more prevalent in women than in men. Further, with the General Health Questionnaire, depression severity in women was significantly associated with the severity of UI. We did not observe correlation between depression severity analyzed with the Hamilton Rating Scale for Depression and UI.

Conclusions: In the cohort of patients treated for depression, UI affected more women than men. In wo- men, UI was associated with the severity of depression. Because UI and depression may coexist and share the symptom burden, particularly in women, clinicians should be aware of the interconnection between these two conditions.
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http://dx.doi.org/10.5173/ceju.2020.0177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7587479PMC
August 2020

Prognostic effect of renal collecting system invasion on survival of patients with renal cell carcinoma and tumor thrombus.

Cent European J Urol 2020 8;73(3):280-286. Epub 2020 Sep 8.

Department of Urology, Jagiellonian University Medical College, Cracow, Poland.

Introduction: Urinary collecting system invasion (UCSI) has been found to have significant prognostic value for patients with renal cell carcinoma (RCC). However, for RCC patients with venous tumor thrombus (VTT), only contradictory data exist regarding the prognostic efficacy of UCSI. Therefore, the aim of this study is to assess the prognostic relevance of UCSI in survival of patients with RCC and VTT.

Material And Methods: Medical records in a prospectively maintained institutional database were analyzed for RCC-VTT patients who had undergone nephrectomy with thrombectomy. Then, the effect of UCSI on overall survival was analyzed.

Results: The study examined data for 114 patients, including patients with VTT present in the renal vein (35 patients, 31%), infrahepatic inferior vena cava (28 patients, 24%), and suprahepatic inferior vena cava (51 patients, 45%). Nineteen percent of patients had UCSI. The median overall survival of patients with UCSI was 9 months, whereas median overall survival was 10 months for patients without collecting system invasion. Survival and regression analyses rejected UCSI as a prognostic marker for overall survival.

Conclusions: UCSI has no effect on survival in our cohort of RCC-VTT patients. Therefore, it should not be considered in risk stratification models or in treatment decision-making for this patient group.
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http://dx.doi.org/10.5173/ceju.2020.0172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7587485PMC
September 2020

Polish versions of the Qualiveen and the SF-Qualiveen: Translation and validation of urinary disorder-specific instruments in patients with multiple sclerosis.

Neurourol Urodyn 2020 08 16;39(6):1764-1770. Epub 2020 Jun 16.

Department of Urology, Jagiellonian University Medical College, Krakow, Poland.

Aims: No specific questionnaire to date has been available in Polish for evaluating health-related quality of life for urinary dysfunctions associated with multiple sclerosis (MS). The aim of this study was to translate, culturally adapt, and validate Polish versions of the Qualiveen and SF-Qualiveen for use in patients with MS.

Methods: Cross-cultural adaptation of the original English Qualiveen and SF-Qualiveen into Polish was performed according to international recommended and standard procedures. Adult patients with MS of the Department of Urology at the Jagiellonian University, Krakow, Poland, completed the Qualiveen, SF-Qualiveen, and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) twice: at baseline and 2 weeks later.

Results: One hundred eighty-nine Polish-speaking patients with MS completed the questionnaires. An intercorrelation study revealed that internal consistency was good for the total Qualiveen and SF-Qualiveen (Cronbach's α >0.8). Test-retest reliability (reproducibility) demonstrated strong stability (intraclass correlation coefficient >0.8). Content validities were optimal. Significant relationships between the Qualiveen and the ICIQ-SF, as well as the SF-Qualiveen and the ICIQ-SF, confirmed good construct/criterion validity.

Conclusion: The Polish Qualiveen and SF-Qualiveen are reliable, valid, and consistent measures of urinary disorder-specific quality of life in patients with MS. After years of no appropriate Polish instrument being available for healthcare professionals to evaluate patients with MS, we provide these versions and recommend their use in research and clinical practice in Poland.
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http://dx.doi.org/10.1002/nau.24419DOI Listing
August 2020

The urinary disorder-specific quality of life in patients after spinal cord injury: Polish translation, adaptation and validation of the Qualiveen and SF-Qualiveen.

Spinal Cord 2021 Feb 15;59(2):105-111. Epub 2020 Jun 15.

Department of Urology, Jagiellonian University Medical College, Krakow, Poland.

Study Design: Prospective cohort validation study.

Objectives: In spinal cord injury (SCI), neurogenic lower urinary tract dysfunction is associated with a reduced quality of life. No specific questionnaire has been translated, culturally adapted, and validated into Polish language to assess urinary disorder-specific quality of life in people after SCI. In this study, we translated, adapted, and validated the Polish versions of the Qualiveen and SF-Qualiveen in individuals with SCI.

Setting: University Hospital in Krakow, Poland.

Methods: Translation and cross-cultural adaptation of the Qualiveen and SF-Qualiveen were done using international recommendations and well-established methods. Adult patients with SCI from the Department of Urology at the University Hospital in Krakow, Poland completed the Polish versions of the Qualiveen, SF-Qualiveen, and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) at baseline and 2 weeks later. The ICIQ-SF served as the reference instrument. Validity and reliability were determined.

Results: Polish-speaking patients with SCI (n = 178) were included. Content validity/cross-cultural adaptation of the translated questionnaires was investigated during face-to-face interviews. Construct/criterion validity was assessed, and positive correlations were found between the Qualiveen and ICIQ-SF as well as the SF-Qualiveen and ICIQ-SF. A reliability study revealed good internal consistency (Cronbach's alpha > 0.8) and reproducibility (intraclass correlation coefficients > 0.8) for both adapted questionnaires. We did not identify floor or ceiling effect.

Conclusions: The Polish versions of the Qualiveen and SF-Qualiveen showed good measurement properties. Polish healthcare providers can now reliably and directly assess the urinary disorder-specific quality of life in individuals after SCI.
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http://dx.doi.org/10.1038/s41393-020-0499-2DOI Listing
February 2021

Neurogenic bladder symptom score: Polish translation, adaptation and validation of urinary disorder-specific instrument for patients with neurogenic lower urinary tract dysfunction.

Int J Clin Pract 2020 Oct 22;74(10):e13582. Epub 2020 Jun 22.

Department of Urology, Jagiellonian University Medical College, Krakow, Poland.

Introduction: There is no comprehensive and specific questionnaire translated, adapted and validated in the Polish language for evaluating symptoms, quality of life and complications associated with the neurogenic lower urinary tract dysfunction (NLUTD). The aim of this study was to translate, culturally adapt and validate a Polish version of the Neurogenic Bladder Symptom Score (NBSS) for patients who experience NLUTD.

Material And Methods: Standardised guidelines and well-established methods were used for translation and cross-cultural adaptation of the NBSS. Adult patients with multiple sclerosis and spinal cord injury completed the NBSS, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the International Prostate Symptom Score (IPSS) and the SF-Qualiveen. Responses were recorded twice within a 14-day period.

Results: Two hundred seventy-four Polish-speaking patients with NLUTD were included in the study. Content validity was optimal. Significant relationships between NBSS (Incontinence) and ICIQ-SF, NBSS (Storage and Voiding) and IPSS, and NBSS (Quality of Life) and SF-Qualiveen confirmed good construct/criterion validity. An intercorrelation study revealed that internal consistency was good for the total NBSS and specific domains (Cronbach's alpha >0.7). Test-retest reliability (reproducibility) demonstrated strong stability (intra-class correlation coefficients >0.7 for the total NBSS). No ceiling or floor effects were present.

Conclusions: The Polish NBSS demonstrated good measurement properties for a large cohort of patients with NLUTD. It is a suitable tool to assess NLUTD symptoms, consequences and quality of life. The Polish NBSS will support routine clinical practice of all types of physicians in Poland who care for patients with NLUTD.
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http://dx.doi.org/10.1111/ijcp.13582DOI Listing
October 2020

Could the kinetin riboside be used to inhibit human prostate cell epithelial-mesenchymal transition?

Med Oncol 2020 Feb 6;37(3):17. Epub 2020 Feb 6.

Chair of Pathomorphology, Jagiellonian University Medical College, Kraków, Poland.

The epithelial-mesenchymal transition (EMT) is a molecular process connected to higher expression of vimentin and increased activity of transcription factors (Snail, Twist) which restrains E-cadherin. EMT has been linked to prostate cancer metastatic potential, therapy resistance, and poor outcomes. Kinetin riboside (9-(b-dribofuranosyl)-6-furfurylaminopurine, KR) is a naturally occurring cytokinin, which induces apoptosis and shows strong antiproliferative activity against various human cancer cell lines. To establish the effect of KR on human prostate cell lines, expression of, e.g. AR, E-, N-cadherins, Vimentin, Snail, Twist, and MMPs, was analysed at mRNA and protein levels using Western Blot and RT-PCR and/or RQ-PCR techniques. KR inhibited the growth of human prostate cancer cells, but also, to a small extent, of normal cells. This effect depended on the type of the cells and their androgen sensitivity. KR also decreased the level of p-Akt, which takes part in androgen signalling modulation. The antiapoptotic Bcl-2 protein was down-regulated in cancer cell lines, while that of Bax is up-regulated upon KR exposure. KR contributed to re-expression of the E-cadherin as well as to significant changes in cell migration. Taken together, our results indicate for the first time that KR can be proposed as a factor for signalling pathways regulation that participates in the inhibition of development of aggressive forms of prostate cancer, and may alter the approach to therapeutic interventions. We propose KR as a potent inhibitor of EMT in human prostate cells.
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http://dx.doi.org/10.1007/s12032-020-1338-1DOI Listing
February 2020

Coexistence of lower urinary tract symptoms (LUTS) with depressive symptoms in patients suffering from depressive disorders.

Psychiatr Pol 2019 Aug 31;53(4):939-953. Epub 2019 Aug 31.

Uniwersytet Jagielloński Collegium Medicum, Katedra Psychiatrii, Klinika Psychiatrii Dorosłych.

Objectives: The aim of the present study was to investigate the correlation between lower urinary tract symptoms (LUTS) and severity of depressive symptoms in patients treated for depression.

Methods: 102 patients (43 males, 59 females) aged 20-67 (M = 46.1) treated for depression were included in this cross-sectional analysis. Depressive symptoms were assessed with the 17-item Hamilton Depression Rating Scale (HDRS) and Quick Inventory of Depressive Symptomatology - Self Report (QIDS-SR). LUTS were examined with the International Prostate Symptom Score (IPSS). In order to analyze the impact of presented symptoms, both urological and psychiatric, on quality of life of analyzed individuals the 30-item General Health Questionnaire (GHQ-30) was used.

Results: The average IPSS score in women was significantly higher than in men (9.59 vs. 6; p = 0.04). Patients suffering from at least moderate depression assessed with QIDS-SR had significantly higher scores in IPSS (9.76 vs. 4.1; p = 0.002). Severity of all LUTS assessed with IPSS correlated with QIDS-SR score in examined men (p < 0.05). In women, the total IPSS score correlated with the QIDS-SR score (p < 0.05) and with the total GHQ-30 score (p < 0.05). Anumber of other significant (p < 0.05) correlations were observed between the total IPSS score and certain items' scores in the GHQ-30 both in men and women.

Conclusions: LUTS are common among patients with depression. There is a correlation between severity of depressive symptoms and LUTS. LUTS affect quality of life and well-being as well as cause marked distress in depressed patients. Comorbidity of LUTS and depression should draw attention of both psychiatrists and urologists and enhance interdisciplinary treatment approach. Further prospective and cohort studies are essential to reveal more details of the correlation between LUTS and depression.
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http://dx.doi.org/10.12740/PP/OnlineFirst/94704DOI Listing
August 2019

Neurotic personality and lower urinary tract symptoms in day hospital patients diagnosed at pretreatment between 2004 and 2014.

Psychiatr Pol 2019 Aug 31;53(4):915-938. Epub 2019 Aug 31.

Uniwersytet Jagielloński Collegium Medicum, Katedra Psychoterapii.

Objectives: Evaluation of the association between the occurrence of lower urinary tract symptoms in patients qualified for psychotherapy and the severity and profile of their neurotic personality disorders.

Material And Methods: Retrospective analysis of questionnaires included in the medical records of 2,450 patients qualified for psychotherapy in 2004-2014 in terms of correlations between the symptoms of pollakiuria and unconscious urinary incontinence, and the global severity of neurotic symptoms (OWK), global severity of neurotic personality disorders (XKON) and abnormal values of 24 scales of the KON-2006 questionnaire. Correlations in the form of OR coefficients with 95% confidence intervals were estimated using logistic regression analyzes.

Results: Lower urinary tract symptoms are associated with a significantly greater severity of neuroticism, both described by the global severity of symptoms (OWK) as well as by the global neurotic personality disorder index (XKON) and abnormal values of the KON-2006 questionnaire scales. The occurrence of both symptoms was associated with the following scales: 'Negative self-esteem' and 'Envy', the occurrence of pollakiuria - with the scales 'Feeling of being dependent on others', 'Demobilization', 'Conviction of life helplessness' and 'Feeling of lack of influence', the occurrence of unconscious urinary incontinence - with the scales 'Feeling of being alienated' and 'Exaltation' for both genders, and only in men 'Risk avoidance' (low 'Risk tendencies'), 'Conviction of life helplessness', 'Difficulties in interpersonal relations'. Extreme severity of pollakiuria was more strongly associated with many of the mentioned scales, and also slightly differently with other scales, e.g., in men - with the 'Sense of overload' and 'Imagination, fantasizing'.

Conclusions: Neurotic personality traits described by abnormal values of the KON-2006 questionnaire scales are associated with the presence (and also to some extent with the severity) of psychogenic lower urinary tract symptoms. Connections may be bi-directional - in some cases experiencing and self-description of personality traits may be secondary to suffering associated with pollakiuria and incontinence.
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http://dx.doi.org/10.12740/PP/97835DOI Listing
August 2019

Preliminary outcomes of the European multicentre experience with the ZSI 375 artificial urinary sphincter for treatment of stress urinary incontinence in men.

Cent European J Urol 2019 12;72(3):263-269. Epub 2019 Jul 12.

Department of Urology, Jagiellonian University, Medical College, Cracow, Poland.

Introduction: The ZSI 375 is a new artificial urinary sphincter utilised in men suffering from stress urinary incontinence (SUI). We present the first European multicentre study on the effectiveness of ZSI 375.

Material And Methods: This study was conducted in a retrospective, non-randomized format in centres across Europe. Between May 2009 and December 2014, ZSI 375 was fitted in 109 SUI patients following radical prostatectomy, transurethral resection of prostate (TURP), rectal surgery and high intensity focused ultrasound (HIFU). Patients with history of pelvic radiotherapy or previous surgical treatment for incontinence or stricture were excluded from the series. Follow-up was completed by December 2016. The key outcome measures included overall improvement and complication rates.

Results: A total of 109 patients in 10 European centres were recruited and had the ZSI 375 device implanted. The average patient age was 72 years old. The indication for the majority of patients was incontinence following radical prostatectomy (100/109 patients, 91.74%). On average, patients were incontinent for 48.6 months prior to treatment. All patients used ≥4 pads daily at baseline and thus were classified as suffering from 'severe incontinence'. The average follow-up until the final visit was 43 months. The pad usage decreased to 0.84 on average by the last visit. There were no reported cases of device infection. A total of 9 patients had urethral cuff erosion (8.25%),which was the most common complication in this series. A further 3 men (2.75%) experienced mechanical failure requiring subsequent device reimplantation. The implantation of the ZSI 375 device was considered successful in 92.66% of patients.

Conclusions: The ZSI 375 is an effective surgical treatment option in men with severe stress urinary incontinence.
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http://dx.doi.org/10.5173/ceju.2019.1920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830485PMC
July 2019

Patterns of gene expression characterize T1 and T3 clear cell renal cell carcinoma subtypes.

PLoS One 2019 31;14(5):e0216793. Epub 2019 May 31.

Center for Medical Genomics OMICRON, Medical Faculty, Jagiellonian University Medical College, Krakow, Poland.

Renal carcinoma is the 20th most common cancer worldwide. Clear cell renal cell carcinoma is the most frequent type of renal cancer. Even in patients diagnosed at an early stage, characteristics of disease progression remain heterogeneous. Up-to-date molecular classifications stratify the ccRCC samples into two clusters. We analyzed gene expression in 23 T1 or T3 ccRCC samples. Unsupervised clustering divided this group into three clusters, two of them contained pure T1 or T3 samples while one contained a mixed group. We defined a group of 36 genes that discriminate the mixed cluster. This gene set could be associated with tumor classification into a higher stage and it contained significant number of genes coding for molecular transporters, channel and transmembrane proteins. External data from TCGA used to test our findings confirmed that the expression levels of those 36 genes varied significantly between T1 and T3 tumors. In conclusion, we found a clustering pattern of gene expression, informative for heterogeneity among T1 and T3 tumors of clear cell renal cell carcinoma.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216793PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6544217PMC
January 2020

How to assess and predict success or failure of intra-detrusor injections with onabotulinumtoxinA.

Adv Clin Exp Med 2019 Apr;28(4):555-567

Department of Urology, Jagiellonian University Medical College, Kraków, Poland.

Intra-detrusor injection therapy with onabotulinumtoxinA is generally accepted as a highly effective, minimally invasive and well-tolerated day procedure for patients with refractory overactive bladder (OAB) and neurogenic detrusor overactivity (NDO). The aim of this study was to summarize currently available methods of assessing treatment efficacy and risk factors that may influence the therapeutic effect of this approach. We found that there are discrepancies in the assessment methods. The evaluation of intra-detrusor injections with onabotulinumtoxinA in clinical trials are not always transposable into day-to-day practice. Moreover, the primary endpoints in clinical trials do not explore the entirety of meaningful patient-centered outcomes. Therefore, in daily clinical practice with patients with overactive bladder syndrome, the therapy should be assessed with objective measures (bladder diaries) and patient-oriented outcomes analyzing the quality of life (questionnaires). In neurogenic individuals, therapeutic efficacy should be additionally evaluated with urodynamic studies. Potential risk factors that may influence the treatment outcomes include urodynamically proven detrusor overactivity, elevated maximum detrusor pressure, greater maximum cystometric capacity, impaired bladder compliance, older age, male gender, a higher baseline bother score, previous anticholinergic treatment, and repeated injections with a subsequent decline in efficacy. The risk of intermittent catheterization following injections seems to depend on the etiology of detrusor overactivity, the injected dose, the injection technique, and the definition of significant post-void residual urine requiring catheterization.
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http://dx.doi.org/10.17219/acem/90764DOI Listing
April 2019

Nocturia has no impact on depression severity in patients suffering from depression but correlates with sleep quality.

Psychiatr Pol 2018 Oct 27;52(5):835-842. Epub 2018 Oct 27.

Oddział Kliniczny Urologii, Uniwersytet Jagielloński Collegium Medicum.

Objectives: In general population, the relationship between nocturia, depressive symptoms and sleep disturbance has been widely investigated. However, there is a paucity of data analyzing the significance of nocturia for depression severity and potential influence of nocturia on sleeping problems in depressed patients. To address this vacuum, we analyzed the impact of nocturia on depression severity and sleep quality in patients suffering from depression.

Methods: We conducted a cross-sectional study of depressed patients treated in outpatient and inpatient Department of Adult Psychiatry, Jagiellonian University, Krakow. All patients met the DSM-5 and ICD-10 criteria for depression. Nocturia was assessed with the International Prostate Symptom Score (IPSS), severity of depression with the 17-item Hamilton Rating Scale for Depression (HRDS), and sleep quality with the Holland Sleep Disorders Questionnaire (HSDQ). Statistical analysis was carried out using an ANOVA test (post-hoc Tukey test).

Results: Totally, 98 patients were included in our analysis. Nocturia was reported by 68 individuals. Majority of our patients (35) suffered from mild depression. The mean HSDQ score was 78.8 (range 32-146). Our analysis rejected the impact of nocturia on depression severity (p = 0.625) but revealed statistically significant correlation between nocturia and sleep quality (p = 0.037). A post-hoc test investigating the relationship between severity of nocturia and sleeping problems has demonstrated that higher number of night-time episodes of urination (at least 3 episodes) leads to significantly higher scores in the HSDQ.

Conclusions: Our analysis showed no impact of nocturia on illness severity in patients suffering from depression. However, we demonstrated correlation between nocturia and sleep quality in depressed individuals. Further studies with a larger number of patients are needed to validate the obtained results.
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http://dx.doi.org/10.12740/PP/89688DOI Listing
October 2018

Four-year follow-up on a Zephyr Surgical Implants 375 artificial urinary sphincter for male urinary incontinence from one urological centre in Poland.

Cent European J Urol 2018 29;71(3):320-325. Epub 2018 Jun 29.

Department of Urology, Jagiellonian University, Medical College, Cracow, Poland.

Introduction: The treatment of choice for patients who have iatrogenic urinary incontinence is the implantation of an artificial urinary sphincter. We performed a prospective study on the outcomes of men undergoing artificial urinary sphincter (AUS) implantation (ZSI 375; Zephyr Surgical Implants, Geneva, Switzerland).

Material And Methods: Patients with moderate-to-severe stress incontinence urinary were included. The ZSI 375 device is a one-piece device with a cuff and a pump unit. Patients underwent a perineal incision for cuff insertion and an inguinal incision for the pump unit to be placed in the scrotum. Complications and number of pads used to manage incontinence were recorded. Perioperative complications were categorized according to the Clavien-Dindo classification. Pain connected with implantation of AUS was assessed with the visual analogue scale (VAS).

Results: Between July 2013 and June 2017, 50 patients underwent ZSI 375 device insertion in the Department of Urology and Urological Oncology in Puławy, Poland. The follow-up stopped at the end of September 2017. The median (range) follow-up was 21.04 (1-50) months. No patient experienced bladder hyperactivity. Complications leading to a revision or permanent device removal arose in 12 patients (erosion = 9, infection = 0, mechanical failure = 3). Social continence (0 or 1 pad/day) was achieved in 29/50 patients (58%). An improvement (50% less pads/day) was achieved in 15/50 patients (30%). A failure was seen in 6/50 patients (12%). Perioperatively, all patients were classified as grade I in the Clavien-Dindo classification. Mean value of pain intensity in VAS was 0.82.

Conclusions: The ZSI 375 device is safe, effective and the follow-up period was long enough to identify all potential complications.
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http://dx.doi.org/10.5173/ceju.2018.1704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202622PMC
June 2018

Dermatologist and urologist? A neglected relationship in neurogenic voiding dysfunctions.

Cent European J Urol 2018 29;71(1):148-149. Epub 2017 Jan 29.

Department of Urology, Jagiellonian University Medical College, Cracow, Poland.

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http://dx.doi.org/10.5173/ceju.2018.1662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5926647PMC
January 2017

Perception of Lower Urinary Tract Symptoms by psychiatrists in mentally affected patients.

Psychiatr Pol 2017 Oct 29;51(5):963-978. Epub 2017 Oct 29.

Oddział Kliniczny Urologii, UJ Collegium Medicum.

Objectives: Lower urinary tract symptoms (LUTS) are highly prevalent and costly condition worldwide. Numerous studies have demonstrated their negative impact on health-related quality of life (HRQL), as well as on physical and mental health. The co-existence of LUTS and psychiatric symptoms is common and has been described by psychiatrists, urologists and gynecologists. However, data are lacking regarding the perception of urological symptoms by psychiatrists in their day-to-day clinical practice.

Methods: 31-question survey was designed to learn what is the perception of LUTS among psychiatrists. Survey link was sent by email to all psychiatrists registered to the Polish Association of Psychiatry via the association's email lists. The SurveyMonkey website was used as a platform where responses were collected and stored.

Results: 953 physicians completed the questionnaire. Majority of investigated psychiatrists only 'occasionally'ask their patients about voiding dysfunctions. Respondents estimated the frequency of voiding dysfunctions in their patients as 'moderately frequent'with a '10-30%' prevalence. However, discrepancies between different subgroups of psychiatrists have been noted. Furthermore, psychiatrists may not be fully aware of the effects of psychiatric treatment (psychotherapy/pharmacotherapy) on LUTS improvement, as well as possible deteriorations of voiding dysfunctions with psychiatric disorder progression.

Conclusions: This survey showed that the perception of urological symptoms by psychiatrists in their patients may be limited. Therefore, it is necessary to adequately inform and educate psychiatrists in terms of the impact of urological symptoms on patients'management, prognosis and quality of life.
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http://dx.doi.org/10.12740/PP/74365DOI Listing
October 2017

Chromium in urothelial carcinoma of the bladder.

Ann Agric Environ Med 2017 Dec 11;24(4):602-605. Epub 2017 May 11.

Department of Urology, Medical College, Jagiellonian University, Krakow, Poland.

Introduction And Objectives: Many epidemiological and experimental studies report a strong role of chemical carcinogens in the etiology of bladder cancer. However, the involvement of heavy metals in tumourigenesis of urothelial carcinoma of the bladder has been poorly investigated. Therefore, the aim of this study was to examine the relationship between chromium (Cr) and bladder cancer.

Material And Methods: Chromium concentration in two 36-sample series of bladder cancer tissue and sera from patients with this neoplasm were matched with those of a control group. The amount of trace elements in every tissue sample was determined using atomic absorption spectrometry. This was correlated with tumour stage.

Results: While the median chromium concentration levels reached statistically higher values in the bladder cancer tissue, compared with the non-cancer tissue (99.632ng/g and 33.144ng/g, respectively; p<0.001), the median Cr levels in the sera of the patients with this carcinoma showed no statistical difference when compared to those of the control group (0.511μg/l and 0.710μg/l, respectively; p=0.408). The median levels of Cr in the bladder tissue, depending on the stage of the tumour, compared with the tissue without the neoplasm, observed the same relationship for both non-muscle invasive and muscle-invasive tumours (p<0.001 and p<0.01, respectively).

Conclusions: This study shows that patients with urothelial carcinoma of the bladder had higher tissue Cr levels than people without tumour, while no difference was found in the Cr serum levels between the two groups of patients under investigation.
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http://dx.doi.org/10.5604/12321966.1232760DOI Listing
December 2017

Ureterorenoscopy training on cadavers embalmed by Thiel's method: simulation or a further step towards reality? Initial report.

Cent European J Urol 2017 14;70(1):81-87. Epub 2017 Mar 14.

Department of Urology, Ninewells Hospital and Medical School, Dundee, United Kingdom.

Introduction: The technique of ureterorenoscopy has a significant learning curve. Cadavers embalmed by the Thiel method have been successfully used for simulation training in a number of surgical specialties. Here we present our experience of the first use of Thiel cadavers in a formal ureteroscopy training course.

Material And Methods: The inaugural 'Masterclass in Flexible Ureterorenoscopy' was run with participants performing ureterorenoscopy on three Thiel cadavers under expert supervision. A qualitative questionnaire was delivered to the participants and faculty. Assessed domains were tissue characteristics of the cadaveric urinary tract, anatomical features and procedural aspects. A five-point Likert score was used to assess responses. Data regarding participant experience in endourology were also collected.

Results: 8 questionnaires were collected. All participants completed cadaveric ureterorenoscopy. Three-quarters reported the overall quality of tissue in the cadaveric bladder, ureters and pelvicalyceal system as high or excellent. Half reported the cadaveric bladder as being softer than in a live patient, whilst five out of eight thought that the cadaveric ureter was softer and more prone to trauma. Seven out of eight were satisfied with the overall quality of the cadaveric model. The quality of vision and irrigation in the upper urinary tracts was reported as high.

Conclusions: Thiel cadavers have been shown to have excellent tissue characteristics, as well as being durable and reusable. We have described the first use of Thiel cadavers in a designated ureterorenoscopy course, with high levels of delegate satisfaction. Further work is required to develop the role of Thiel cadavers as part of an integrated, modular urology training.
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http://dx.doi.org/10.5173/ceju.2017.913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407331PMC
March 2017

New Insights into Diagnosis and Treatment of Renal Cell Carcinoma, Bladder Cancer, and Prostate Cancer.

Biomed Res Int 2017;2017:6467072. Epub 2017 Mar 13.

Department of Urology and Centre for Urooncology, Semmelweis University, Üllői út 78/b, Budapest 1082, Hungary.

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http://dx.doi.org/10.1155/2017/6467072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366782PMC
October 2018

Associations of selected lower urinary tract symptoms with biographical context in patients of a day hospital for neurotic disorders.

Psychiatr Pol 2016 Dec;50(6):1207-1234

Zakład Zaburzeń Afektywnych Katedry Psychiatrii, Collegium Medicum UJ.

Objectives: To assess the correlation of subjectively estimated biographical context and lower urinary tract symptoms reported by patients with neurotic and personality disorders.

Methods: This was a retrospective analysis of the biographical context of co-existence of urinary frequency and urinary incontinence reported by 3,929 patients in a day hospital for treatment of neurotic disorders. The symptom checklists KO "0" were completed by patients prior to any treatment.

Results: Urinary frequency reported by patients in a day hospital for treatment of neurotic disorders was associated with the difficulties from their childhood and adolescence (i.e. with perception of inferiority with regard to one's family and among siblings, parents' low education level), as well as the disparities in terms of sexual education and troubled relationships.

Conclusions: In the studied group of patients with neurotic and personality disorders, selected lower urinary tract symptoms were associated with adverse life circumstances from childhood and adolescence (which can show the tendency towards regression and protracted character to experience of family's dysfunction due to feeling of being neglected or abandoned), as well as, to a larger or a smaller degree, their consequences - dysfunctions in adulthood, relationship/marriage, functioning at work and dealing with finances. These associations indicated the probable significance of experiencing these aspects of life in patients, not only in day hospitals or psychiatric hospitals which reported "pseudo-urological complaints", but also in at least part of urological patients - going to hospitals due to neurotic disorders, particularly those occurring in a somatic form.
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http://dx.doi.org/10.12740/PP/61583DOI Listing
December 2016

Occurrence of selected lower urinary tract symptoms in patientsof a day hospital for neurotic disorders.

Psychiatr Pol 2016 Dec;50(6):1181-1205

Zakład Zaburzeń Afektywnych, Katedra Psychiatrii UJ CM.

Objectives: To assess the occurrence of selected lower urinary tract symptoms in the population of patients with neurotic and personality disorders.

Methods: This was a retrospective analysis of occurrence, co-existence and severity of two selected lower urinary tract symptoms in 3,929 patients in a day hospital for neurotic disorders. The KO "O" symptom checklist was used to measure the study variables.

Results: Although the symptoms associated with micturition are not the most prevalent symptoms of neurotic disorders, neither are they the most typical ones, the prevalence of urinary frequency referring to the last week before psychotherapy evaluated among the patients of a day hospital, was approximately 50%. Involuntary micturition, a symptom with a significant implication on the self-esteem and social functioning was much less common; it was reported by approximately 5% relatively healthy and young group of patients. Major bother from urinary frequency was reported by 9-14% of patients, whereas from involuntary micturition by only 0.6%-1% of the surveyed patients.

Conclusions: Selected urological symptoms seem to be prevalent among the patients with neurotic and personality disorders, and are independent of the specific diagnosis or patients' gender. Their co-existence with other symptoms of neurotic disorders reported by the patients indicates their strongest relationship with the somatoform, dissociative, sexual and agoraphobic disorders.
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http://dx.doi.org/10.12740/PP/OnlineFirst/61109DOI Listing
December 2016

Mast cells influence neoangiogenesis in prostatic cancer independently of ERG status.

Pol J Pathol 2016;67(3):244-249

Department of Pathomorphology, Collegium Medicum of the Jagiellonian University, Krakow, Poland.

A significant proportion of prostatic adenocarcinomas show recurrent translocation leading to ERG expression. Previously we found that ERG+ cases have higher microvessel density than negative ones. One factor influencing angiogenesis in cancer is mast cells. The aim of the present study was to evaluate the relationship between microvessels, mast cells and ERG status. Tissue microarrays prepared from 113 radical prostatectomy specimens were analyzed with immunohistochemistry for CD31, tryptase and chymase. Vascular profiles and tryptase-positive and chymase-positive cells were counted. The average number of tryptase-positive cells was 28.93/mm2 and chymase-positive cells 9.91/mm2. The average number of CD31+ vascular profiles was 352.66/mm2. The average number of tryptase-positive cells was 26.35/mm2 for ERG- cases and 32.12/mm2 for ERG+ cases. The average number of chymase-positive cells was 8.14/mm2 for ERG- cases and 12.06/mm2 for ERG+ cases. The average number of CD31+ vascular profiles was 321.34/mm2 for ERG- cases and 390.74/mm2 for ERG+ cases. The number of CD31+ vascular profiles was positively correlated with the number of tryptase-positive and chymase-positive cells (R = 0.26 and R = 0.20). In summary, we demonstrated an interrelationship between mast cells, microvascular density and ERG status in prostatic carcinoma.
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http://dx.doi.org/10.5114/pjp.2016.62027DOI Listing
June 2017

Mutations of KRAS, NRAS, BRAF, EGFR, and PIK3CA genes in urachal carcinoma: Occurence and prognostic significance.

Oncotarget 2016 Jun;7(26):39293-39301

Department of Urology, Semmelweis University, Budapest, Hungary.

Purpose: Targeted therapy represents an attractive alternative for rare tumors such as urachal carcinoma (UrC). The aim of this study was to assess the mutations of the most commonly affected 5 genes in the targetable EGFR-pathway in UrC and comapre their frequencies to those of found in urothelial and colorectal cancer.

Materials And Methods: Mutational hot-spots of selected genes were tested in 22 UrC samples by pyrosequencing. Mutational patterns were compared to those published for colorectal and urothelial cancers. Furthermore, we sought correlations between mutations and clinicopathological and follow-up data.

Results: We found 11 mutations in 10 of 22 (45%) patients. The most frequently mutated gene was KRAS (27%) followed by BRAF (18%) and NRAS (5%), while no mutations were detected in the EGFR and PIK3CA genes. No correlation was found between the mutation status and clinicopathological parameters (Sheldon/Mayo stage, tumor grade, metastases). Furthermore, none of the mutations correlated with progression-free or overall survival.

Conclusions: The mutation pattern of UrC is more similar to colorectal than to urothelial cancer. However, the mutation characteristics of UrC seems to be unique suggesting that clinical decision-making for UrC cannot be simply adopted from urothelial or colorectal carcinoma. The high occurence of EGFR-pathway mutations warrants the testing for KRAS and BRAF mutations when considering anti-EGFR therapy in UrC.
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http://dx.doi.org/10.18632/oncotarget.9828DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129933PMC
June 2016

Evidence-based recommendations on androgen deprivation therapy for localized and advanced prostate cancer.

Cent European J Urol 2016 20;69(2):131-8. Epub 2016 Jun 20.

Department of Urology, Jagiellonian University, Medical College, Cracow, Poland.

Introduction: The management of prostate cancer (PC) is still evolving. Although, androgen deprivation therapy (ADT) is an established treatment option, particularly in patients with disseminated disease, important data regarding hormonal manipulation have recently emerged. The aim of this paper is to review the evidence on ADT, make recommendations and address areas of controversy associated with its use in men with PC.

Material And Methods: An expert panel was convened. Areas related to the hormonal management of patients with PC requiring evidence review were identified and questions to be addressed by the panel were determined. Appropriate literature review was performed and included a search of online databases, bibliographic reviews and consultation with experts.

Results: The panel was able to provide recommendations on: 1) which patients with localised PC should receive androgen deprivation in conjunction with radiotherapy (RT); 2) what standard initial treatment should be used in metastatic hormone-naïve PC (MHNPC); 3) efficacy of androgen deprivation agents; 4) whether ADT should be continued in patients with castration resistant PC (CRPC). However, no recommendations could be made for combined ADT and very high-dose RT in patients with an intermediate-risk disease.

Conclusions: ADT remains the cornerstone of treatment for both metastatic hormone-naïve and castration-resistant PC. According to the expert panel's opinion, based on the ERG report, luteinizing hormone-releasing hormone agonists might not be equivalent but this needs to be confirmed in long-term data. The combined use of ADT and RT improves outcome and survival in men with high-risk localised disease. The benefits in patients with intermediate-risk disease, particularly those subject to escalated dose RT are controversial.
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http://dx.doi.org/10.5173/ceju.2016.812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986307PMC
August 2016

Regenerative medicine- techniques and methods of administering autologous derived stem cells in urinary incontinence.

Ginekol Pol 2016 ;87(3):205-10

The aim of the work is to present regenerative medicine achievement as an alternative SUI treatment and the variety of injected cells type as well as injection techniques itself with the analysis of their quality and possible the mechanism in which they reduce urinary incontinence symptoms. For over a decade numerous authors declare use of different type of autologous mesenchymal-derived stem cells (AMDC) in male and female SUI. The leakage improvement reached 80%, despite the number of injected cells as well as the injection technique. Important subject in the AMDC treatment is the precise cell material injection into the selected spot which might be possible with the use of the endoscopic assisting robot. The robotic supported system for cells procedure might bring the missing percentage in reaching the goal in SUI treatment.
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http://dx.doi.org/10.17772/gp/60973DOI Listing
July 2018

Lower urinary tract symptoms, nocturia and overactive bladder in patients with depression and anxiety.

Psychiatr Pol 2016 ;50(2):417-30

Klinika Urologii UJ CM.

Lower urinary tract symptoms (LUTS) remain highly prevalent worldwide, and are well known to negatively impact patients' quality of life, sleep and psychosocial wellbeing. Conversely, both depression and anxiety have been shown to have a negative effect on perception, development and prolongation of LUTS. This paper provides an overview of an association between the lower urinary tract symptoms, depression and anxiety. It also explores possible common mechanisms underlying the causes of both conditions. There has been a large body of evidence linking LUTS with anxiety and/or depression. Studies have documented not only a significant impact of LUTS on the psychosocial wellbeing, but also showed a strong negative effect of depression and anxiety on perception, development and prolongation of LUTS. High level of psychiatric morbidity has important implications on the appropriate management in patients with LUTS, as well as LUTS may have important implications on development and management of depression and anxiety. Therefore, clinicians should be aware of the bidirectional association between LUTS and anxiety and/or depression, as some patients may require a multidisciplinary approach and a combined treatment. The precise common mechanism underlying LUTS, depression and anxiety remain largely unknown and further research is needed to elucidate the underlying pathophysiological pathways.
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http://dx.doi.org/10.12740/PP/OnlineFirst/59162DOI Listing
April 2017

The role of micronutrients in the risk of urinary tract cancer.

Arch Med Sci 2016 Apr 12;12(2):436-47. Epub 2016 Apr 12.

Department of Urology, Jagiellonian University Medical College, Krakow, Poland.

Prostate, bladder and kidney cancers remain the most common urological malignancies worldwide, and the prevention and treatment of these diseases pose a challenge to clinicians. In recent decades, many studies have been conducted to assess the association between supplementation with selected vitamins and elements and urinary tract tumour initiation and development. Here, we review the relationship between vitamins A, B, D, and E, in addition to calcium, selenium, and zinc, and the risk of developing prostate, kidney and bladder cancer. A relatively consistent body of evidence suggests that large daily doses of calcium (> 2,000 mg/day) increase the risk of prostate cancer. Similarly, supplementation with 400 IU/day of vitamin E carries a significant risk of prostate cancer. However, there have been many conflicting results regarding the effect of these nutrients on kidney and bladder neoplasms. Moreover, the role of other compounds in urinary tract carcinogenesis needs further clarification.
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http://dx.doi.org/10.5114/aoms.2016.59271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848374PMC
April 2016