In this study our aim is to increase the understanding of the prostate and related organs anatomy for better continence and erectile function results after urological surgery. Prostate and related organs were dissected from seven cadavers. After dissection, 165 serial sections with 300 lm thickness were derived at a 100 lm interval. The histological images were examined and imported to the computer. Three-dimensional (3D) remodeling had been performed. The findings were evaluated into three categories: macroscopic, microscopic and 3D reconstruction. Striated muscle fibers had been detected at the anterior fibromuscular stroma in histological sections. In 3D remodeling, urethra seemed to be a complete functional unit, beginning from the trigone up to the membranous urethra. The neurovascular bundles run under the pelvic fascia on both sides and go through to the bladder neck at 5 and 7 o'clock. Computer remodeling demonstrated that neurovascular structures had a close association with the bladder neck and the seminal vesicle. Computer program made it possible to rotate all 3D-reconstructed figures by 3601 and examine them from all possible angles. All reconstructed structures can be examined together at the same time or one by one. Surgeons must pay special attention to the continence area described as a single unit, beginning from trigone to the membranous urethra, during the surgery. Meticulous dissection of the neurovascular bundles, especially close to the seminal vesicles and bladder neck, during the radical prostatectomy is necessary. These reconstructions can be used for the educational purpose of medical students as well as the urology surgeons.

Background and ObjectiveTo analyze p53, Ki-67 and bcl-2 expressions immunohistochemically and their predictive role in biochemical recurrence after radical prostatectomy.Materials and MethodsSeventy one patients who had undergone radical prostatectomy between 1992 and 2001 were randomly selected. Tissue microarrays were constructed from their radical prostatectomy specimens. They contained four cores from neoplastic and additional four cores from corresponding non-neoplastic regions. Gleason score ranged from 6-9, and pathological stage ranged from T2N0Mx to T3BN1. Staining for bcl-2 was scored visually taking percent negative, weak, moderate and strong positivity into consideration. Strong immunoreactivity was considered positive for p53. Ki-67 index was measured as the percentage of positive nuclei among tumor cells. Statistical analysis was performed to explore correlations between staining patterns and clinicopathological prognostic parameters.ResultsThe follow-up period extended from 13 to 112 months with a mean 60 (48 ± 23, 2) months. Of all, 38.02% had no evidence of disease, 52.1% were alive with disease and 9.8% were died during follow-up. The expression of p53, Ki-67 and bcl-2 in tumors were 39%, 76% and 5% respectively. While the secretory layer showed negative or weak bcl-2 staining in most cases, expression in basal cells was often stronger. Statistical analysis revealed differences in staining between normal and carcinoma for all three markers. There was no correlation between staining patterns and time to biochemical relapse. On the other hand, cases with higher Gleason sum showed the tendency for over expression of p53, Ki-67 and bcl-2 although the differences were not statistically different. Multivariate analysis revealed CMS group and seminal vesicle invasion as the independent predictors of PSA failure (log rank P = 0.0039 and P = 0.001, respectively).ConclusionThe proteins bcl-2, p53 and Ki-67 were expressed at a different rate in normal and neoplastic prostate tissue. Bcl-2 was mainly expressed by basal cells in normal glands. p53 and Ki-67 expression were increased in most prostate carcinomas. However, overall expression levels did not correlate with biochemical recurrence in this study.

BackgroundSince majority of IgG4-related disease (IgG4-RD) patients in the literature are from Far East and United States, there is a lack of large series from other parts of the world.ObjectivesWe aimed to identify the clinical characteristics and outcome of Turkish IgG4-RD patients from a tertiary center.MethodsIn step 1, clinical and histopathological features of patients having any disease under the clinical spectrum of IgG4-RD were retrospectively reviewed. For step 2, patients prospectively diagnosed are enrolled into the study. Patients fulfilling the “definite” diagnosis according to comprehensive diagnostic criteria were recruited (enrolled (n=52), excluded (n=47).ResultsMedian age was 51.1 years and no gender predominance was observed (Male/female: 26/26). Retroperitoneal fibrosis is the most frequent presentation; others were lymphadenopathy, orbital pseudotumor, pancreas and salivary glands in decreasing order (Table). Twenty-four (46.1%) of patients had localized involvement. Corticosteroids were mainstay of treatment in 92.5% of patients, and in 57.5% with any immunosuppressive agents as first line treatment. Rituximab has been used for cases resistant to previous treatment or with relapses in 19 (47.5%) of patients. A complete response was achieved in 52.5% of patients and partial response (<50% of regression) in 40%. Two patients deceased due to IgG4-RD attributed problems and no malignancy was observed (median follow up: 18 months).Table 1.Distribution of clinical findings and organ involvement (n=52)Constitutional symptoms, n (%) Fatigue31 (59.6) Tiredness16 (30.7) Night sweats15 (28.8) Weight loss14 (26.9) Fever13 (25)Retroperitoneal fibrosis, n (%)23 (44.2)Lymphadenopathy, n (%)20 (39.2)Any cardiovascular involvement, n (%)15 (28.8) Periaortitis12 (23.1) Pericardium5 (9.6) Coronary periarteritis4 (7.7) Abdominal aort aneurysm1 (1.9)Orbital pseudotumor, n (%)12 (23.1) Orbitalmass/proptosis6 (11.5) Extraoculary muscles6 (11.5)Pancreas, n (%)12 (23.1)Major salivary glands, n (%)11 (21.2)Lacrimal glands, n (%)9 (17.3)Mediastinal fibrosis, n (%)6 (11.5)Ear, nose, sinuses, n (%)5 (9.6)Lung fibrosis, n (%)5 (9.6)Skin , n (%)4 (7.7)Pleura, n (%)4 (7.7)Gall bladder and Biliary ducts, n (%)4 (7.7)Thyroid, n (%)3 (5.8)Liver, n (%)3 (5.8)Kidney (mass) , n (%)3 (5.8)Pachymeningitis, n (%)2 (3.8)Breast involvement: (n=1), tubulointerstitial nephritis (n=1).ConclusionsWe observed similar features with previous European cohorts however no male predominance was seen. Even though conventional immunosuppressives were used in more than half of patients, treatment had switched to rituximab ∼50% patients owing to resistance or relapses.Disclosure of InterestNone declared