OBJECTIVETo determine the effect of nephroureterectomy (NU) on the glomerular filtration rate (GFR), and to determine whether the estimated GFR after NU is influenced by age and other factors associated with renal impairment. PATIENTS AND METHODSWe retrospectively identified 131 patients who had had a NU at either of two UK institutions. Their serum creatinine levels were recorded before and after NU, along with comorbidity data, and from this their GFR before and after NU was estimated using the Modification of Diet in Renal Disease Study Group equation. RESULTSAt a median follow-up of 5 years there was an 18% deterioration in estimated GFR in the 131 patients. The percentage deterioration in estimated GFR was greater in those aged ≥ 70 years than in those aged < 70 years (20% vs 15% deterioration). Those with more risk factors for renal impairment had a greater percentage deterioration in estimated GFR than those with no such risk factors. CONCLUSIONSThis study shows that NU has a profound effect on future estimated GFR, an effect that is further compounded in those with risk factors for renal impairment. This study therefore provides both the patient and the urologist with an idea of potential future renal function after NU and contributes greatly to preoperative counselling.

Studies of seminal tissue factor (TF) are few and mostly based on small numbers. Due to the reported lack of factor (F) X in semen, it has been suggested that TF may not have a role in seminal coagulum formation. However, recent identification of a number of haemostatic factors in semen justifies a re-evaluation of its occurrence. Semen specimens were collected from sub-fertile (n = 19), normally fertile (n = 33), semen donors (n = 30) and vasectomized subjects (n = 62), some fractionated into sperm, a prostasome-rich fraction and seminal plasma. Functional and antigenic TF levels were measured and related to conventional fertility parameters. Semen contains high concentration of functional and antigenic TF. Most TF was found in seminal plasma prepared by low-speed centrifugation. When further fractionated by ultracentrifugation much of this may reside in the pellet (prostasomal fraction). It was also detectable on sperm. TF antigen levels were higher in vasectomized subjects than sub-fertile, normally fertile, donor (p = 0.02) and a 'pooled normal semen parameters' (PNSP) stratification (derived from a combination of measurements) (p = 0.06). The sub-fertile group showed a wider variation than normal, donor or the PNSP subjects. Seminal TF antigen levels correlated significantly with sperm agglutination (p = 0.03) and abnormal sperm morphology (p = 0.04). Subjects with anti-sperm antibodies also showed high TF antigen levels. In conclusion, semen contains functional and antigenic TF at high concentrations. A full complement of clotting factors probably exists in semen, so some pro-coagulant role for TF should not be excluded. Decreased seminal TF levels appear to be associated with seminal parameters that are known to favour male fertility.

OBJECTIVES To investigate whether cellular exosomes liberated by prostatic cell lines in culture might be acting as the transport vehicles for the dietary antioxidant lycopene, known to be sequestered in the prostate gland and to reduce the risk of developing benign prostatic hyperplasia (BPH) and prostate cancer; its subsequent secretion into seminal plasma also confers protection to spermatozoa against oxidative free‐radical damage. MATERIALS AND METHODS Using benign and malignant human prostatic cell culture models, we assessed the role that their exosomes (the putative in vitro analogues of prostasomes) might have in the transport of lycopene. RESULTS Cells exposed to lycopene in vitro accumulated the molecule and secrete lycopene‐enriched exosomes. This continued after the lycopene exposure was stopped. Extraction of lycopene from the exosomes, followed by high‐performance liquid chromatography, confirmed nanogram quantities of lycopene per milligram of exosomal protein. Packaging into exosomes for export resulted in reduced degradation of this labile antioxidant, and therefore maximized the effectiveness of delivery to the sites of action. CONCLUSION These results support the likelihood that these organelles act as the transport vehicles for this important lipophilic agent known to have a role in the chemoprevention of various urological pathologies such as BPH, prostate cancer and male infertility.