Search

Background: Profound alterations in immune responses associated with uraemia and exacerbated by dialysis increase the risk of developing active tuberculosis (TB) in chronic haemodialysis patients (HDPs). In the current study, was determined the impact of various risk factors on TB development. Our aim was to identify which HDPs need anti-TB preventive therapy., Methods: Prospective study of 272 HDPs admitted, through a 36-month period, to our institutions. Specific Relative Risk (RR) for TB was estimated, considering age matched subjects from the general population as reference group. Entering the study all patients were tested with tuberculin (TST). Using Cox's proportional hazard model the independent effect of various risk factors associated with TB development was estimated., Results: History of TB, dialysis efficiency, use of Vitamin D supplements, serum albumin and zinc levels were not proved to influence significantly the risk for TB, in contrast to: advanced age (>65 years), BMI, diabetes mellitus, tuberculin reactivity, healed TB lesions on chest X-ray and time on dialysis. Elderly (>70 years old) HDPs (Adjusted RR 25.3, 95%CI 20.4-28.4, P < 0.02), diabetics (Adj.RR 25.3, 95%CI 17.2-21.1, P < 0.03), underweighted (Adj.RR 72.3, 95%CI 65.2-79.8 P < 0.001), tuberculin responders (Adj.RR 41.4, 95%CI 37.9-44.8, P < 0.03), HDPs with fibrotic lesions on chest x-ray (Adj.RR 82.3, 95%CI 51.3-95.5, P < 0.03) and those treated with haemodialysis for < 12 months (Adj.RR 110.0, 95%CI 97.4-135.3, P < 0.001), presented significantly higher specific RR for TB even after adjusting for the effect of the remaining studied risk factors., Conclusion: The above mentioned factors have to be considered by the clinicians, evaluating for TB in HDPs. Positive TST, the existence of predisposing risk factors and/or old TB lesions on chest X-ray, will guide the diagnosis of latent TB infection and the selection of those HDPs who need preventive chemoprophylaxis.

Aim: To define any gender-related differences in the prevalence and risk for tuberculosis (TB) in hemodialysis (HD) patients., Methods: All active TB cases were recorded during a 36-month follow-up of 272 (193 male and 79 female) HD patients. Entering the study, HD patients were tested with tuberculin and 2,4-dinitrochlorobenzene, and a cell-mediated immunity (CMI) index was estimated. Relative risks (RR) for TB were calculated considering subjects from the background general population as a reference group. The independent effect of age, BMI and tuberculin sensitivity was determined using Cox's proportional hazard model., Results: Female HD patients presented significantly lower CMI indices and rates of positive Mantoux tests, but higher rates of DM, as compared to males. The male:female ratio in TB for the general and HD patients population was 1.8 and 0.6, respectively. There was a significantly lower TB prevalence in male as compared to female HD patients (7.7% vs. 11.3%), and a subsequent female predominance in risk for TB in those HD patients aged <49 and 50-69 years (M:F adjusted relative risk 0.67 and 0.53) was recorded., Conclusions: In contrast to the general population, there is a female predominance among dialysis TB patients younger than 70 years associated with the coexistence of DM. Female gender should always be considered as a risk factor when evaluating diabetic HD patients for active TB.

We report a case of laparoscopic management of a primary malignant melanoma of the left adrenal gland. A 42-year-old male presented a 55 x 60-mm round, inhomogeneous, noninvasive mass of the left adrenal gland. Hormone-activity values were within normal range. The mass was removed laparoscopically en bloc along with the left adrenal gland, and its histopathologic evaluation was consistent with the features of a malignant melanocytic tumor. Postoperatively, the patient presented no signs of fever or remarkable blood loss and was discharged on the third day in good clinical condition. He is free of disease 1 year later.

A case of isolated, bilateral, adrenal tuberculosis is presented. A 25-year-old male was admitted to the hospital due to lumbar pain, fever, weight loss and anorexia. Abdominal ultrasonography and computed tomography demonstrated bilateral adrenal enlargement. Laboratory investigations were remarkable for adrenal insufficiency. The Mantoux reaction was positive but there was no evidence of lung or urinary infection. CT-guided biopsy of the left adrenal gland was performed and established the diagnosis of adrenal tuberculosis., (Copyright (c) 2006 S. Karger AG, Basel.)

Background: Dialysis patients are at increased risk of tuberculosis (TB) and anergy due to attenuated cellular immunity., Aim: To define specific risks of TB in anergic and non-anergic dialysis patients., Methods: A total of 272 dialysis patients were enrolled in this prospective study over a 36-month follow-up. Entering the study, participants had Mantoux and 2,4-dinitrochlorobenzene skin tests and their cell-mediated immunity (CMI)-index was estimated. Patients were classified as anergic (CMI-index

Purpose: The aim of the present study was to evaluate and quantify the antiangiogenetic effect of ionizing radiation on tumor angiogenesis using digital subtraction angiography (DSA) in conjunction with computer assisted image analysis (CAIA)., Methods: Walker 256 carcinosarcoma was inoculated in both glutei of 12 Wistar rats. When the tumors reached a diameter of 1.5 cm, local irradiation of the right gluteus was performed. The left gluteus of each animal served as a control. After 24 hours of irradiation, angiography was performed, and images where digitized and subsequently processed. The effect of irradiation was observed both in big and small vessels (smaller or greater than 200 microm)., Results: Irradiated areas of both small and big vessels showed a statistically significant reduction in both total vessel area and length. Small vessels showed a greater trend toward suppression by irradiation (not statistically significant)., Conclusion: Irradiation had a deleterious effect in both macro- and micro-blood supply of a tumor. The use of CAIA enhanced the efficacy of DSA and enabled the in vivo identification of the effect of irradiation on various caliber vessels as well as the ratios of total length and total area of small and big vessels.

There are four types of ureteral metal stents: self expandable, balloon expandable, covered, and thermoexpandable shape-memory. Insertion of metal stents requires expertise with transurethral and percutaneous techniques. The stricture is traversed with the aid of a guidewire via a percutaneous nephrostomy, and the stenotic segment is dilated using a high-pressure balloon catheter. The stent is then inserted over the guidewire, such that the upper end bypasses the obstruction by at least 3 to 4 cm, while the lower end extends intravesically for 0.5 to 1 cm from the ureteral orifice. If necessary, two or more stents are placed in sequence, overlapping by at least 2 to 3 cm. Metal stents were initially used for the relief of end-stage malignant disease, and their role in the treatment of benign ureteral strictures is still undefined. Patients often complain of abdominal discomfort and mild pain after stent insertion, which soon resolve spontaneously. Hematuria usually stops after a few days and does not necessitate any treatment. Mild urothelial hyperplasia in the stent lumen is common but usually regresses after 4 to 6 weeks. Many authors suggest the use of a double-pigtail catheter for the first 4 to 6 weeks to avoid narrowing of the ureteral lumen. The influence of stents on ureteral peristalsis is a major but poorly documented issue. Encrustation is a significant problem that needs to be addressed. The characteristics of both the patient and the stent influence its likelihood. Migration of coated metal stents was seen in 81% of patients at our center. Virtual endoscopy has recently been introduced as a tool for the follow-up of patients with stented ureters. Further design development is necessary to obtain the ideal ureteral metal stent. In a recent study in female pigs, paclitaxel-eluting metal stents engendered less inflammation and hyperplasia of the surrounding tissues.

Purpose: To evaluate the use of virtual endoscopy (VE) for the investigation of the pelvicaliceal unit and the depiction of its anatomic deformities., Patients and Methods: Two study groups were prospectively enrolled in our protocol: ten patients with nonurologic pathologies, and thus without any known deformity of the pelvicaliceal unit (group A), and five patients with caliceal obstruction (group B). Virtual endoscopy represented a non-invasive technique providing amplification of the image in three-dimensional space., Results: Virtual endoscopy was feasible in all patients, and in all cases succeeded in demonstrating the threedimensional morphology of the region of interest. The entire processing time ranged from 10 to 15 minutes (mean 12.6 minutes), and the three-dimensional image could be viewed from different angles, allowing better evaluation of the collecting system and its deformities than is possible with conventional intravenous urography or percutaneous nephrostomography., Conclusion: Virtual endoscopy enabled the creation of endoluminal views of the renal pelvis and calices from spiral tomographic images, thereby allowing diagnostic-preoperative and postoperative evaluation of the pelvicaliceal unit.

Purpose: To design a Web-based network for diagnostic and therapeutic guidance in urology., Materials and Methods: We designed an architectural model of a low-cost multimedia Web platform that runs on a collection of distributed collaborative network nodes to provide a set of urologist-oriented Web-enabled services. Any node of the platform was able to share patient-oriented data via automated processes with appropriate authorization, confidentiality, and high-security protocols. The urologist can show the details of the records of patients and additionally enrich the world experience with his or her own cases. Video clips maintained locally at the nodes will be accessible by clinicians in a trouble-free way with MS Windows Media player and a relatively small amount of source code., Results and Conclusions: The primary advantage of this architectural model is that it provides Web-enabled integrated urologic services while using a distributed storage scheme for urological video files (AVI format) and a global repository of laboratory results using Extensible Markup Language (XML) and Data Grid technologies. In addition, this model provides decision-support services (knowledge from a global database and predefined procedures). The architecture model is based entirely on HTTP, XML, GRID-like environment and DotNet technologies. Finally, the platform provides extensibility and scalability targeted to large-scale Web-enabled global urologic databases.

Purpose: To determine the composition and the extent of crystalline (and other) encrustation on ureteral catheters inserted under sterile conditions in stone formers, in comparison with catheters of the same type inserted in nonstone formers for the same time but for different clinical reasons., Materials and Methods: Forty consecutive self-retained polyurethane pigtail ureteral catheters removed by cystoscopy between November 2000 and February 2002 were studied, 30 from stone formers and 10 from patients without stone histories. The mean dwelling time was 55 days for the stone formers and 79 days for the other patients. The encrustations were collected and analyzed with Fourier-transform infrared spectroscopy, powder X-ray diffraction, or both. The stones from nine of the patients were also subjected to the same spectroscopic analysis. Representative sections of the catheters were investigated by scanning electron microscopy and energy-dispersive X-ray analysis., Results: The most common encrustation in stone formers was calcium oxalate monohydrate. In patients without stones, deposits of organic compounds were found consistently. The mean mass of encrustation of stone formers was larger (71.05 mg) than that of patients without stones (1 mg)., Conclusions: Calcium oxalate is the predominant type of encrustation on ureteral catheters in stone formers. Prevention of heavy encrustation should be directed to therapeutic measures concerning calcium oxalate lithiasis and development of new materials by the medical industry that are less prone to encrustation.

Purpose: We investigated the utility of virtual endoscopy (VE) as a diagnostic and follow-up tool in patients with renal artery stenosis, especially as a means of defining vascular patency., Patients and Methods: We performed VE in 24 patients with ostial atherosclerotic renal artery stenosis and correlated the results with those of conventional angiography. The patients were treated successfully by placement of metal stents and conventional catheter angiography and VE for patency assessment 6 and 12 months after stent insertion., Results: In all patients, the stenotic segment was identified, and VE findings were concordant with those of angiography. The average degree of stenosis was estimated to be 70% +/- 20% when angiography was used and 62% +/- 15% when VE was used. After metal stent insertion, the 12-month patency rate was 83.3% (20 patients). Angiography and VE findings remained concordant during the follow-up period, but VE provided more information beyond the stenotic segment, allowing examination of the arterial lumen both cephalad and caudal to the point of obstruction., Conclusion: Virtual endoscopy provided a more dynamic, direct, minimally invasive approach that was equal to or better than angiography for both the verification of the vascular stenosis and the evaluation of the arterial lumen.

We report a case of laparoscopic excision of a large symptomatic left seminal vesicle cyst and ipsilateral renal agenesis. A 26-year-old man presented with a 15-year history of dysuria and irritative voiding symptoms. The diagnostic evaluation revealed a 62 x 40 x 35-mm left seminal vesicle cyst. In addition, he had a solitary, right, functioning kidney, with no evidence of the left renal unit. Transperitoneal laparoscopic excision of the cyst was performed successfully. The total operative time was 190 minutes, and blood loss was minimal. The patient was discharged from the hospital on the second postoperative day and did not present with any complaints or complications thereafter.

Objective: In the present study we have applied virtual endoscopy (VE) in patients with ureteral metallic stents as a follow-up tool study especially in the need to define ureteral patency., Methods: We performed the suggested technique in 6 patients with malignant ureteral obstruction treated successfully by placement of Wallstent intraureteral metallic stents, and correlated the results with antegrade nephrostomography 48 hours after initial stent placement., Results: In 2 patients restenosis was observed, and in the remaining 4 patients the stented ureters remained patent during the follow up evaluation. VE and antegrade nephrostomography, were concurrent as to their findings. Moreover, VE proceeds beyond the stenotic segment, allowing visualization of the ureteral lumen both cephalad and caudal to the point of obstruction., Conclusion: VE is providing indeed a more accurate, direct and dynamic approach in the evaluation of a strictured ureteral lumen within the metallic stent.

Purpose: We report our experience with auto-expandable metallic stents for treating ureteropelvic junction obstruction., Materials and Methods: We treated 4 patients with a mean age of 45 years who had ureteropelvic junction obstruction with placement of a self-expandable intraureteral metallic stent (Wallstent, Schneider, Zurich, Switzerland). All patients presented with recurrent ureteropelvic junction obstruction after open pyeloplasty. Excretory urography and 3-dimensional reconstruction computerized tomography were performed 1 and 6 months after stent insertion. Virtual endoscopy images were obtained at followup due to the need to define ureteral patency., Results: Mean followup was 16 months (range 9 to 24). Wallstent placement was successful and immediate patency was achieved in all cases. During followup 3 patients required no further intervention and the stented ureteropelvic junction remained patent. In the remaining patient stricture recurred 2 months after initial stent insertion due to the ingrowth of scar tissue through the prosthesis. Additional intervention was deemed necessary after placing a longer 6 cm., completely coaxial overlapping metal stent. Virtual endoscopy and excretory urography findings concurred. Virtual endoscopy allows visualization of the stented ureteropelvic junction lumen cephalad and caudal to the prosthesis. It also enables easy navigation within the stent at different angles of view., Conclusions: The concept of applying metallic stents for ureteropelvic junction obstruction and adjacent adynamic ureteral segments combined with virtual endoscopy is strengthened by the results of this study.

Objective: The purpose of the present study was to evaluate the use of externally coated stents in patients with malignant ureteral obstruction., Materials and Methods: We have prospectively evaluated 16 patients, 10 men and 6 women, with malignant ureteral obstruction treated successfully by placement of Passager metal stents (Boston Scientific, Natick, MA, USA) bypassing the stricture. Mean patient age was 65.6 years (range 62-78 years). Ureteral patency was confirmed 24 and 48 hours by injection of contrast material through the nephrostomy tube, and after patency confirmation the nephrostomy catheter was removed., Results: All stents were positioned successfully, and the postoperative course was uneventful. In 13 cases (81.2%) the prostheses finally migrated into the bladder hindering overall ureteral patency (mean time of migration: 1.5 months). Patency was achieved in the remaining ureters (n=3), during the follow-up period (mean: 8 months, range 6-16 months), without any need for further intervention., Conclusion: The inappropriate anchorage and the increased ureteral peristalsis are the main causes of migration towards the bladder, thus, minimizing the usefulness of this stent for the treatment of ureteral strictures.

Fistula formation between a ureteral branch of a renal artery and the ipsilateral ureter is rare. We describe a case that followed ureterolithotomy of an impacted stone. Selective angiography with embolization of the bleeding branch was curative.

We report our experience with two cases of late migration of the suture and bolster occurring 2 years after a modified Stamey endoscopic bladder neck suspension. Delayed migration of the suture and bolster after an endoscopic bladder neck suspension across tissue planes, with subsequent erosion into the bladder, is uncommon. Recurrent urinary tract infection and mild suprapubic discomfort were the only symptoms. Cystoscopy was the only helpful diagnostic tool and should be considered early in the evaluation of this kind of patients. The mechanism of migration of the cuff and the operative technique are discussed.

Purpose: To evaluate the use of the tissue adhesive enbucrilate in the treatment of symptomatic nephroptosis., Materials and Methods: We performed adhesive nephropexy in 9 patients who presented with well-documented symptomatic nephroptosis that was demonstrated with intravenous pyelography and/or radionuclide renogram studies. The ptotic kidney was fixed on the psoas muscle using 0.5 ml of enbucrilate (Histoacryl)., Results: Adhesive nephropexy was successful in all 9 patients. Average operative time was 37 min. Postoperative opioid analgesia duration and hospital stay were limited (mean 2 and 4.4 days, respectively). Most patients returned to normal activity within 2 weeks (mean 14.2 days). Mean follow-up was 25 months and showed postoperatively a good anatomical result in radiographic studies as well as significant pain alleviation (mean 1 vs. 7 preoperatively, on a 10-point scale, p < 0.005 Wilcoxon rank test)., Conclusions: The tissue adhesive enbucrilate seems to be a safe, efficient agent to obtain good results in a simple, quick approach in the surgical treatment of symptomatic nephroptosis., (Copyright 2002 S. Karger AG, Basel)

Purpose: We report on our experience with the use of metal stents for the treatment of atherosclerotic renovascular disease., Patients and Methods: Since 1996, 62 patients (mean age 67 years) with ostial atherosclerotic renal artery stenosis were treated successfully by placement of metal stents. All patients presented with renovascular hypertension, and eight had additionally impaired renal function. In 12 patients, stents were placed bilaterally. In 54 patients, the introduction of stents was performed as the primary mode of treatment, and in the remaining 8 patients, the positioning of the endoprosthesis was deemed necessary because of recurrence of stenosis previously treated by renal percutaneous transluminal angioplasty (PTA). The patients were followed for a mean period of 18 months (range 9-48 months)., Results: Positioning of the endoprosthesis was successful in all patients. No major complications were reported. The 18-month patency rate was 77.4% (48 patients). Hypertension resolved in 39 patients and showed a trend to improvement in 15 patients. We observed no improvement of renal function in the eight patients who had impaired function prior to the procedure., Conclusion: Implantation of metal stents is a safe and effective method for the treatment of atherosclerotic renal artery stenosis and certainly presents an important alternative to renal PTA.

Purpose: The purpose of the present study was to compare the standard metal stents with internally and externally coated metal stents in the pig model., Materials and Methods: In nine female pigs weighing between 25 and 30 kg, the metal stents were randomly placed in either the right or left ureter, for a total of 18 stented ureters. Six ureters were stented with a Wallstent (Schneider, Zurich, Switzerland), six with a Passager stent (Boston Scientific, Natick, MA, USA), and six with a Corvita endoluminal graft (CEG) (Boston Scientific, Natick, MA, USA). Patency was examined by nephrostotomography 24 hours and 21 days after the initial procedure., Results: Free flow of urine through the stents into the bladder was revealed in all ureters with the exemption of four cases where a Passager stent migrated into the bladder, jeopardizing ureteral patency. The Wallstent generated mild inflammation with metaplasia of the urothelium; the CEG a more pronounced inflammatory response in the adjacent ureter; and the Passager stent severe inflammatory reaction with necrosis of the urothelium. The sections of the Wallstents revealed the presence of a mild polypoid reaction adherent to the internal surface of the devices. The coated stents showed no tissue ingrowth through the lining material into the ureteral lumen, and thus, the urothelium was compressed beneath the prostheses., Conclusions: Our experimental results suggest that the standard Wallstent generates less inflammation of the surrounding tissues than coated stents. The coated stents have the advantage of minimal tissue ingrowth but have a tendency to migrate toward the bladder.

Purpose: A detailed clinical management of the urological manifestations of multiple sclerosis (MS) is presented as it is practiced in our department, and therapeutic algorithms are constructed., Materials and Methods: One hundred and ten patients were consecutively and prospectively studied with a clinical syndrome of MS. ranging in age from 32 to 65 years of age. Clinical diagnosis of the voiding dysfunction associated with MS was classified as a malfunction causing either problems of bladder evacuation, or storage, or a combination of both., Results: All patients were initially managed in a conservative way avoiding surgical procedures and following primarily pharmacologic treatment, because of the quite common reversibility of MS. The detailed management of the related voiding dysfunction is given by the proposed algorithms., Conclusions: Our purpose was to present the algorithms that can help the practicing physician to come to reasonable conclusions as to therapeutical choices directed to specific pathophysiologic characteristics of voiding dysfunction related to MS.

Purpose: In this study a detailed clinical management is presented as it is practiced in our department, and possible correlations between grade of the disease and therapeutic responses are examined., Materials and Methods: One hundred and ten patients were consecutively and prospectively studied with a clinical syndrome of MS, ranging in age from 32 to 65 years of age. Clinical diagnosis of the voiding dysfunction associated with MS was classified as a malfunction causing either problems of bladder evacuation, or storage, or a combination of both. Therapeutic responses of the voiding dysfunction were correlated with grade of the disease. Mean follow up period was 54 months., Results: All patients were initially managed in a conservative way avoiding surgical procedures and following primarily pharmacologic treatment, because of the quite common reversibility of MS. A possible correlation of response to treatment according to grade of the disease was studied. There was significant difference in the response to drug treatment among patients of different grades favoring grade 1 patients with both storage and evacuation voiding dysfunction., Conclusions: Our suggested treatment has secured the conversion of a high pressure into a low pressure vesicourethral system, thus obviating possible risk factors for the upper urinary tract and the bladder itself. Therapeutic responses were dependent upon the grade of the disease.

Purpose: In the present study we have performed a correlation of the most prevailing clinical conditions of multiple sclerosis (MS) with overall drug response and the grade of the disease., Materials and Methods: One hundred and ten patients were consecutively and prospectively studied with a clinical syndrome of MS, ranging in age from 32 to 65 years of age. In the present study we evaluated the patients with DESD (n = 35), detrusor hyperreflexia (n = 32), and/or low compliance (n = 8). The latter three conditions were considered as the most threatening, and thus a correlation with the drug response and the grade of the disease was attempted., Results: All patients were initially managed in a conservative way avoiding surgical procedures and following primarily pharmacologic treatment, because of the quite common reversibility of MS. Our results suggest that there is no correlation between the prevailing clinical status and drug response (p = 0.06) or grade of the disease (p = 0.07). The only statistically significant correlation was seen between grade of the disease and overall drug response (p < 0.0001), Conclusions: Therapeutic responses were dependent upon the grade of the disease. The continuation of this study recruiting more patients into various subgroups of voiding dysfunction will further validate the statistical correlations among disease grade and therapeutic responses.

Purpose: In vitro preparation of liposome-covered metal stents and loading of liposomal drug formulations that will slowly release the drug in the vicinity of the stent., Materials and Methods: Polytetrafluoroethylene-coated stents were used. Large multilamellar (MLV) liposomes (phosphatidylcholine:cholesterol 1:1 mol/mol), empty or entrapping the corticosteroid anti-inflammatory drug, dexamethasone, were prepared by the thin-film hydration method and applied to pieces of stent using a simple and mild evaporation technique. Initially, a freeze-drying method for applying liposomes to stents was also evaluated, but it failed to produce stents that efficiently retain liposomal lipid when incubated in an aqueous environment. The presence of liposomes on the stent surface was confirmed by scanning electron microscopy., Results: After analyzing the release of liposomal lipid (using a phospholipid assay) and liposomal drug (by a modified dexamethasone high-pressure liquid chromatography method) in an in vitro system developed to simulate in vivo conditions, it was found that 39.11+/-6.8% of the lipid and 50.84+/-5.48% of the drug was released from the stent pieces during 48 hours of incubation in the presence of artificial urine. The amount of dexamethasone released from stents during their application procedure was found to be negligible in an in vitro dry run., Conclusion: The use of stent-associated liposomal drug formulations as slow-release depots could be an efficient method of treating the untoward event of ureteral stent obstruction.

Objectives: Retinoids are unique modulators of gene activity, cell growth and differentiation by binding to a series of nuclear receptors, i.e. all-trans-retinoic acid receptors (RAR) or 9-cis-retinoid receptors (RXR). In this study, the expression of RARalpha was immunohistochemically evaluated in benign, hyperplastic and malignant prostatic tissue and correlated with sex steroid receptor status., Methods: Twenty-four cases of BPH and 139 cases of primary prostatic carcinoma were evaluated for RARalpha expression in correlation with androgen (AR), estrogen (ER) and progesterone (PGR) receptor staining, as well as with tumor grade., Results: RARalpha was detected in the nuclei of epithelial cells in both BPH and prostate carcinoma cases. A modest inverse relationship with grade was present, especially for grade I and grade II tumors. AR staining was intense and a strong inverse relationship with grade was revealed. Although ER and PGR showed nuclear staining in prostatic epithelium, the overall expression for these receptors was low. When RARalpha content was compared to the nuclear AR expression, at least two-fold higher RARalpha levels were observed in AR+ grade II and grade III tumors., Conclusions: RARalpha expression can be immunohistochemically evaluated in formalin-fixed paraffin-embedded prostatic tissue. RARalpha expression is significantly elevated in AR+ moderately and poorly differentiated prostate carcinomas. Immunohistochemical determination of RARalpha content may be useful in defining the patient subsets in which retinoid-based treatment may be of clinical value.

Materials and Methods: A section of a metal stent consisting mainly of tantalum coated partially by strongly adhering calcium oxalate monohydrate (COM) crystals was immersed in supersaturated solutions prepared from calcium chloride and sodium oxalate at 37 degrees C and ionic strength 0.15 M in NaCl. Abstract, Objectives: To investigate the kinetics of encrustation of a metall alloy urinary stent system in vitro by calcium oxalate and characterize the crystals forming from solutions supersaturated with respect to all calcium oxalate hydrates., Results: The COM-coated stent mineralized upon immersion in the supersaturated solutions. The process was monitored with a calcium ion-selective electrode and the rates were measured at conditions of sustained solution supersaturation. COM crystals formed on the stent and the rate of COM crystal growth yielded a second-order dependence on the solution supersaturation., Conclusions: The deposition of COM crystals on the metal stents coated partially with COM crystals by adhesive forces was found to be most important for the acceleration of the encrustation process. The dependence of the rates on the solution supersaturation suggested absence of secondary nucleation and a surface-controlled process for the encrustation process.

Objective: We report on our experience with the use of self-expandable metal stents for the treatment of extramural ureteral obstruction in patients with gynecologic cancer to restore ureteral patency and to alleviate the ureterectasis and hydronephrosis proximal to the ureteral narrowing., Methods: Fourteen women (mean age 48 years) with obstructive uropathy secondary to gynecologic malignancies were treated successfully by placement of Wallstent self-expandable intraureteral metallic stents. The patients were followed for a mean period of 15 (range 9-24) months., Results: Obstructive uropathy was resolved in all cases. In 1 patient placement of an additional, totally coaxial, stent was considered necessary because of tumor ingrowth, occurring 6 months after the procedure. In another patient, tumor overgrowth invading the borderline area between the proximal ureteric end and the metallic prosthesis was seen 12 months after stent placement causing obstruction. Thus, an additional Wallstent was implanted overlapping the initially placed stent. Patency was achieved in all the remaining ureters, during the follow-up period, without any need for further intervention., Conclusion: Implantation of self-expandable metal stents is a safe and effective method for bypassing ureteral obstruction due to gynecologic malignancies.

Purpose: We assess the efficacy of intravesical administration of oxybutynin chloride in patients with interstitial cystitis., Materials and Methods: The study included 36 women with a mean age of 45 years with a diagnosis of interstitial cystitis. Patients were treated with gradual intravesical instillation of saline oxybutynin solution (oxybutynin group) or gradual filling of simple saline (control group). Evaluation parameters consisted of symptom problem index, voids per day, volume per void, functional bladder capacity, volume at first sensation, cystometric bladder capacity and cystometric volume at first sensation., Results: Statistically significant improvement of all evaluated parameters was found in both groups. When comparing the outcomes statistically significant improvement of parameters favored the oxybutynin group., Conclusions: Bladder training alone produces a satisfactory result by gradually expanding the bladder, and an additional statistically significant improvement is evident with intravesical oxybutynin.

Purpose: To evaluate the efficacy of alcohol in combination with tetracycline for the treatment of symptomatic renal cysts., Patients and Methods: Twenty-four patients age 45 to 77 years (mean 66 years) with a large (5-13-cm; mean 7.5-cm) symptomatic renal cyst associated with flank pain were treated by aspiration under ultrasound guidance and injection of alcohol and tetracycline. Patients were followed with ultrasonography at 1, 6, and 12 months and once a year thereafter., Results: The aspirated volume ranged from 65 to 1500 mL (mean 360.5 mL). Two patients experienced mild pain during alcohol injection, but the procedure was completed successfully. One patient reported severe pain after tetracycline injection. The tetracycline was immediately aspirated, and the procedure was then aborted. The remaining patients were relieved of their symptoms after treatment, and they remained symptom free during a mean follow-up of 20 months (range 7-36 months)., Conclusions: The combination of alcohol and tetracycline is safe and effective and offers a very favorable minimally invasive therapeutic alternative for the treatment of symptomatic renal cysts.

Pheochromocytoma of the bladder is an unusual tumor that typically presents with hypertensive crises related to micturition. We describe a case of bladder pheochromocytoma in a 42-year-old female in which macroscopic hematuria was the only alarming symptom. The diagnostic and operative issues of this type of tumor are discussed, along with the challenging treatment option of transurethral resection. Diagnosis, treatment and follow-up trends of this rare tumor are reviewed., (Copyright 2000 S. Karger AG, Basel)

Background: The use of retinoids as differentiation therapy is a novel approach to prostate cancer. Retinoids act via their own nuclear receptors, RARs and RXRs, modulating gene activity, cell growth and differentiation. This study provides new data on the content and cellular distribution of RARalpha protein in prostate cancer specimens, in correlation to tumor grade and proliferative activity., Material and Methods: A total of 84 cases of primary prostate carcinoma, divided into 3 subgroups according to tumor grade, were immunohistochemically evaluated for retinoic acid receptor-alpha (RARalpha) and Ki67 using the streptavidin/peroxidase method on formalin fixed, paraffin embedded tissues., Results: RARalpha positivity was detected in all cases of prostatic carcinoma, with a more profound expression in well differentiated cancers. A statistically significant correlation between RARalpha staining and tumor grade was found (ANOVA, p < 0.031). Ki67 immunoreactivity was present in 35.7% of cases, but no correlation with tumor grade was found. When RARalpha staining was correlated with Ki67 positivity, a statistically significant correlation was present (unpaired t-test, p < 0.003)., Conclusions: These findings indicate that RARalpha expression is correlated to some extent with tumor grade and its presence is more profound in highly proliferative tumors. Further studies are needed to establish the possible clinical value of the immunohistochemical evaluation of RARalpha content in tumor specimens.

A study was carried out to determine the spatial-temporal distribution of the radiopharmaceutical, 99mTc-DTPA in the kidney and its compartments during renography and the use of compartmental analysis to improve the diagnostic capability of renography. A total of 60 individuals formed three groups: group A consisted of 30 normals taken as controls, group B consisted of 15 patients with unilateral nephropathy, and group C consisted of 15 patients with unilateral obstructive uropathy. This retrospective study was performed by processing of the frames acquired in the various stages of renography and determination of the time distribution of radioactivity in the aorta, the renal parenchyma and the renal pelvis. The data acquired were used to produce three curves instead of one for each kidney and to study renal function as a system of six compartments (aorta, left and right renal parenchyma, left and right renal pelvis, and bladder). In all the above compartments the differences among the three groups were significant and were quantified using the flow coefficients of the aortorenal compartments. The differences between the aortic flow coefficients (k1) were statistically significant not only between normal controls and patients, but also between individuals with parenchymatic dysfunction and patients with pelvocalyceal obstruction. The same differences were seen comparing the pelvocalyceal coefficients (k3) of all three groups. The parenchymatic coefficient (k2) presented statistically significant differences between normals and patients which were not observed between the two groups of patients (B and C). Compartmental analysis thus increases the sensitivity of renography, is objective by utilizing quantitative parameters, enables the separate analysis of the functional behavior of the various renal compartments, and improves the differential diagnosis between parenchymatic dysfunction and pelvocalyceal obstruction.

Background and Objectives: Radical nephrectomy has been the traditional surgical treatment for renal cell carcinoma in patients with a normally functioning contralateral kidney. The necessity for a less aggressive surgical approach has emerged in cases in which there is a need to preserve renal function., Methods: We retrospectively evaluated the records of 41 patients with localized, symptomless small renal masses (<5 cm) treated with nephron-sparing surgery (group A) and 48 patients matched for age, tumor location, size, and stage who were treated with radical nephrectomy (group B)., Results: The 5-year cancer-specific survival rates were 97.5% and 98. 4% for the treated patients of groups A an B, respectively. No statistical association was found between cancer-specific survival and surgical approach, tumor stage, tumor location, or recurrence. The size of the primary tumor did not seem to influence the cause-specific survival. Local recurrence was observed in 3 patients (7.3%) who underwent partial nephrectomy. In our series, the overall incidence of multifocality was 10.4%., Conclusions: We propose segmental renal resection for unifocal small adenocarcinoma of the kidney in preference to radical surgery as it is corroborated by the presented data., (Copyright 1999 Wiley-Liss, Inc.)

A group of 42 hypercalciuric patients (24 males and 18 females) aged 23 to 61 years (mean 45.57+/-12.27) with recurrent stone disease was studied. We applied for a period of 10 days a normocalcium, moderately low protein diet. We found statistically significant variations of azotaemia, venous pH, and vitamin D 1-25. In the 24 h urine collection we found a statistically significant decrease of nitrogen, uric acid, sodium, chloride, calcium, phosphates, oxalate, and hydroxyproline. In conclusion, the present study suggests that the restricted consumption of animal protein can produce a limited effect in urinary biochemistry. The actual efficiency of this dietary restriction on stone formation remains to be evaluated by a prospective long-term study of a larger population. Whether this has an effect on the future incidence of stone formation has to be further verified.

An unusual case of a 15-year-old male who presented with a characteristic clinical syndrome of testicular torsion one week prior to our observation, is reported. During our intervention the testicle was not removed but, on the contrary, restoration of a satisfactory testicular albugineal appearance was achieved.

We have evaluated 21 patients, ranging in age from 44 to 71 years (mean: 55 years), who presented to our department with the radiologic characteristics of retroperitoneal fibrosis. Ureterolysis was performed in all cases. Intraperitoneal placement of the ureter was performed in 9, and placement of the ureter in a lateral extraperitoneal position in 12 cases. We found no difference in the postoperative course and radiological and clinical improvement to favour the first or the second method, and therefore we consider the intraperitoneal approach as an unnecessary manoeuvre.

We herein report a case of a female embryo who died in utero and at autopsy she was found to have bilateral renal agenesis with the extrarenal manifestations of Potter's syndrome together with mermaid syndrome which is a rare combination. From all the anomalies of the upper urinary tract bilateral renal agenesis seems to have a cardinal role in the survival of the embryo afflicted with the spectrum of associated anomalies.

Purpose: We report our experience with the use of self-expandable metallic stents to bypass anastomotic strictures after ureteroileal urinary diversion., Materials and Methods: We evaluated 3 men and 1 woman with invasive bladder carcinoma who underwent radical cystectomy and ileal conduit urinary diversion. Ureteroenteric anastomotic strictures developed after a mean of 16 months. Self-expandable metallic stents were successfully placed (bilaterally in 2) comprising 6 stented ureters that bypassed strictures. Mean patient age was 64 years and mean followup was 12 months., Results: No restenosis was observed in 3 patients during followup. The stricture recurred 1 month after stent placement in the remaining patient and additional intervention was necessary, consisting of placement of a totally coaxial overlapping metal stent. No sepsis or other complication was observed. One patient died of metastatic disease 12 months after stent placement., Conclusions: We propose the use of metal stents as an adequate, safe and effective alternative treatment for anastomotic strictures after ureteroileal diversion.

Purpose: We investigate the association of clinical and urodynamic findings with corresponding clinical grade and possible predictors of clinical grade of multiple sclerosis (MS)., Materials and Methods: A total of 90 patients, 28 to 62 years old (mean age 45.8 +/- 12.1), with the clinical syndrome of MS were consecutively and prospectively studied. All patients were subjected to detailed video urodynamic evaluation and electromyography of the external urethral sphincter., Results: Urodynamic evaluation revealed detrusor hyperreflexia in 52 patients (57.7%), detrusor external sphincter dyssynergia in 27 (30%) and hypocontractility or areflexia of the detrusor in 15 (16.6%). Residual urine varied widely from 50 to 900 ml. Decreased compliance with areflexia was seen in 5 patients (5.5%) and nonrelaxing sphincter (but not contracting) with bladder hypercontractility was noted in 9 (10%). Statistical analysis followed comparison of 2 proportions. When patients with a less severe form (grades 1 and 2) were differentiated from those with a more severe form of MS (grade 3), we observed a significant difference only in incontinence, high post-void residual, leg spasticity, urinary stones, hydronephrosis, type 3 detrusor external sphincter dyssynergia, no electromyography activity and positive sharp waves. The variables with the highest predictive value between the groups were urinary stones, sepsis, type 3 detrusor external sphincter dyssynergia and no electromyography activity of the external urethral sphincter (100%)., Conclusions: Proper identification of the bladder and external urethral sphincter status, especially exclusion of detrusor overactivity or a dyssynergic response of the external urethral sphincter, will prevent complications that may result in deterioration of quality of life.

Background: A randomized study evaluated the efficacy of treatment with transrectal microwave hyperthermia (TMH) treatment in patients with benign prostatic hyperplasia (BPH)., Methods: Eighty BPH patients received TMH therapy and 20 patients were given a sham treatment. TMH was achieved using a prostathermer which includes a microwave transrectal heat generator, a cooling system and a transurethral sensor probe. Patients that received TMH had 5 to 6 sessions of 1 hour each where the prostate was heated to 42 degrees C to 43.5 degrees C. The sham treatment consisted of a single session where the temperature was maintained at 37 degrees C. All patients were evaluated at 3 and 12 months after treatment., Results: There was an improvement of subjective obstructive symptoms in 54 patients (75%) after TMH. An evaluation of urodynamic parameters revealed an increase in the maximum flow rate and a decrease of the detrusor opening pressure as well as the detrusor pressure at maximum flow in patients treated with TMH. A significant improvement in the amount of residual urine was seen in all TMH-treated patients (P < 0.0001)., Conclusion: Although TMH cannot be considered a superior alternative to open surgical or transurethral excision of the prostate, it is a valid option for patients who have indwelling urethral catheters and for those at high surgical risk.

Purpose: This study was undertaken to evaluate the immediate and long-term effects of the combination of alpha-blockers and antibiotics in the treatment of chronic prostatitis., Materials and Methods: The patients eligible for study were assigned to 3 groups: group 1--nonprostatodynia, abacterial prostatitis (134), group 2--prostatodynia (72) and group 3--chronic bacterial prostatitis (64). alpha-Blockers were administered to all patients of groups 1 and 2 with demonstrable high maximal urethral closure pressure and typical clinical complaints irrespective of the presence of inflammatory findings in expressed prostatic secretion. alpha-Blockers were given to 50% of patients with bacterial prostatitis. Antibiotics were administered to all patients with positive expressed prostatic secretion cultures, and in half of those with abacterial prostatitis and inflammatory expressed prostatic secretion. Mean followup was 22 months (range 6 months to 3 years). The sign 1-tailed test was used for statistical analysis of data., Results: The recurrence rate of bacterial prostatitis was significantly reduced by alpha-blockade (expressed prostatic secretion culture negative) and symptom relief was achieved for many months. For abacterial prostatitis statistical analysis revealed a lower symptom recurrence rate in patients receiving only alpha-blockers in comparison with those treated with a combination of alpha-blockers and antibiotics., Conclusions: The use of alpha-blockers is justified, not only for prostatodynia, but also for abacterial and bacterial prostatitis. In the latter case alpha-blockade not only caused enhanced clinical improvement but also reduced the recurrences as defined by expressed prostatic secretion positive segmental cultures.

We present herein a case of bleeding angiomyolipoma with disruption of the renal capsule, which was treated by hyperselective embolization of the corresponding renal artery branch.

We report on our experience with a new surgical procedure of forming a pseudoneotesticle from indigenous tissues obtained from the existing scrotal contents. This procedure has been performed in 32 patients with a diagnosis of hormone dependent cancer of the prostate as a therapeutic manoeuvre, and in 3 children who had diminution of their testicle down to a peanut size secondary to neglected testicular torsion on the ipsilateral side. The follow-up examination revealed a small decrease in the size of the pseudotesticles that remained stable in further evaluation. This new surgical technique is proposed as a viable alternative to the placement of various artificial scrotal prostheses.