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BCG has been used in the treatment of NMIBC for more than 40 years. Nevertheless, its exact working mechanisms have not been completely discovered. Clinical and basic research done over all these years has generated much information but it could be summarized in a few simple statements. It has been demonstrated the best route of administration is intravesical, BCG is superior than intracavitary chemotherapy to prevent recurrence but its adverse events are worse. Recently, it has been demonstrated that BCG could delay or prevent progression to infiltrative cancer. Nevertheless, to achieve this, maintenance therapy is necessary. Therefore, the recommendation is to treat middle and high risk cases with BCG. No significant differences in efficacy have been found between the various strains but differences in recurrence have been found between standard and reduced doses.Furthermore, the presence or absence of side effects does not seem to be a prognostic factor for the efficacy of BCG and, maintenance therapy is not associated with a significant increase in toxicity. In the future, the optimal schedule and doses must be defined, and it probably will be different for each individual. BCG shortage has led to try alternative therapies through chemo hyperthermia or electrical gradient application the efficacy of which should be evaluated. New strains and immunological treatments are also under research.

Objectives: To determine if p53 expression in patients with infiltrative bladder cancer is a prognostic factor on clinical staging and cancer specific survival., Methods: Immunohistochemical analysis of p53 in 34 patients (33 males and 1 female) undergoing radical cystectomy for infiltrative bladder cancer, with a mean follow-up of 16 months., Results: p53 overexpression was detected in 18 patients (64%). In the p53 positive group two patients were stage T1G3, 18 patients T2, 1 patient T3, and 2 patients T4. In the negative group a better correspondence between TUR and cystectomy stage was found, with stage worsening only in 3 patients. On follow-up, p53 positive patients showed worse outcomes due to their worse stages, although no statistical differences were found (p = 0.24). In the group of patients following a bladder sparing protocol (n = 6), p53 negative patients had complete remission of the disease., Conclusions: We see significant differences on understaging/more aggressive local outcome in p53 positive patients, with no greater mortality in this group. P53 expression does not contraindicate the inclusion of a patient in a bladder sparing protocol, although larger studies would be necessary to confirm these results.

Objectives: To report one case of renal cell carcinoma and contralateral metacronous oncocytoma, and to perform a bibliographic review on the topic., Methods: 52-year-old male patient with history of right radical nephrectomy for renal cell carcinoma. On his ten-year follow-up multiple lesions appeared in the left kidney. Partial nephrectomy was performed. Pathological study showed three oncocytomas., Conclusions: The presence of metacronous lesions in the contralateral kidney of a patient with history of renal cell carcinoma is rare. The presence of the same histological type of tumor should always be suspected and the management should follow this suspicion. Contralateral metacronous oncocytoma is a rare pathology which has not been reported in the literature so far.

Objective: We expose the arguments supporting radical and conservative surgery based on international bibliography and our own experience, with special citation of endoscopic surgery (percutaneous and ureteroscopy)., Methods/results: We evaluate the criteria of multifocality, cell seeding and number of recurrences separately, as well as the diagnostic difficulties establishing tumor grade and stage, by connecting the various techniques and their results., Conclusion: the choice between radical or conservative surgery for upper urinary tract TCC is conditioned by precise indications and the surgical technique chosen does not influence the final outcome of low grade/stage tumors.

Objectives: To evaluate variations on the serum PSA levels during and after administration of intravesical BCG and its relationship with previous transurethral resection of the prostate (TURP)., Methods: PSA serum concentration variations were studied after each instillation, at 1 month and at 3 months in 24 patients with superficial bladder cancer and/or CIS under weekly BCG instillations treatment. Three patients had undergone TURP., Results: A raise in PSA was observed in 87.5% of the cases during BCG instillations, although the increase was only significative in patients who had undergone TURP. PSA values descended at one and three months., Conclusions: Endovesical BCG administration produces an increase on serum PSA levels. This variation is higher in patients with history of TURP.

Objective: To evaluate the efficacy of finasteride in the treatment of prostatic origin haematuria., Methods: This is a prospective observational study in 29 patients with hematuria from a demonstrated prostatic-origin which were treated with finasteride 5 mg/day. 58.6% had undergone previous prostatic surgery. Both previous-to-treatment hematuria and response to treatment were evaluated under the Puchner & Miller's criteria., Results: Response rate was 86.2% without additional haematuria episodes. The remaining patients had mild haematuria episodes during follow-up. No patient needed surgery., Conclusions: Finasteride is effective in the treatment of prostatic-origin haematuria.

Objective: The pathogens responsible for urinary infection originate from the digestive tract prior passage through the genital region. Samples were obtained from this region in an attempt to identify women with these pathogens. We have analyzed the most frequently colonized areas of the genital region in order to develop a method for obtaining samples. Risk factors were evaluated by determining the relationship of the samples with factors implicated in the pathogenesis of recurrent infection., Methods: Samples were obtained from 146 women of all ages that consulted for recurrent urinary tract infection. The samples from the genital region (perimeatal vulva, vagina, urethral and intraurethral meatus) and urine obtained through a catheter were cultured., Results: The overall incidence of positive samples was 41%; 23% of the patients showed urinary infection (urine obtained by catheterization) at the time the samples were taken. The vaginal samples were the most frequently colonized and the intraurethral samples were the most sensitive when compared with the urinary samples. The sensitivity, specificity, positive and negative predictive values of these two samples were the same as those of the other samples together. In regard to colonization, a difference was found only between menopausal and premenopausal women, and in proportion to the duration of the history of infection., Conclusions: The study shows that it is unnecessary to obtain various samples; vaginal and intraurethral smears are sufficient. Menopausal women who referred two symptomatic episodes a year were found to be at a higher risk for vaginal infection, and in proportion to the number of years they have had recurrent infection.

Objective: To review the efficacy of radiotherapy and BCG in the treatment of transitional cell carcinoma of the urinary bladder in its different forms of presentation, with special reference to patients with infiltrating bladder tumors receiving radiotherapy and those in whom the lesion recurs as a high grade superficial bladder tumor., Methods/results: 10 patients who previously received radiotherapy for T2-4 infiltrating bladder tumor that recurred as a high grade superficial tumor were treated with BCG. Four patients are alive and disease-free with a preserved bladder at 2-8 years follow-up. Four other patients who required cystectomy for persistence or progression of the tumor to the bladder wall, are alive and disease free at 3-7 years follow-up. The remaining two patients who were not amenable to major surgery died from the disease more than two years after treatment with BCG. BCG was well-tolerated by 70% of the patients and the rest showed minor complications., Conclusions: 28.3% of recurrences after radiotherapy are superficial tumors and 7% are carcinoma in situ. The appearance of carcinoma in situ or T1 G3 lesions following radiotherapy of the bladder questions its efficacy against these superficial forms for which cystectomy is reserved. BCG has been found to be effective in high grade superficial bladder tumors that have not been previously irradiated, therefore it would be acceptable to extend its application to those patients in whom radiotherapy has achieved control of the infiltrating tumor but not the high grade superficial tumor. The 40-70% of patients who are alive with a preserved bladder appears to be sufficient to recommend BCG salvage for high grade superficial bladder tumors post-radiotherapy. BCG therapy does not entail major complications or compromise patient survival, including those cases that will require cystectomy.

Objective: Drug-induced lithiasis was well-known some years ago, when sulfonamides poorly soluble in urine were in use. Now, they are again in use for some opportunistic AIDS-related infections. We report herein the case of an AIDS patient, treated with sulfadiazine because of Nocardia pneumonia, that came to the emergency room in acute renal failure., Methods/results: Obstructive uropathy due to radiolucent calculi was suspected and retrograde ureteral catheterization was necessary. The calculi recovered were identified as N-acetyl sulfadiazine by infrared spectrophotometry., Conclusion: Rapid improvement can be achieved in these patients when the drug is discontinued or decrease and systemic fluid and urine alkalinization are started.

We evaluated 665 patients who had undergone TURP and 100 patients who had undergone TUIP (50 bilateral, 50 unilateral). Transurethral incision, when indicated (less than 35 gm, no middle lobe), had the following advantages: easy to perform, short operating time (39 minutes) and hospitalization (3-4 days). There was less bleeding; 2% versus 6% for TURP. The complication rate was lower: no bladder neck sclerosis for TUIP versus 2.9% for TURP; urethral stenosis: 6% for the bilateral and 0% for the unilateral incision versus 8.7% for TURP, and the incidence of retrograde ejaculation was 24% for the bilateral and 19% for the unilateral incision versus 82% for TURP. We also evaluated the disadvantages of transurethral incision: no tissue for study 4% incidental prostate cancer for TURP, limited indications, anatomic variability, less disobstructive, reoperation rate was 10% versus 11.7% for TURP, design of comparative studies deficient and no long-term follow up. The results of bilateral and unilateral incision were compared, however no statistically significant differences were observed. The bilateral incision procedure was slightly more disobstructive: 92% clinical improvement for the bilateral and 84% for the unilateral, increased flow was 6.5% for the bilateral versus 5.6% unilateral, and the reoperation rates were 2% for the bilateral and 8% for the unilateral incision procedure. However, there were less complications for the unilateral incision procedure: no stenosis for the unilateral and 6% for the bilateral, and retrograde ejaculation was 81% for the unilateral and 76% for the bilateral incision procedure. For all the foregoing reasons, we prefer to do unilateral incision of the prostate.

We reviewed the records of 34 patients with epididymal and/or testicular abscess that were treated at our institution. The mean age of the patients was 48.6 years. The most common clinical manifestation was scrotal pain. The diagnosis was made on the clinical and/or scrotal ultrasound findings. E. coli was isolated in 84.6% of the cases. Chronic and acute orchitis with abscess formation were the most common histological findings. Twenty-nine cases required antibiotic therapy plus surgery and five cases required antibiotics alone.

We report an uncommon case of ureteral obstruction arising from the cement utilized to fix a total hip prosthesis. The pathophysiological mechanisms that may cause urinary tract involvement in this type of surgery are discussed.

Transcatheter ascending pyelography is commonly performed in the post-operative evaluation of patients submitted to ileal diversion or continent bladder replacement after radical cystectomy. The present study investigated the usefulness of this procedure in the control of these patients. Of 51 patients that underwent cutaneous ileal diversion, the IVP revealed a leak of the contrast medium in only one case (1.9%). Of the 18 patients that received a continent neobladder, radiologic signs of changes were detected in 6 cases (33.3%). The complications of the IVP in our patients were fever in 26 patients (37.7%) and septicemia in one patient (1.45%). Considering the information obtained and the rate of morbility, we believe that ascending pyelography through catheters is not justified in the routine post-operative control of patients who have undergone radical cystectomy and ileal diversion. However, it appears to be a useful procedure in those cases that have undergone bladder replacement and/or continent diversion procedures.

Two patients who had undergone resection of a transitional cell bladder tumor presented with nephrogenic adenoma of the bladder during treatment with BCG. Nephrogenic adenoma presenting in the course of intravesical chemotherapy has been previously reported in 5 cases and can mimic tumor recurrence. Thus, we consider the present case to be of special interest.

A simplified technique for nephroureterectomy is described. This technique consists of resection of the intramural ureter followed by lumbar nephrectomy and traction of the previously detached distal ureter. The use of this technique is advocated because it is easy to perform and radical from the oncologic viewpoint.