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Objectives: To evaluate the incidence and characteristics of anastomotic strictures (AS) after radical retropubic prostatectomy (RRP) with bladder-neck preservation (BNP), the efficacy of management with cold-knife incision (CKI), and its impact on urinary continence., Methods: Seven hundred five consecutive patients who underwent RRP with BNP were prospectively followed with uroflowmetry at postoperative months 1, 3, 6, 9, 12, and investigated for urinary incontinence with the 1-h pad test at AS diagnosis obtained with urethroscopy. If the instrument could not dilate the stricture, CKI was subsequently performed. Follow-up after treatment was performed with uroflowmetry and 1-h pad test at months 1, 3, 6, 9, 12. Recurrent AS was always treated with repeated CKI., Results: Six hundred forty-eight patients were assessable. After a median time of 3.8 mo from RRP, 46 (7.1%) patients developed AS. Urinary incontinence was present in 21 (46%) men at AS diagnosis. Three (7%) patients were successfully managed by urethroscopic dilation only, whereas 43 (93%) required CKI. Eleven (26%) of the latter had recurrent AS. After a median follow-up of 48 mo from the last AS treatment, all patients are stricture-free, de novo urinary incontinence was never documented, and of the 21 originally incontinent men, 11 became continent, 8 improved and 2 remained unchanged., Conclusions: In our experience, BNP does not decrease the incidence of AS after RRP; however, AS can be effectively managed with repeated CKI with a final 100% success rate. CKI has a possible positive impact on urinary continence in 90% of patients, without causing de novo incontinence.

Objectives: We evaluated the clinical and radiological aspects of isolated duplications of the bulbous urethra and assessed the results of surgical treatment., Methods: The experience with 11 male patients presenting with duplications of the bulbous urethra is reported. The duplications were incomplete in 7 cases and complete in 4, the accessory channel was ventral in 8 patients and dorsal in 3. The presenting symptoms were seldom indicative of the condition. Surgical treatment was performed in 10 cases and consisted in transurethral resection of the septum between the two channels in 2 patients, one-stage urethroplasty in 6 and two-stage urethroplasty in 2., Results: With a follow-up ranging between 1 and 4 years the results were considered satisfactory in 4 cases and excellent in 6., Conclusions: Duplications of the bulbous urethra deserve careful evaluation of the cost-benefit ratio when surgical treatment is considered. The goal of reconstructive surgery, which can be open or transurethral, should be a functional urethral channel.

The authors present their clinical experience in conservative surgery for renal cell carcinoma, which was performed in two cases of simultaneous bilateral tumours, in a case of neoplasm in solitary kidney, in two cases of cancers with damaged contralateral kidney and in two cases of association between cyst and small tumour. All patients are alive and without evidence of residual or recurrent malignancy with a followup ranging between 6 months and 7 years. The pros and cons of the various surgical solutions are discussed.

Total ureteral substitution had been performed with a pedicled gastric flap shaped as a tubule in 6 dogs. No dilatation was found at X-ray controls. No metabolic changes were recorded. The HCl secretion diminished the possibility of an infecting reflux.

The appearance of solitary late metastases of renal cell carcinoma has seldom been documented. A female patient, who 13 years previously underwent left radical nephrectomy and right lower polar resection for bilateral simultaneous renal cell carcinoma, presented with a solitary pancreatic metastasis which was successfully treated with pancreaticoduodenectomy. The major points of interest of this report are the occurrence of a primary bilateral tumor, the initial treatment with conservative surgery and the site of late recurrence. The diagnostic and prognostic implications of late metastases of renal tumors are discussed.

A review of 62 patients who underwent surgical treatment for xanthogranulomatous pyelonephritis is presented. Polar resection was performed in 3 cases with localized disease, while the remaining 59 patients were treated by nephrectomy. Preoperative diagnosis is still tentative, but the recent advances in imaging techniques and urinary cytology will provide greater accuracy in the future.

A boy presenting with a small bladder and refluxing blind-ending ureteral stumps following multiple attempts at ureteral reimplantation and supravesical diversion with a high left-to-right transureteroureterostomy and right cutaneous ureterostomy underwent successful undiversion. Surgery consisted of bilateral ureterectomy and ileocecocystoplasty, with intussusception of the ileocecal valve and anastomosis of the ileal tail to the right renal pelvis.

A 10-cm-long refluxing ureteric stump following nephrectomy in a woman with a neurogenic bladder was successfully treated endoscopically. The procedure consisted of endoluminal occlusion with a fibrin adhesive complex followed by meatal sealing by a submucosal injection of polytetrafluoroethylene paste.

A series of 33 posterior urethral strictures in children is presented. The etiology was traumatic in 31 cases and iatrogenic in 2. Complex strictures were treated by a transpubic approach (20 cases) or by a posterior scroto-urethral inlay (1 case). Simple strictures were directly treated via the perineum: by a push-in technique (6 cases); by end-to-end anastomosis (3 cases); by a skin pedicled tube urethroplasty (1 case); by free skin graft (1 case), and by endoscopic urethrotomy (1 case). The use of omentum, employed in 19 cases, is considered a necessary step in transpubic urethroplasty. Favorable results were observed in 18 out of 20 transpubic procedures, in 8 out of 9 perineal urethroplasties and in 3 out of 4 other techniques, with an overall success rate of 87.8%.

3 cases of granulomatous orchitis are described. Treatment consisted of radical inguinal orchiectomy in 2 cases, and biopsy followed by steroid therapy in the 3. The clinical and pathologic aspects of this rare inflammatory disease of the testis are reviewed.

3 cases of prostatic leiomyosarcoma, observed over a 15-year period, are reported. 2 patients underwent radical surgical treatment only and succumbed to metastatic diffusion after 13 and 29 months, respectively. After palliative surgery, a 3rd man received subsequent radiation therapy for pelvic and pulmonary recurrences, and is alive with tumor after 6 years and 8 months. The diagnostic and therapeutic aspects of this uncommon and aggressive prostatic neoplasm are discussed.

Extracorporeal shock wave lithotripsy was used as an elective treatment in 128 ureteral stones. Of the 108 with adequate follow-up, 88% were successfully disintegrated. Ureteral catheters proved to be particularly useful for more precise stone localization and as a mechanical means to push the calculi inside the renal cavities or to create a fluid interface around them, in order to increase the efficiency of the shock waves. When ureteral catheters were used a success rate of 95.5% was observed, as opposed to 82.8% when stents were not used (p less than 0.05).

Augmentation enterocystoplasty was performed in 28 patients with tuberculous, interstitial, radiation and chronic bacterial cystitis and hypertonic neurogenic bladder. Better results were observed in tuberculous contracted bladders where the extent of bladder resection and the bowel segment used were not related to the surgical outcome. In the other forms, the ileocecal segment is preferable. In our experience patients with neurogenic bladder did not benefit from the procedure. Radiographic and urodynamic studies are valuable for an accurate follow-up; radioisotope scan is also useful in selected cases. Anatomical and surgical causes of failure are discussed. Pharmacologic treatment is useful in partial surgical failure and provides indications for further bladder neck surgery.

One hundred and twenty patients with large renal calculi (greater than 3 cm), who had not undergone previous stone-debulking procedures, were treated with extracorporeal shock wave lithotripsy (ESWL) monotherapy using a Dornier HM3 lithotripter. Stones were divided into four categories according to Rocco's classification: 20 C2, 25 C3, 51 C4 and 24 C5. Repeated treatments were necessary in 13 patients, while planned two-stage treatments were performed in 8. Pretreatment adjunctive endourological maneuvers (except for the placement of ureteral stents for visualization of 37 contrast-negative stones) were used in 16 cases (13.3%) and posttreatment maneuvers in 20 (16.6%). Open surgery was necessary in 6 patients, including one nephrectomy. Complete elimination of all concrements was documented in 74 patients (61.6%): 63 within 3 months and 11 within 6-12 months. The stone-free rates for different categories were: 80% for C2, 64% for C3, 58.8% for C4 and 50% for C5. The stone-free rate for contrast-negative calculi was 83.7% (31/37), and for radiopaque ones 51.8% (43/83) (p less than 0.001). It is concluded that ESWL monotherapy is an adequate treatment choice for some categories of large radiopaque stones and for all radiolucent ones.

A renal cell carcinoma was incidentally discovered with sonography in a 32-year-old pregnant woman. Magnetic resonance imaging was used to provide further information about tumor stage without causing adverse effects on the fetus. The patient underwent radical nephrectomy at the third month of pregnancy and subsequently delivered a normal full-term child. Pathology revealed regressive aspects which can be possibly ascribed to high progesterone levels during pregnancy.