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A prospective study was conducted on 62 female patients with overactive bladder syndrome, to check for differences in clinical profiles, subjective symptoms and urodynamic findings, between patients with or without cystometric evidence of detrusor overactivity (DO). Later both groups of women were assessed for the effect of an antimuscarinic agent, solifenacin succinate (SS), on the considered parameters.Each patient underwent a full history, a physical examination, urinalysis and a urodynamic study. Provocative manoeuvres - cough, postural changes - were used when the cystometric study was performed. Hence two groups of patients were formed, divided according to the presence or absence of DO at the cystometric study: patients with overactive bladder syndrome (OAB) with DO (29), patients with OAB without DO (33). The two groups were compared before and after treatment with SS.When we compared the two groups, before treatment with SS, we saw statistically significant differences in just a few of the parameters assessed in the clinical profiles: patients with DO had a higher rate of constipation; whereas patients without DO had a higher rate of stress incontinence and a larger number of deliveries. Following treatment with SS, in both groups, significant differences were shown in subjective symptoms and urodynamic findings, with a reduction of the numbers of voids and incontinence episodes and an improved urge score. A significant increase in bladder capacity during the cystometric study was shown only in patients with DO. Whereas no statistically significant improvement was shown in patients without DO. Treatment with SS was connected with delayed involuntary detrusor contractions during cystometry and a reduction of their number and amplitude. Finally, SS did not produce any significant negative effects on detrusor function during voiding.The findings of this study suggest that it is important to conduct a urodynamic study in patients with OAB, to check for DO. In our experience, treatment with SS was shown to be effective only in patients with involuntary detrusor contractions at the cystometric study.

The case of repeated metastases of the bladder from renal cell carcinoma in a 59 year old male patient is presented. Two years after nephrectomy the ureteral stump and the bladder were interested by two different metastases. Afterwards, other nine metastases developed into the bladder during the following 12 months. Biopsy with coagulation were performed in any case. Bladder metastases ranged between 2 and 4 mm. No other metastasis was discovered by MRI and skeletal scintigraphy. Thirteen months after the first bladder metastasis, intracavitary Bacillus Calmette-Guerin was used. No report was found in the literature about BCG in the treatment of superficial bladder metastases from renal cell carcinoma. However 15 months from beginning of BCG treatment no metastasis developed from the bladder that now is disease-free after a follow-up of 19 months.

The case of a 56 year-old male patient with asynchronous isolated metastases to the ureteral stump and bladder from renal cell carcinoma is presented. Ureteral metastasis was discovered 2 years after nephrectomy. Cystoscopy and MRI were performed. An excision of the ureteral stump with a cuff of bladder was carried out. No other metastasis was observed. Six months later a transurethral resection was performed on account of metastasis of the right wall of the bladder. Pathological examination demonstrated a renal cell carcinoma metastasis. After 6 months a new vesical metastasis from renal cell carcinoma was found. The small nodule of the lower part of the right wall of the bladder was removed. The literature is reviewed and the presentation, metastatic pathways, management of ureteral stump and bladder metastases from renal cell carcinoma are discussed.

Thirty-two female patients affected by urinary incontinence were enrolled for rehabilitative treatment (functional electro-stimulation by vaginal electrode performed three times a week for one month followed by biofeedback performed three times a week for one month). Complete clinical and urodynamic studies, urethrocystography in order to allow Blaivas and Olsson radiologic evaluation were performed. Echography of the bladder and urine cultures were done too. Patients with severe urogenital prolaxus and obesity, neurologic urinary disorders and surgery for incontinence, were excluded. The same patients were urodynamically reassessed at the end of the treatment and a detailed clinical evaluation was obtained from each patient. 78% of patients reported a considerable improvement in clinical symptoms and only 9% reported no improvement. Urodynamic findings showed an increase of maximum cystometric capacity in 6 patients, improvement of maximum urethral closure pressure and/or functional profile length in 17 patients. Disappearance or reduction of involuntary detrusor contractions were found in 2 out of 6 patients with unstable bladder.

A total of 60 patients with transitional cell carcinoma of the bladder G1-G2, pTa pT1 previously subjected to TUR, were randomised to receive Mitomycin-C (MMC) 30 mg for 12 months (A group) or Mitomycin-C 40 mg for 6 months (B group). The objective of this trial was to compare the prophylactic activity of MMC using two different dosages and treatments. All patients were evaluated with cystoscopy. Follow-up was of 24 months. The incidence of recurrence in the A group was 40% with a recurrence rate of 3.3. In the B group the incidence of recurrence was 27.6% with a recurrence rate of 2.2. One case of progression was present in the A group. The side effects were more frequent in the A group (37% vs 13.3%) and they were mainly due to chemocystitis. These data suggest that MMC 40 mg for 6 months appears to be superior to MMC 30 mg for 12 months in the prophylaxis of superficial bladder carcinoma.

62 men with prostatic hypertrophy and bladder obstruction and 31 age matched women without lower urinary tract obstruction, underwent urodynamic testing which included uroflowmetry, gas cystometry, urethral pressure measurement: electromyography and pressure flow study was only performed to the patients with prostatic hypertrophy. No patient with neurological disease, diabetes mellitus, pelvic operation, neoplasm or stone of the bladder was admitted to the study. Involuntary detrusor contractions (unstable detrusor) were found in 74.2% of male patients and in 25.8% of female patients. In male patients aged over 72 the percentage was 81.8% while in the female patients of the same age was 60%. All the 62 male patients underwent prostatectomy. Two months after surgery, acystometry was done. Unstable detrusor was found in 63.1% of cases. Patients over 80 had a percentage of 100%. These data suggest obstructive prostatic hypertrophy as an important factor in development of involuntary bladder contractions, but the primary pathophysiological factor appears to be age of patients.

No. 54 patients with transitional cell carcinoma G1-2; pTa-pT1, were treated with intravesical therapy with Mitomycin C (MMC) (first group of 27 patients), and Interferon alfa 2a (IFN) (second group of 27 patients), following transurethral resection. The objective of this trial was to compare the prophylactic activity of these two drugs. All patients were evaluated with cystoscopy and urine cytology. Mean follow-up was for the first group of patients (MMC) of 10.4 months, for the second group (IFN) of 12 months. The incidence of recurrence in the first group (MMC) was 11.1% with a recurrence rate of 2.1. In the second group (IFN) the incidence of recurrence was 51.9% with a recurrence rate of 7.4. No case of progression evaluated by grade and stage was observed. The side-effects were more frequent in the MMC group and they were mainly due to chemocystitis. These data suggest that MMC appears to be superior to IFN in intravesical therapy of superficial bladder carcinoma.

A case of leiomyosarcoma arising from the wall of arterious renal vessel is described. While the origin of this neoplasm from the smooth muscle cells of the capsule, blood vessels or the pelvis of the kidney is well known, it is rarely possible to demonstrate the site of origin.

During the period 1988-1990, 683 patients with diagnosis of benign prostatic hyperplasia underwent transvesical prostatectomy. The purpose of the study was to establish the possible presence of incidental carcinoma of the prostate (ICP). Prostatic tissue was studied with sections taken every 0.5 cm. The incidence of ICP was 12.00%. The mean age of patients was 73.5 years. 60.98% of tumors classified T1a, 39.02% T1b. No case of G3 tumor was observed while 92.68% of neoplasms was classified G1 and 7.32% G2. 74.95% of tumoral nests into the prostatic tissue had a breadth about one millimetre.

The Authors report a retrospective review of 224 cases of transitional cell carcinoma of the bladder observed between 1986 and 1990. Squamous metaplasia was present in 45 case. This histological feature was found especially in association with poorly differentiated and invasive tumours: the presence of extensive areas of squamous metaplasia (metaplastic areas = or greater than 50% of neoplastic surface) was always found in association with high grade neoplasms and with a disease-free period shorter than transitional cell carcinoma. The Authors conclude that squamous metaplasia in transitional cell carcinoma of the bladder is a really unfavourable prognostic factor.

The Author presents a case of primary signet-ring cell carcinoma of the urinary bladder treated with radical cystectomy and died 17 months after surgery. Only 14 well documented cases have been previously published. Biological and clinical aspects of the neoplasm and its therapy are discussed too.

The Authors report their personal experience of pure squamous cell carcinoma of the bladder. Between 1984 and 1988 they have observed 389 tumors of the bladder; squamous cell carcinoma was present in fifteen cases (3.8%). Epidemiology, pathology (gross configuration of tumor, histologic grading, staging according to the criteria of the UICC of 1987), presenting symptoms, treatment and survival have been considered. The Authors underline the importance of a careful histologic examination of the vesical tumors.

Five cases of chronic perirenal hematoma are reported. Preoperative tests were performed to assess the malignant or benign nature of the lesions which were observed some time after the dramatic episode which marked their onset. The varying characteristics of the disease showed by different imaging techniques (urography, arteriography, US, CAT) are such that only surgery can remove all doubts in the majority of cases.

The Authors describe a case of simultaneous, contralateral, transitional cell carcinoma of the ureter in a 64-year-old man. Surgical conservative therapy was performed. The patient is well and free from recurrence 3-years after.

The Authors report a case of leiomyoma of the prostate. It's a relatively rare neoplasm and although usually benign, malignant changes have been noted.