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Diverticular disease of the colon is the most frequent cause of colovesical fistulas. In this study we evaluated the accuracy of different diagnostic procedures for the detection of colovesical fistula and the clinical outcome in a series of 49 patients who underwent surgery for colovesical fistula due to sigmoid diverticulitis.Between 1982 and 2007, 42 men and 7 women underwent surgery for colovesical fistula due to sigmoid diverticulitis. Preoperative diagnostic procedures included the poppy seed test, abdominopelvic computerized tomography, magnetic resonance tomography of the abdomen, cystogram, retrograde colonic enema, urethrocystoscopy and colonoscopy.All patients had urinary tract infections and dysuria. Pneumaturia and fecaluria, which are pathognomonic symptoms of colovesical fistula, were present in 71.4% and 51.0% of the patients (35 and 25 of 49), respectively. Colovesical fistula was correctly diagnosed by the poppy seed test in 94.6% (35 of 37 examined patients) compared to abdominopelvic computerized tomography in 61.0% (25 of 41), magnetic resonance tomography in 60.0% (3 of 5), cystogram in 16.7% (5 of 30), retrograde colonic enema in 35.7% (15 of 42), cystoscopy in 10.2% (5 of 49) and colonoscopy in 8.5% (4 of 47). Patients underwent resection of the fistulized bowel, single stage bowel anastomosis without protective colostomy and closure of the bladder defect. Postoperative morbidity was 8.2% (4 of 49) and mortality was 0%. During a median followup of 68 months there were no recurrent fistulas.In our series the poppy seed test had the highest sensitivity to detect colovesical fistulas. However, abdominopelvic computerized tomography, colonoscopy and cystoscopy are essential diagnostic procedures because the presence of colon or bladder cancer as an underlying cause of colovesical fistula will determine further therapy.

We determined indications for preoperative prostate biopsy in patients undergoing radical cystoprostatectomy for bladder cancer.Of 316 cystoprostatectomy specimens concomitant prostate cancer was diagnosed in 21.5%. Prostate cancer was diagnosed preoperatively in 24% of cases (evident prostate cancer), 32% were suspicious for prostate cancer but no biopsy was done (suspected prostate cancer) and in 44% prostate cancer was incidental. Patients were stratified into probability groups of intermediate/high risk prostate cancer by digital rectal examination and prostate specific antigen. The incidence of unfavorable histopathology was determined in each group.Of prostate cancers 85% were organ confined and the Gleason score was favorable (2-6) in 74%. Of cases of incidental prostate cancer tumors were organ confined in 97%. There were no unfavorable Gleason scores (8-10). In the low probability group 83% of patients had organ confined prostate cancer and only 17% had an unfavorable Gleason score. In the intermediate probability group prostate cancer was organ confined in 73% of patients, 45% had a favorable Gleason score (2-6) and 55% had an intermediate Gleason score (7). In the high probability group 29% of patients had high risk prostate cancer.Most concomitant prostate cancers were organ confined and had a favorable or intermediate Gleason score when digital rectal examination was not suspicious and prostate specific antigen was less than 10 ng/ml. As a consequence, patients with a low/intermediate probability of detecting intermediate/high risk prostate cancer do not require preoperative prostate biopsy unless nerve sparing surgery is planned. In contrast, all patients should undergo preoperative biopsy for prostate cancer when digital rectal examination is suspicious or prostate specific antigen is more than 10 ng/ml because the rate of high risk prostate cancer was 29% in this group.

We report the long-term results of our consecutive series of 504 patients who underwent NSS for cancer suspicious, solid renal tumors in the presence of a normal opposite kidney at our institution since 1979.A total of 715 patients underwent NSS since 1969, including 504 for an elective indication, that is with a normal opposite kidney. Of these patients 381 (75.6%) had RCC, 123 (24.4%) had cancer suspicious benign lesions, including 53 (10.5%) with oncocytoma, 33 (6.5%) with angiomyo(lipo)ma, 23 (4.6%) with a complicated cyst and 13 (2.8%) with other benign lesions. Of the 381 patients with RCC 283 (74.3%) had clear cell, 68 (17.8%) had papillary and 30 (7.9%) had chromophobic RCC. Mean tumor diameter was 3.0 cm (range 0.5 to 11.0). Mean followup was 6.77 years (range 0.2 to 24.1). The oncological outcome was studied, including pathological features associated with tumor progression.Estimated cancer specific survival rates at 5 and 10 years were 98.5% and 96.7%, respectively. Estimated survival rates free of distant metastasis at 5 and 10 years were 97.5% and 95.1%, respectively. Nine patients with localized RCC experienced local recurrence after NSS. Estimated survival rates free of local recurrence at 5 and 10 years were 98.3% and 95.7%, respectively.The long-term results of our series support the concept of organ sparing surgery for RCC in the presence of a normal opposite kidney with excellent long-term survival and a low tumor recurrence rate.

A 63-year-old woman presented elsewhere with a unifocal pT1, G3 transitional cell carcinoma at the bladder base in 1995. She underwent urethral sparing cystectomy and ileal neobladder. Intraoperative frozen section from the proximal urethra did not demonstrate tumor involvement. Final histological examination revealed pT1, pN2, G3 transitional cell carcinoma. Adjuvant chemotherapy was not given. In 1998 the patient had symptoms of obstructive voiding due to a 3 3 3 cm. solid mass at the neobladder-urethra anastomosis (see figure). After 6 cycles of methotrexate, vinblastine, doxorubicin and cisplatin and a transient tumor size reduction, the patient was referred to us for local tumor progression. Endoscopy identified a tumor at the neobladder-urethra anastomosis. Magnetic resonance imaging demonstrated a 2.5 3 1 cm. tumor infiltrating the anterior vaginal wall. With a combined abdominovaginal approach complete removal of the tumor was accomplished, including removal of the introitus and vagina, lower third of the ileal neobladder and entire urethra. The ileal neobladder was converted to a continent cutaneous urinary diversion with umbilical stoma. Histopathological examination revealed poorly differentiated transitional cell carcinoma and tumor-free margins of resection. Two months later multiple hepatic metastases were diagnosed and the patient died 3 months later.