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We report on the use of a new compact, inexpensive, portable shock wave lithotriptor. To date 40 treatments on 37 patients with different calculi in the upper urinary tract have been performed at our institution with excellent results and no complications. More patients currently are being treated with this machine at additional centers with equally good results.

The relevance of the presence of steroid receptors in the response to hormonal therapy was examined in 19 patients with renal cell carcinoma who were treated by surgery and progestins. Estrogen and progesterone receptors were determined in tissue samples obtained from the tumors, and normal (autologous) and control kidneys. The tumoral tissues had the lowest content of estrogen and progesterone receptors, and the lowest percentage of samples positive for receptor. Autologous kidneys had a higher percentage of positive estrogen and progesterone receptors compared to tum oral tissues, and a lower estrogen receptor content compared to control kidneys. The 18-month survival rate under progesterone therapy for 9 patients with stages I and U tumor was 86 per cent and for 10 with stage IV tumor it was 8 per cent. The low content of progesterone and estrogen receptors in patients with renal cell carcinoma may explain the poor response rate of these patients to hormonal therapy.

A case is reported of nephrogenic diabetes insipidus and gross bilateral hydronephrosis associated with massive post-obstructive diuresis (40l. per day).

We studied retrospectively 78 patients with recurrent superficial bladder tumors in an effort to determine whether transitional tumor cells implant and grow preferentially in patients who have undergone endoscopic resection of stage Tl bladder tumors in the presence of an inflamed urothelium. Of the patients 32 (group 1) had an undetected lower urinary tract infection at the time transurethral resection was performed and 46 (group 2) were free of infection.

The potential of lymphoscintigraphy to detect lymph node metastases compared to lymphangiography and computerized tomography scanning was evaluated in 26 patients who underwent radical cystectomy for invasive bladder cancer. Four-view images of the abdominoperineal area were taken 90 to 120 minutes after 99mtechnetium-rhenium sulfide was injected into 2 interdigital spaces in each foot. Results of lymphoscintigraphy interpretation correlated with surgical and histological findings: a correct diagnosis was made in 61.5 per cent of the patients, while 23.1 per cent had false positive and 15.4 per cent had false negative results. Although computerized tomography was the most accurate method to detect lymph node metastases (correct diagnosis in 73.1 per cent of the patients) no significant difference was found among the 3 diagnostic methods.

A patient with life-threatening sepsis following extracorporeal shock wave lithotripsy (ESWL**Dornier Medical Systems, Inc., Marietta, Georgia.) is described. The urosepsis was complicated by meningitis and diffuse metastatic endophthalmitis necessitating enucleation of the right eye. Retinal detachment occurred in the left eye following focal endophthalmitis and the operation yielded a poor functional result. The patient was discharged from the hospital 3 months after the ESWL therapy, free of urinary stones. The etiology, treatment and prophylaxis of this serious problem are discussed.

Genitourinary malacoplakia in renal transplant patients is rare. We report a case of malacoplakia of the bladder, which presented as a vesical tumor.

We studied the incidence of myelosuppression and renal function in 33 patients treated by repeated resections of bladder tumors and thiotepa instillations for at least 26 months in the presence of vesicoureteral reflux. Of the 33 patients 28 had unilateral and 5 had bilateral reflux. Transient myelosuppression occurred in 5 patients (15.1 per cent), including 2 with bilateral reflux. Renal function remained stable in all but 2 patients who had decreased renal function when thiotepa was started.

A total of 66 patients with low grade, low stage transitional cell carcinoma of the bladder who were treated with intravesical bacillus Calmette-Guerin (BCG) underwent cystourethrography to detect vesicoureteral reflux. BCG was instilled weekly for 6 weeks and monthly thereafter for up to 24 months. Whenever vesicoureteral reflux was found or morphological abnormalities were detected on excretory urography (IVP) an isotope renal scan was performed to evaluate the relative renal function. Vesicoureteral reflux was found in 13 patients (19.7%): 10 had grades 1 and 2A, and 3 had grade 2B reflux. The number of BCG instillations ranged from 8 to 22. IVPs were normal in 11 patients. In 2 patients mild unilateral dilatation was present before BCG instillations, and this remained unchanged during and after therapy. None of the 13 patients with vesicoureteral reflux had IVP features suggestive of urinary tuberculosis. In 11 patients the refluxing renal systems had normal relative renal function (50 to 55%). Two patients had a decrease to 40% of the relative renal function with normal IVPs, suggesting a nonBCG related cause. We conclude that BCG therapy is safe in patients with minimal reflux.