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The paper reports on the tardy results following conservative surgeries performed in 15 cases of transitional supravesical carcinomas (8 pyelocaliceal and 7 ureteral). In cases the surgery was necessary (patients with tumours developed on the conservative operation was made deliberately. a unique kidney, in uremia, infiltrative, highly anaplastic), and in 8 patients. Two years after the surgery, 80% of the patients were alive, after 3 years, 66%, after 4 years, 47%, and after 5 years, 33%. The conservative surgeries in the transitional pyelocaliceal carcinomas have deliberate indications for small, unique lesions, T0-T1 N0 M0 G1, technically easily accessible. For the ureteral tumours, the conservative surgeries may be extended to T3 lesions, but with N0 M0, observing the oncologic limits of exeresis in length, that permit the reconstruction of the urinary tract by a rational surgery.

Two cases are presented, of male sexual impotence of vascular origin. In one case presenting with obstruction of the pudenda artery revascularization of the penis was achieved by anastomosis of the inferior epigastric artery to the deep dorsal vein of the penis. In the second case the insufficient erection was due to a rapid venous drainage of the cavernous bodies, and a venous disjunction was carried out, involving all the superficial veins of the penis and the deep dorsal vein. The results obtained were good. The importance is stressed of the test to papaverin for the differentiation of patients with psychogenic impotence, and the value of the Doppler study for the evaluation of the arterial deficiency of the penis, that should be confirmed by selective angiography. Finally the authors stress the importance of cavernography and of cavernometry for the diagnosis of impotence due to the venous loss.

Between 1976 and 1987 the authors have operated 351 renal carcinomas of the clear cell type, and 51 Wilms tumours. In 35 of the patients there was malignant thrombosis of the abdominal vena cava. Total resection of the vena cava was done in the subhepatic portion in 6 of the patients, and lateral resection with removal of the thrombus was carried out in another 15 patients. In the other 14 cases thrombosis of the vena cava was accompanied by visceral, lymph node metastases, or by invasion of the surrounding organs, and palliative nephrectomy alone was done in 13 patients. One of the patients declined surgery. A new staging is suggested, of the venous invasion, which correlates satisfactorily with the patients' perspectives. Invasion of the main renal venous pathway is noted by V1, invasion of the abdominal vena cava is noted by V2 (with subgroups V2a, when the thrombus is free in the vein, without contacts with the venous wall, and V2b, when the thrombus infiltrates the wall of the vena cava. In cases staged as N0M0V2a perifascial nephrectomy and unblocking of the abdominal vena cava may achieve remarkably long survival, while the V2b substage should be assimilated to visceral metastases.

The paper reports on the results of the endoscopic treatment in 16 cases of orthotopic ureterocele, out of which 11 developed on a simplex ureter and 5 on the superior ureter of the pyeloureteral duplicity (ren duplex). In 6 patients the pseudocystic dilatation of the submucous ureter contained calculi. The endoscopic treatment consisted of: the ureterocele resection in 12 patients (in 6 of them it was associated with the extraction of the calculi with Lowsley's lithotryptic clip): the ureterocele incision in 3 cases; and the endoscopic resection of the intravesical sac, with nephrouretectomy of the dysfunctional pelvis and the respective ureter in one case. The results recorded showed urographic improvement in 14 patients and uroculture sterilization in 11 cases of 14 with postsurgical urinary infections. Only in one case, the ureterohydronephrosis advanced, requiring the subsequent ureter-bladder reimplantation. No case of bladder-ureter reflux following the endoscopic resection or incision of the orthotopic ureterocele was recorded. Endoscopic resection or incision is a simple and efficient method for treating small or middle orthotopic ureteroceles, if the superior urinary system is recoverable. The method is simple and with low risks, and it can be applied as first therapeutic time in all the cases, even in those in which the chance of the definitive solution is less probable, as in the secondary surgical time the classical surgical correction of the uretero-bladder junction can be used.

The authors report their experience with 341 radical cystectomies, and 61 anterior pelvectomies for infiltrating urinary bladder tumours, of which 269 were followed at long periods of time after surgery. In 56% of the patients there was tumoural involvement of lymph nodes at the time when cystectomy was performed. In 88% of the cases the tumours were of G3 stage. Fifty-one percent of the patients had had one previous surgical procedure, and in 75% of the cases surgery was performed when the upper urinary apparatus was already dilated by tumoural obstruction, or when high serum nitrogen was present. Planned radical cystectomy was possible in only 26% of the patients. The technical procedure implies a significant change consisting in the exclusive use of the urethropelvic drainage, and this had excellent results. The urinary derivation used was adapted to the stage of development of the tumour, and after consideration of the condition of the upper urinary apparatus. In 130 cases cutaneous urethrostomy was performed, in 95 patients urethrocolic derivation, in 23 cases cutaneous transurethral ureterostomy, and in 6 patients substitution bladder was achieved. The global postoperative mortality of 16.6% was mainly due to the advanced age of patients, the advanced stages of the tumours, to high serum nitrogen, infections, and to operatory indications that were not always justified but were determined by clinical complications and the extreme discomfort of patients. The most frequent early postoperative complications included an association of toxic shock and high serum nitrogen. In the authors' experience preoperative radiotherapy did not have satisfactory results, and chemotherapy only resulted in inconstant improvement of the patients' condition The late results were not satisfactory, the deaths in the first two years after surgery being the result, almost in exclusivity, to a continued evolution of the neoplastic tissue remaining in the pelvic cavity, and that was due to the fact that the patients had been operated at a very advanced stage of the disease. Total cystectomy has an elective indication in urinary bladder tumours of the T2, T2a, or T3b type, with N0 and M0. It should be carried out as planned surgical intervention and presumes a mandatory urinary derivation that should provide a maximal renal protection.

Analysis of a group of 276 patients with congenital hydronephrosis by dysfunction of pyeloureteral function shows that in the most cases the diagnosis has to be established by corroborating the data given by urography, echography, and isotopic renogram. In the cases of controversial hydronephrosis diagnostic, urography and renogram under diuresis induction are very important in practice.

A total of 111 nonselected cases are presented, of infiltrative urinary bladder tumours, in which endoscopic resections were performed. In most of the cases (83% of the patients) the tumours were of the transitional carcinoma type, the transurethral intervention having been planned in advance. In 35% of the cases resection was done by necessity, and in 3% of the patients resection was done as an emergency for hemostatic purposes. Haemorrhage was the most frequent of the surgical complications, and was reported in 5 patients. Renal failure was the most frequent of the medical complications. In 50 patients radiation therapy was carried out following surgery. The late results are as follows; 44% survivals at 2 years, 14% survival at 3 years, and 9% survivals at 9 years.