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Intraoperative penile erection during endoscopic surgery, although an infrequent occurrence, is a troublesome complication and a challenge to the urologist. It is difficult to perform the procedure during penile erection, because various complications may occur. The etiology is unclear, and a number of pharmacological remedies have been discussed in the literature. Herein, we describe the treatment and outcomes for 3 patients with intraoperative penile erection and provide a brief review of the associated literature. Intraoperative penile erection is a rare event during transurethral procedures, with a frequency of approximately 0.1% in our institution. To our knowledge, no generally accepted protocols for the prevention or treatment of this phenomenon have been reported in the literature. We recommend intracorporeal injection of 250 microg of phenylephrine: detumescence occurred rapidly in all patients after a single injection. The mode of administration is simple, and no complications have been reported. J Androl

N-acetyltransferase-2 (NAT-2) and Glutathione-S-transferase M1 and T1 (GSTM1 and GSTT1) polymorphism have been implicated in the detoxification of urothelial carcinogens, such as arylamines and polycyclic aromatic hydrocarbons. The results of epidemiological studies examining the role of NAT-2, GSTM1 and GSTT1 genotypes on the risk factors for bladder cancer were controversial, although suggesting that there may be an increased risk of the disease associated with these genotypes. The aim of the present study was to examine the independent effect and a possible interaction of NAT-2, GSTM1 and GSTT1 genotypes on the risk of bladder carcinogenesis, in the frame of a case-control study. We also investigated the possible association of specific genotype combinations with more aggressive disease in terms of tumor grading and local staging at the time of initial diagnosis. Between August 1996 and May 1998, 89 newly-diagnosed bladder cancer patients (transitional cell type) and 147 controls were included in the study. All patients were selected at the time of first diagnosis, done in the Department of Urology at the University Hospital of Ioannina, in north-western Greece. GSTM1 and NAT-2 deficient genotypes were found to be independently associated with the risk of bladder cancer (odds ratios 2.87 and 2.64, respectively). The GSTT1 genotype did not present any significant association with bladder cancer risk. We did not find a significant interaction between genotypes. These results could be explained by the independent activity of the two enzymes. Studies that will simultaneously examine the role of several genetic and environmental factors involved in bladder carcinogenesis are needed to give a global picture for the risk factors of bladder cancer and their potential interaction. Anticancer Research

OBJECTIVE: To describe the pattern of bladder cancer mortality in the Epirus district population (North-Western Greece) and to establish some relationships with cigarette smoking. PATIENTS AND METHODS: Mortality rates of bladder cancer in the Epirus district population were analysed according to the official data from the Department of Statistics of the University Hospital of Ioannina during the last decade (January 1990-January 2000). Age standardization of death rates was done by the direct method, using the world population as a standard. Fisher's test was used as a significance test for linear regression coefficient in time trend analysis of mortality. RESULTS: The average annual standardized mortality rates from bladder cancer during the study period were 5.23 per 100,000 population (96% Confidence Interval--Cl 4.02-5.63) in males and 1.63 per 100,000 population (96% Confidence Interval--CI 1.18-1.96) in females. Significantly increasing trends of the rates were observed in males (y = 2.421 + 0.231x; p < 0.01), but not in females (y = 1.263 + 0.027x: p > 0.05). The greatest increase in age - specific rates in males was observed in the age group of 70 and more years (y = 25.602 + 3.673x; p < 0.01). In females, all age--specific rates except for the group 60-69 years showed significantly increasing tendency. The increasing tendency of bladder cancer mortality is followed by the rise of per capita cigarette consumption among the Epirus district population. CONCLUSION: Further studies are needed for the explanation of the irregularities in the age-specific rates. Int Urol Nephrol

We herein present a case of formation of a large infectious bladder calculous resulted from placement of a double pigtail catheter for an extensive period. The concomitant poor function of the corresponding renal unit made selection of nephroureterectomy unavoidable in the management of our patient. Int Urol Nephrol

OBJECTIVES: This study was conducted (1) to examine whether the GSTM1 and GSTT1 null genotypes are risk factors for bladder cancer, and (2) to study a possible association of these genotypes with disease severity. METHODS: This case-control study was undertaken over a 21-month period and included 89 newly diagnosed transitional cell bladder cancer patients and 147 controls; both patients and controls originated from a defined population (residents of the loannina region, Northwestern Greece) and were similar with regard to mean age, male to female ratio and smoking habits. The GSTM1 and GSTT1 genotypes were identified by multiplex polymerase chain reaction on peripheral blood DNA samples. Genotype frequencies among patients and controls were assessed and the association of the genotypes with tumor grade and stage at presentation were statistically evaluated by the chi(2) test. RESULTS: The GSTM1 null genotype was strongly associated with bladder cancer. The odds ratio, attributable and population attributable risks were estimated at 2.76, 0.64 and 0.40, respectively. The correlation between the GSTM1 null genotype with stage, although not statistically significant, was estimated at an odds ratio of 2.6 for invasive disease. The correlation of GSTM1 null genotype with tumor grade did not yield a statistically significant result. The GSTT1 null genotype was not statistically associated with bladder cancer. CONCLUSION: According to our study, individuals with the GSTM1 null genotype carry a substantially higher risk for bladder carcinogenesis. The GSTM1 null genotype is not associated with more aggressive disease in terms of tumor grade, although there is a correlation between this genotype and stage of the disease. Eur Urol

We hereby present a rare case of a 46,XY/45,XO/47,XXY mosaic male patient with a predominance of the XY cell line. The patient, who exhibited phenotypic stigmata of both XO gonadal dysgenesis and Klinefelter syndromes, suffered from infertility and multiple urogenital abnormalities, as our investigation revealed. Urol Int

The relationship between renal stones and urinary tract infection is frequent but not well-known. In this study, urinary tract infection was found in 12% of renal stone formers. It is four times more common in females than in males. Urea splitting bacteria (Proteus, Klebsiella, Staphylococcus and Pyocyaneus) lead to stone formation. They were identified in 72% of cases. Proteus was predominant and the organism most frequently found in staghorn stone formers. Other non urea-splitting bacteria (E. coli, Enterobacter, Streptococcus) were observed in 25% to 30% of cases. The percentage of the various bacteria varies according to the degree of resistance to therapy and the patients sex. Ann Urol (Paris)

Penile squamous cell carcinoma arising from balanitis xerotica obliterans is rarely reported. We describe a 58-year-old man in whom penile squamous cell carcinoma developed after 25 years of observation for balanitis xerotica obliterans. It is important to recognize the possibility of this uncommon complication of balanitis xerotica obliterans, because survival of patients with squamous cell carcinoma depends on early diagnosis and treatment. Int Urol Nephrol

The ureteral double pigtail stents are versatile and valued for proper urinary drainage in the setting of trauma, fistula formation, after extra-corporeal shock wave lithotripsy (ESWL) and surgical manipulations of the upper urinary tract. Also they are used for prolonged urinary drainage in patients with chronic tumor-induced ureteral obstruction, and present an exceptional patient tolerance. The authors' experience is based upon 54 patients treated for ureteral obstruction of malignant origin between January 1989 and October 1995. Complications of this method as well as the quality of life of these patients are analysed and the results compared with those of the literature. The patient tolerance was excellent. Mean survival time after ureter catheterisation was 18 months. Complete urine diversion was achieved and hydronephrosis disappeared soon after stent placement in 42 patients (80%). In addition hydronephrosis persisted in 12 cases (20%), despite orthotopic positioning of the catheter and numerous stent changes for larger caliber stents. The palliative use of the double pigtail stent when no other treatment is possible for malignant ureteral obstruction, precludes the need for ureterostomy and offers the patient a comfortable quality of life. Bladder disease is a contraindication to the use of these catheters, although their insertion is rarely impossible. In case of acute obstruction, it is better to prepare the pathway with a standard ureteral catheter, which is easier to manage. It is always possible to insert the pigtail stent after some time has elapsed. J Urol (Paris)

Surgical injury to the ureter is an important problem that confronts the urologist, the gynecologist and the general surgeon. The authors report 20 cases of iatrogenic pelvic ureteral injuries (22 ureters) observed after gynecological surgery between January 1985 and January 1995. The ureter was injured during ligation of the lumbo-ovarian vascular pedicle because it was inadequately protected during the operation. Open surgery and double pigtail stent insertion using retrograde route were used for treatment. The iatrogenic ureteral injury was in 18 patients unilateral and in the remaining 2 patients both ureters were damaged. As regards treatment, the authors recommend immediate repair, whenever the lesion is noticed at operation. In the post-operative period, ureteral stent or double pigtail stent insertion using balloon dilatation or ureteroscope, may be a successful conservative treatment. If the damage is only diagnosed subsequently, they recommend a ureterovesical implantation, using the psoas hitch bladder procedure or the Boari-Cassati-Kuss procedure if the lesion is in the lower ureter or a transuretero-ureterostomy if it is in the upper ureter. J Urol (Paris)

The results observed in a series of 40 patients treated for urethral stricture by endoscopic resection of the callus after internal endoscopic urethrotomy (Guillemin's technique) are presented. The mean age of the patients was 57 years, with a follow-up of five years. The authors obtained 80% (32 patients) of very good results for urethral strictures less than 1 cm long. The success rate of the technique was 10% (4 patients) when the callus was between 1 and 2 cm long. The recurrence rate was high for strictures longer than 2 cm (4 patients) (10%). Complications consisted of 2 cases of acute epididymitis, 2 cases of urethral perforation, 2 cases of urethral haemorrhage, 2 cases of perineal haematoma and 3 cases of meatal stenosis. The indications of this original technique therefore depend more on the length of the urethral stricture than on its topography or its aetiology. J Urol (Paris)

Three rare cases of benign ureteral polyps are presented. The rareness of benign mesenchymal ureteral tumors and the difficulty in pre-operative differential diagnosis from malignant epithelial are remarkable. The diagnosis is made on characteristic appearance at operation and is confirmed by frozen section and histological examination. Minerva Urol Nefrol

From 1987 to 1990, 719 subjects (385 males and 334 females) were screened, by means of urocystin-kit, for cystinuria and cystine lithiasis, in Epirus district (North-West Greece). The positive results were confirmed by chromatographic analysis of urine amino acids and laboratory tests. Forty patients, belonging to six cystinuric families, were identified. These patients were excreting 3.1 +/- 1.7 mmol/24 h of cystine in urine. All patients were treated by per os administration of alpha-MPG in daily doses of 400-1,200 mg/24 h). We therefore report the results of a 4 +/- 2 year follow-up of these patients. We conclude that treatment with alpha-MPG is very effective with minimal side effects in patients suffering from cystinuria or cystine urinary calculi. J Urol (Paris)

A case of interstitial cystitis in a patient with a 5-year history treated by intravesical instillations of Lidocaine is reported. The repeated treatment relieved the patient from her pain and induced a potent anti-inflammatory effect on the bladder wall. The concentrations of plasma Lidocaine were between 1.4 and 1.1 mg/ml. No adverse reactions were reported with a follow-up of 2-years. Arch Ital Urol Nefrol Androl

Seventy patients with urethral strictures underwent endoscopic urethrotomy in the Department of Urology of the Ionnina University Hospital since 1983. The mean age of the patients was 58 years and they were treated for single (53 cases) or multiple (17 cases) urethral strictures. The cause of stricture was traumatic, post-infections, iatrogenic (post-TURP or open adenomectomy) or unknown in 6, 21, 28 and 15 patients respectively. Good results were obtained after the first endoscopic urethrotomy in 36% of cases (25 patients), at 5 year follow-up. The success rate of repeated internal urethrotomies was satisfactory in 54% of cases (38 patients). Finally, 4 patients (6%) had 5 or 6 internal urethrotomies and many urethral dilatations and were then treated by urethrectomy followed by termino-terminal urethrraphy. J Urol (Paris)

Actas Urol Esp

Brux Med

Ureteric obstruction is rarely encountered in abdominal aortic aneurysms and is due to perianeurysmal fibrosis. 3 cases are described in which aortic aneurysm and retroperitoneal fibrosis are found. Excision of the aneurysm and ureterolysis with intraperitonization of the ureter is the most appropriate surgical procedure but treatment must be individualized according to the patient's condition and the operative discoveries. Eur Urol