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Aim: Several studies have proposed a role for alpha1 adrenoceptors (ARs) in ureteral physiology, indicating that they are present in the ureter; however, few studies have been done to identify alpha1 AR subtypes present in this area. Thus, this study was carried out to characterize the alpha1 AR subtype gene and protein expression in proximal, medial, and distal region of the human ureter., Methods: Molecular characterization of alpha1 AR subtypes were analyzed by semi-quantitative RT-PCR. alpha1 AR protein expression was studied by saturation binding curves and by competition binding curves with selective antagonists. Analysis of data was performed using the GraphPad PRISM 4 software., Results: Analysis of saturation binding curves revealed a heterogeneous distribution of alpha1 AR binding sites, the B(max) for the distal ureter was indeed 52.5 +/- 5.4 fmol/mg prot, while a lower similar density of alpha1 ARs was demonstrated in the medial (25.2 +/- 1.7 fmol/mg prot) and proximal (23.4 +/- 0.4 fmol/mg prot) ureters. Molecular and pharmacological characterization of alpha1 AR subtypes indicated that each receptor was present, although with differences in terms of the amount expressed., Conclusions: Human ureter was endowed with each alpha1 AR subtype, although alpha1D and alpha1A ARs were prevalent over alpha1B ARs. Radioligand binding results revealed that there were no significant differences in the K(d) between ureteral regions, while a heterogeneous distribution of alpha1 AR binding sites was detected, with the highest density of alpha1 ARs in the distal ureter and a lower similar density in the medial and proximal ureters., (Copyright 2005 Wiley-Liss, Inc.)

A detailed study of the presence of alpha1 AR binding sites and alpha1 AR subtype mRNA expression in human urinary bladder areas involved in the micturition (i.e. detrusor, trigone and neck) is reported here, investigating whether or not there are differences between sexes. Results obtained indicated that alpha1 AR proteins were detectable in each bladder area. In both sexes, the detrusor and the neck expressed similar levels of alpha1 ARs: respectively, detrusor: 14.6 +/- 1.2 in men and 13.1 +/- 1.1 fmol/mg prot in women; neck: 16.9 +/- 3.2 in men and 17.5 +/- 4.1 fmol/mg prot in women. In the trigone, significantly higher alpha1ARs were found in women compared to men (20.6 +/- 1.1 vs 11.7 +/- 0.7 fmol/mg prot). Subtype analysis indicated that in women, each area was endowed with mRNA encoding for each alpha1 AR subtype. The men detrusor expressed alpha1a and alpha1d ARs, while in the trigone and the neck, each subtype was present. Since the detrusor muscle hypertrophy is a marker of bladder obstructive outlet, the selective alpha1 AR subtype targeting arouses much interest, as evidence indicates that there are differences in signalling pathways among the subtypes. Furthermore, the significance of the alpha1 ARs coexpression is still unknown; interestingly, recent papers demonstrate that alpha1 AR subtypes could dimerize. Thus, in the human urinary bladder it may be suggested a potential level of alpha1 AR complexity that could have an impact on drug development.

Endometriosis is a biologically benign albeit aggressive pathology marked by high local recurrences. Ureteral involvement accounts for only a minority of cases (0.1-0.4%) with often non-specific symptoms at clinical presentation and difficult preoperative diagnosis. Thirteen cases of severe ureteral endometriosis (i.e. causing significant obstruction to the urinary flow) were observed and surgically treated, out of 17 ureteral units affected (three cases of bilateral involvement, one case of complete pyeloureteral duplicity). The initial symptomatology was acute and related to ureteral obstruction in eight cases, silent and non-specific in the other five; a presumptive diagnosis was made only for the seven patients (53.9%) with a positive medical history for pelvic (and in two cases also ureteral) endometriosis. Preoperative drainage of urine proved necessary for eight patients due to the complete functional exclusion of the excretory axis. One patient (7.7%) underwent nephrectomy due to renal atrophy. Segmental ureteral resection and termino-terminal anastomosis were performed in two patients, while seven patients underwent segmental ureterectomy and ureterocystoneostomy, with bladder psoas hitching in four cases and vesical flap according to Casati-Boari in one case. All three cases of bilateral involvement were treated by bilateral segmental ureterectomy and trans-uretero-uretero-cystoneostomy with bladder psoas hitching. Following histological examination, all patients were diagnosed with active ureteral endometriosis, which was found to be intrinsic in five cases (38.5%) and extrinsic in the other eight. One of the two patients that had undergone ureterectomy and termino-terminal anastomosis had to undergo ureteral resection and ureterocystoneostomy 22 months later due to relapsing endometriosis-induced stenosis. Conversely, no ureteral endometriosis relapses occurred in the remaining 12 patients within the mean follow-up time of 41.1 months (range 6-91). Ureteral endometriosis is marked by non-specific symptoms, making preoperative diagnosis often difficult. Therefore, an ultrasound or urographic examination of the urinary tract in case of pelvic endometriosis is absolutely essential. In our experience, terminal ureterectomy with ureterocystoneostomy has provided long-term favourable results as extended ureteral resection can be performed and continuity of the urinary tract can be restored without resorting to the distal pelvic ureter, which is often affected by the disease besides being more subject to relapses.

Retroperitoneal fibrosis (RF) is an uncommon disease with an estimated incidence of 1 case on 200.000 inhabitants. Idiopathic RF (2/3 of cases) must be distinguished from secondary RF, caused by hexogen substances assumptions, radiotherapy and various diseases. The treatment of RF is not yet univocally defined. From 1984 to 2002 we observed 15 patients (1 case with idiopathic retroperitoneal fibrosis) i.e. 27 ureteral units (1 patient was previously nephrectomized and 2 showed a monolateral ureteral involvement). The mean age was 55 and the male:female ratio was 0.66:1. The commonest presenting symptoms were acute renal failure or renal colic. 14 patients needed preoperatory urinary drainage by nephrostomy or ureteral stenting. 6 patients were treated with steroids or tamoxifen without response so that all the 15 patients underwent surgery. 6 patients were lost to follow-up after 8 months while the other 9 underwent clinical and radiological controls for a mean time of 84 months (range 12-168) with evidence of normal canalization or steady dilatation of the excretory system for 8 of them. 1 patient developed a relapsing ureteral stenosis after ureterolysis and intraperitonealisation and needed ureterectomy with ileal interposition. In a case with monolateral presentation a controlateral stenosis was evidenced 5 years later. According to literature data, the surgical technique that ensured us the best results was ureterolysis with omental wrapping of the ureter. In our experience, medical treatments gave poor outcomes. However, in consideration of the low incidence of RF, perspective and multicentric studies are necessary to establish which is the most suitable treatment for each patient. Follow-up must be extended in patients with monolateral presentation to precociously reveal a possible contralateral involvement.

The ileal conduit has been widely used for urinary diversion. It is a safe procedure with acceptable results, but it has become clear that the conduit can give rise to serious complications, notably renal deterioration in the long run. Stenosis of the ileal conduit, usually developing insidiously many years after the diversion, may be the cause of upper urinary tract damage. In most cases, a variety of possible factors is considered, including microvascular ischemia, urine-borne toxic material, infectious and allergic stimuli and an immunologic defect. Crohn's disease may affect an ileal loop urinary conduit. It presents as a diffuse loop stenosis. Recurrent transitional carcinoma arising within an ileal conduit following cystectomy for malignant disease is rare, but late malignancy in bowel segments exposed to urine without fecal stream is well known. In literature, distinction between conduit complications of patients with underlying benign disease and those with malignancy has not always been clear. Stoma and skin complications are frequently observed and the patients who practiced inadequate stoma care routines are more likely to show peristomal skin complications. Patients bearing an abdominal urostomy should be followed up stringently in stoma centers.

Objectives: To determine the endocrine effects, efficacy and tolerability of the 3-month formulation of goserelin acetate ('Zoladex' 10.8-mg depot; 'Zoladex' is a trade mark of the AstraZeneca group of companies) in the treatment of patients with advanced prostate cancer., Methods: Between February 1996 and October 1997, this open, multicentre study enrolled 120 patients with locally advanced (T3/4) or metastatic (N+ or M1) disease, or an increase in prostate-specific antigen (PSA) level after radical prostatectomy. Patients received goserelin acetate 10.8-mg depot every 12 weeks until clinical progression or interruption for adverse events or other reasons., Results: The mean testosterone concentrations were suppressed to the castration range (< or =2 nmol/l) after 4 weeks of treatment and remained suppressed throughout the study. In total, 99/115 (86%) patients had a serum PSA response, and the mean PSA value decreased significantly during treatment (p = 0.006). The mean PSA level at baseline was significantly lower in patients without disease progression compared to those who experienced disease progression (p = 0.0002). Goserelin acetate 10.8-mg depot was well tolerated and there were no injection site reactions., Conclusions: The goserelin acetate 10.8-mg depot is well tolerated with no injection site reactions. It produces PSA responses and provides reliable suppression of serum testosterone., (Copyright 2003 S. Karger AG, Basel)

Objectives: To study the mRNA expression of each muscarinic receptor subtype in bladder areas involved in micturition, such as the bladder dome, neck, and trigone. Our study focused on the analysis of the gene expression of muscarinic receptors in the human male and female urinary bladder. Other than the well-known role of bladder parasympathetic innervation, an extensive study of the muscarinic receptor mRNA distribution in male and female urinary bladder is still lacking., Methods: The study was carried out on 5 female (age 56 +/- 10 years) and 5 male (age 70 +/- 9 years) patients. The patients selected for this study did not have any lower urinary tract symptoms, as determined by International Prostate Symptom Score questionnaire. The mRNAs encoding muscarinic receptor subtypes were assessed by reverse transcription-polymerase chain reaction, followed by Southern blot analysis., Results: Using a molecular approach, we demonstrated the presence of all muscarinic receptor subtypes in the different urinary bladder areas involved in micturition; in particular, our data indicated that mRNAs encoding muscarinic receptors are largely expressed in all examined bladder areas, both in men and women, although with some remarkable differences and a peculiar distribution., Conclusions: Our results indicate that the pharmacology of the human bladder may be more complex than previously recognized. Furthermore, the choice to study each biopsy as a single sample and not use a pool of tissues allowed us to point out the individual variability between subjects and sex-related differences in the expression profile of muscarinic receptor subtype mRNAs.

Endometriosis affects about 10-20% of premenopausal women but ureteral involvement is an infrequent event occurring only in 0.1-0.4% of cases. Clinical presentation and radiological aspects are non-specific so that preoperative diagnosis is difficult, requiring a high index of suspicion. Intravenous urography is mandatory in all patients with pelvic endometriosis. Between 1995 and 2001, 10 patients with severe endometriosis of the ureter were referred to our center. Bilateral involvement was present in 3 cases. 6 patients showed a significant involvement of other pelvic organs, with subsequent surgical treatment. 1 patient with bilateral ureteral endometriosis was treated by bilateral stenting and medical hormonal therapy, with good results. 2 patients underwent ureteral resection with primary reanastomosis; one of them showed an ureteral relapse 22 months after surgery, with the necessity of a second resection and ureteroneocystostomy. Ureteric resection and ureteroneocystostomy were initially performed in the other 7 patients, without evidence of recurrences in all cases (median follow-up 31 months). Hormonal therapy or hysteroadnexiectomy, when feasible, are necessary to reduce the risks of relapses. In our opinion, ureteral resection associated with ureteroneocystostomy gives the best chances to cure severe ureteral endometriosis.

Surgery of gynecologic area and of pelvic cavity in general is a risk situation for ureteral injury. The incidence of these injuries is about 1% and may be considered as "unavoidable", irrespective of the surgical approach which could be either abdominal, vaginal or laparoscopic. In this study, 37 patients who had undergone a previous gynecological surgery were assessed for 38 ureteral units. Ureteral injury was identified at the surgical table in 2 patients who were treated successfully during the same surgical session with an end-to-end anastomosis. In 8 patients, a double-J ureteral stent was placed and the cure was obtained in 7 patients. The single case of failure was converted to surgery. 22 female patients for 23 ureteral units were subjected to open surgery performing 16 ureterocystoneostomies, 6 of them with a combined psoas-bladder hitching. In 1 patient a termino-terminal anastomosis was performed due to an injury in an upper site. Finally, in 3 patients nephrectomy was carried out due to a nonfunctional kidney; 1 patient refused surgery, whereas in another patient a spontaneous canalization of the excretory tract was obtained after reposition of a percutaneous nephrostomy. The minimum follow-up is of at least 1 year. The diagnostic aspects and therapeutic indications are then described with a special emphasis on the so-called prognostic factors which could influence the outcome of the treatment. Finally, the main surgical correction techniques employed in case of leakage of ureteral substance, are reviewed.

Right nephrectomy and ligation of the left renal vein often lead to acute renal failure, but not obligatorily to renal infarction and chronic uremia, thanks to the peculiar venous supply of the left kidney. A man underwent right nephrectomy, inferior cavectomy and ligation of the left renal vein and became anuric. Hemodialysis was necessary for some days, but he partially recovered his renal function. Proteinuria occurred a few days after the operation and decreased but had not disappeared after ten months. Eventually the patient died of brain metastases. There are a few reports of similar operations, some successful, others not, but very few papers report an adequate follow-up of subsequent changes in renal function. Nephrologists could be involved in the postoperative care of these cases. They should be aware of the possible recovery of renal function and should try all possible strategies to help the left kidney recover its function.

Purpose: A retrospective study was done to analyze late urological complications following curative radiotherapy of primary gynecological carcinomas., Methods: From 1990 to 2000, 167 patients with primary gynecological cancer treated with external radiotherapy or intracavitary applications were observed. During the follow-up, all signs, symptoms and therapy of late treatment complications were recorded., Results: Most patients with ureteral stenosis or obstruction required surgical correction. Most patients with bladder fistulas were best served by creation of a cutaneous urinary diversion., Conclusion: Ureteral complications after radiotherapy of the pelvis are rare but severe. Surgical therapy of irradiated tissues has a higher complication rate compared to surgery on non irradiated tissue. A cutaneous urinary diversion may be an acceptable and safe procedure when the bladder is definitely compromised.

Two new cases of chromophobe renal cell carcinoma were diagnosed on the basis of their morphology and their karyotype complemented by flow cytometry. In one of these cases, however, all these investigations were not sufficient and additional histochemistry investigation had to be used to completely rule out other renal tumors such as oncocytoma, the prognosis of which is totally different.

53 patients presenting with post-prostatectomy obstructive complications above the colliculus seminalis were treated in a single session by means of guided dilatation of the stricture followed by transurethral resection of the stenosing fibrotic tissue. No failures or complications with the guided dilatation technique have been observed. The results obtained after resection in cases of bladder neck stenosis were very encourging. Unsatisfactory results were observed in cases of prostatic urethral stenosis because resection is not a technique sufficient for stable resolution of the obstruction.