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Objective: To review the efficacy of radiotherapy and BCG in the treatment of transitional cell carcinoma of the urinary bladder in its different forms of presentation, with special reference to patients with infiltrating bladder tumors receiving radiotherapy and those in whom the lesion recurs as a high grade superficial bladder tumor., Methods/results: 10 patients who previously received radiotherapy for T2-4 infiltrating bladder tumor that recurred as a high grade superficial tumor were treated with BCG. Four patients are alive and disease-free with a preserved bladder at 2-8 years follow-up. Four other patients who required cystectomy for persistence or progression of the tumor to the bladder wall, are alive and disease free at 3-7 years follow-up. The remaining two patients who were not amenable to major surgery died from the disease more than two years after treatment with BCG. BCG was well-tolerated by 70% of the patients and the rest showed minor complications., Conclusions: 28.3% of recurrences after radiotherapy are superficial tumors and 7% are carcinoma in situ. The appearance of carcinoma in situ or T1 G3 lesions following radiotherapy of the bladder questions its efficacy against these superficial forms for which cystectomy is reserved. BCG has been found to be effective in high grade superficial bladder tumors that have not been previously irradiated, therefore it would be acceptable to extend its application to those patients in whom radiotherapy has achieved control of the infiltrating tumor but not the high grade superficial tumor. The 40-70% of patients who are alive with a preserved bladder appears to be sufficient to recommend BCG salvage for high grade superficial bladder tumors post-radiotherapy. BCG therapy does not entail major complications or compromise patient survival, including those cases that will require cystectomy.

Practical guidelines for the diagnosis and treatment of chronic prostatitis are presented. Chronic prostatitis is classified as chronic bacterial prostatitis (culture-positive) and chronic inflammatory prostatitis (culture-negative). If chronic bacterial prostatitis is suspected, based on relevant symptoms or recurrent UTIs, underlying urological conditions should be excluded by the following tests: rectal examination, midstream urine culture and residual urine. The diagnosis should be confirmed by the Meares and Stamey technique. Antibiotic therapy is recommended for acute exacerbations of chronic prostatitis, chronic bacterial prostatitis and chronic inflammatory prostatitis, if there is clinical, bacteriological or supporting immunological evidence of prostate infection. Unless a patient presents with fever, antibiotic treatment should not be initiated immediately except in cases of acute prostatitis or acute episodes in a patient with chronic bacterial prostatitis. The work-up, with the appropriate investigations should be done first, within a reasonable time period which, preferably, should not be longer than 1 week. During this period, nonspecific treatment, such as appropriate analgesia to relieve symptoms, should be given. The minimum duration of antibiotic treatment should be 2-4 weeks. If there is no improvement in symptoms, treatment should be stopped and reconsidered. However, if there is improvement, it should be continued for at least a further 2-4 weeks to achieve clinical cure and, hopefully, eradication of the causative pathogen. Antibiotic treatment should not be given for 6-8 weeks without an appraisal of its effectiveness. Currently used antibiotics are reviewed. Of these, the fluoroquinolones ofloxacin and ciprofloxacin are recommended because of their favourable antibacterial spectrum and pharmacokinetic profile. A number of clinical trials are recommended and a standard study design is proposed to help resolve some outstanding issues.

Contribution of a complex case of lumbar ureteral fistula with secondary abscess after aortobifemoral bypass in a patient with a background of radical cystectomy with ileal conduit and pelvic radiotherapy. A nephrostomy was established and the retroperitoneal collection was drained so that in a second phase ureteral replacement with ileum could be performed using uretero-ileal terminoterminal and ileum-ileal terminolateral by-pass with good therapeutic and functional results.

A right-renal angiomyolipoma with tumour thrombus into the inferior vena cava was incidentally detected. This is the ninth published case of its type and the second incidental case. Presence of a thrombus does not imply invasive disease, but the tumour then is often bigger than 6 cm and radical surgery is mandatory.

Renal cell carcinoma (RCC) is a common neoplasm of the urinary tract, that is nowadays often diagnosed incidentally. The risk of developing neoplasms in immunosuppressed patients is well documented. The increasing rate of heart transplantation, and the complementary studies required in the follow up of those patients probably will increase the detection rate of RCC in this population. Due the lack of published reports about the management and evolution of RCC in these patients, we performed a radical nephrectomy, on a immunosuppressed patient without evidence of recurrence 24 moths after surgery.

Objective: Drug-induced lithiasis was well-known some years ago, when sulfonamides poorly soluble in urine were in use. Now, they are again in use for some opportunistic AIDS-related infections. We report herein the case of an AIDS patient, treated with sulfadiazine because of Nocardia pneumonia, that came to the emergency room in acute renal failure., Methods/results: Obstructive uropathy due to radiolucent calculi was suspected and retrograde ureteral catheterization was necessary. The calculi recovered were identified as N-acetyl sulfadiazine by infrared spectrophotometry., Conclusion: Rapid improvement can be achieved in these patients when the drug is discontinued or decrease and systemic fluid and urine alkalinization are started.

We evaluated 665 patients who had undergone TURP and 100 patients who had undergone TUIP (50 bilateral, 50 unilateral). Transurethral incision, when indicated (less than 35 gm, no middle lobe), had the following advantages: easy to perform, short operating time (39 minutes) and hospitalization (3-4 days). There was less bleeding; 2% versus 6% for TURP. The complication rate was lower: no bladder neck sclerosis for TUIP versus 2.9% for TURP; urethral stenosis: 6% for the bilateral and 0% for the unilateral incision versus 8.7% for TURP, and the incidence of retrograde ejaculation was 24% for the bilateral and 19% for the unilateral incision versus 82% for TURP. We also evaluated the disadvantages of transurethral incision: no tissue for study 4% incidental prostate cancer for TURP, limited indications, anatomic variability, less disobstructive, reoperation rate was 10% versus 11.7% for TURP, design of comparative studies deficient and no long-term follow up. The results of bilateral and unilateral incision were compared, however no statistically significant differences were observed. The bilateral incision procedure was slightly more disobstructive: 92% clinical improvement for the bilateral and 84% for the unilateral, increased flow was 6.5% for the bilateral versus 5.6% unilateral, and the reoperation rates were 2% for the bilateral and 8% for the unilateral incision procedure. However, there were less complications for the unilateral incision procedure: no stenosis for the unilateral and 6% for the bilateral, and retrograde ejaculation was 81% for the unilateral and 76% for the bilateral incision procedure. For all the foregoing reasons, we prefer to do unilateral incision of the prostate.

We reviewed the records of 34 patients with epididymal and/or testicular abscess that were treated at our institution. The mean age of the patients was 48.6 years. The most common clinical manifestation was scrotal pain. The diagnosis was made on the clinical and/or scrotal ultrasound findings. E. coli was isolated in 84.6% of the cases. Chronic and acute orchitis with abscess formation were the most common histological findings. Twenty-nine cases required antibiotic therapy plus surgery and five cases required antibiotics alone.

We report an uncommon case of ureteral obstruction arising from the cement utilized to fix a total hip prosthesis. The pathophysiological mechanisms that may cause urinary tract involvement in this type of surgery are discussed.

Transcatheter ascending pyelography is commonly performed in the post-operative evaluation of patients submitted to ileal diversion or continent bladder replacement after radical cystectomy. The present study investigated the usefulness of this procedure in the control of these patients. Of 51 patients that underwent cutaneous ileal diversion, the IVP revealed a leak of the contrast medium in only one case (1.9%). Of the 18 patients that received a continent neobladder, radiologic signs of changes were detected in 6 cases (33.3%). The complications of the IVP in our patients were fever in 26 patients (37.7%) and septicemia in one patient (1.45%). Considering the information obtained and the rate of morbility, we believe that ascending pyelography through catheters is not justified in the routine post-operative control of patients who have undergone radical cystectomy and ileal diversion. However, it appears to be a useful procedure in those cases that have undergone bladder replacement and/or continent diversion procedures.

We present of one patient with isolated pharmacological fever probably caused by Isoniazid given prophylactically 24 hours prior to each vesical instillation with BCG as maintenance therapy for in situ vesical carcinoma. The fever appeared in two occasions before the instillation and did not returned once the drug was discontinued. We Review this adverse effect which may lead to diagnostic error.

Two patients who had undergone resection of a transitional cell bladder tumor presented with nephrogenic adenoma of the bladder during treatment with BCG. Nephrogenic adenoma presenting in the course of intravesical chemotherapy has been previously reported in 5 cases and can mimic tumor recurrence. Thus, we consider the present case to be of special interest.

A simplified technique for nephroureterectomy is described. This technique consists of resection of the intramural ureter followed by lumbar nephrectomy and traction of the previously detached distal ureter. The use of this technique is advocated because it is easy to perform and radical from the oncologic viewpoint.

Of 288 patients with superficial transitional cell carcinoma of the bladder vesicorenal reflux developed after transurethral resection in 26 per cent. This proportion was higher (77 per cent) when we considered only those tumors located near the ureteral orifices. There was a statistically significant relationship (p less than 0.001) between the development of upper urinary tract tumors and vesicorenal reflux (20 per cent of the patients with reflux and 0.9 per cent without reflux had a tumor), which corresponds to a 22-fold greater risk in the former group. Close followup is advised, since 1 of 5 patients with reflux after transurethral resection may have upper urinary tract transitional cell carcinoma.

We present here a 42-year-old female who developed a renopleural fistula after a percutaneous nephrolithotomy through the 11th intercostal space of a calculus of the upper calyces of the right kidney. The fistula was resolved with a chest tube and a double-J ureteral catheter.