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We followed 657 primary bladder carcinoma patients for at least 10 years or until death. Subsequent carcinomas of the renal pelvis or ureter were found in 11 patients (1.7 per cent) 10 months to 13 years after the primary bladder tumor. In 3 patients the tumors were diagnosed or suspected by excretory urography, while in 5 the tumors were not found until autopsy. Four patients had undergone cystectomy and 9 had multiple bladder tumors at the initial assessment or during followup. The initial or recurrent bladder tumor involved the ipsilateral ureteral orifice in 6 patients. We conclude that in bladder cancer patients routine excretory urography is not indicated in the absence of upper urinary tract symptoms but it should be performed in selected patients, that is those with multiple and recurrent bladder tumors or tumors involving the ureteral orifices, or those with a previous cystectomy.

A technique for creating an intra-arterial renal artery stenosis in the dog by a percutaneous approach is described. The effect of such a stenosis is evaluated with angiography, renal blood flow measurements, arterial blood pressure determinations and kidney histology. It is concluded that the method is applicable in studies on renal artery stenosis with the advantage of producing a progressive stenosis without any exploration of the kidney.

The absorption of Adriamycin (ADM) into the systemic circulation and into different organs including the urinary bladder was investigated in the rat after intravesical instillation of ADM with or without a surface active detergent, Tween 80. The postinstillation plasma concentration of ADM increased significantly with increasing dose of the drug. Even though the leakage of ADM into the systemic circulation and into extravesical organs in general was slight a significant increase was observed after addition of Tween 80. The uptake of ADM into the urinary bladder wall was also significantly enhanced by Tween 80 thus the role of this agent in conjunction with intravesical chemotherapy should be further investigated.

In a randomised, double blind, long term, crossover study 1 g twice daily of methenamine hippurate was compared with placebo for its preventive effect on recurrent attacks of acute cystitis. Methenamine hippurate and placebo were interchanged every six months for two years. During one of the years patients took 250 ml extra fluid every morning and evening. Out of 21 enrolled patients, 14 completed the first year and 13 both years of treatment, which permitted the evaluation of 27 patient years. There were 52 episodes of acute cystitis caused by reinfection: 41 occurred during placebo treatment and only 11 during the methenamine hippurate regimen (p less than 0.01). Extra fluid intake did not reduce the incidence of acute cystitis, nor did it reduce the effect of methenamine hippurate. Methenamine hippurate is an effective prophylactic agent against recurrent acute cystitis and has the advantage of not inducing cross resistance to conventional antibiotics.

29 mongrels were subjected to splenic artery implantation into the left kidney. Consecutive angiographies showed that this procedure regularly was followed by an initial thrombus formation in the implanted artery and an early recanalization of this thrombus. After creation of stenosis and eventually occlusion of the left renal artery, newly formed intrarenal vessels could be demonstrated next to the implanted artery. These vessels formed communications between the splenic and intrarenal arteries. At angiography of the implanted splenic artery the constrast medium was seen to pass over to the newly formed vessels and to intrarenal arteries followed by contrast medium opacification of the renal parenchyma and the renal vein and excretion to the pelvis and ureter. The experimental animals survived contralateral nephrectomy and ligature of the ipsilateral renal artery provided that a slowly progressing stenosis of this artery was created.

In a randomized control study comprising 261 patients undergoing transurethral prostatic resection (TUR), the effect of a short perioperative course with the oral combination of pivampicillin/pivmecillinam (PAPM) was analysed in 129 patients. The study was divided in 2 parts: the first 60 patients received 450 mg and the following 69 patients, 900 mg every 12 h until removal of catheter but not longer than for 1 week. 132 controls received parenterally 1 g of cefotaxime (CFT) daily throughout the study. During the first part of the study the frequency of bacteriuria in the PAPM group was 43% preoperatively and 30% 10 days postoperatively, during the second part 47% and 12%, respectively (p less than 0.025). In the CFT group the frequency of bacteriuria was reduced from 52% preoperatively to 28% postoperatively. The prophylactic effect (i.e. the protection against acquired bacteriuria) was 96% and 92% in the PAPM and the CFT groups, respectively. Preoperative bacteriuria was eliminated in 40% of the patients during first part and 69% during second part in the PAPM group, while corresponding figures were 48% and 46% in the cefotaxime group. There were 2 cases of septicemia and 5 of upper urinary tract infections throughout the study evenly distributed between the two groups. Oral pivampicillin/pivmecillinam 900 mg every 12 h was found to be a good alternative for perioperative antibiotic prophylaxis at TUR.

A case of retrocaval ureter is reported taking especially the diagnostic procedure and the therapeutic alternatives into account.