Assessment of angiogenic factor, vascular endothelial growth factor, serum and urine level changes in superficial bladder tumor immunotherapy by intravesical Bacillus Calmette-Guerin

Bladder tumor is one of the most common genitourinary tumors. Management of non-muscle invasive [NMI] bladder tumors is primarily by transurethral resection [TURBT] followed by intravesical immunotherapy or chemotherapy. Bacillus Calmette-Guerin [BCG] is the most effective adjuvant therapy in NMI bladder tumor. Since angiogenesis is an essential factor in solid tumor progression and vascular endothelial growth factor [VEGF] is an important factor in angiogenesis, the aim of this study is the assessment of angiogenic factor, VEGF, serum and urine level changes in superficial bladder tumor immunotherapy by intravesical BCG. A total of 23 patients with bladder transitional cell carcinoma [TCC] in stage Ta/T1 or carcinoma insitu [CIS], low or high grade, which passed a 2-4 week period from TURBT participated in this study. Blood and urine samples were obtained at first and sixth sessions before instillation of BCG. Enzyme-linked immunosorbent assay [ELISA] method was used to obtain VEGF level in samples. Urine and serum VEGF levels did not change significantly before and after BCG therapy. Changes in VEGF level were significantly different neither in low grade against high grade tumors nor in stage T1 against stage Ta tumors. A significant difference in VEGF level was seen between low grade and high grade tumors in serum after BCG therapy [P=0.007]; but not in urine samples. Although intravesical BCG possesses anti-angiogenic activity, it seems that it exerts its effect through pathways other than VEGF, especially in low grade tumors

Retrocaval ureter a study of 13 cases

The aim of this study was to report our 23-year experience in the diagnosis and treatment of retrocaval ureter. Data from 13 patients with retrocaval ureter were reviewed. Intravenous urography and retrograde pyelography had been used for confirming the diagnosis. All of the patients had been symptomatic and undergone surgery. A control intravenous urography had been performed 6 months postoperatively. The mean age of the patients was 23 years [range, 12 to 37 years]. Twelve patients [92.3%] were men. The clinical manifestations were pyelonephritis in 7 [53.8%], right flank pain in 4 [30.8%], gross hematuria in 1 [7.7%], and ureteral calculus in 1 [7.7%]. All of the patients had type 1 right-sided retrocaval ureter. Associated anomalies were seen in none of the patients. The control intravenous urography showed improvement of renal function. In our patients, the most common cause of referral was pyelonephritis. In symptomatic cases, operation is needed and can improve renal function

Distilled water as an irrigation fluid in percutaneous nephrolithotomy

The aim of this study was to evaluate the effect of distilled water as an irrigation fluid for percutaneous nephrolithotomy [PCNL] on the serum concentrations of sodium. A total of 30 patients with kidney calculi underwent tubeless PCNL using distilled water as the irrigation fluid. During the procedure, intravenous Ringer lactate solution was used if necessary. The patients received infusion of two-thirds dextrose 5% and one-third normal saline solution postoperatively. Four blood samples were taken to determine serum sodium and potassium levels at admission, just before the operation, after the operation, and on the first postoperative day. The mean distilled water used was 8.1 L [range, 5.6 L to 11.2 L]. Target and complete stone-free rates were 100% and 80%, respectively. None of the patients developed hyponatremia. The mean serum levels of sodium [meq/L] were 141.5 [range, 140 to 143], 140.7 [range, 125 to 159], 139.7 [range, 125 to 164], and 138.9 [range, 125 to 146], respectively [P = .005]. Comparing every 2 samples, a significant difference was seen only between samples 1 and 4 [P = .005]. Serum levels of potassium were all in normal range and there was no difference between the 4 samples [P = .12]. Our findings showed that using distilled water as an irrigation fluid during PCNL does not result in a clinically significant decrease in the serum level of sodium and can be used if necessary. However, evaluation of the serum sodium level on the postoperative day is mandatory