Risk factors of urethral involvement of bladder cancer after radical cystectomy with orthotopic neobladder in females.

The cystectomy and urethrectomy specimens of 20 females with invasive bladder cancer were studied for evidence of urethral involvement. The bladder showed transitional cell carcinoma in 18 cases (90%) and squamous cell carcinoma in 2 cases (10%). Urethral involvement was found in 5 cases (25%). The trigone was the most common site of tumor (50%) which had 33 per cent chance of urethral involvement. Bladder neck was the next common site of tumor (15%) and had 66 per cent chance of urethral involvement. High stage (T3b, T4) and high grade (III) at trigone also correlated with urethral involvement. The tumor bearing node showed only 20 per cent correlation with urethral involvement. Female patients with high stage/high grade at trigone and any stage/grade at bladder neck are at high risk of urethral recurrence after radical cystectomy and orthotopic neobladder procedure.

The current therapy of urinary calculi in Thailand.

The paper analyses the impact of modern therapy of urinary calculi in Thailand since the introduction of ESWL and endourology (PCNL and URS) in 1988. Up to then, conservative and open surgical measures had been the standard procedures. The study covers 12 medical centres in the north, northeast, south and central parts of the country between 1988 and 1997. Approximately 40 ESWL machines have been in use. ESWL was used in 66.1 per cent and 20.8 per cent of patients with renal and ureteric calculi respectively. Only 1.1 per cent of the patients had PCNL. URS was used in 20.8 per cent of patients with ureteric calculi. Open operations were required in 32.6 per cent and 53.6 per cent of patients with renal and ureteric calculi respectively. Nephrectomy was required in 4.8 per cent--16.0 per cent of patients with renal calculi. Certain considerations have been put forward to appraise the situation concerning urinary stone therapy in Thailand.

The organization of Kidney Transplantation Services at Ramathibodi Hospital: fourteen years experience on waiting list, kidney donors and kidney transplantation.

The Kidney Transplantation Program at Ramathibodi Hospital was established in 1985. By the end of 1998, there were 1,614 patients on the cumulative waiting list. The first kidney transplantation (KT) was started in 1986 by using kidney from living-related donor (LD) while cadaveric KT (CD-KT) was started in 1987. A total of 528 KT were done, 278 cases (52.7%) were CD-KT and 250 cases (47.3%) were LD-KT. Six patients had two kidney transplants. 278 kidneys were donated from 189 cadaveric donors. Fifty cadaveric donors (26.4%) were from Ramathibodi Hospital while the rest were from other hospitals and the Organ Donation Center, Thai Red Cross Society. For LD, 233 out of 250 (93.2%) were from living-related, more than 50 per cent of these donors were from siblings. 17 spousal donors have been accepted for KT at Ramathibodi Hospital since 1997. Concerning the recipient pools, 522 patients (32.3%) were transplanted, 123 patients (7.6%) died without KT, 111 patients (6.9%) underwent KT at other hospitals, and 78 patients (4.8%) changed to waiting lists at other hospitals. The rest were lost to follow-up. At present, only 265 patients are still actively waiting (send serum every month). The number of KT and living donors has gradually increased, whereas, the number of cadaveric donors has decreased. However, cooperation with the "Organ Donation Center" has improved the number of cadaveric donation in the last two years. Sufficient organ donations and an active working team will provide a good kidney transplant service for the patients.