Retrocaval ureter with ureteral carcinoma.

The authors report a rare congenital anomaly, retrocaval ureter (RCU) with carcinoma. The patient had recurrent pyelonephritis, hematuria and renal colic. Urography shows no function on right side. Abdominal ultrasound revealed marked right hydronephrosis. Antegrade ureterography through nephrostomy revealed a RCU. Helical C.T. confirmed the RCU and also revealed a defect in contrast medium in the upper ureter. We performed percutaneus antegrade nephro-ureteroscopy and found carcinoma of the retrocaval ureter. This may be the first case of tumor in the RCU. We did not find any other in the literature. (Fig. 3, Ref. 14.).

Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker--Tamsulosin.

BACKGROUND: Alpha-I blockers decrease the tension and release the spasm of smooth muscles and thus lessen the obstruction and irritation symptoms in the lower urinary tract (LUTS). They make a faster passing of calculi from the terminal part of the ureters possible. OBJECTIVES: The goal of this study was to objectively assess the improvement of difficulties caused by obstructions in ureterolithiasis localized in the lower part of the ureters of 104 randomly chosen patients (pts.) in a double-blind study. METHODS: During a period of 2 and half years (June 1999-January 2002) 104 pts. suffering from ureterolithiasis of the lower urinary tract were treated and observed. Patients were divided into two groups: A (n:53; later only 51 were evaluated) which was subjected to standard treatment and group B (n:51) where the standard treatment was supplemented by the alpha-1 blocker. As alpha-1 blocker one capsule of Tamsulosin/OMNIC 0.4/ was administered daily. RESULTS: With alpha-1 blocker, we have registered a more speedy passing of calculi from the terminal parts of ureters in 17.6% of pts. Recurrence of renal colics was less frequent and occurred in one of eight pts. as compared with group A (without the alpha-1 blocker) where a recurrence of the renal colic was observed in about every fifth pts. In group A (n:51), 62.8% of the pts. passed the calculi, whereas in group B (n:51), where standard treatment was supplemented by the administration of the alpha-1 blocker Tamsulosin, this percentage increased to 80.4%. CONCLUSION: The treatment by alpha-1 blockers considerably decreased not only LUTS but also helped to accelerate the passing of minor calculi from the terminal parts of the ureters of 80.4% of pts. It seems that alpha-1 blockers potentiate the spasmoanalgetic action of drugs used in standard methods of treatment.

Our experience with the treatment of benign prostatic hyperplasia (BPH) with tamsulosin.

BACKGROUND: Alpha 1-blockers decrease the tension, ease the tonus of smooth muscles and thus alleviate the voiding and storage symptoms of the lower urogenital tract. OBJECTIVES: The goal of this study was to assess objectively the improvement of the voidings and storage difficulties in 72 randomly chosen patients suffering from Benign Prostatic Hyperplasia (BPH) prior to, and in the course of 15 months of treatment with this alpha 1-blocker in a dose of one capsule of tamsulosin daily after meal. METHODS: During the period of three years (1997-1999), we have treated and studied 72 patients suffering from lower urinary tract symptoms (LUTS). The age of the patients ranged from 55 to 80 years with the median age of 71 years. The patients were examined physically, by laboratory methods, by ultrasonography (USG) and by uroflowmetry. Anamnestic data were justified by the application of the IPSS questionnaire and blood pressure tests (BP). The eventual volume of residual urine, as well as the condition of the kidneys were checked by USG. The Qmax values were measured by uroflowmetry prior to, and during treatment (0-3 weeks--6 months). We have continued with this treatment even after 6 months, but we have discontinued the biochemical, haematological and uroflowmetrical assessments. On the other hand, we have continued with quarterly examinations of urine, digital rectal examinations (DRE), measuring of BP and IPSS evaluation. PSA was checked at least once a year. Our patients were checked in this way for 12 to 18 months (median of 15 months). One capsule of tamsulosin was administered daily after meal. RESULTS: The prostatoselective alpha 1-blocker tamsulosin is a well-tolerated medication applied in the treatment of BPH. We did not have to discontinue the treatment with any of the patients during the 15 months of assessment. It is equally well tolerated at a dose of one capsule of tamsulosin daily, administered after the morning or evening meal without any orthostatic defect symptomatology. The quality of life has improved by three symptomatic units; the blood pressure remained practically unchanged, the IPSS score for BPH decreased by 6.8 score and the Qmax was upgraded from 10.1 ml/s to 14.9 ml/s. This finding remained practically unchanged during the 15 months of assessment and later. CONCLUSION: In the course of the recent years, the conservative treatment of BPH by phytotherapeutics but mainly by alpha 1-blockers have resulted in a considerable reduction of transurethral resections of the prostate (TURP), and of the transvesical "open" prostatectomy (PE open). This reduction down to 50% can be observed nearly all over the world. The presence of alpha 1-a, alpha 1-b, alpha 1-d receptors in the lower urinary tract is a good prerequisite for successful treatment of voiding and storage symptoms. In the assessment of the effects of a 15-month continuous treatment by tamsulosin, we have registered a considerable improvement in the quality of life (QOL), an increase in the Qmax, and decrease in the IPSS score. The age of patients under or over 60 years as well as their weight did not play significant roles. We have not registered any interaction with other medications generally used by older patients. (Ref. 30.)

Fournier's gangrene: can aggressive treatment save life?

Fournier's gangrene (FG) is a rapidly progressive, fulminant infection of the scrotum, perineum and the abdominal wall. FG is caused by synergic aerobic and anaerobic organisms. Modern surgical series report mortality of up to 67%. This originally rare disease has become more frequent. Aggressive treatment including antibiotics, antigangrenous serum, and treatment of all accompanied diseases and disorders can be successful. Treatment also includes debridement and plastic corrections. Authors describe management of 8 patients with FG. Treatment of FG and all accompanied diseases was in all cases successful. Treatment costs of this kind of patients were approximately 20 times higher than treatment of patients with other urologic diseases.

'Hot flush', an unpleasant symptom accompanying antiandrogen therapy of prostatic cancer and its treatment by cyproterone acetate.

From 1995 to 1997 the authors have assessed 31 patients with histologically verified advanced carcinoma of the prostate (CaP) and the ensuing symptom of 'hot flush'. Patients underwent transurethral resection of the prostate (TURP), bilateral orchiectomy (OE) and combined androgen blockade (CAB) by the administration of non-steroid antiadrogens. The authors present the mechanism of the genesis of the 'hot flush' symptom as well as its subjective manifestations, methods of laboratory monitoring as well as their experience with the treatment of this symptom. 50 mg tablets cyproterone acetate administered twice daily or Androcur depot 300 mg i.m. inj. once in 14 days were the main factors in the treatment of 'hot flushes' which reduced subjective difficulties in 80.6% of the patients studied.

Alpha 2-b interferon and farmarubicin in the prophylaxis of recurrence of superficial transitional cell carcinoma of the urinary bladder.

OBJECTIVE: To ascertain the effect of intravesical instillation of Alpha 2-b Interferon (IFN a-2) 10 million I.U. in 50 ml physiological saline as a monotherapy and in combination with Farmarubicin (FRC) 50 mg dissolved together in 50 ml of physiological saline. These substances were administered four times during the first month after TUR-BT and then once monthly for one year either in the form of an IFN a-2 monotherapy or as an IFN a-2 and FRC combination in the therapy of recurrence of transitional cell carcinoma (TCC) of the urinary bladder after transurethral resection of the bladder tumor (TUR-BT). THEORETICAL CONSIDERATION: One of the causes of malignancy is an irreversible shift in the balance between protooncogens and tumor supressorgens. In the genetical process of the control of cell apoptosis, an important role is played by the tumor-supressorgen p 53. By the means of mutation of protooncogenes, cellular oncogenes(C-MYC) are formed, inducing the proliferation of cells of the tumor and via feedback induce also the p53 mutation. By the reduction of cellular oncogenes, IFN a-2 and FRC intervene by blocking the proliferation of tumor cells. PATIENTS AND METHODS: Authors have checked and treated 33 patients (pts) with recurrent TCC. The first group of 20 pts were after TUR-BT with BCG unsuccessful intravesical therapy, and 13 pts in the second group were with recurrence of TCC, but contraindicated for BCG treatment. These 33 pts (the first and second groups) were compared with 33 pts of the third group after TUR-BT but without intravesical instillation therapy. The pts of the third group did not suffer from any other significant ailment. IFN a-2 monotherapy (10 mill. I.U./or a combination of IFN a-2 + FRC (50 mg/50 ml solution were administered for 2 hours, 1 week after TUR-BT. During the first month, instillations were done weekly, from the second to the twelfth month only once monthly. The results were evaluated for 12 to 33 months (median: 24 months). RESULTS: Group I: From 20 pts after TUR-BT + unsuccessful BCG + IFN a-2 monotherapy recurrence was registered in 4 pts (20%). Group II: Out of 13 pts after TUR-BT + IFN a-2 + FRC, recurrence was registered in 3 pts (23%). Group I + II: Recurrence in both groups was observed in 7 pts (21.2%). Group III: Out of 33 pts after TUR-BT without immuno- et chemotherapy recurrence was registered in 18 pts (54.5%). After one year of treatment, patients were checked for 24 months. The transition into an invasive tumor was observed in 4 pts (12.1%). In the comparative group of 33 pts without instillation after TUR-BT, recurrence was detected after one year in 18 pts (54.5%) and the transition into an invasive tumor was observed in 7 pts (21.2%). CONCLUSION: Intravesical instillation of BCG used to be the most frequently applied therapy following TUR-BT. The toxicity of this vaccine as well as the contraindication of this treatment in some diseases, and also the primary or secondary resistance of TCC to BCG have challenged the search for alternative possibilities of the intravesical instillation treatment. IFN a-2 monotherapy and IFN a-2 in combination with FRC are new alternative approaches in the improvement of TCC treatment. This therapy is also supported by research of molecular genetics. (Ref.18.)

Some measures of lipid metabolism in young sterile males before and after testosterone treatment.

The concentration of total cholesterol and triacylglycerols in plasma and their distribution in lipoproteins as well as the level of apolipoprotein-B and of endogenous testosterone were measured in 30 young sterile males before and after the treatment with methyltestosterone (Agovirin SPOFA) in a dose of 10 mg daily for 30 days. Before the treatment the level of total cholesterol in plasma and in VLDL fraction was normal, while that in LDL fraction was increased and in HDL fraction decreased. Similarly, the level of triacylglycerols in plasma was increased and correspondingly also the levels of that in all lipoprotein fractions. After the treatment no changes in total and VLDL cholesterol were found, while a significant decrease in LDL fraction and increase in HDL fraction was observed. Moreover, a significant decrease was found in a level of total plasma and VLDL triacylglycerols.

[Treatment of priapism]. / Aktuálna liecba priapizmu.

The authors describe the development of conservative and surgical treatment of priapism. They analyze the aetiopathogenesis of its development. They report on their own experience with the surgical treatment in four patients, where they made three times a spongiocavernous anastomosis on one side according to Quackels' method, twice spongio cavernous anastomosis via the glands penis according to Ebbehøj-Winter. They prefer glandocavernous anastomoses because it is a simpler, less time consuming operation.

Malignant Leydig-cell tumour of testis.

A rare case of a malignant Leydig-cell tumour of the testis in a 26-year-old patient, with radical orchiectomy from an inguinal incision is described. Although the results of AFP, HCG, biochemical, X-ray, lymphographic and scintigraphic examinations were negative, the first metastases into the lungs appeared one year after the operation. Combined cytostatic treatment, polychemotherapy and X-ray therapy proved ineffective. The patient died of multiple metastases 28 months after the surgical intervention.