Primary and secondary prostatic adenocarcinoma of the urinary bladder.

Urinary bladder involvement by prostatic adenocarcinoma (PAC) is not well characterized in the literature. Fifteen consecutive cases of PAC diagnosed in the urinary bladder over a period of 10 years were reviewed. All bladder and prostate slides from each patient were evaluated. Eleven patients (group A) had synchronous PAC in the prostate. In these patients, bladder PAC occurred 2 to 11 years after the initial diagnosis of PAC in the prostate and tended to have a higher Gleason score than the original prostatic PAC. Four cases of bladder PAC in group A had areas with features of urothelial carcinoma, with focal positive immunoreactivity for thrombomodulin in 2 cases. Two patients (group B) had undergone radical prostatectomy for PAC 15 years earlier. The lesions in the urinary bladder in both cases showed histopathologic features similar to those seen in the previous prostatic malignancies. Two patients (group C) had histories of previously resected urothelial carcinoma. Bladder PAC was diagnosed at routine follow-up, and repeated prostate biopsy up to 2 years after the diagnosis of bladder PAC showed no evidence of prostatic PAC. PAC in the urinary bladder may be either primary or secondary. Secondary PAC is usually associated with high-grade and high-stage carcinoma in the prostate and may mimic transitional cell carcinoma. Primary bladder lesions may or may not be associated with a history of PAC in the prostate. The prognosis of patients with the primary carcinoma is favorable. HUM PATHOL 32:434-440.

[FPSUND: a pan-Canadian evaluation of a clinical classification of urinary incontinence]. / FPSUND: évaluation pan-canadienne d'une classification clinique de l'incontinence urinaire.

Historically, urinary incontinence is divided into 3 subtypes: stress, urge and mixed. This latter group, which according to many studies can account for up to 50% of the patients, is very heterogenous. For this same reason, the reports of treatments of urinary incontinence are very difficult to analyse using this simple classification. In a attempt to clarify this situation and to help the acquisition of useful clinical information relating to urinary incontinence, were have developed a clinical classification of urinary incontinence (FPSUND) in which 6 symptoms are graded in severity from 0 to 3. In this acronym, the F stands for frequency, the P for the use of protection, the S for stress-related complaints, the U for urge-related complaints, the N for nocturia and the D for the number of daily micturitions. Urologists across Canada were sent the French or English version of the classification and used it to evaluate 148 female patients aged from 18 to 70, suffering from urinary incontinence. A second, independent evaluation, was also performed on the same patients by registered nurses or urodynamic technicians. Reproducibility between observers, as assessed by the weighted Kappa score ranged from 0.47 and 0.74 (p < 0.05), was very good. Generally, the users of the classification found it very easy to use. In summary, we propose the FPSUND clinical classification of urinary incontinence as a useful and accurate tool to classify urinary incontinence and as a means to assess treatment outcome.

Antiandrogen withdrawal syndrome with nilutamide.

Antiandrogens are combined with medical or surgical castration to achieve total androgen blockade in metastatic prostate cancer. Discontinuation of antiandrogens at disease progression has been associated with prostate-specific antigen (PSA) decrease, symptom improvement, and occasionally objective tumor regression. Two cases of metastatic prostate cancer demonstrating decrease in PSA of 92% and 56% on discontinuation of nilutamide therapy are reported. Improvement in urinary symptoms, bone pain and, in one, disappearance of para-aortic lymphadenopathy paralleled the PSA decrease. The duration of the withdrawal response of 6 months was comparable to those reported with discontinuation of flutamide.

Proliferating cell nuclear antigen (PCNA) and MIB 1: Markers of locally advanced and biologically aggressive prostate cancer.

Using archival radical prostatectomy specimens from patients with prostate cancer (n=19) we studied the relationship between staining with two different markers of cellular proliferation and the local extent or eventual progression of disease. In cases where the disease had spread outside the capsule of the prostate (n=9) the average staining patterns for proliferating cell nuclear antigen (PCNA) and MIB 1 were higher than in cases where the disease was organ-confined (n=10). The difference in the staining patterns for these two groups was greater for the MIB 1 antigen and this was shown to be statistically significant (p=0.01) whereas the smaller difference seen for proliferating cell nuclear antigen was not statistically significant. There was a higher staining pattern seen for these antigens in cases where disease progression was evident by a rising prostatic specific antigen level. The difference was greater and statistically significant (p

Papillary transitional cell carcinoma arising in a calyceal cyst and masquerading as a renal cyst.

We report the case of a 74-year-old man with a papillary transitional cell carcinoma, grade 1-2/3, growing within a bilobated calyceal cyst, measuring up to 8.5 cm in diameter, and masquerading as a simple renal cyst. The cyst was lined by atrophic simple and transitional epithelium and showed intracystic hemorrhage. Leakage of blood into the calyx was probably the cause of the hematuria for which the patient presented. However, with retrograde pyelography and careful gross examination of the excised kidney, no communication of the pyelocalyceal system with the cyst could be identified. By ultrasound examination and computerized tomographic scan the lesion showed several small renal cysts, measuring up to 1.1 cm in diameter, as well as several hepatic parenchymal cysts. To our knowledge, this is the first report of a papillary transitional cell carcinoma arising from a cyst of calyceal origin.

An unusual pelivc mass: cystic fibroadenoma of the prostate.

Cystic fibroadenoma is an extremely rare benign lesion of the prostate. Herein we report a case of such a lesion in a 52-year-old man initially thought to have locally advanced prostate cancer.

Sarcomatous transformation of prostatic adenocarcinoma after radio- and chemotherapy.

We report a case of a sarcomatous transformation of a prostatic adenocarcinoma after radiotherapy and chemotherapy. The sarcomatous tumor showed features of myogenic differentiation. DNA flow cytometry demonstrated a change in the DNA ploidy, from a diploid pattern in the adenocarcinoma, to an aneuploid pattern in the sarcoma. This is the first report of a prostatic sarcomatous tumor studied in this way. Review of medical literature revealed five additional cases of prostatic adenocarcinoma undergoing sarcomatous transformation following radiotherapy with or without chemotherapy or hormonal therapy.

Long-term survival with malignant melanoma metastatic to the bladder.

Malignant melanoma metastatic to the bladder is a relatively common autopsy finding, but rarely manifests clinically as it is usually a late finding in the course of the disease. Herein is the report of a case of muscle invasive malignant melanoma at the dome of the urinary bladder treated by radical transurethral resection with no evidence of bladder recurrence four years later.

Calculus formation on migrant surgical staples in urinary undiversion.

Urinary undiversion and bladder reconstruction has led to some of the most ingenious uses of bowel by urologists and will improve the quality of life for patients. The use of the stapler has helped create intussuscepted nipple valves that are more likely to be effective and less likely to extussuscept. Calculi can form on surgical staples exposed to urine and measures to prevent this have been described. We report a case in which there was rapid development in multiple calculi, each having a single staple as a nidus, following urinary undiversion using an antireflux intussuscepted stapled nipple valve in which the distal-most staples were removed from the staple cartridge to its use.

Xanthogranulomatous pyelonephritis with multiple cutaneous fistulae.

Xanthogranulomatous pyelonephritis is characterized by a xanthogranulomatous inflammatory response by the kidney to bacterial infection. The actual histologic diagnosis of this condition is usually made by the pathologist following nephrectomy. Cutaneous fistulae and internal sinus formation, albeit rare, have been reported to occur. Herein we report a case of xanthogranulomatous pyelonephritis in which multiple internal and cutaneous sinuses first developed two months following nephrectomy.

Complete ureteral replacement by Boari bladder flap after cadaveric renal transplant.

Boari bladder flaps are generally used to bridge a loss of distal ureter in ureteric reconstruction, especially after ureteric injury during pelvic surgery. Herein is reported a case of total ureteral replacement in a cadaveric renal allograft fifteen days after initial implant, for total ischemic loss of the donor ureter.

Risk factors for upper tract deterioration in chronic spinal cord injury patients.

A total of 140 patients with neurogenic voiding dysfunction secondary to chronic spinal cord injuries was assessed initially at a tertiary care urodynamic center an average of 8 years after the acute injury. As a result of testing patients were divided into 2 functional urodynamic groups. Group 1 included 40 patients with an areflexic bladder, of whom 33 maintained normal upper tracts and 7 had significant upper tract deterioration. Group 2 included 100 patients with a hyperreflexic bladder, of whom 84 maintained normal upper tracts and 16 had documented upper tract deterioration. Maximum detrusor pressure during urine storage in group 1 with abnormal upper tracts was significantly higher than in those with normal kidneys (p less than 0.0001). Maximum detrusor contraction pressure during voiding in group 2 was significantly higher in those with abnormal upper tracts secondary to neurogenic outflow obstruction (p less than 0.0001). The most common outflow problem in this group was type 3 detrusor-sphincter dyssynergia. With guidelines thus developed for acceptable detrusor pressure in both types of bladder, silent upper tract damage can probably be prevented in most cases by proper and diligent followup and appropriate intervention, avoiding major morbidity and mortality in these high risk patients.

Nephrogenic adenoma with bladder exstrophy and immunosuppression.

Nephrogenic adenoma, an unusual proliferative lesion, often occurs in association with chronic inflammation of the bladder and is rarely found in children. Two cases are reported, one occurring in a young child born with bladder exstrophy, and one in a young female, with both interstitial cystitis and chronic use of immunosuppressive therapy. We believe these are the first case reports of nephrogenic adenoma occurring in this specific clinical setting.

Eosinophilic cystitis presenting as invasive bladder cancer: comments on pathogenesis and management.

Eosinophilic cystitis is a rare bladder lesion that usually presents with hematuria and has the cystoscopic appearance of a bladder tumor. Ten cases (only 4 adults) have been reported in which this disease has presented with a palpable mass. We report a case in which the lesion presented as an invasive bladder tumor with a palpable mass in an adult and comment on the possible etiology.

Acute ureteral obstruction from candidal cystitis requiring bilateral percutaneous nephrostomies.

A case of acute bilateral ureteral obstruction due to severe candidal cystitis is described. The obstruction was due to inflammation and fungal plaque formation in the bladder, rather than the usual intraureteral fungus balls. Percutaneous nephrostomies were required bilaterally for resolution of sepsis and renal failure. The case and its management are presented.

Transurethral puncture in management of ectopic ureteroceles.

In the past, treatment of ectopic ureteroceles with duplicated collecting systems with little or no function in the upper pole segment has been heminephrectomy, often followed by reconstruction of the ureterovesical junction. Herein we review our initial use of transurethral puncture of ureteroceles to initiate drainage with potential return or improvement of function to the upper pole segment. The initial goal was to do pyelopyelostomy rather than heminephrectomy with less potential morbidity to the patient and preservation of functional renal tissue.