[Ureteral stent reinforced with a spiral--an alternative to internal drainage of urine]. / Sonde urétérale renforcée par une spirale--une alternative pour le drainage interne de l'urine.

Internal urinary diversion of chronic ureteral obstruction is not sufficient in up to 60% of the cases. Factors for this high failure rate are tumor compression, catheter kinking or a small stent lumen. To prevent such problems we have developed a new ureteral stent which is stable in form in spite of a large stent lumen. This catheter is made of a thin polyurethane tube which is supported by a built-in metallic spiral wire. We have used this stent in 16 cases of chronic ureteral obstruction. Stent placement was successful in 14 cases. Other than urinary tract infection in two cases, bladder urgency in one case and stent dislocation in another case there were no complications. Hydronephrosis disappeared soon after stent application in 12 out of 14 cases. In the remaining two cases hydronephrosis was decreased, but not totally eliminated. Catheters were left in place for an average of 6.5 weeks (2.5-8.5). A change of catheter due to catheter blockage was necessary only in one case. In conclusion, this spiral reinforced stent enables a better internal urinary drainage especially in cases of malignant ureteral obstruction.

[Internal drainage of urine in cases of complicated urinary stasis caused by pregnancy]. / Le drainage interne de l'urine en cas de stase urinaire compliquée provoquée par une grossesse.

In 14 women with sympthomatic hydronephrosis due to pregnancy (calyx diameter 1-2,6 cm) an internal urinary drainage was carried out during the second half of pregnancy. Retrograde stenting was placed per cystoscopy in all cases. Follow-up examinations were taken weekly for the first two weeks and further on biweekly. Primary stenting was possible in 12 out of 14 cases, and in two patients dilatation of the ureteral orifice was necessary. 11 out of 14 patients suffered from complications such as severe dysuria (9), urinary tract infection (7), persisting lumbar pain plus catheter lumen obstruction (6 each) as well as catheter migration (3). Long-term follow-up showed that urinary tract obstruction was relieved by stenting in only 6 out of 14 patients. Sufficient urinary drainage by so called double-J ureteral stents was achieved in less than half of the cases. Moreover, there was a complication rate of more than 75%. Taking these results into consideration, internal drainage of complicated pregnancy hydronephrosis needs careful evaluation.

[Success and failure with double J ureteral stent. Analysis of 107 cases]. / Succès et échecs avec la sonde double J. Analyse de 107 cas.

An internal urinary diversion of the upper urinary tract was planned in 107 patients with acute, stone-related or chronic tumor-induced ureteral obstruction. Acute ureteral obstruction (n = 34, group I): in 30 of 32 cases (94.1%), successful placement of an indwelling stent resulted in complete drainage in 28 of 30 patients (93.7%). In 2 cases, no satisfactory urine diversion was possible, despite several catheter changes and confirmed clearway through the installed catheters. Chronic ureteral obstruction (n = 73, group II): successful placement of the indwelling stent was possible in 63 of 73 (86.3%) cases. Complete urine diversion was achieved in only 25 patients (39.7%). Hydronephrosis was diminished in 28 patients (44.4%) and persisted or increased in 10 cases (15.9%), despite orthotopic positioning of the catheter and numerous stent changes. Complete urine drainage was achieved with an internal urine diversion in only 4 of 10 cases with chronic hydronephrosis. It is assumed that the reason for the high failure rate lies in the catheter construction and, with respect to chronic hydronephrosis, the reduced or non-existent contractility of the upper urinary tract in combination with the inevitable pressure connection between the upper and lower urinary tract.

Adjuvant systemic chemotherapy after complete transurethral resection of superficially invasive bladder carcinoma (T1 G3-4 and T2 G2-4).

A prospective multicenter phase-two study was initiated in 1983 to evaluate the effect of systemic chemotherapy after complete resection of T1 G3-4 and T2 bladder carcinomas. Chemotherapy consisted of three cycles of cisplatin alone, a modified MVAC scheme or the combination of cisplatin and methotrexate. 52 patients entered the study. After a medium follow-up of 36 months 11 patients developed progression of the disease; cystectomy had been performed in 8 patients and 6 patients died due to progressive bladder carcinoma. These encouraging results should be the base for a randomized trial with the aim to improve survival and avoid cystectomy in selected patients with superficially invasive bladder cancer.

[New aspects of calcium metabolism in kidney calculus disease]. / Neue Aspekte des Kalzium-Stoffwechsels bei Nierensteinerkrankung.

Recurrent calcium stone disease appears to be related to a high dietary intake of animal protein. The following mechanisms have been discussed to explain the relationship between dietary protein and calciuria: increased glomerular filtration rate (GFR), increased rate of sulphate excretion, acidosis-induced increase in ionised serum calcium ("filtered load") and decrease in tubular reabsorption, and mobilisation of bone mineral. Protein also diminishes urinary citrate. However, it has not been established in controlled trials whether a reduced dietary intake of protein diminishes the recurrence rate of renal stones. Determination of the normal range of urinary calcium is dependent on numerous variables: size; GFR; age; excretion of Na, Mg and Pi; dietary intake of Ca and protein; season. Ideally, all these variables should be evaluated. In many patients with recurrent stone formation hypercalciuria will be found. There is a consensus of opinion that intestinal Ca absorption is increased, but elevated frequency of a renal Ca leak has not been established. For patient management discrimination between absorptive and resorptive hypercalciuria is important; a simple test that can be performed as an outpatient procedure is proposed in order to make this distinction.

Different effects of oral glycine and methionine on urinary lithogenic substances.

Nine male healthy volunteers were examined during a control period, during an oral glycine load (45 g/day, 600 mmol) and oral methionine (6 g/day, 40 mmol). Glycine caused a significant increase of urinary oxalate above baseline (from 644 to 797 mumol/day) without change in calciuria (4.74 vs 4.84 mmol/day). In contrast methionine caused no change of oxaluria, but a significant increase in calciuria (from 4.74 to 6.9 mmol/day). Alterations of lithogenic ions in urine after protein ingestion are mediated by different amino acids. The particular lithogenic risk of animal protein may be related to its high methionine/cystine and glycine content.

[Calibration of the urethra and video-cystomanometry. Indication and technic]. / Harnröhren-Kalibrierung und Video-Zystomanometrie. Indikation und Technik.

Recurrent urinary tract infections, vesicoureteral reflux and enuresis in children want a detailed urologic evalution which often makes - in addition to obvious urinealysis, urine culture, excretory urography and voiding cystourethrography-extended diagnostics necessary including an urethral calibration to definitely exclude a distal urethral stenosis, and a cystoscopy under general anesthesia in order to reveal abnormalities of shape and placement of the ureteral orifice (e.g. lateral placement, "stadium", "horseshoe" or "golf-hole" shape). Then micturition urodynamic flow studies using a suprapubic cystocath are done to recognize an infravesical obstruction, a sphincter dyssynergia, an unstable bladder, an uninhibited bladder or a neurogenic bladder. All these examinations are imperative concerning the decision on either conservative (medical) or surgical treatment or both.