Hydatid cyst of urinary tract: 11 cases at a single center.

INTRODUCTION: We retrospectively reviewed clinical records of 11 patients with hydatid cyst of the urinary tract admitted to our institution from 1998 to 2005. MATERIALS AND METHODS: Hospital and follow-up records of 11 patients with hydatid cyst of the urinary tract were reviewed and data on the patients' symptoms and signs at presentation, radiological findings, diagnostic tests, pathologic findings, and surgical outcomes were reviewed. RESULTS: The chief complaint was flank pain in 7 patients (63.6%). Hydaturia was not seen in any of our patients. Ten patients had renal involvement and 1 had a retrovesical hydatid cyst. Eosinophilia was detected in 2 of 11 patients who were tested. A positive indirect hemagglutination test was seen in 4 of 7 patients and a positive Casoni test in 1 of 2. Intravenous urography revealed caliceal distortion in 6 patients (54.5%), caliectasis in 3 (27.3%), and nonfunctioning kidney in 2 (18.2%). Ultrasonography showed a complex cyst in all of the patients. Computed tomography demonstrated multivesicular cystic structure in 4 patients (36.4%), complex cyst in 4 (36.4%), and a simple cyst in 3 (27.3%). Definite diagnosis was made only after surgical operation. We performed nephrectomy in 2 patients (18.2%), partial nephrectomy in 2 (18.2%), cystectomy plus marsupialization in 5 (45.4%), and retrovesical surgery in 1 (9.1%). One patient refused surgical treatment. There was no perioperative major complication. CONCLUSION: Renal hydatidosis is a rare entity and the main challenge is preoperative diagnosis. Radiological and serologic studies, although indicative, cannot confirm the diagnosis, and only pathologic examination after surgical removal can confirm echinococcal infection.

Comparative evaluation of urinary bladder cancer antigen and urine cytology in the diagnosis of bladder cancer.

INTRODUCTION: The diagnostic value of the urinary bladder cancer (UBC) antigen as a tumor marker is not clear yet. We designed this study to compare the accuracy of the UBC antigen and voided urine cytology in patients with bladder cancer. MATERIALS AND METHODS: Fifty-four consecutive patients admitted for a diagnostic workup for bladder cancer were enrolled. Two separate morning midstream voided urine samples were taken for urinalysis, both before performing cystoscopy. The samples were examined for urinary creatinine level, urine cytology, and UBC. Cystoscopy was performed. Resection was performed in the presence of an apparent pathologic lesion, and if no lesion were seen, random biopsies of multiple foci of the bladder were taken. The results of the diagnostic tests were compared with the pathology examination results. RESULTS: Of 54 patients, 31 had histologically confirmed transitional cell carcinoma. Results were positive for UBC in 28 and for urine cytology in 16 patients. Sensitivities and specificities were 74.2% and 78.3% for UBC, 48.4% and 95.7% for urine cytology, and 87.1% and 73.9% for combined UBC and cytology, respectively. Positive and negative likelihood ratios were 3.42 and 3.03 for UBC, 11.3 and 1.85 for urine cytology, and 3.34 and 5.73 for combined UBC and cytology, respectively. CONCLUSION: The UBC test had acceptable sensitivity and specificity in our study. However, results of voided urine cytology are significantly more reliable. A combination of tumor markers may help diagnose new tumors and lower the requirements for cystoscopy during follow-up. Further studies are warranted to find a more accurate noninvasive test or a complex of tests comparable with cystoscopy for diagnosis of bladder cancer.