Radiological findings and the clinical importance of megacalycosis.

OBJECTIVE: To describe the radiological findings and the clinical importance of megacalycosis. MATERIALS AND METHODS: On the basis of a case report and literature review, diagnostic criteria and clinical significance of megacalycosis are presented. RESULT: Megacalycosis is mostly asymptomatic and is usually discovered either accidentally or as a result of its complications, such as stone formation, flank pain, hematuria, infection, and fever. The renal pelvis, infundibulum, and ureter are not dilated. Calyces have a semilunar configuration rather than the conventional triangular or conical form. The tip of each pyramid is flat, and the calyces possess neither fornix nor papillae impressions. The number of calyces is increased compared to the healthy condition, typically from 20-25. The renal parenchyma has a normal width but with a slight narrowing of the renal medulla. The kidney exhibits normal function, in particular with respect to its ability to concentrate the urine. CONCLUSION: Megacalycosis is a rare, usually unilateral dilatation of the kidney calyces in the presence of a normal, undilated renal pelvis and ureter. Its pathological significance lies in the occurrence of complications.

Perioperative prostate specific antigen levels among coronary artery bypass grafting patients: Does extracorporeal circulation and body temperature induce prostate specific antigen levels alterations?

PURPOSE: The purpose of this study is to compare the perioperative total prostate specific antigen (tPSA) levels among coronary artery bypass grafting (CABG) patients with and without extracorporeal circulation (ECC), to investigate the changes overtime of tPSA in each group separately and to determine the effect of body core temperature on tPSA levels. MATERIALS AND METHODS: A prospective study was conducted. Our sample was allocated to: (a) Seven patients who underwent off pump CABG (Group I) and (b) 16 CABG patients with ECC (Group II). The levels of tPSA were measured preoperatively (baseline), intra-operatively and at the 4(th) postoperative day. We compared the two groups on their tPSA levels and we investigated the changes of tPSA overtime in each group separately. RESULTS: Intra-operative serum samples were obtained in significantly lower body temperature in patients of Group II than in those of Group I (31°C vs. 36.9°C, P < 0.001). In each group separately, postoperative tPSA levels were increased significantly compared to the baseline values (2.55 ng/ml vs. 0.39 ng/ml for Group I, P = 0.005 and 4.36 ng/ml vs. 0.77 for Group II, P < 0.001). CABG patients with ECC had significantly lower intra-operative tPSA levels than the baseline values (0.67 ng/ml vs. 0.77 ng/ml, P = 0.008). We did not observe significant differences of tPSA levels between the two groups. CONCLUSIONS: CABG surgery affects similarly the perioperative tPSA independently the involvement of ECC. Although all patients had significantly higher early postoperative tPSA levels, only those who underwent CABG with ECC had exceeded normal values and significantly decreased intra-operative tPSA. Hypothermia seems to be the causal factor of tPSA reduction.

Laparoscopic transvesical resection of an en bloc bladder cuff and distal ureter during nephroureterectomy.

OBJECTIVE: The most appropriate technique for excising the distal ureter and bladder cuff during laparoscopic nephroureterectomy is still debated. We report our experience with a pure laparoscopic transvesical method that duplicates the long-standing open transvesical approach. MATERIALS AND METHODS: Seven men and three women diagnosed with upper tract transitional cell carcinoma were treated with this procedure. Three intravesical ports were inserted, and pneumovesicum was established at 12 mmHg. Transvesical laparoscopic circumferential detachment of the bladder cuff and en bloc mobilization of the last centimeters of the distal ureter were performed, followed by the closure of the bladder defect. Subsequently, a nephrectomy was performed either laparoscopically or using an open flank approach. RESULTS: The median age was 68.5 years. The procedure was completed uneventfully in all cases. The median operating time for distal ureter excision was 82.5 minutes (range 55-120). No complications directly related to the pneumovesicum method were recorded. The median follow-up period was 31 months (range 12-55). During the follow-up period, two patients (20%) died from the disease, and a bladder tumor developed in three cases (30%). CONCLUSION: The laparoscopic transvesical resection of the en bloc bladder cuff and distal ureter is a reliable, effective, and oncologically safe technique, at least in the midterm.

Severe bladder contracture leading to cystectomy after intravesical mitoxantrone chemotherapy.

Since the early 1990s, mitoxantrone has been used as a chemotherapeutic agent for adjuvant intravesical treatment following transurethral resection of superficial transitional cell carcinomas of the bladder. Although its efficacy as adjuvant intravesical therapy remains questionable and its use has not gained wide acceptance, the safety profile of the drug has been reported as favorable. We report the first case of mitoxantrone-induced severe bladder contracture leading to a completely nonfunctional bladder after intravesical administration of the drug. Cystectomy and urinary diversion were the final consequences for the patient.

Ureterosciatic hernia with compression of the sciatic nerve.

Ureterosciatic herniation is a rare cause of ureteral obstruction. Sciatic hernia is a well-defined anatomic defect that is the result of atrophy or abnormal development of piriform muscle. Patients with sciaitic hernias commonly present with symptoms of flank, abdominal, pelvic, lower back or thigh pain. The hernia sack can contain small bowel, ureter, ovary, colon or bladder. Ureterosciatic hernia causing ureteral obstruction should be surgical repaired.

Effects of renal denervation of the contralateral kidney on blood pressure and sodium and eicosanoid excretion in the chronic phase of two-kidney, one-clip renovascular hypertension in rats.

OBJECTIVE: To define the role of the renal nerves of the contralateral kidney in the maintenance of two-kidney, one-clip (2K-1C) renovascular hypertension in rats. MATERIAL AND METHODS: The contralateral kidney of 2K-1C rats was denervated 6 months after induction of hypertension and 4 weeks after nephrectomy of the clipped kidney. Blood pressure, sodium and potassium balance and eicosanoid excretion were measured. RESULTS: Denervation of the contralateral kidney induced normalization of blood pressure in post-Goldblatt hypertensive rats. This effect was not mediated by a negative sodium balance. Excretion of prostaglandin E2 and thromboxane B2 increased after denervation of the contralateral kidney in both post-Goldblatt hypertensive and post-Goldblatt normotensive rats, while urine extraction remained unaffected. CONCLUSION: Afferences from the contralateral kidney appear to participate in the maintenance of 2K-1C renovascular hypertension due to the activation of central mechanisms regulating blood pressure.