Unilateral urinothorax can occur contralateral to the affected kidney.

Urinothorax is a rare cause of transudative pleural effusion with biochemical characteristics of urine, usually secondary to obstructive uropathy. Urine usually moves into the pleural space from the retroperitoneal or peritoneal space via diaphragmatic lymphatics or an anatomical diaphragm defect. A total of approximately 70 cases have been previously described in the literature, and in the vast majority of cases urinothorax is unilateral and ipsilateral to the side of obstructive uropathy, trauma or malignancy. This report describes a rare case of unilateral urinothorax occurring contralateral to the side of obstruction.

Does intubated uretero-ureterocutaneostomy provide better health-related quality of life than orthotopic neobladder in patients after radical cystectomy for invasive bladder cancer?

OBJECTIVES: Ileal orthotopic neobladder (ONB) has not proved to provide better health-related quality of life (HRQoL) than other urinary diversion techniques after radical cystectomy. The aim of the study is to compare HRQoL assessed by four questionnaires between ONB and uretero-ureterocutaneostomy (UUC). METHODS: Thirty-nine patients (35 men and 4 women) aged 66.95 ± 8.18 years old underwent radical cystectomy due to invasive bladder cancer and urinary diversion. Patients randomized to ileal ONB and UUC groups, except if certain limitations did not allow performing an ONB. Patients were interviewed face-to-face 7-84 months (median 17) after the operation and completed the Functional Assessment of Cancer Therapy Scale-General (FACT-G), the FACT Vanderbilt Cancer Index (FACT-VCI), the Beck Depression Index (BDI), and the generic RAND 36-item Health Survey Short Form (SF)-36 questionnaire, to asses HRQoL. RESULTS: Comparing the two groups there were no statistically significant differences for the scores of FACT-G, FACT-VCI, and BDI. For VCI score there was a borderline nonsignificant difference (P = 0.051). No statistically significant differences were noticed also from the comparison of SF-36 subgroups for the two groups except SF. Role emotional subgroup on behalf of UUC (P = 0.022). CONCLUSIONS: Patients with UUC surprisingly presented at least equal quality of life than the presumably less debilitating and more recent ONB. This could be explained due to lower complication rate and to lower expectations of the UUC group. UUC is a considerable option for urinary diversion after radical cystectomy in the era of HRQoL for selected patients.

Is urinary tract infection after shock wave lithotripsy an aggravating factor for renal damage?

OBJECTIVES: To prospectively assess if urinary tract infection (UTI) after extracorporeal shock wave lithotripsy (ESWL) enhances immediate renal damage in patients with renal stones. METHODS: Levels of lactic dehydrogenase (LDH), creatine phosphokinase (CPK), and beta2 microglobulin were measured in the urine of 171 patients, before and after ESWL for treatment of up to 3 cm renal stones. Standard investigation included urine sample before and after treatment. Patients were divided in two groups in accordance to presence of positive bacterial urine sample after ESWL. Changes in biomarker values pre and post- ESWL were assessed via X2 test for both groups and compared between the two groups for post-treatment values. RESULTS: Despite pre-treatment antibiotic therapy, 21.6% of the patients presented with UTI after ESWL. In the group with clear post-treatment urine samples there was a 5.8, 2.2, and 0.7 fold increase of CPK, LDH, and beta2 microglobulin levels after ESWL, respectively (p<0.001), indicating some degree of immediate renal damage. In patients with UTI, the levels of the enzymes elevated by 80, 15, and 2.2 fold after ESWL, respectively, which represents a significantly increased elevation comparing with the sterile urine group (p<0.001). CONCLUSIONS: ESWL results in transient immediate renal damage, which is exaggerated in patients with persistent or treatment prompted UTI. Long-term importance of this finding must be determined.

¿Es la infección urinaria post-litotricia factor agravante del daño renal de dicha terapia? / Is urinary tract infection after shock wave lithotripsy an aggravating factor for renal damage?

OBJETIVO: Evaluar de manera prospectiva si la infección post-litotricia por ondas de choque aumenta el daño renal en los pacientes que se trataron por calculos renales con este método.MÉTODOS: Los niveles de LDH, CPK y β2 – microglobulina se midieron en la orina de 171 pacientes con litiasis renal de más de 3 cm antes y despues de la litotricia. Los cambios en los valores de los biomarcadores pre y post litotricia se evaluaron mediante la prueba de X2 para ámbos grupos y se compararon entre los 2 grupos con los valores post-tratamiento.RESULTADOS: A pesar del tratamiento previo con antibioticos el 21,6% de los pacientes presentaron una infeccion post-litotricia. En el grupo de pacientes con orina esteril después de la litotricia hubo un aumento de 5.8, 2.2 y 0.7 veces de los valores de CPK, LDH y β-2 microglobulina respectivamente (p < 0.001), lo que indica un cierto grado de daño renal immediato. En el grupo de los pacientes con infección urinaria post-litotricia el aumento era 80, 15 y 2.2 veces respectivamente mucho mayor del grupo anterior (p<0.001).CONCLUSIONES: La litotricia extracorpórea provoca un daño renal transitorio mayor en pacientes que presentan infección urinaria post-litotricia. La importancia de este hallazgo debe investigarse a largo plazo(AU)

OBJECTIVES: To prospectively assess if urinary tract infection (UTI) after extracorporeal shock wave lithothripsy (ESWL) enhances immediate renal damage in patients with renal stones.METHODS: Levels of lactic dehydrogenase (LDH), crea-tine phosphokinase (CPK), and β2 microglobulin were measured in the urine of 171 patients, before and after ESWL for treatment of up to 3cm renal stones. Standard investigation included urine sample before and after treatment. Patients were divided in two groups in ac-cordance to presence of positive bacterial urine sample after ESWL. Changes in biomarker values pre- and post- ESWL were assessed via X2 test for both groups and compared between the two groups for post-treatment values. RESULTS: Despite pre-treatment antibiotic therapy, 21.6% of the patients presented with UTI after ESWL. In the group with clear post-treatment urine samples there was a 5.8, 2.2, and 0.7 fold increase of CPK, LDH, and β2 microglobulin levels after ESWL, respectively (p<0.001), indicating some degree of immediate renal damage. In patients with UTI, the levels of the enzymes elevated by 80, 15, and 2.2 fold after ESWL, respectively, which represents a significantly increased elevation comparing with the sterile urine group (p<0.001).CONCLUSIONS: ESWL results in transient immediate renal damage, which is exaggerated in patients with persistent or treatment prompted UTI. Long-term importance of this finding must be determined(AU)

Bilateral synchronous occurrence of three different histological types of renal tumor: a case report.

INTRODUCTION: Renal cell carcinomas account for 85% of all renal neoplasms. With the introduction of modern imaging modalities, there has been an increased diagnosis of renal tumors. Recent studies have shown that partial nephrectomy can be as safe as radical nephrectomy for smaller renal tumors. Renal cell carcinomas are usually unilateral, however, they can be bilateral in 2% to 4% of sporadic cases and considerably more common in familial cases. CASE PRESENTATION: In this case report, we describe an unusual case of two bilateral synchronous chromophobe renal cell carcinomas accompanied by an oncocytoma and an angiomyolipoma, that were all treated by open partial nephrectomy. CONCLUSIONS: To the best of our knowledge, this is the first case report on the synchronous occurrence of bilateral chromophobe renal cell carcinomas associated with an oncocytoma and an angiomyolipoma.

Solitary multilocular cystic renal cell carcinoma in adults: diagnostic problems, pathological features and treatment.

Multilocular cystic renal cell carcinoma represents a rare clinical entity in adults. This report describes the authors' experience with seven tumours, including the first two tumours in the literature diagnosed during pregnancy.

Our experience with salvage genitourinary fistulae repair: technique and outcomes.

OBJECTIVES: The objectives are to present the long-term results of vaginal reconstructive operations using the labial fat pad flap (Martius flap) interposition. PATIENTS AND METHODS: Eight women, 27-65 years old (mean 40), suffering from urinary fistulae (five urethrovaginal and three vesicovaginal) who failed primary repair underwent salvage vaginal reconstruction for damaged urethra or bladder. Urethral or bladder and vaginal defect was closed and a Martius fat flap was interposed between urethra or bladder and vaginal wall flap to secure a watertight separation of the structures. A Martius flap was also used successfully for salvage vaginal reconstruction in three more women, two with extensive injury of their urethra and bladder neck and one with vaginal leakage, after a rectosigmoid neobladder diversion following cystectomy. RESULTS: The repair was successful in all eight patients with urinary fistulae and in the one with rectovaginal leakage. The patient with the traumatically injured urethra and bladder neck developed an anastomotic stricture treated with urethral dilatations and internal urethrotomy. The older one developed a vesicovaginal fistula due to bladder neck closure, and this was repaired with a second transvaginal closure. CONCLUSION: Martius labial fat flap is an easy to prepare, well-vascularized tissue that can be most helpful in achieving a long-lasting favorable outcome in vaginal reconstructive surgery.

Application of dorsal preputial island flap in meatoplasty.

INTRODUCTION AND OBJECTIVES: Meatal stenosis usually presents in adults with a history of urethral trauma or inflammation or as a complication after hypospadias repair. The objective of this study is to present the correction of meatal stenosis using a preputial island flap, created on the dorsal surface of the penis. METHODS: During the last 3 years 12 patients were subjected to meatoplasty using a preputial flap. A meatotomy was performed and a preputial island flap was raised on the dorsal surface of the penis, that was brought to the ventral surface and anastomosed to the opened fossa navicularis. RESULTS: Mean follow-up is 22.3 (range 6-40) months and urethral meatus remains normal with good caliber in routine examination mainly with dilators and uroflowmetry. CONCLUSIONS: The described method was based on the on-lay preputial island flap procedure (Duckett's method) for correction of anterior hypospadias. The cosmetic result is excellent and normal penile morphology and function are well preserved.

Dorsal on-lay preputial graft urethroplasty for anterior urethra strictures repair.

OBJECTIVES: To report the long-term results and evaluate the effectiveness of the dorsal on-lay preputial graft urethroplasty in patients suffering from anterior urethra strictures. METHODS: A total of 21 male patients, mean age 46.3 years (range 17-67), with anterior urethral strictures, underwent the dorsal on-lay preputial graft urethroplasty during the last 8 years, from October 1997 to September 2005. Strictures were located in bulbar urethra in 16 patients and in penile urethra in the remaining 5. The aetiology the stricture was traumatic injury of the anterior urethra in 12 patients and iatrogenic in 9 patients. A direct vision dorsal urethrotomy and the insertion of an urethral Foley catheter right before the procedure, facilitated the corpus spongiosum dissection and the preparation for urethroplasty. A voiding cystogram was performed on the day of urethral catheter removal to exclude extravasation and estimate the postoperative result. RESULTS: Mean follow-up time has been 49.9 months (range 6-95) and the outcome was favourable in 15 patients (71.43%). There were 3 recurrences in penile urethra strictures managed conservatively and three in bulbar urethroplasties, treated with internal urethrotomy followed by urethral dilatations. CONCLUSION: Our results indicate that dorsal on-lay urethroplasty using preputial graft is an easy to learn and perform procedure, and offers the patient durable results with rather minimal complications.

A rare case of renal oncocytoma associated with erythrocytosis: case report.

BACKGROUND: Oncocytomas are benign tumors of the kidney that are usually diagnosed postoperatively due to differential diagnostic problems from renal cell carcinoma. Although the latter are neoplasms that have been associated with erythrocytosis in 3.5% of cases, there are no reports in the literature about a similar occurrence in oncocytomas. CASE PRESENTATION: In this case report we present a unique case of a right lower pole oncocytoma associated with erythrocytosis. Erythrocytosis subsided after partial nephrectomy. CONCLUSION: Erythrocytosis can sometimes occur in association with renal oncocytomas.

Case report: microcystic transitional cell carcinoma of the urinary bladder.

We report a rare case of microcystic transitional cell carcinoma involving the urinary bladder, in a 38-year-old man, and we add our experience in the treatment of this neoplasm. The tumor was muscle invasive, and a radical cystectomy was performed. The patient received no postoperative chemotherapy or radiotherapy, and he has not signs of local recurrence or distal metastasis after 3 years of intense follow up. Even though the number of cases documented so far, is insufficient to draw safe conclusions regarding the optimal treatment of the microcystic variant of transitional cell carcinoma. Our case indicates that even in cases of microcystic transitional cell carcinoma with infiltrative nature, aggressive therapy is associated with good control of the disease locally and distally.