Giant adrenal myelolipoma.

Authors present a case of giant adrenal myelolipoma, where the tumor was hormonally inactive but caused abdominal and flank pain. The huge tumor, a 20x18x10 cm mass, was surgically removed. The ipsilateral kidney was preserved.

Prognostic index of renal carcinomas.

Authors analysed the survival of 126 patients operated for kidney carcinomas. The data on anamnesis, laboratory results and TNM histological classification were compared with the results on "relative survival" and correlation analysis was performed. Based on these, the 12 most important criteria (with the highest correlation coefficient) were emphasized and regression equation was formed based on the TSP (Time Series Processing) Version 4 (Hall). Using this method, a numerical prognostic index can be established for the judgement of prognosis regarding certain patients.

A case of a calcified renal cyst.

Authors review a case of a calcified renal cyst. The literary data at hand give evidence that the spreading processes in the kidney can be benign or malignant according to their form of calcification and their localisation. Despite the modern diagnostic techniques, it is not easy to set up the diagnosis or to avoid the need for surgery, as was the case in the present report.

Anatomic variations in patients operated for bladder substitution.

Authors review the anatomic variations observed throughout orthotopic ileal neobladder formation in 38 cases following radical cystectomy. A part of the variations was necessitated because of deviation from the classic Hautmann-type surgical technique: in 6 cases the site of ileal resection was modified due to abnormal mesenterial art. course, on 2 occasions Meckel diverticules were detected while cutting the ileal neobladder, in 13 cases the laterally adhered sigma bladder necessitated the left-sided ureter to be pulled through beneath the mesosigma for the purpose of making sure the ureter--ileal neobladder anastomosis became free of any tension, while on 1 occasion the left ureteral preparations went with some injury. Since the left ureter became short, ureter replacement variation was needed, similar to the Studer method of ileal neobladder formation. All these variations, however, did not implicate the essence of the Hautmann technique. Follow-up of the patients did not reveal high frequency of occurrence of any complications.

Eosinophilic cystitis.

Authors report on two rare cases of eosinophilic cystitis, giving a review of the etiologic assumptions and pathogenetic, pathologic aspects of the disease, based on the available literary data. The course of the disease can be either acute or subacute, and is most often chronic. Relapse and progression can interchange in irregular manner, attention is therefore called to the importance of follow-ups. Resection deep into the intact--also containing muscle fibre--as well as histologic examination are considered essential as the only method of differentiation, giving precise diagnosis in the present two cases, too.

Comparison of morbidity of lumbar flank approach and transperitoneal approach for radical nephrectomy.

PURPOSE: This is a retrospective study comparing the clinical data and morbidity of transperitoneal radical nephrectomy (TRN) and simple nephrectomy. MATERIAL AND METHODS: From 1st January, 1989 to 1st January, 1996 a total of 90 simple nephrectomies and from 1st January, 1996 to 1st August, 1999 a number of 85 TRN were performed at the Department of Urology of the Saint Stephen Hospital. The analysis of clinical data included operative time, length of analgesics, postoperative hospital stay and blood loss, as well as morbidity. RESULTS: The mean operative time for TRN was 170 min., being 95 min. for simple nephrectomy. The mean blood loss for TRN was 250 ml, and 400 ml for simple nephrectomy. There were different types of morbidity for TRN and simple nephrectomy. The complications of TRN mean minimal risk and easy correctibility. CONCLUSION: Our results demonstrate an overall clear advantage of TRN when compared to simple nephrectomy.

Metabolic consequences of orthotopic ileal neobladder.

PURPOSE: Orthotopic ileal bladder substitution is a well accepted form of urinary diversion providing high quality of life. However, potential metabolic consequences remain a serious problem. These complications are discussed in the present article. MATERIAL AND METHODS: Authors review the metabolic complications of 45 orthotopic ileal neobladder cases. RESULTS: Insufficient absorption (malabsorption) associated with ileal resection is quite rare, while hyperchloremic metabolic acidosis after ileal neobladder is a rather common phenomenon (55%). CONCLUSION: Authors suggest careful patient selection, correct operative technique and vigilant follow-up for successful treatment of metabolic complications.

Isolated urethral amyloidosis (case report).

A case of urethral amyloidosis is presented in a 31-year-old male patient. Through this case, authors draw attention to the recommended forms of examination in the event of this illness being suspected, and also discuss problems in differential diagnosis. A reviewed the relevant data in the literature is also provided.

Heteromorphic grade of renal cell cancer.

The present study demonstrates by means of histopathologic analysis that most of the renal adenocarcinomas are microscopically heterogeneous--named by authors as heteromorphic. This heteromorphism means the mixture of different cell types, histological patterns and fields of tumor with different nuclear atypia. 300 surgical specimens of renal cell cancer (RCC) were reclassified retrospectively. The histologic classification was as follows: 1. Nuclear atypia (nuclear grading according to Skinner); 2. Histological structure (compact, tubular, papillary, cystic); 3. Tumor cell types (clear, chromophobe, chromophilic basophilic, chromophilic eosinophilic). Homogeneous tumors consist of the three categories of this basic classifications. Heteromorphic tumors have combinations the three categories: different cell types (clear and granular) and/or histological elements (tubulo-papillary) and/or nuclear structure. Heteromorphism of RCC can be graded as: G-I: homogeneous structure (three patterns, one-one pattern of the three categories; G-II: 3 + 1 patterns.... G-III: 3 + 2 patterns.... G-IV: 3 + 3 or more patterns of the classification given above. This grading system is recommended for the heteromorphism of renal adenocarcinomas.

Experiences of 25 orthotopic ileal neobladders.

Authors report on their results obtained from orthotopic ileal neobladders following 25 cases of radical cystectomy. Analysis is given of the possible complications, their prevention, as well as of surgical techniques. It is determined that orthotopic ileal neobladder is one of the best bladder substitution methods, giving the patient a chance for a high quality of life.

Experiences on 25 cases of radical cystectomy.

Authors review their early experiences and the oncopathological relations in respect to 25 cases of radical cystectomy involving orthotopic bladder substitution. The difficulties of diagnostics and indication are discussed. Attention is drawn to the fact that pathological "staging", "grading" are not entirely exact and reliable, though surgical indication is positioned on these. It is the opinion of authors that in case of TIG3 radical surgery is indicated. Due to the shortness of the follow-up periods, no studies on survival were performed. It remains an open question whether radical cystectomy is indicated as opposed to the possible choice of organ-preserving surgery.

Factors affecting prognosis of renal cell carcinomas.

Author analyzed the survival of 126 patients operated on because of kidney carcinomas. The data on anamnesis, laboratory results and TNM histological classification were compared with the results on "relative survival" and correlation analysis was performed. Based on these, the 12 most important criteria (with the highest correlation coefficient) were emphasized and regression equation was formed based on the TSP--Time Series Processing--Version 4 (Hall). Using this method, a numerical prognostic index can be established for the judgement of prognosis regarding certain patients.

Schistosomiasis of the urinary bladder.

Authors review a case of urinary schistosomiasis, where the process caused left-sided urinary obstruction. Because of the suspicion of a tumor transurethral resection was performed, whereafter the ureter passage became unhindered. Diagnosis became clear upon the histological examination of the resected tissue. Based on the cited literature, reference is made to the mortality rate of the disease in the expanded endemic areas, as well as to the high number of patients at risk. A brief summary is given of the pathology, symptoms, diagnostics of the disease, with mention of differentiation and therapeutic possibilities as well. With regard to importation of the disease, attention is called to the importance of careful anamnesis.

Retroperitoneal malignant fibrous histiocytoma.

Authors review the case history and follow-up a rare malignant fibrous histiocytoma patient, based on the relevant literary data. The tumor filled the retroperitoneum on the right side, in front of the right kidney. Intravenous urography and computer tomography revealed a 10 x 15 cm sized mass, suspect of being a kidney tumor. Upon surgery, the tumor was found to be a retroperitoneal malignant fibrous histiocytoma. In connection to the case, a brief review is given of the storiform type of malignant fibrous histiocytoma, regarding its etiological, clinical and pathological aspects, the difficulties in diagnosis, as well as the therapeutic possibilities. Authors regard their case worthy of publication because of the retroperitoneal location and significant size of the tumor, and because of the unproven diagnosis prior to surgery. Even after 4 years the patient is symptom- and complaint-free, and CT has revealed no metastases.

Minimal access ureterolithotomy.

A new minimally invasive ureterolithotomy is herein described which utilizes a 3 cm long skin incision. Surgery is performed with the aid of a newly developed bivalve retractor endoscope (Jakoscope) which provides excellent illumination with built-in double fiberoptic light cables and high intensity light source. The new surgical technique can be utilized in the rare cases of ureteral stone when other standard modalities may not work or when the patient demands definitive rapid treatment, and cannot be followed postoperatively.

Minimal and direct access surgery in urology.

An alternative method to laparoscopic surgery has been developed for urological procedures. The surgery is minimal access because the length of the single skin incision ranges from 3-6 cm depending on the type of operation. It is direct access because the surgeon sees the operative area directly and stereoscopically by eye without video-optical support. The procedure requires a special open-lumen retractorscope (Jakoscope(TM)) with a high intensity fiberoptic light system and modified standard hand instruments. Among the procedures performed nephrectomy, ureterolithotomy, prostatic adenomectomy, spermatic vein ligation and others have been performed. The kidney procedures have been operated retroperitoneally through a minilumbotomy incision. The procedures are simple, rapid and the instruments are inexpensive. The postoperative pain and morbidity are comparable to the laparoscopic approach.

Retractorscopic nephrectomy: initial report.

The authors describe a newly developed minimal access method for nephrectomy. The mini approach-a 5 cm skin incision-can be performed with a special retractorscope, which is an open lumen "scope" with fiberoptic light system.