Bladder cancer mortality in the Epirus district population (Greece).

OBJECTIVE: To describe the pattern of bladder cancer mortality in the Epirus district population (North-Western Greece) and to establish some relationships with cigarette smoking. PATIENTS AND METHODS: Mortality rates of bladder cancer in the Epirus district population were analysed according to the official data from the Department of Statistics of the University Hospital of Ioannina during the last decade (January 1990-January 2000). Age standardization of death rates was done by the direct method, using the world population as a standard. Fisher's test was used as a significance test for linear regression coefficient in time trend analysis of mortality. RESULTS: The average annual standardized mortality rates from bladder cancer during the study period were 5.23 per 100,000 population (96% Confidence Interval--Cl 4.02-5.63) in males and 1.63 per 100,000 population (96% Confidence Interval--CI 1.18-1.96) in females. Significantly increasing trends of the rates were observed in males (y = 2.421 + 0.231x; p < 0.01), but not in females (y = 1.263 + 0.027x: p > 0.05). The greatest increase in age - specific rates in males was observed in the age group of 70 and more years (y = 25.602 + 3.673x; p < 0.01). In females, all age--specific rates except for the group 60-69 years showed significantly increasing tendency. The increasing tendency of bladder cancer mortality is followed by the rise of per capita cigarette consumption among the Epirus district population. CONCLUSION: Further studies are needed for the explanation of the irregularities in the age-specific rates.

Large infectious bladder stone after long delay in removing ureteral stent.

We herein present a case of formation of a large infectious bladder calculous resulted from placement of a double pigtail catheter for an extensive period. The concomitant poor function of the corresponding renal unit made selection of nephroureterectomy unavoidable in the management of our patient.

Six cases of prenatal and neonatal torsion of the spermatic cord.

Torsions of the spermatic cord occurring from the intrauterine period to the end of the first year of life are termed perinatal. These are divided into prenatal and postnatal torsions, depending on their occurrence in the intrauterine or postuterine period. From January 1984 to January 1996, 6 cases were identified at our institution, involving 4 prenatal and 2 postnatal extravaginal torsions of the spermatic cord. These cases are reviewed with regard to optimal therapeutic approaches for the treatment of both the affected gonad as well as the contralateral one, and whether the event occurred prenatally or postnatally. The authors also propose several clinical indications useful for obstetricians, pediatricians, urologists and nurses.

Massive haemorrhage of inoperable bladder carcinomas: treatment by intravesical formalin solution.

Numerous modalities of treatment have been used in the past to control massive bladder haematuria, with varying degrees of success. Formalin has been used in urology only for the treatment of intractable haematuria of inoperable bladder carcinomas, usually as the last resort when all other nonsurgical attempts have failed and before more aggressive surgical measures are considered. Eight patients with bladder tumours classified T2 (2 cases), T3 (2 cases) or T4 (4 cases) and 2 patients with radiation cystitis were assessed as being beyond the scope of even palliative surgery, severe haemorrhage being present in all cases. The treatment was instituted in all cases by intravesical instillation of a 10 per cent formalin solution under general anaesthesia. Four patients received 4 and 6 instillations, respectively, the former over 4 weeks and the latter over 10 months. The bladder was filled completely and an indwelling-catheter introduced, the formalin solution being left in the bladder for 5 to 30 min (mean: 12 min). Haematuria was absent after 1 to 25 days (mean: 11 days) in 9 cases. The 10th patient died before arrest of haemorrhage. Survival after instillation was 65 days to 27 months (mean: 11.5 months). The outcome was fatal within 4 months or less in 3 cases and 4 patients died of renal failure within 3 months, one within 65 days after instillation. In 4 cases, treatment with formalin reduced bladder capacity to less than 100 ml. Other complications included retroperitoneal fibrosis (1 case), urinary incontinence (3 cases) and severe frequency and nocturia (3 cases). This procedure should therefore be reserved for terminal cases unable to support more aggressive therapy.

Benign fibroepithelial ureteral polyps. Report of 3 cases.

Three rare cases of benign ureteral polyps are presented. The rareness of benign mesenchymal ureteral tumors and the difficulty in pre-operative differential diagnosis from malignant epithelial are remarkable. The diagnosis is made on characteristic appearance at operation and is confirmed by frozen section and histological examination.

[Results of treatment of cystinuria and cystine lithiasis with alpha-mercaptopropionylglycine. Apropos of 40 patients]. / Résultats du traitement de la cystinurie et de la lithiase cystinique par l'alpha-mercaptopropionylglycine. A propos de 40 patients.

From 1987 to 1990, 719 subjects (385 males and 334 females) were screened, by means of urocystin-kit, for cystinuria and cystine lithiasis, in Epirus district (North-West Greece). The positive results were confirmed by chromatographic analysis of urine amino acids and laboratory tests. Forty patients, belonging to six cystinuric families, were identified. These patients were excreting 3.1 +/- 1.7 mmol/24 h of cystine in urine. All patients were treated by per os administration of alpha-MPG in daily doses of 400-1,200 mg/24 h). We therefore report the results of a 4 +/- 2 year follow-up of these patients. We conclude that treatment with alpha-MPG is very effective with minimal side effects in patients suffering from cystinuria or cystine urinary calculi.

The blind-ending bifid ureter.

A bifid blind-ending ureter is an extremely rare congenital anomaly of the upper urinary tract. This unusual ureteric condition appears to be more common in female subjects. Such patients may be asymptomatic or present with recurrent urinary tract infections, frequency, nycturia, abdominal pain or calculi. Asymptomatic patients without urinary tract infection require no treatment. When symptoms or infection are present, the treatment is surgical excision of the blind branch with antireflux reimplantation of the normal ureter. If hydronephrosis, pyonephrosis or renal damage is present, nephroureterectomy may be required.