Long-term results of the treatment of complete distal ureteral stenosis using a cutting balloon catheter device.

PURPOSE: We evaluated the long-term efficacy of endoscopic treatment of complete distal ureteral stenosis using a cutting balloon catheter. MATERIALS AND METHODS: We performed a total of 10 procedures in 9 patients with complete distal ureteral stenosis at or near the ureterovesical junction. Depending on presenting anatomy cases were treated with a retrograde only (6), antegrade only (1) or combined antegrade and retrograde (3) endoscopic technique. RESULTS: At a mean followup of 36 months (range 24 to 43) 9 of the 10 procedures (90%) were successful. Stenosis recurred in 1 of the 9 patients (10%) but a repeat procedure was successful. There were no intraoperative complications and no procedures required open surgical conversion. Although all patients noticed a various degree of hematuria postoperatively, none required blood transfusion or further intervention. Mean hospitalization was 1.1 days. CONCLUSIONS: Endoscopic repair of distal ureteral stenosis using a cutting balloon catheter is a viable option in patients with complete ureteral obstruction. This technique results in low morbidity, a short hospital stay and excellent long-term patency. Endoscopic treatment using a cutting balloon catheter may be a therapeutic option in many patients with complete distal ureteral obstruction at or near the ureterovesical junction.

Ureteral obstruction secondary to indinavir in the pediatric HIV population.

Indinavir sulfate is a protease inhibitor used in the treatment of the human immunodeficiency virus (HIV). This case report describes the radiographic and urologic manifestations of indinavir urolithiasis in two pediatric patients with acquired immunodeficiency syndrome (AIDS). Management involves aggressive hydration and surgical intervention when indicated.

Tamoxifen for flutamide/finasteride-induced gynecomastia.

OBJECTIVES: Current therapies for advanced prostate carcinoma lead to a marked decrease in serum testosterone levels, which renders patients impotent. In preliminary studies, combination therapy with flutamide and finasteride has been used as an alternative therapy for the treatment of prostate carcinoma because potency can be preserved. Both of these agents can cause gynecomastia and breast/nipple tenderness. METHODS: Six men being treated for advanced prostate carcinoma with flutamide/finasteride combination therapy developed painful gynecomastia, which was treated with tamoxifen 10 to 30 mg/day for 1 month. Clinical follow-up included breast measurements and determination of prostate-specific antigen (PSA), testosterone, and estradiol levels. RESULTS: While on this combination therapy for prostate carcinoma, 4 of 6 patients experienced a decrease in PSA level to less than 0.5 ng/mL. All patients remained potent. Serum testosterone increased in each patient who had a baseline level drawn. Estradiol levels were noted to be elevated in 4 of 6 patients at the time of evaluation for gynecomastia. After treatment with tamoxifen, circulating estradiol levels increased in 3 patients from 1.3 to 2.2 times the baseline level. Five patients experienced complete resolution of breast and nipple pain on tamoxifen 10 mg/day within the first month. The other patient had to be treated with 30 mg/day for 1 additional month, which subsequently resulted in pain resolution. CONCLUSIONS: These preliminary results suggest that low-dose tamoxifen is useful in treating painful gynecomastia for those patients on flutamide/finasteride combination therapy for advanced prostate carcinoma.

Giant malignant fibrous histiocytoma of the testis/spermatic cord: psychologic and possible etiologic complications of unethical Nazi medical experimentation.

This case of malignant fibrous histiocytoma of the testis/spermatic cord was found in a Holocaust survivor who was injected with an unknown substance in the left testicle while in Auschwitz concentration camp in 1943. Because malignant fibrous histiocytoma is a neoplasm rarely found in this location, with only 26 previously reported cases, a review of this entity was performed. A review of Nazi medical practices in the literature and through the Holocaust Museum research department was undertaken in an attempt to ascertain identification of the unknown substance injected into this patient; however, exact identification of the Auschwitz experiment or experimenter could not be determined. A left radical orchiectomy was performed, and subsequent histolopathologic review revealed a well-encapsulated 27 x 22 x 17-cm malignant fibrous histiocytoma. The left testis was not clearly identified due to necrosis of the tumor. This is the largest malignant fibrous histiocytoma of the spermatic cord/testis recorded in the literature to date. Based on the unusual location and size, the intratesticular injection probably contributed to the tumor development and certainly caused the patient's delay in seeking medical treatment.