Genitourinary tuberculosis: historical and basic science review: past and present.

Genitourinary tuberculosis (GUTB) usually results from the reactivation of old, dormant tuberculous diseases by pathogens of the mycobacterium tuberculosis complex. GUTB is the second most common form of extrapulmonary tuberculosis, with more than 90% of cases occurring in developing countries. In GUTB, the kidneys are the most common sites of infection and are infected through hematogenous spread of the bacilli, which then spread through the renal and urinary tract. Patients with genital and urethral TB present with a superficial tuberculous ulcer on the penis or in the female genital tract develop mainly due to primary contact with mycobacterium exposure during intercourse or inoculation via goods or chattels contaminated with mycobacterium. The diagnosis of TB of the urinary tract is based on the case history, the finding of pyuria in the absence of infection as judged by culture on routine media, and by radiological imaging. However, a positive yellow egg culture and/or histological analysis of biopsy specimens, possibly combined with the polymerase chain reaction (PCR), is still required in most patients to establish a definitive diagnosis of GUTB. The standard antituberculous drug treatment should be administered initially for two months during the intensive phase with three or four drugs daily followed by dual continuation therapy for four months. Surgery as a treatment option in GUTB might be indicated in complicated urinary tuberculosis. After antituberculous treatment of GUTB, surveillance with regular follow-up visits over the next five years is recommended. In cases of drug resistance, additional drugs and prolonged treatment are required. Furthermore, increasing rates of drug-resistant cases and co-infection with HIV pose challenges in the treatment GUTB and other forms of TB.

Johann Anton von Mikulicz-Radecki (1850-1905)--a pioneer of gastroscopy and modern surgery: his credit to urology.

The author presents the life and achievements of Johann von Mikulicz-Radecki and his contribution to European and world surgery. Mikulicz was born in Czernowitz, then a part of the Austro-Hungarian Empire. He was educated in numerous Austrian schools and graduated at Vienna University in 1875. In 1880 he became surgeon and lecturer (Docent) in the famous Billroth's School of surgery in Vienna. His scientific and clinical activity as assistant in Vienna and full professor in Cracow, Koenigsberg and Breslau resulted in 232 publications. He described many at that time novel surgical methods. He constructed the esophagogastroscope, scoliometer, peritoneal clamp and many other surgical devices. He organized the first in the world aseptical operation theatre in Breslau. He adopted hand disinfection, cotton and rubber gloves, mask, cup and general and local anaesthesia. Besides his many contributions to general, gastrointestinal and thoracic surgery Mikulicz devoted himself also to urological surgery. He performed ureterointestinal anastomosis and the first ileocystoplasty on a patient suffering from extrophy of the bladder. He died prematurely at the age of 55 in Breslau.

Scrotal bladder hernia: report of two cases.

Two new cases of scrotal bladder hernia (SBH) are presented. The first patient developed leakage of urine from the wound after "hydrocele" surgery. Revision of the wound showed a defect in the bladder wall. The bladder was separated from hernias sutures and closed in two layers. In the second, obese patient with a right scrotal swelling and two-stage voiding SBH was recognized preoperatively. The peritoneal sac and bladder wall were separately sutured and herniotomy was performed. The history, clinical features, pathology and treatment of SBH are summarized. The literature is briefly reviewed.

Julius Bruck (1840-1902) and his influence on the endoscopy of today.

A hundred years ago, on 20 April 1902, Breslaus most famous dentist of the time died. Julius Bruck was not only the most famous dentist and fighter for dentists' education in Germany in his time, but also one of the most successful inventors. In 1866, he produced light by using an exposed electrically heated platinum loop, which at that time was the most powerful light source known. He conceived of the possibility of placing the source of light in the distal end of an instrument and invented a double glass tube with a water-cooling compartment. This water cooled apparatus (diaphanoscope) was inserted into the rectum or vagina, to transilluminate the bladder. The key to further advances was born with the introduction of an internal electric light source. In 1877, the potential of Bruck's theoretical advance was realised in combination with other advances which virtually established the form of the clinically useful cystoscope as it is used today. The remarkable man responsible for this synthesis was Maximilian Nitze.