Radical cystectomy and lymphadenectomy to two patients with pelvic kidney: surgical pitfalls and considerations.

Our goal is to describe our experience in the difficulties encountered during radical cystectomy for muscle invasive bladder cancer in patients with contemporary pelvic kidney. Two patients with muscle invasive bladder cancer and contemporary pelvic kidney were subjected to radical cystectomy and extended lymphadenectomy with conversion to an ileal pouch. In both cases, lymphadenectomy was the first step after entering the true pelvis. In order to proceed to the cystoprostatectomy, careful dissection of the ectopic renal vessels and proper mobilization of the kidney were performed. In both cases, an ileal pouch was our choice. The pelvic kidney is the most common sight of renal ectopia. The etiology is the aborted ascent of the fetal kidney from its initial position in the pelvis. This is the first case series describing radical cystectomy for muscle invasive urothelial carcinoma of the bladder in patients with a pelvic kidney.

Methotrexate-paclitaxel-epirubicin-carboplatin (M-TEC) combination chemotherapy in patients with advanced bladder cancer: an open label phase II study.

The present phase II study aimed to define the application of a novel regimen incorporating methotrexate, paclitaxel, epirubicin, and carboplatin (M-TEC) in advanced bladder cancer, essentially as an M-VAC-like regimen, by substitution of cisplatin by carboplatin, doxorubicin by epirubicin and vinblastine by paclitaxel. Forty patients with advanced bladder cancer entered the study; 34 males/6 females, median age: 68 (range, 59-76), median PS (Karnovsky): 80, without receiving prior chemotherapy. Disease extention was as follows; 11/40 had local recurrence, 6/40 liver metastases, 14/40 lung metastases, bone and lymph node 8/40, bones-lymph node-lung metastases 4, lymph node and liver 4/40, lymph node-liver and lung metastases 2/40. Drug schedule and doses were as follows: paclitaxel 180 mg/m2, carboplatin AUC = 5 (according to creatinine clearance, based on Calvert's formula), and epirubicin 40 mg/m2 were administered during day 1, whereas methotrexate 30 mg/m2 and epirubicin 40 mg/m2 were administered on day 14. All patients were evaluable for response with 24/40 responding [response rate (RR) 60%]; 10/40 (25%) CR, 14/40 (35%) PR, 9/40 (22.5%) SD, and 7/40 (17.5%) PD. Symptomatic improvement was observed in 50% of patients. The median duration of response was 22 (14-32) weeks, median time-to-progression (TTP) 33 (12-44) weeks, and median survival was 56 (20-84) weeks. Toxicity was well accepted and was mainly neutropenia > grade 3: 17%, anemia >grade 3: 16%, thrombocytopenia > grade 2: 6%, nausea & vomiting mainly > grade 2: 31%, according to the administered chemotherapy cycles, whereas fatigue grade 2-3: 19%, neurotoxicity grade 1-2 13% of patients, and alopecia grade 2 was observed in all patients. The present pilot study indicates the feasibility of the M-TEC combination for bladder cancer with acceptable toxicity.

Morphologic findings and blood flow parameters of penile vasculature in patients with erectile dysfunction.

The objective was to study the risk factors in patients with erectile dysfunction in correlation with ultrasound findings of penile vasculature. Patients with erectile dysfunction were classified in four groups according to their risk factors. Group A (37 pts) who were heavy smokers, group B (40 pts) who suffered from diabetes mellitus, group C (30 pts) who suffered from hyperlipidemia and group D (40 pts) with no risk factors. The peak systolic velocity (PSV) was measured after the intracavernous injection of 10 mg alprostadile. Normal values were PSV>35 cm/s and endiastolic venous velocity<4 cm/s. It was found that the mean PSV in group A was 22.2+/-2.25 cm/s without venous leakage, in group B the mean PSV was 24.6+/-1.29 cm/s but there was a significant venous leakage (mean end-diastolic velocity 6.2+/-1.37 cm/s). Patients with hyperlipidemia (group C) had a mean PSV of 26.2+/-1.74 cm/s and insignificant venous leakage and patients in group D had a normal vascular profile. Patients with erectile dysfunction who are heavy smokers are predisposed to have penile arterial insufficiency, while diabetics have both arterial insufficiency and venous leakage.

The distribution of S-100 protein in hyperplastic and neoplastic prostatic epithelium.

Specimens from 30 cases of benign prostatic hyperplasia and 75 cases of prostatic carcinoma obtained during suprapubic prostatectomy, transurethal resection of the prostate and radical prostatectomy, were stained immunohistochemically for S-100 protein, prostatic acid phosphatase (PAP), prostatic specific antigen (PSA), neuron specific enolase (NSE) and polyclonal keratin. S-100 protein was positive in 9.3% of prostatic carcinomas and negative in all cases of prostatic hyperplasia. PAP and PSA were positive in all cases, while NSE was positive in 16% of the carcinoma cases. Polyclonal keratin was positive in both cell layers of the double layered hyperplastic prostatic epithelium with a more intense staining pattern in the outer cell layer. The authors believe that the S-100 protein immunoreactivity observed in some prostatic carcinomas, reflecting the change in the functional status of the neoplastic cells, might be of prognostic significance. They also emphasize the non-myoepithelial nature of the outer cell layer of the double layered prostatic epithelium.

[Urogenital lesions diagnosed incidentally during evaluation for blunt renal injuries]. / Lésions urogénitales diagnostiquées par hasard au cours du bilan pour des contusions fermées rénales.

OBJECTIVES: Pre-existing pathology of the urogenital system may interfere with the pathophysiology of trauma, alter the radiographic imaging and influence the way of therapeutic approach. The aim of our study was to record the pathological lesions of the urogenital tract found incidentally during evaluation for blunt renal trauma and subsequently comment on their importance. MATERIAL AND METHODS: The files of 675 patients referred to our department from 1982 to 1998 for further evaluation of possible blunt renal injury were reviewed. Our standard procedure is to perform an ultrasonogram and intravenous pyelography while CT scan and angiography are performed when indicated. No pediatric cases are encountered. RESULTS: Ultrasonographic and radiological evaluation revealed the presence of various congenital or acquired lesions of the urinary tract in 24 patients (3.5%). Lithiasis was the most common finding; multiple bladder stones and staghorn calculi were found in 8 and 4 cases, respectively. In 4 cases a renal mass other than hematoma was present while in 3 cases the trauma to the kidney was accompanied by rupture of large cortical cysts. Left renal agenesia was detected in 1 patient, a duplicated renal pelvis system in 1, bilateral ureterocele in 2, and retroperitoneal fibrosis in another patient. In 4 cases (2 with ruptured renal cyst, 1 with renal cell carcinoma and one with staghorn calculus) concomitant renal injury requiring immediate surgical intervention was detected. CONCLUSION: Lesions of the urinary tract found incidentally during evaluation for suspected renal injury are uncommon. However, they may complicate an otherwise negligible renal trauma while in some cases they may be of vital importance for the patient's final outcome.

Management of renal colic with intranasal desmopressin spray.

This study evaluates the effectiveness of desmopressin renal spray, an antidiuretic drug, in treating patients with acute renal colic. One hundred and eight patients admitted to the emergency room of our hospitals with acute renal colic were included in the study. Each patient, except those with hypertension or other cardiac insufficiency, received 40 micrograms desmopressin intranasal spray. In 58 patients (53.7%) pain was eliminated 30 min after desmopressin administration. Forty-four patients (40.7%) did not respond to desmopressin and received prostaglandin synthesis inhibitors, while another 6 patients required intramuscular pethidine for pain relief. No patient showed any side effects. We conclude that the simplicity and effectiveness of intranasal desmopressin spray in treating renal colic makes this simple method a useful means of confronting a frequent and disturbing urological problem.

[Total extended ++urethrectomy and transureteral continent cystostomy in the treatment of urethral melanoma in women. Report of a case]. / Uréthrectomie totale élargie et cystostomie continente trans-urétérale dans le traitement du mélanome de l'urèthre chez la femme. A propos d'un cas.

Malignant melanoma of the urethra is one of the rare urethral tumours which can be controlled by total urethrectomy with preservation of the bladder. The authors report the first case of melanoma of the urethra treated by total urethrectomy and continent transureteric urinary diversion according to Mitrofanoff's principle.

T-lymphocyte subsets in the peripheral blood of patients with renal cell carcinoma.

We analyzed the phenotypic distribution of the major T-lymphocyte subsets in the peripheral blood of 22 renal cell carcinoma patients before and after nephrectomy. We also compared these distributions to those of healthy controls and related them to tumor spread. The lymphocyte subsets were analyzed by means of flow cytometry. The CD4+ subset was the only one which was significantly decreased (x +/- SD: 36.2 +/- 6.4 vs 41.4 +/- 2.2 in healthy controls, P < 0.05), this contributing to a significant decrease in the CD4/CD8 ration (x +/- SD: 102 +/- 0.56 vs 1.42 +/- 0.28, P < 0.05). The decrease was more apparent with advanced stage. Helper cell activity increased significantly after nephrectomy in the higher stage patients (x +/- SD: 41.1 +/- 4.6 vs 36.4 +/-3.1 and 38.2 +/- 3.9 vs 30.1 +/- 4.2 for stage T3 and T4 patients respectively). Knowledge of peripheral blood lymphocyte patterns that correlate with various tumor stages and therapies could provide information in host-tumor relationship and predict the clinical outcome and response to therapy.

[Isolated amyloidosis of the ureter. Apropos of a case and review of the literature]. / Amylose isolée de l'uretère. A propos d'un cas et revue de la littérature.

Stenosis of the mid-portion of the right ureter and moderate hydronephrosis of the right kidney was seen on the intravenous pyelography of a 60-year-old patient consulting for sudden onset pain in the right inguinal region. Confirmation was obtained with retrograde urography and abdominal computed tomography. Right nephroureterectomy was performed. The pathology examination revealed characteristic features of amylosis located solely at the narrowing of the ureter. Isolated amylosis of the ureter is rare and difficult to diagnose.