Simultaneous adenomectomy and preperitoneal repair of inguinal hernias by a single incision with the application of polypropylene mesh.

Preperitoneal inguinal herniorraphy in conjuction with other pelvic procedures has been described in the literature, but it has not gained wide popularity mainly due to the high recurrence rate. Recently, there has been a resurgence of interest in the preperitoneal repair of inguinal hernias with the application of mesh on the deficiency of the inguinal wall using the method commonly known as the Stoppa procedure. We evaluated the results and complications of 22 patients who underwent open surgical prostatectomy (adenomectomy) and simultaneous preperitoneal application of polypropylene mesh. Nineteen (86.4%) patients suffered from unilateral inguinal hernia whereas the remaining 3 (13.6%) had bilateral protrusions. Primary hernias only and not recurrences were included in our series. The median clinical follow-up was 20.4 months (range 9-50 months). The hernioplasty itself prolonged the whole procedure for only a few minutes and it did not affect the patients' hospitalization time (mean 6.7 days). Wound infection with subsequent development of cutaneous fistula occurred in one patient (4.5%) and treated conservatively. During follow-up one recurrence (4.5%) at the side of the previous repair of the left inguinal hernia was recorded; the protrusion was insignificant and left untreated. In all but one patient (21/22, 95.5%), the surgical results were excellent. In our experience, simultaneous transvesical adenomectomy and mesh preperitoneal hernioplasty is a convenient and safe procedure which can easily be performed by urologists in just a few minutes. The procedure which is both cost and time effective for the surgeon, achieves long-lasting beneficial results for the vast majority of patients.

Intravesical instillations of interferon gamma in the prophylaxis of high risk superficial bladder cancer--results of a controlled prospective study.

OBJECTIVE: To determine if intravesically administered recombinant interferon (IFN) gamma may serve as adjuvant first line treatment in prophylaxis of superficial bladder cancer by reducing its risk for recurrence, in the short term. MATERIAL AND METHODS: A total of 54 patients (43 males and 11 females) with superficial bladder tumours (Ta/T1) initially treated with transurethral resection for their tumors were randomized into two groups: Twenty-eight patients were left untreated after the transurethral resection (controls) whereas 26 patients received intravesical IFN gamma adjuvantly, at a dosage of 0.7 mg per week for 8 weeks. Patients with G1 tumors and carcinoma in situ were excluded. The follow up had a mean time of 12.1 months. Recurrence or progression, as terminal events of the study, were recorded. The comparison of the recurrences between the two groups was performed by estimating: (a) the simple recurrence rate, and (b) the interval to tumor recurrence in each group. RESULTS: Tumor recurrence was detected in 24 controls (86%) and in 16 (62%) patients of the IFN gamma group (p = 0.043). The comparison of the Kaplan-Meier disease-free survival curves between the two groups of patients indicated that intravesical instillations of IFN gamma exerted a continuous protective effect to those who received the agent, in the follow up period (p = 0.0237). No serious side-effects were noted. CONCLUSIONS: Intravesically administered IFN gamma has a demonstrable protective role as first line adjuvant treatment in superficial bladder cancer. This role is mainly focused on prevention of recurrences in the short term. Further prospective studies with longer follow up are required, in order to define the exact place of the drug in the urologist's armamentarium.

Varicocele in schoolboys.

This study was conducted to examine the effect of height and weight on the incidence of varicocele in schoolboys aged 5-16 years and the impact of varicocele on testicular size. Genital stage, height, weight, varicocele grade, and testicular size were recorded for 3047 school boys who were clinically examined while standing by a specialist in urology. Left varicocele was detected in 98 of the boys who were all aged 9-16 years. The mean weight of boys with and without varicocele was 42 kg (95% confidence interval [CI] 40-44 kg) and 47 (95% CI 47-47 kg), respectively (p =.00). There was no difference in mean height between the two groups nor in left and right testicular volume. Although 6 boys with varicocele had a left testicular volume > or =2 mL less than right, there were also 7 boys of comparable age who had a left testicular volume > or =2 mL larger than right. The incidence of varicocele in Greek adolescents is low. Boys with varicocele weighed significantly less but there were no significant differences in height or left versus right testicular volumes. In the light of these observations, the use of left testicular hypotrophy (> or =2 mL compared with the right testicle) should be reconsidered as an indicator for varicocele-induced damage of the testicle in this age group.

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.

Glutathione S-transferase null genotypes in transitional cell bladder cancer: a case-control study.

OBJECTIVES: This study was conducted (1) to examine whether the GSTM1 and GSTT1 null genotypes are risk factors for bladder cancer, and (2) to study a possible association of these genotypes with disease severity. METHODS: This case-control study was undertaken over a 21-month period and included 89 newly diagnosed transitional cell bladder cancer patients and 147 controls; both patients and controls originated from a defined population (residents of the loannina region, Northwestern Greece) and were similar with regard to mean age, male to female ratio and smoking habits. The GSTM1 and GSTT1 genotypes were identified by multiplex polymerase chain reaction on peripheral blood DNA samples. Genotype frequencies among patients and controls were assessed and the association of the genotypes with tumor grade and stage at presentation were statistically evaluated by the chi(2) test. RESULTS: The GSTM1 null genotype was strongly associated with bladder cancer. The odds ratio, attributable and population attributable risks were estimated at 2.76, 0.64 and 0.40, respectively. The correlation between the GSTM1 null genotype with stage, although not statistically significant, was estimated at an odds ratio of 2.6 for invasive disease. The correlation of GSTM1 null genotype with tumor grade did not yield a statistically significant result. The GSTT1 null genotype was not statistically associated with bladder cancer. CONCLUSION: According to our study, individuals with the GSTM1 null genotype carry a substantially higher risk for bladder carcinogenesis. The GSTM1 null genotype is not associated with more aggressive disease in terms of tumor grade, although there is a correlation between this genotype and stage of the disease.

Genotypes of N-acetyltransferase-2 and risk of bladder cancer: a case-control study.

PURPOSE: This study was conducted to examine whether certain slow N-acetylation genotypes could be risk factors for bladder cancer, and the possible association between specific genotypes and the severity of the disease at first diagnosis. MATERIALS AND METHODS: This case-control study included 89 patients with transitional cell bladder cancer (diagnosed over a period of 21 months) and 147 controls. N-acetyltransferase-2 (NAT-2) genotypes were identified by allele specific polymerase chain reaction (PCR) on peripheral blood DNA samples. The x2 test was used for statistical evaluation to compare the differences observed between patients and controls and the different genotypes with tumor grading and local staging at presentation. Relative, attributable and population attributable risks were estimated for the genotypes found to present a significantly increased frequency for bladder cancer. RESULTS: A statistically significant difference in the frequency of genotypes was found between the two groups. The patient group had the higher frequency of slow acetylation genotypes (p = 0.0016). Among slow acetylators, homozygotes 341C/341C and compound heterozygotes 341C/857A had the most excessive risk for bladder cancer (p = 0.0041 and 0.0031, respectively). The 341C/341C genotype was found to be associated with more aggressive disease, in terms of tumor grading at presentation (p <0.05). CONCLUSIONS: According to our data, slow acetylators with 341C/341C and 341C/857A genotypes carry a substantially higher odds ratio (3.73 and 12.46, respectively) for bladder carcinogenesis. Additionally, among the slow acetylators, 341C/341C homozygotes are likely to have a higher risk for more aggressive disease.

Infertility and multiple urogenital abnormalities in a male with mosaic 46,XY/45,XO/47,XXY karyotype and mixed phenotype.

We hereby present a rare case of a 46,XY/45,XO/47,XXY mosaic male patient with a predominance of the XY cell line. The patient, who exhibited phenotypic stigmata of both XO gonadal dysgenesis and Klinefelter syndromes, suffered from infertility and multiple urogenital abnormalities, as our investigation revealed.

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.