Studer orthotopic ileal bladder substitute construction - surgical technique and complication management: one-center and 12-year experience.

PURPOSE: We have performed Studer neobladder creation in 61 patients (53 male and 8 female). The aims of this study were to evaluate the clinical outcomes, to review the surgical technique modification, postoperative complications management and metabolic disturbances. MATERIAL AND METHODS: All patients were retrospectively studied and followed-up. The follow-up: 12 years to 2 months. 44 patients (41 male and 3 female) returned for a control visit. All completed IIQ-7 questionnaire. Continence was analysed. Kidney ultrasound, post void residual and uroflowmetry, blood tests (electrolytes, kidney markers, acid-base balance) were performed. All patients were divided into two groups: I (with Zuber mineral water intake) and group II (without Zuber mineral water intake) for acid-base balance analysis. RESULTS: Early complications occurred in 13.1% (enterocolitis, neobladder-urethral anastomosis leakage, pyelonephritis, and lymphorrhoea). Late complications occurred in 14.0% (stricture of the neobladder-urethra anastomosis, urosepsis secondarily to bilateral hydronephrosis, stone formation, and pyonephrosis). In the follow-up 88.6% of patients revealed normal continence. The nocturnal incontinence, nocturia, and external or indwelling catheter were reported in 9, 6 and 5 patients, respectively). In IIQ-7 the mean negative impact of continence level on patients quality of life was 10.08% ± 14.47%. The mean Qmax., Qave., post void residual were 15.8 ± 4.9 ml/s, 7.9 ± 3.0 ml/s, and 151.2 ± 139.2 ml, respectively. Patients who regularly intake the Zuber present significant decrease of BE deficiency as compared to patient without Zuber usage. CONCLUSIONS: The Studer neobladder is the alternative urinary diversion. This is the difficult, skill demanding procedure, nevertheless gaining experience with self modifications resulted in decrease of complications. The Zuber mineral water intake ameliorates the base excess deficiency after Studer creation.

Vesico-ileal fistula caused by a foreign body.

An enterovesical fistula due to an intestinal foreign body is presented and the therapeutic aspects of the lesion are discussed.

Spontaneous regression of hepatic metastases after nephrectomy and metastasectomy of renal cell carcinoma.

We report a case of clear cell carcinoma of the kidney with multifocal metastases to the lymph nodes, vagina and liver. Spontaneous regression of liver metastasis has been described after nephrectomy. Surgical management of primary and metastatic tumors should be considered in all patients with renal cell carcinoma.

Acute ureteral elongation in two animal models using a balloon expander.

BACKGROUND AND OBJECTIVE: Repair of ureteral injuries and strictures often necessitates a major reconstructive procedure such as a psoas hitch, Boari flap, renal mobilization, ileal interposition, or autotransplantation. Tissue expanders have been used to elongate nerves and arteries. We examined the effects of acute ureteral elongation in two animal models. MATERIALS AND METHODS: In eight female rabbits, we exposed the left ureter through a midline incision and placed a Ruiz-Cohen balloon beneath the undermined portion. The expander was then inflated until the ureter was tightly stretched across it. After deflation, the expanded segment was measured in situ and compared with its original length. Follow-up urography was performed, and the tissue was harvested and examined by a pathologist. The same procedure was performed in five pigs; however, in these animals, a segment of ureter was excised, and a ureteroureterostomy was performed, after the acute expansion. RESULTS: We were able to achieve acute elongation of the expanded ureteral segment. The mean elongation was 31.3% in the rabbits and 32.0% in the pigs. An intravenous urogram (IVU) 6 weeks after the elongation showed a functioning kidney and a patent ureter. Histologic examination of the ureter within 24 hours after the expansion revealed that all segments were viable, the luminal epithelium was intact, and the muscular layers appeared normal. At 6 weeks, the expanded segment showed mild inflammatory changes, but the overall morphology, size, and cytology findings were similar to those of a normal control. CONCLUSIONS: Acute ureteral elongation using a tissue expander is a new method of increasing ureteral length. It may be useful to cover defects that would need major operations with greater morbidity.

Percutaneous removal of stone from caliceal diverticulum in patient with nephroptosis.

A novel method is introduced for percutaneous stone extraction from a lower pole caliceal diverticulum in a patient with nephroptosis, also known as a floating kidney. The patient was fully recovered and asymptomatic at 2 months postoperatively with her kidney fixed in the flank position.

Necrosis of the urethra and tissue sloughing: a delayed complication after transurethral microwave thermotherapy.

Transurethral microwave thermotherapy is a minimally invasive treatment for benign prostatic hyperplasia designed to destroy hyperplastic tissue without damaging the urethra. We present an unexpected complication of prostatic urethral necrosis and tissue sloughing after thermotherapy and discuss its possible cause.

Endopyelotomy after failed pyeloplasty: the long-term results.

PURPOSE: Endopyelotomy has been proposed as a technique to treat ureteropelvic junction obstruction after failed open pyeloplasty. However, to our knowledge no long-term results of this treatment have been reported. We report the long-term followup of a cohort of patients in whom pyeloplasty failed and who subsequently were treated with endopyelotomy. MATERIALS AND METHODS: From January 1985 to February 1996, 72 patients in whom open surgical pyeloplasty failed were treated with percutaneous endopyelotomy. Mean patient age was 35 years (range 5 to 82). The interval between pyeloplasty and subsequent failure ranged from 2 months to 30 years (mean 57 months). The major presenting symptoms were pain in 82% of cases, fever and urinary tract infections in 37.5%, stone formation in 25% and gross hematuria in 21%. RESULTS: Antegrade endopyelotomy using a hooked knife was performed in all patients with no unusual difficulty and minimal complications. A total of 63 patients (87.5%) had long lasting clinical and radiographic treatment success after a mean followup of 88.5 months. Of the 9 endopyelotomy failures (12.5%) 7 (77.8%) were detected immediately after stent removal at 6 weeks, 1 (11.1%) at 6 months and 1 (11.1%) at 10 months postoperatively (mean failure interval 3.3 months). The failures were corrected with repeat endopyelotomy in 1 patient, pyeloplasty in 3, ileal interposition in 1 and nephrectomy in 4. CONCLUSIONS: Endopyelotomy is the treatment of choice for recurrent ureteropelvic junction obstruction after failed pyeloplasty, with a high and sustained long-term success rate and no reported new failures after 1-year followup. Furthermore, endopyelotomy is technically easier with less morbidity than repeat open pyeloplasty.

Endopyelotomy for horseshoe and ectopic kidneys.

PURPOSE: We report our experience with endopyelotomy for horseshoe and ectopic kidneys in the largest series to date to our knowledge, and discuss the technical modifications adopted to perform successfully percutaneous antegrade endopyelotomy. MATERIALS AND METHODS: From September 1987 to April 1996, 4 patients with horseshoe and 5 with ectopic kidney underwent percutaneous antegrade endopyelotomy for symptomatic ureteropelvic junction obstruction. The percutaneous puncture was made more posteromedial and the ureteropelvic junction was incised lateral. A retrograde percutaneous access tract was created under laparoscopic guidance in pelvic kidneys. RESULTS: The operative procedure was performed uneventfully in all patients with no major bleeding, pleural effusion or visceral perforation. The stents were removed at 6 weeks, and an excretory urogram was performed at 2 weeks, 6 months and yearly thereafter. In 2 patients (22%) with severe hydronephrosis, poor renal function and a long ureteral stricture surgical treatment failed immediately. The remaining 7 patients (78%) had long lasting clinical and radiographic success with a mean followup of 62 months. CONCLUSIONS: Percutaneous antegrade endopyelotomy, with a few technical modifications, is a safe and effective treatment for ureteropelvic junction obstruction associated with horseshoe and ectopic kidneys.

Transurethral microwave thermotherapy for management of benign prostatic hyperplasia: a single-institution experience.

OBJECTIVES: This is the first and largest single institution retrospective study in the United States to examine the effects of transurethral microwave thermotherapy (TUMT) for the treatment of benign prostatic hyperplasia (BPH). METHODS: From September 1996 to June 1997, 78 men with moderate to severe symptomatic BPH were treated with the Prostatron at our institution. Patient age ranged from 52 to 85 years. Prostate volume ranged from 23 to 110 cc, and mean total energy applied during the treatment was 156.17 kJ. Patients were re-evaluated at 3 months and were asked to answer a questionnaire regarding their opinion about the treatment. RESULTS: At 3 months there was a significant decrease in mean symptom score from 19.6 to 11.2 (P <0.0001). Mean peak flow rate increased from 8.5 to 12.8 mLs (P <0.0001). Mean postvoid residual urine decreased from 56.8 to 22.0 mL (P <0.0001). We did not observe any severe complications. Unlike prior studies, we removed the Foley catheter, and patients performed clean intermittent catheterization (CIC) when necessary. There was no significant differences in subjective and objective parameters between these patients and those who did not need CIC. Patient opinion about the treatment was not affected by CIC. About two thirds (67.2%) of the patients in the study group were satisfied with the results of treatment, and 60.3% would undergo the same procedure again. CONCLUSIONS: TUMT of the prostate is an effective, safe, and acceptable form of treatment for patients with BPH. Longer follow-up is needed to examine the durability of TUMT treatment.

Temporal advancement of diethylnitrosamine carcinogenesis in aging mice.

Female BALB/c mice were given diethylnitrosamine (DEN) in their drinking water beginning at 2.5, 9.5, and 17 months of age (cumulative dose approximately 300 to 400 mg/kg body weight) or were untreated. Median times of death for the treatment groups were 193, 168, and 125 days, respectively, after cessation of DEN treatment and were significantly different (p less than .01). Induced tumors in the three respective age groups were of squamous forestomach (88, 87, and 84%), vascular tumors of the liver (11, 13, and 16%), and adenomas of the lung (65, 56, and 54%). Controls had no forestomach or liver tumors and relatively low incidences of lung tumors. The fact that aging mice have similar incidences and types of tumors of the same size and in the same tissues, but at an earlier time, shows that (1) DEN is carcinogenic in aging BALB/c mice; (2) age at treatment does not alter the tumor-susceptible tissue nor types of tumors after DEN treatment; (3) tumor incidences are not affected by age at time of treatment; (4) mice die earlier with induced tumors with increasing age at time of treatment; (5) age-matched non-DEN-treated mice die from different diseases (leukemias) than do DEN-treated mice (stomach and liver tumors). These observations may be related, in part, to an identified age-dependent decrease in immunocompetency or to other age-related changes, such as vascular or hormonal, which could explain temporal advancement in the tumorigenic process.

A positive correlation between declining immune competence and early mortality associated with diethylnitrosamine carcinogenesis in aging mice.

The effect of age (2.5, 9.5, and 17 months) at time of treatment upon diethylnitrosamine (DEN) carcinogenesis and immune competence has been assessed in female BALB/c mice. Median times of death were 193, 168, and 125 days, respectively, after termination of DEN treatment. Immune competence as a measure by both cell-mediated and humoral immune parameters immediately after DEN treatment was not significantly different among treated and age-matched non-treated control animals. In contrast, a significant age-related decline in immune competence was seen in both DEN-treated and non-treated controls, thereby demonstrating a direct and positive correlation between the natural age-related decrease in immune competence and cancer-induced advanced mortality.

Selective sex-related modification of diethylnitrosamine-induced carcinogenesis in BALB/c mice by concomitant administration of butylated hydroxytoluene.

Tumor induction in BALB/c mice by diethylnitrosamine (DENA) was shown to be sex related. Female mice killed 13.5 months after DENA exposure generally had higher incidences of forestomach and lung tumors than did males and also had higher numbers of lung tumors per tumor-bearing mouse. Although neither sex developed stomach tumors spontaneously, males had higher incidences of spontaneous lung tumors than did females (45 vs. 26%). When butylated hydroxytoluene (BHT) was given concomitantly with DENA treatment, females had an increased survival (68 vs. 43%) and a reduced incidence of forestomach squamous cell carcinomas (77 vs. 100%) compared with females given DENA alone. No such protective effect on survival or on the occurrence of stomach tumors was seen in males given BHT and DENA or on lung tumorigenesis in either sex. In males, BHT given alone increased survival of treated mice over that of untreated controls, but it had no such effect on the females. The results of this study suggested an as yet unexplained hormonal influence and/or dependence for this BHT modification of DENA tumorigenesis.

Diseases of aging untreated virgin female RFM and BALB/c mice.

Diseases of untreated, virgin female barrier-maintained RFM and BALB/c mice used as controls in a large radiation aging experiment were necropsied after natural death. The spectrum and incidence of neoplastic and nonneoplastic diseases were somewhat different in the two strains. Both strains show a high incidence of neoplasma (largely reticulum cell sarcomas and lung tumors) and of glomerulosclerosis. A wide variety of other diseases was noted in much lower incidence. The findings in the RF were briefly compared with those in earlier experiments with that strain in this laboratory.