Uroscopy in Byzantium (330-1453 AD).

PURPOSE: The macroscopic examination of urine constituted a lasting diagnostic method from the time of Hippocrates and Galen until the Renaissance. The Byzantines, as the carriers of ancient Greek medical knowledge, adopted uroscopy. MATERIALS AND METHODS: We reviewed the medical and historical bibliography as well as the original texts of Byzantine doctors. RESULTS: The outcome was impressive since, at that time, uroscopy was considered a main tool of clinical diagnosis. The Byzantines influenced the Arabs and Western Europe, their scriptures were considered points of reference, and they were regarded as experts on the subject of uroscopy. CONCLUSIONS: Byzantine doctors added new elements to the concept of uroscopy, which was based on ancient Greek knowledge. Throughout the centuries uroscopy was established as an irreplaceable diagnostic method which affected medical thinking as well as the perception of examination and cure since it practically isolated doctor and patient, especially in Western Europe.

Robotic radical prostatectomy in Greece: the learning curve and beyond. The initial 40 cases.

Radical prostatectomy is the treatment of choice for management of organ-confined prostate cancer. Minimally invasive treatments, as an alternative, have refined been recently by the introduction of da Vinci robotic technology which has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. We report on our experience with robotic radical prostatectomy using the first da Vinci robotic system in our country. During 8 months, 40 robotic radical prostatectomies were performed by a single surgical team at Athens Medical Centre (Marousi, Greece). Preoperative data collection included basic demographics, prostate-specific antigen (PSA), clinical stage, and Gleason score. Operative outcomes included operative time, estimated blood loss, and complications. Postoperative outcomes included hospital stay, pain, catheter time, pathology, PSA, return of continence, and potency. Average operative time was 186.25 min with an estimated mean blood loss of 135 ml. There were no intra-operative complications. Ninety per cent of the patients were discharged home on postoperative day 1 with mean haematocrit 36.7 (range 29-43). All patients reported minimal postoperative pain and resumed regular diet on the first postoperative day. Average catheter time was 6.6 days (range 5-10). Early continence was observed in 47.5% of the patients, seven days after catheter removal. Continence at 1, 3, and 6 months was 75, 82.5 and 95%, respectively. The overall positive margin rate was 17.5%. Ninety-five per cent of the patients had undetectable postoperative PSA levels (less than 0.1 ng/ml) at a median follow-up of 6 months. Our initial experience with robotic radical prostatectomy is very promising. The learning curve was approximately 10-12 cases. With a methodical approach we were able to implement the method safely and effectively in our practice, combining minimal morbidity with good oncological and functional outcomes.

Prevention of retrograde calculus migration with the Stone Cone.

Retrograde calculus migration during ureteroscopic lithotripsy remains a problem in 5-40% of cases. We assessed the safety and efficacy of the Stone Cone device, in comparison with the standard flat wire basket. A total of 56 consecutive patients with ureteral calculi, suitable for ureteroscopic extraction and/or lithotripsy, where included in this prospective study. Patients were randomly allocated into two groups. In group A (30 patients), we used the Stone Cone, while in group B (26 patients) we used the standard flat wire basket. The Stone Cone was placed through a cystoscope under fluoroscopic guidance, or when necessary under direct ureteroscopic control. Whenever necessary, intracorporeal electrohydraulic lithotripsy took place in both groups. Statistical significance was assessed by the paired t-test. The mean operative time was 48.5 min in group A, and 42.4 min in group B. Intact calculus extraction was possible in 16.6% in group A, and in 7.6% in group B (P < 0.01). Retrograde stone migration was revealed in 23% in group B only (P < 0.001). Also, residual fragments > 3 mm were recorded in 30.7% in group B only (P < 0.001). None of the patients in group A required auxiliary procedures, in contrary to 23% in group B (P < 0.001). No major complications were recorded in group A, while in group B a case of major ureteral mucosal abrasion was recorded. The Stone Cone is safe and efficient in preventing retrograde stone migration and in minimizing residual fragments during ureteroscopic lithotripsy in comparison with the flat wire basket.

Two cases of acute polyarthritis secondary to intravesical BCG adjuvant therapy for superficial bladder cancer.

We report two cases of acute polyarthritis secondary to intravesical BCG therapy for superficial bladder cancer. This extremely rare complication requires high clinical suspicion and responds well to non-steroidal anti-inflammatory drugs and conservative management.

Endoscopy vs. extracorporeal shockwave lithotripsy in the treatment of distal ureteral stones: ten years' experience.

BACKGROUND: The lower third is the location of the great majority of ureteral stones. Treatment of these stones remains controversial: in situ extracorporeal shockwave lithotripsy (SWL) vs. ureteroscopy (URS). METHODS: During the last decade, 633 distal ureteral calculi were treated at our institution using in situ SWL (Siemens Lithostar electromagnetic lithotripter) in 395 patients and URS (with 11.5F instrument and ultrasonic lithotripsy) in 228 patients. The patients' age and stone size were similar in the two groups. All SWL therapies were performed on an outpatient basis. RESULTS: The overall success rate was 99% for SWL, and the efficiency quotient (EQ) was 92.4%. The treatment was more effective for <10 mm calculi. In the URS group, there was a 92% overall success rate with an EQ at 91.2%. Compared with SWL, URS was more time consuming, at least for the initial cases; often required intravenous sedation; entailed routine placement of a ureteral stent; and more often led to hospitalization. On the other hand, stone clearance was rapid after URS, although most of the SWL patients were stone free at the end of 6 weeks. The cost was similar in the two groups. CONCLUSION: We believe that multiple factors should be considered when deciding the most appropriate approach to distal ureteral calculi. In situ SWL provides optimal first-line treatment for calculi < 10 mm, whereas URS is better reserved for stones >10 mm.

The genetic polymorphism of aminolevulinate dehydratase (ALADH) in Greece.

The distribution of phenotypic and allelic frequencies of aminolevulinate dehydratase (ALADH) in different areas of Greece is reported. The frequencies of the allele ALADH1 and ALADH2 in Greece are 0.955 and 0.0455, respectively.

Carcinosarcoma of the bladder.

We present a case of carcinosarcoma of the bladder, the first in our experience. This tumour is generally considered to be a rare one, has uncertain aetiology and poor prognosis. At present, radical cystectomy is the treatment of choice.