Specific gravity test strips used in monitoring urine concentrations of urolithiasis patients.

Current therapy for urolithiasis patients includes instructions to increase water intake and 24-hour urine output. Previous studies have measured changes in the 24-hour urine volume to evaluate the efficacy of fluid therapy in each patient. We used paper test strips to monitor urine pH and specific gravity in 22 of our stone clinic patients: 10 were instructed to increase water intake just before the study (group 1) and 12 were not so instructed (group 2). Mean specific gravities of 1.0222 (1.0238 corrected for pH) for group 1 and 1.0197 (1.0220 corrected for pH) for group 2 did not differ significantly. Urine specific gravities also were compared for 3 intervals: 1 to 9 a.m., 9 a.m. to 5 p.m. and 5 p.m. to 1 a.m. Of the 22 patients 10 (3 from group 1 and 7 from group 2) had significant diurnal variations in the urine specific gravities, corrected and uncorrected, among these 3 periods. In addition, both groups had a significantly higher mean specific gravity from 1 to 9 a.m. (1.0234 uncorrected and 1.0248 corrected) than from 9 a.m. to 5 p.m. (1.0194 uncorrected and 1.0218 corrected). The 5 p.m. to 1 a.m. (mean of 1.0220 uncorrected and 1.0239 corrected) specific gravity did not differ significantly in either group. If 1.015 is the highest acceptable specific gravity of urine in stone patients, the findings suggest inadequate dilution of urine in these patients, whether or not they were instructed to increase water intake. Also, the significant diurnal variation in urine specific gravity would allow a nighttime triggering event at these hours of higher urine concentration.

5-year experience with intravesical therapy of carcinoma in situ: an inquiry into the risks of "conservative" management.

Recent reports of disease progression in patients being treated with intravesical agents for carcinoma in situ of the bladder led us to examine our 5-year experience with 26 consecutive patients with carcinoma in situ treated with intravesical therapy for this lesion. Nine patients with isolated carcinoma in situ and 17 with carcinoma in situ associated with papillary lesions were treated intravesically with a variety of agents in a closely monitored program for a mean of 22 months. All patients wished to exhaust conservative options before accepting cystectomy. Of 26 patients treated 9 (35 per cent) have no evidence of disease with a functional bladder after 27 months, 13 (50 per cent) are treatment failures and 4 (15 per cent) maintain an equivocal status to date. Successful treatment results with each drug were 6 of 24 thiotepa, 0 of 7 mitomycin, 0 of 6 doxorubicin and 3 of 8 bacillus Calmette-Guerin. Treatment failure was associated with disease progression to muscle invasion, adjacent organ invasion or metastases in 7 patients (27 per cent). Significant reduction in bladder capacity after prolonged therapy occurred in 3 patients. Our results suggest that persistent, intensive, "conservative" intravesical therapy in the face of recurrent or persistent disease is associated with substantial patient risk.