[Pulsed Neodimium-Yag laser in the management of ureteral calculi]. / Pulzáló Neodimium-Yag lézer az uréterkövek kezelésében.

The authors report their experience with the laser smashing of 105 ureteral calculi between Sept. 1 1989 and Sept. 30 1992. Applying the pulsating Nd-Yag laser through an ureteroscope as a monotherapy, they have obtained good results in 83% of the cases. Using complementary methods in addition, the successful elimination of calculi was 95%. The possible complications are discussed and the advantages and disadvantages of the different energy sources used for smashing the calculi are compared. On the basis of their results, the authors consider that endoscopic treatment of ureteral calculi may be indicated even in the era of extracorporeal stonesmashing. They stress that endoscopic operations are only preferable compared to ESWL-treatment if all indispensable devices are available: energy sources and thin, flexible devices for energy conduction. Among them--literature confirms it--laser-energy is the most expedient and least invasive. Laser was first applied for smashing ureteral calculi in Hungary.

[Nd. Yag treatment of bladder tumors]. / A hólyagdaganatok Nd. Yag lézer kezelése.

Between 1989 and 1992 116 patients suffering from tumours of the bladder were treated with Nd. Yag laser. In 74 cases only laser treatment was applied, in 42 cases the laser treatment was combined with transurethral resection (TUR). The patients were in the phases TA, T1, T2 and in the majority of them the histological examination did not reveal grade 3. No considerable complications, e. g. perforation of the bladder or important haemorrhages were observed during laser treatment. After laser and TUR + laser treatment, respectively, relapses occurred in 16-19% of the cases, considerably less than after treatment carried out with TUR exclusively.

Nd-Yag laser treatment of bladder tumours.

Between 1989 and 1992, 116 patients suffering from bladder tumours had been treated with Nd-Yag laser. In 74 cases only laser treatment was applied, in 42 cases laser treatment was combined with transurethral resection (TUR). The patients were in phases Ta, T1 or T2 and in the majority of them histological examination did not reveal Grade 3. No considerable complications, e.g. perforation of the bladder or severe haemorrhages, were observed during laser treatment. After laser and TUR+laser treatment, respectively, relapses occurred in 16-19% of the cases, considerably less frequently than after treatment with only TUR.

Uro-Vaxom and the management of recurrent urinary tract infection in adults: a randomized multicenter double-blind trial.

A total of 112 patients with recurrent lower urinary tract infection (UTI) completed the 6-month period of the trial. Patients were treated for 3 months, under double-blind conditions, with one capsule daily of either Uro-Vaxom (UV) or placebo, together with an antibiotic or chemotherapeutic agent when necessary, and observed for a further 3 months. During the 6 months of the trial a significant decrease in the number of recurrences (p < 0.0005) was noted in the UV group as compared to the placebo group. A total of 67.2% of the patients had no recurrences (p < 0.0005). The incidence of bacteriuria (germs > or = 10(5)/ml), dysuria and leukocyturia was significantly reduced. UV was well tolerated, no side effects were recorded during the trial. The drug is a useful adjuvant for the management of UTIs and for the prevention of recurrences.

[Indications for organ-conserving operations in cases of kidney tumors in the age of radical surgery]. / Szervmegtartó mütétek helye vesetumorok esetén a radikalitás korában.

The authors analyze the experiences of 29 operations of malign renal tumors, performed during the last 10 years conservating the organs. In 20 cases the conservation of the organ was indicated by necessity due to some diseases or the lack of the contralateral kidney, and in 9 cases due to the small extension of the tumor. The authors reveal their experiences on preoperative examinations; they discuss some questions of surgical techniques and describe their system of patient control. Based upon their experiences, in selected cases they consider indicated conservation of the organ, if the tumor can be extirpated ablastically.

Endoscopic diagnosis and therapy of urothelial tumours of the upper urinary tract (an analyses of our own cases with literary review).

The authors review the importance of ureteropyeloscopy and nephroscopy in the diagnostics and endoscopic treatment of urothelial tumours of the upper urinary tract, in view of their two-year experience and discuss indications and technical difficulties compared to those described in the literature. Practice is demonstrated with the description of two cases. Follow-up and care-tactics are detailedly described.

Evaluation of 1000 percutaneous nephrostomies with a special view to efficiency and complications.

The authors summarize the experience gained with 100 percutaneous nephrostomies including the evaluation of the efficiency of the applied technique, complications and the possibilities to decrease the number of complications in 900 nephrolithotomies. Discussing efficiency, they stress the importance of appropriate indication, to which low failure rate (3%) is attributed. In the prevention of complications accessories are of importance. Experience has shown that the number of perforations in the cavity system can significantly be decreased in multi-operated, cicatrized kidney--where perforations occur most frequently--with the use of the Amplatz dilator system. This type of dilator system is also recommended to unexperienced endoscopic specialists for use in primary cases. Favourable experience was gained with the use of the so-called swab balloon catheter in haemorrhages from nephrostomy. In the end they give a summary of the present fields of application of this technique and its role in the treatment of nephrolithiasis.

The development and progress of urology in Europe.

Based on the data of eminent European urologists, author gives an overview of the development of urology in Europe from the Ancient Times to our days. Reviewing the history, he has attempted to follow the simultaneous events in various countries. In discussing them, the most important events are highlighted. Such milestones in the history of urology were lithotomy and litholapaxy. He attributes no less importance to the development of the individual urological schools. He could not aim at completeness, since it was not easy to gather the historical data. At the end of the paper he expresses his thanks to all those who were of great help in compiling the data.

CO2 laser in surgery of the renal parenchyma. A preliminary report.

The experiences of renal parenchymal surgery performed by CO2 laser knife are reported. A short surgery is given of the preliminaries of the use of CO2 laser in urological practice and of the biological effects of the laser beam. The coagulating effect of the laser beam in the cases of nephrotomy, polar resection, heminephrectomy, adrenal resection and of cavernotomy was studied and the incision time of the parenchyma measured. The amount of blood lost comparing with that during traditional operative techniques, was found to be essentially smaller. It is stressed that, in some cases, the compression of the renal peduncle could be avoided. Favourable experiences were obtained with interventions on an inflamed renal substance. This paper has been intended to be a preliminary report, with the detailed histological and isotope functional examinations to be presented later.

The importance of closed bladder irrigation in prostatectomy.

Closed bladder irrigation in transvesical prostatectomy is an important factor in arresting bleeding and preventing or diminishing bacterial infection. A bladder irrigation of appropriate intensity may ensure that the blood clots be removed rapidly from the bladder and thereby the formation of larger clots and bladder tamponade can be avoided. The bacteriological examination of the eluents of 82 patients revealed that the longer the patient is maintained on a catheter, the longer bacteriuria and pyuria will persist. Two days are considered by the authors to be the optimal time of maintaining a closed bladder irrigation.

Percutaneous technique in the diagnostics and therapy of renal diseases.

Based on the literature and of their own experience, authors deal with the possibility of the percutaneous approach of renal diseases. Of the diagnostic and therapeutic interventions, they report their experience regarding percutaneous nephrolithotomic investigative methods employed in the differential diagnosis of renal masses. During a period of one-and-a-half years, percutaneous nephrostomy was performed in 130 cases, of them in 64 for removing stones. In 48 cases of renal tumours revealed to be cystous structures by ultrasonography, puncture controlled by ultrasound was made. Based on the cytological and chemical analyses of the samples obtained by puncture, exploration was made in 6 cases for suspicion of malignancy. The requirements of the application of the percutaneous technique is discussed.

Evaluation of imaging methods in the diagnosis of vesical tumours.

Literary data and personal experience furnished ground for assessing the value and determining the proper employment of imaging methods as used in the detection of bladder carcinoma. It seems highly advisable to perform native radiography and excretion urography. Upon the recording of a transabdominal echogram, intravesical ultrasonography, performed under narcosis simultaneously with biopsy and cystoscopy, constitutes an ideal complement to the latter and has proved to be the most effective diagnostic method to detect a carcinomatous infiltration of the bladder wall. Extravesical propagation is assessed with the help of CT whose degree of reliability increases in proportion with the progression rate of the tumour. Foot-dorsum type lymphography only visualizes juxtaregional lymph nodes, endovesical lymphography the regional ones. Additional modes of metastasis detection include chest X-ray, liver-spleen scintigraphy and bone scintigraphy. Uretero-entero-anastomosis must be preceded by irrigoscopy.

Electrical stimulation of the bladder and gravidity.

Following experimental investigations, the authors have performed bladder stimulator implantation for paralyzed bladder patients since 1969. Up to 1983 altogether 32 operations were carried out for bladder paralysis following 21 peripheral and 11 central neural lesions. The patients urinated without residue after the operation. The observations showed that regular use of the stimulator led to the elimination of reflux in patients who had vesicoureteral reflux before the operation. It was found that, if the stimulator had to be removed for any reason after a period of 1 or 2 years, the urinating ability was maintained. Of the 7 female patients operated, 2 became pregnant. During pregnancy and delivery, the patients did not experience any problem with the implanted stimulator, and the children were born healthy and at term.

[Value of ultrasonography in the diagnosis of bladder tumors]. / Der Wert der Ultrasonographie in der Harnblasentumordiagnostik.

The authors have compared the value of transabdominal, transrectal and intravesical ultrasonography in 100 patients with carcinoma of the bladder. They have also compared the pathological stage, determined at operation or post mortem, with the "ultrasound" stage. Transabdominal examination resulted in agreement in 61% cases, transrectal 69% and intravesical in 92%. In the authors' opinion, transabdominal ultrasonography is suitable for general orientation. It can determine the size and position of the tumour. Transrectal examination is particularly valuable if, for any reason, it is impossible to perform cystoscopy. It is also valuable for the examination of tumours localised at the bladder base. Intravesical sonography demonstrated the tumour in every case. During this examination, changes in the elasticity and distensibility of the bladder due to tumour and changes in the bladder volume can be determined. Intravesical ultrasonography carried out at the same time as cystoscopy is a rapid and highly practical procedure, which ideally supplements cystoscopy. At present it is the best method for demonstrating infiltration of the bladder wall.

Intravesical ultrasonography as an aid to study the size of bladder cancers.

On clinical examination of 50 patients with bladder cancer the authors performed intravesical ultrasonography. By this method they never failed to detect the tumours. The stage of the pathological material obtained by operation or at autopsy was compared with that obtained by the intravesical ultrasonography. In 88% of the cases the two classifications gave identical results. By ultrasonography the pathologic stage was overestimated in 4, and underestimated in 2 cases. Intravesical ultrasonography can be combined with cystoscopy. It is a fast procedure and an ideal supplement to cystoscopy. The combination of the two methods permits the localization of intravesical tumours as well as the estimation of invasion and of the degree of infiltration.

Ultrastructural investigations of undescended testicles.

In agreement with data in the literature it has been demonstrated that the degree of testis degeneration is directly proportional to the duration of cryptorchism. Though no changes relating tumour or precancerous state have been found, it is suggested--especially in the case of macroscopically intact contralateral testis--that semicastration should be done instead of forced orchidopexy. More examinations are necessary in order to form a final opinion.

Diverticulum of the female urethra: a report of 50 cases.

In the last ten years 50 patients were treated for urethral diverticulum. In contrast to data in the literature the condition does not seem to be infrequent. The main symptoms are recurrent or long persisting disorders of urine flow often accompanied by loin pain during coitus. Beside the history, the diagnosis is based on anterograde or retrograde cystourethrography, urethroscopy , catheterization combined with vaginal exposure and bimanual examination. In treatment, diverticulectomy is a simple and successful method without complications, always relieving the long persisting or recurring complaints.

One thousand cases of prostatectomy.

A survey of one thousand transvesical prostatectomies was conducted for studying occasional complications. An improved technique is recommended for the removal of adenomas, 30-40 g in weight or above. The number of complications showed a decline which, together with the possibility to reduce the operating and nursing periods, is attributed to some outstanding features of the method such as the use of continuous running haemostatic synthetic sutures for constricting the edges of the prostatic bed, the use of a three-bore catheter with its balloon located inside the bladder, rinsing the bladder system, ambulation on the first postoperative day, the application of absorbable synthetic sutures and the early removal of the catheter.

Paralimbic nephrotomy. Preliminary report.

This preliminary report discusses a method which unites the advantages of the surgical procedures introduced by Gil Vernet and Boyce for the transparenchymal removal of staghorn calculi. The significance of the length of the incision involving the parenchyma and the reduced thickness of the incised parenchyma are stressed. The urine collecting system (pyelocalyceal system) is explored through the renal pelvis making all the calyces well visible. Stones from the kidney can be removed and any anatomical alteration of the pyelocalyceal system is easily noticed. The worsening or improvement of the parenchymal function was assessed in gamma (ionization) chamber isotope studies and with intravenous urography. The restricted bleeding during the operation is attributed to the difference in blood supply between the limbus and other parts of the parenchyma.