An ureteric polyp removed by ureteroscopy.

A case of benign ureteric polyp resected in one piece endoscopically is reported. The authors emphasize the role of ureteroscopy in the differential diagnosis of ureteric tumours. Unnecessary nephroureterectomies or open explorations can be avoided by the use of this procedure.

Perineal prostatic cancer seeding following Urocut needle biopsy.

A case of perineal tumour seeding after needle core biopsy of prostatic cancer is presented. This rare complication of prostatic needle biopsy occurred following false-negative tissue sampling in a patient subsequently treated by irradiation therapy and total androgenic blockade.

[von Hippel-Lindau hereditary tumor syndrome. Mutational analysis may improve prognosis]. / von Hippel-Lindaus ärftliga tumörsyndrom. Mutationsanalys kan förbättra prognosen.

The von Hippel-Lindau disease is a familial tumour syndrome characterised by greatly increased risks of developing central nervous haemangioma, renal cell carcinoma, retinal angioma and pheochromocytoma. Carriers have inherited a mutated tumour suppressor gene located at chromosome 3p25-26. The VHL gene has recently been cloned, three exons identified and the DNA sequence determined. A Swedish kindred comprising four generations and 41 individuals was investigated. Three living individuals with clinically verified VHL disease demonstrated a single base deletion of a cytosine residue at position 761 of the VHL gene, corresponding to amino acid 254. Among the remaining family members, two asymptomatic carriers of this VHL mutation were identified and offered a clinical follow-up programme for early detection and treatment of future VHL manifestations.

Spontaneous rupture of an L-shaped kidney.

A case of spontaneous renal rupture caused by obstruction due to a ureteral stone in the L-shaped kidney of a young obese, diabetic man is reported. The role of CT beside excretory urography and ultrasound is emphasized in the diagnosis of crossed renal ectopia, and the transabdominal approach is recommended to resolve its complications needing operative management.

Splenic injury: a rare complication of percutaneous nephrolithotomy.

Splenic injury in the course of percutaneous nephrolithotomy is extremely rare. We report on a splenic perforation and subcapsular haematoma of a female patient who was treated for staghorn stone in the left kidney by percutaneous nephrolithotomy. The splenic injury without external bleeding was diagnosed by ultrasonography and computed tomography. The patient was subjected to splenectomy.

Spontaneous rupture of the kidney: a report on 5 cases.

Five cases of spontaneous rupture of the renal parenchyma are reported. Two patients had renal cell cancer, one sustained acute purulent pyelonephritis secondary to stone related ureteral obstruction, one suffered from aposthematous pyelonephritis without obstruction, while one had chronic pyelonephritis and a cortical cyst as probable predisposing factors. Aetiology and important points concerning diagnosis and therapy are discussed.

[Cystectomy in the management of bladder cancer]. / Cystectomia a hólyagrák kezelésében.

In the course of 20 years 83 patients with tumor of the bladder were treated by cystectomy. The infiltrations of the tumors were 14 pT1, 12 pT2, 44 pT3 and 13 pT4. There were metastatic regional lymph nodes in 11 cases (13%). The urinary diversions were 64 ureterosigmoidostomies, 18 ileal conduits and one cutaneous ureterostomy. The perioperative complication rate was 48% and mortality rate was 12%. The 3-year and 5-year survivals were 50% and 44.4%, respectively. Twenty three patients (28%) died as a result of cancer recurrence. Parallel with the increase in the depth of neoplastic bladder wall infiltrations increases were observed in the rates of lymph node metastates and tumorous mortality while a decrease of survival was noted. Owing to the observed significant differences in survival (3-year survivals 12/23 vs 0/4.5-year survivals 9/20 vs 0/2) and tumorous mortality (9/38 vs 4/6) of the T3a and T3b stage patients the authors think it has to be justified to separate the two patient groups as regarding therapy and prognosis. In T3a cases cystectomy is employed as monotherapy, while for T3b cases also adjuvant chemotherapy is recommended. The prognosis of tumors extending over the bladder wall is extremely poor. An exception to this in the bladder cancer infiltrating the prostate following whose extirpation authors have observed more than ten-year survivals in two cases.

Evaluation of 88 cystectomies for bladder cancer.

Cystectomies performed in 88 patients with bladder cancer in the course of 20 years had perioperative complications in 47%, mortality in 11%, with a decreasing tendency in the last 10 years. The extent of infiltration of the removed tumours was pT1 in 14 cases, pT2 in 14 cases, pT3 in 47 cases, and pT4 in 13 cases. Regional lymph node metastases were present in 11 cases (12.5%). Three-year survival was 50%, while five-year survival was 44.4%. Twenty-three patients (26%) died because of tumour recurrences. With increasing infiltration of the bladder wall lymph node metastases and tumour-related mortality also increased, while survival decreased. On the basis of the significant differences encountered in the survival and tumour-related mortality of patients with T3a and with T3b tumours, the distinction between the two groups with respect to therapy and prognosis is justified. In T3a tumours cystectomy is applied as monotherapy, while in T3b tumours adjuvant chemotherapy is also indicated. The prognosis of tumours extending beyond the bladder muscles is extremely unfavourable, with the exception of bladder cancers infiltrating the prostate, the removal of which may result in lasting survival in a part of the cases.

Transurethral resection of 1250 bladder tumours.

A total of 1250 bladder tumours were subjected to transurethral resection (891 curative, 107 palliative operations, 252 TUR biopsies). Complication rate was 9.9%, mortality rate 0.8%. In patients with primary tumours the 1-year recurrence rate after TUR was 23.8%, the 3-year rate was 36.6%, with an increase in proportion to stage. The 5-year survival rate was 66.5%. Within five years 9% of the patients died from tumour generalization, also with a rising tendency in proportion to stage. TUR as a curative method is suitable mainly for the removal of Ta and T1, under circumstances also of T2 G1-G2 tumours.

[A case of retroperitoneal fibrosis associated with renal angiomyolipoma]. / Retroperitonealis fibrózis és vese angiomyolipoma társult esete.

The authors performed intraperitoneal transposition of the right ureter in a patient who suffered from dilatation of the renal cavity-system due to retroperitoneal fibrosis. One and a half year later an angiomyolipoma was eliminated from the left kidney of the patient. Describing the associated occurrence of these 2 infrequent diseases the authors deal with the problem of etiology, diagnosis and treatment.

Local BCG therapy of superficial bladder tumours.

A total of 126 patients, whose superficial bladder tumours (Ta-Tl) had been removed by TUR, were subjected to local BCG therapy. Marked by frequent though mild side effects, they presented a significantly lower rate of tumour recurrence than the control group under exclusive TUR treatment. During a follow-up period of 3 years, 74% of the patients proved recurrence-free. BCG and Adriamycin were found largely similar in degree of effectiveness.

[Uterus-bladder fistula causing repeated spontaneous abortion]. / Ismételt spontán vetélést okozó méh--hólyag sipoly.

The case of an uterus--bladder fistula which developed after a Cesarean section and caused repeated spontaneous abortion is presented. With the already existing fistula dry labor was followed by the prolapse of the umbilical cord and finally by spontaneous abortion in the course of 2 successive pregnancies. As surgical solution hysterectomy and closing of the bladder fistula were carried out.

Diagnosis and treatment of inflammatory intestinovesical fistulas.

The histories of 3 patients operated for inflammatory intestinovesical fistulas are reviewed. Two of them were treated for colovesical, one for ileovesical fistula. The questions concerning the development, diagnostics and surgical management are discussed in detail. The importance of cystoscopy in diagnosis is emphasized. In all three patients one-session operations were performed with good results.

Local adriamycin treatment for prevention of recurrence of superficial bladder tumours.

Forty-nine patients with superficial Ta-Tl, G1-G2 vesical tumours were subjected to local Adriamycin treatment. Following transurethral resection (TUR), 50 mg doses of Adriamycin in 50 ml physiological salt solution were instilled into the bladder 4 times at intervals of one week and then 12 times at intervals of one month (i.e. a total of 15 times). Upon exclusion of two patients who failed to appear at follow-ups and one more in whom treatment was discontinued because of side effects, the remaining 46 were followed up cystoscopically for 2 years at intervals of 3 months. The recurrence rates of 12% and 24% for the primary and secondary tumours, respectively, were found to be significantly lower than those found in the control group (37% and 65%).