An unusual cause of ureteral obstruction in a renal transplant recipient: ureteric aspergilloma.

Mycotic infections in various organ transplant recipients represent severe and often fatal complications. Aspergillosis isolated from the urinary tract occurs quite infrequently in renal transplant recipients. Besides, fungus balls are rare causes of ureteral obstruction. We report a 51-year-old patient with the diagnosis of ureteral obstruction caused by aspergillosis in the early post-renal transplant period, who unfortunately died with the clinical picture of disseminated infection and its complications.

Diabetic ketoacidosis following development of de novo diabetes in renal transplant recipient associated with tacrolimus.

Although drugs used in renal transplant recipients such as steroids, cyclosporine, and particularly, tacrolimus have diabetogenic potential, diabetic ketoacidosis is uncommon. There are few data concerning the long-term follow-up of these patients. Diabetic ketoacidosis occurred in a renal transplant recipient following de novo development associated with tacrolimus.

Role of ejaculation in the treatment of chronic non-bacterial prostatitis.

BACKGROUND: Chronic non-bacterial prostatitis (NBP) is the most common prostatitis syndrome. Prevention and cure are not possible because the cause of NBP is unknown. However, patients may benefit from supportive measures. The impact of the frequency of ejaculation alone on the course of NBP was evaluated in the present study. METHODS: Thirty-four single male patients who avoided masturbation and extramarital sexual intercourse for personal and/or religious beliefs and who did not respond to a clinical trial of doxycycline hydrochloride therapy (200 mg daily for 4 weeks) directed against mycoplasmas, chlamydiae and ureaplasmas were enrolled in the study. They were encouraged to masturbate regularly at least twice a week and were re-evaluated at the end of a 6 month period, including a complete inquiry regarding their sexual function during this time. Response was assessed by a symptom severity index. RESULTS: Clinical and laboratory re-evaluation could be performed in 28 patients. Of 18 patients who adhered to the recommendations, two (11%) experienced complete relief of symptoms, whereas six (33%) had marked improvement, six had moderate improvement and four (22%) did not benefit. In contrast, three of seven patients who masturbated less frequently reported partial improvement. Three patients who did not ejaculate other than during wet dreams had a worse prognosis. CONCLUSIONS: Young men who are single and suffering from NBP must be informed about their illness in detail and, if they are not doing so, they should be encouraged to ejaculate regularly, for example by masturbation in the absence of a sexual relationship with a partner. We believe that normal sexual activity decreases the incidence of NBP in some cases.

Renal cell carcinoma with solitary synchronous pancreaticoduodenal and metachronous periprostatic metastases: report of a case.

We report herein the case of a patient who underwent successful resection of a solitary metachronous periprostatic metastasis 12 months after undergoing a right radical nephrectomy with pylorus-preserving pancreaticoduodenectomy for renal cell carcinoma (RCC) with a synchronous pancreaticoduodenal metastasis. At present the patient is free of any signs of recurrence 12 months after removal of the metachronous mass in the periprostate. This case report supports the opinion that an aggressive surgical approach is appropriate for RCC metastasis.

Pneumatic lithotriptor--a useful tool for challenging renal stone surgery.

Open surgical measures may be undertaken in the treatment of some complex calculi and manoeuvres such as extended pyelolithotomy or nephrolithotomy may be necessary. In an attempt to improve surgical results with less morbidity and maximum ease, we used the Swiss Lithoclast to disintegrate large stones presenting as hard cases. Five patients with renal pelvic stones associated with calyceal stones in two and two further cases with staghorn stones were treated surgically using the pneumatic lithotriptor probe with less dissection and without nephrotomy. Only one of the patients with staghorn stones had residual fragments which were then treated with ESWL. We believe that when open surgical treatment is considered in hard cases, especially in those with small renal pelvises, the best results may be achieved with minimum surgical intervention if it is combined with pneumatic lithotripsy.

A very long foreign body in the bladder.

We report on a 58-year-old man in whom a very long rubber catheter was self-inserted for the purpose of increasing rigidity during erection. Eight years elapsed between insertion of the catheter and its retrieval. The foreign body was removed from the bladder by endoscopy.

Percutaneous suprapubic transvesical route: a new and comfortable method of intraprostatic injection.

To assess the efficacy and safety of the percutaneous suprapubic transvesical route (STR) for intraprostatic antibiotic injections and compare it with the transperineal route (TPR), a total of 37 patients suffering from chronic bacterial prostatitis, resistant even to treatment with fluoroquinolones, were randomized to intraprostatic amikacin injections using either STR (n = 19) or TPR (n = 18). Follow-ups were done at weeks 4, 12, 24 and 52. Patients found to have failures at the first follow-up were given an additional injection using the initial route. At the 24th week, 15 patients from both groups were given another injection using the alternative route and were asked to report any subsequent voiding difficulties and compare the discomfort and pain experienced. At the end of 52 weeks, bacteriological cure rates did not differ significantly (44.4 vs. 47.3%). Overall improvement rates in the severity of symptoms and signs were similiar. Considerable difficulty in directing the needle to the prostate due to an excessive amount of subcutaneous fat was experienced, and more than 1 skin puncture was necessary in 5 of the STR group, whereas in the TPR group 7 patients with external hemorrhoids and 1 patient with a rectal fissure had prominent discomfort and pain during the transperineal procedures. Complications such as dysuria or hemospermia were encountered infrequently in both groups, but hematuria was observed more frequently in the STR group (85 vs. 54%). Less discomfort (p < 0.01) and pain (p < 0.01) were reported during access to the prostate by STR, but pain during the injection of the drug did not differ significantly. In conclusion, the percutaneous STR may well be used efficiently and comfortably as an alternative method to TPR when intraprostatic injections are needed in a limited number of cases such as those with a known hypersensitivity to fluoroquinolones or with a history of failure despite long-term systemic treatment with these agents.

The effects of ejaculation on serum prostate-specific antigen (PSA).

To determine the effects of ejaculation on serum PSA, we measured serum levels just before masturbation and 24 hours and 5 days later in a study group (n=25) aged between 23 and 25 years. In the study group, 16 cases showed a decrease (mean 22.37%, range 10-50%) in serum PSA levels 24 hours after ejaculation, while 6 had higher levels (mean 38.33%, range 21-67%) and 3 had no changes. No relation was found between seminal plasma levels or total amounts expelled of this marker and the difference in serum levels due to ejaculation. In the control group free of ejaculation in the same period determinations of serum PSA levels revealed no significant changes between days 0, 1 and 5. As compared with the control group, the changes in the study group were found to be statistically insignificant. These results may indicate that ejaculation has an insignificant effect on serum PSA levels.

Intracorporeal pneumatic lithotripsy for ureteral and vesical calculi.

To evaluate the effectiveness of pneumatic lithotripsy, 92 patients with 98 lower or mid-ureteric calculi and 8 with vesical calculi were treated with pneumatic lithotripsy (Swiss Lithoclast) under spinal anaesthesia. Successful stone fragmentation was achieved in 96 patients. In two patients their stones migrated to the upper ureter and renal pelvis during the procedure and so they were referred for extra corporeal shock wave lithotripsy. Total ureteral avulsion occurred in one patient and in another case attempts to dilate the stenotic ureteral orifice failed. In both cases, ureterolithotomy and ureteral reimplantation were performed. Pneumatic lithotripsy is found to be an easy, reliable and cost-effective method of endoscopic lithotripsy.