Carlo Fiorelli

Surgical treatment of rectourethral fistulae.

9 male patients with rectourethral fistula were treated. Fistulae were congenital in 1 case, iatrogenic in 6 cases and traumatic in 2 cases. In 8 cases we used an abdominoperineal approach with omentoplasty or peritoneal flap; in 1 case a perineal approach was made. In 2 cases it was also necessary to use a transpubic approach to the posterior urethra. Good results were obtained in all cases. The importance of a proper radiological investigation of the fistulous tract and the use of omentoplasty are both emphasized.

Selective Transcatheter Arterial Embolization of Renal Carcinoma: An Original Technique

The association of pharmaco-angiography with norepinephrine and transcatheter arterial embolization is a technique used to obstruct arteries invaded by renal carcinoma. We treated 4 patients with this method before nephrectomy and recommend its use as a complement to an operation for renal carcinoma or as definitive treatment in poor surgical candidates.

Ureteral Intussusception by a Fibroepithelial Polyp

Abstract We report a case of ureteral intussusception caused by a fibroepithelial polyp as a result of forced mucosal sliding. Renal colic was the presenting symptom. Radiologically, it appeared as a pyeloureteral junction obstruction. Pyeloureteral resection was done.

Arteriovesical fistula after ureterolithotomy: a case report and review of the literature.

A case is reported of massive recurrent hematuria after ureterolithotomy caused by a fistula between a branch of the hypogastric artery and the bladder.

Elective treatment of ureteral stones with extracorporeal shock wave lithotripsy.

Extracorporeal shock wave lithotripsy was used as an elective treatment in 128 ureteral stones. Of the 108 with adequate follow-up, 88% were successfully disintegrated. Ureteral catheters proved to be particularly useful for more precise stone localization and as a mechanical means to push the calculi inside the renal cavities or to create a fluid interface around them, in order to increase the efficiency of the shock waves. When ureteral catheters were used a success rate of 95.5% was observed, as opposed to 82.8% when stents were not used (p less than 0.05).

Experimental ureteral replacement with a vascularized gastric tubule.

Total ureteral substitution had been performed with a pedicled gastric flap shaped as a tubule in 6 dogs. No dilatation was found at X-ray controls. No metabolic changes were recorded. The HCl secretion diminished the possibility of an infecting reflux.

CYCLOPHOSPHAMIDE, EPIDOXORUBICIN AND CARBOPLATIN AS TREATMENT FOR ADVANCED-CARCINOMA OF THE BLADDER - A PHASE-II STUDY

In advanced carcinoma of the bladder, the M-VAC chemotherapy schedule can yield positive results, but at the cost of very high toxicity. Recent studies have shown epidoxorubicin and to a lesser degree, carboplatin to be active against urothelial tumors, with cardiac, haematological and renal toxicity lower than that observed with CISCA or M-VAC chemotherapy regimens. In this study, we determined the toxicity and efficacy of cyclophosphamide 400 mg/m(2), epidoxorubicin 75 mg/m(2) and carboplatin 300 mg/m(2) in a 28-day course. From February 1990 to December 1991, we enrolled 33 advanced bladder cancer patients (25 males, 8 females), mean age 63 years. 31 patients were evaluable for toxicity and response. The major disease localizations were: locoregional 15 (48%), lymph nodes 6 (20%), liver 5 (16%), lung 3 (10%) and bone 2 (6%). A total of 186 cycles of therapy were administered, with a mean of 5.4 per patient. Six patients (19%) had a complete response (CR): 2 locoregional, 3 lymph node and 1 lung. Eleven patients (36%) had a partial response (PR), for an overall response rate of 55%. The median duration of response was 53 weeks and median survival for the entire group of patients was 40 weeks. No delays or interruptions due to sepsis occurred during therapy; haematological, cardiac and renal toxicity were below WHO grade 3. The efficacy of this chemotherapy regimen proved to be comparable to that of more aggressive schedules, while its toxicity was markedly lower.

Value of Stents in Management of Ureteral Stones with Extracorporeal Shock Wave Lithotripsy

Extracorporeal shock wave lithotripsy was used as an elective treatment in 292 stones located in the upper two-thirds of the ureter and in 103 patients with stones located below the iliac crest. Ureteral stents were used in 192 cases of upper ureteral stones, and these stents proved particularly useful for precise radiological stone localization, as a mechanical means to create a fluid interface around the stone, and as a means of pushing the stone into the kidney. A statistically significant difference was observed for calculi treated in situ without stent (85% stone free) v those relocated in the pyelocalyceal system (97.5% stone free, p < 0.02).

Coexistence of Renal Artery Stenosis and Ureteropelvic Junction Obstruction in Hypertensive Patients With Elevated Renin

Two hypertensive patients with elevated renin presenting with renal artery stenosis and ureteropelvic junction obstruction are reported. Nephrectomy was successful in 1 patient and the other patient was treated wiht renal autotransplantation and dismembered pyeloplasty. The diagnostic and therapeutic problems of coexistent renal lesions are discussed.

Visualization of paravesical lymphatics by direct injection of contrast medium

Abstract Several contrast media were injected endoscopically into the bladder of 10 patients. Satisfactory visualization of the paravesical lymphatics occurred in some cases. This was due to the physical properties of iodine compounds and their degree of lymphatic absorption.