Irwin N. Frank

Intravesical formalin for hemorrhagic cystitis: analysis of therapy.

In an extensive search of the literature 235 cases of intractable hemorrhagic cystitis treated with intravesical formalin were identified. Effectiveness of therapy, rate of recurrence of hematuria, morbidity and mortality were analyzed with respect to concentration of formalin and to the etiology of hematuria. Increasing concentrations of formalin slightly improved effectiveness of therapy and reduced the rate of recurrence of hematuria. However, this often resulted in an increase in morbidity. When patients were categorized according to the etiology of intractable hematuria it was noted that lower concentrations of formalin were effective in controlling hematuria caused by either cyclophosphamide cystitis or unresectable carcinoma of the bladder. In contrast, higher formalin concentrations were required to control bleeding due to radiation cystitis.

Diagnosis of Nonopaque Calculi by Computed Tomography

Computed tomography can aid in the distinction of calculi from both tumors and clots in the urinary tract. Its availability, simplicity of interpretation, and noninvasiveness establish it as an important diagnostic modality in selected cases when calculus is in the differential diagnosis of upper urinary tract filling defects.

Primary localized amyloidosis of urinary bladder

Primary localized amyloidosis of the bladder is rare. Two new cases are presented, and 44 cases from the literature are reviewed. The disease tends to occur in a younger age group in men than in women. It presents most frequently with gross painless hematuria, and usually appears at cystoscopy as a tumefied, yellowish, and occasionally ulcerated lesion. The amyloid deposits usually involve suburothelial connective tissue, suburothelial vessels, and less markedly the vesical muscularis. The treatment varies from transurethral resection to total cystectomy with urinary diversion. Transurethral resection appears to be the treatment of choice, if feasible. Close follow-up of the patient is necessary because of the frequency of multiple recurrences, which may require an ablative procedure.

DNA cytometry and chromosome 9 aberrations by fluorescence in situ hybridization of irrigation specimens from bladder cancer patients

OBJECTIVES To determine the sensitivity and specificity of combining fluorescence in situ hybridization (FISH) measurement of chromosome 9 and DNA cytometry of bladder irrigation specimens in the detection of bladder cancer. METHODS Bladder irrigation specimens were obtained from 37 normal control patients and 317 bladder cancer patients during cystoscopic examinations. Bladder cancer patients were sampled in the absence of observable tumor (256 specimens) and concurrently with tumor (204 specimens). Chromosome 9 copy number was determined on a cellular basis by FISH, and cellular DNA content was determined by Feulgen DNA staining and image cytometry. RESULTS Sensitivity of chromosome 9 FISH was 42% for all tumors and was not correlated to transitional cell carcinoma tumor grade, while the sensitivity of DNA cytometry was 55% and improved with increasing grade from 38% for grade 1 to 90% for grade 3 tumors. The results of FISH and DNA cytometry were combined, resulting in specificity of 92% and sensitivity of 69% for grade 1, 76% for grade 2, and 97% for grade 3 tumors. CONCLUSIONS The lack of increase with grade in the percentage of positive specimens by FISH supports the hypothesis that chromosome 9 aberrations are critical events in bladder tumorigenesis for many patients. These data demonstrate the presence of cells in irrigation specimens with specific genomic lesions of chromosome 9 and DNA content. Combining FISH on chromosome 9 and DNA cytometry provides an increase in sensitivity to transitional cell carcinoma over either test alone.

Leydig cell tumor of testis

In adult patients with Leydig cell tumor of the testis, endocrinologic signs occur in 30 per cent of the cases and often precede the onset of a palpable testicular mass. Gynecomastia is the most common endocrinologic manifestation and probably is due to increased estrogen secretion by the Leydig cells. In the patient with adrenogenital syndrome and testicular enlargement it is difficult to distinguish Leydig cell tumor from adrenal rest hypertrophy. Four patients with Leydig cell tumor and endocrinologic manifestations are discussed; three are adults who presented with gynecomastia and the fourth is a patient with congenital adrenogenital syndrome. In the adult patient inguinal orchiectomy is the treatment of choice, while in the patient with adrenogenital syndrome initial management by high-dose steroid suppression should be attempted prior to testicular exploration.

Blunt renal trauma in the pediatric patient

Injury to the kidney from blunt trauma occurs rather frequently in the active, pediatric patient. Early evaluation and treatment of these children is essential in order to preserve maximum renal function. Ninety cases of pediatric renal trauma from blunt injury have been reviewed. The majority of these responded well to careful conservative, non-operative management. Many of those requiring surgical intervention responded well to initial conservative treatment followed by surgical intervention conducted as an elective procedure within the first week after injury. Five case reports with associated radiographic studies are presented.

Percutaneous Nephropyelostomy in the Management of Acute Pyohydronephrosis

Percutaneous nephropyelostomy using the posterolateral approach was employed together with antibiotics and other supportive therapy as the initial step in the treatment of acute pyohydronephrosis, with gratifying results. Percutaneous nephropyelostomy is recommended as the procedure of choice for this specific clinical emergency.

Percutaneous Aspiration in the Treatment of Renal Abscess

The conventional treatment of a renal abscess has been surgical exploration, drainage and marsupialization of the cavity. There have been isolated reports in the literature regarding the successful use of systemic antibiotics alone in the management of patients with renal abscesses. We report a case in which percutaneous aspiration of a renal abscess led to successful non-operative management. In addition, 4 previously reported cases of renal abscesses treated with this modality are analyzed.

Recent Advances in the Diagnosis and Management of Blunt Renal Trauma

Experience with 207 cases of blunt renal trauma is reviewed. We have found that renal scans and selective renal arteriography are the most informative diagnostic tests. However, in a small community setting we suggest use of an infusion urogram and a retrograde pyelogram. Our accuracy rates with these 4 diagnostic tests are listed and selected cases are illustrated. We believe that if exploration is warranted, kidney salvage rates will be improved because of an accurate assessment of the extent of renal injury.

Trilaminar musculature of submucosal ureter Anatomy and functional implications

Abstract The musculature of the ureterovesical junction was studied by dissection and histologically in man, dog, cat, and rabbit. It was found that the segment of the ureter so far known as “submucosal” is crossed as far as the ureteral orifice by vesical muscle bundles, the transureteral bundles. The musculature of the roof of the “submucosal” segment has a trilaminar arrangement, consisting of the transureteral bundles, deep periureteral sheath, and ureteral muscularis. This arrangement, which has not previously been described, exists also in relation to the intramural segment. Transverse muscle fascicles are constantly found in the superior lip of the ureteral orifice. No true space exists anywhere in the ureterovesical junction. The physiologic and clinical implications of these findings, particularly in relation to vesicoureteral reflux, are discussed.