Jacob Kaneti

Leiomyoma of the Genitourinary Tract

OBJECTIVE To review our experience and the literature with respect to leiomyomas of the genitourinary tract with special emphasis on the role of the clinical presentation and imaging studies in the differential diagnosis. MATERIAL AND METHODS During a period of 35 years in our department, five patients were treated with symptomatic leiomyomas, originating from the renal pelvis, bladder, urethra and epididymis. All the cases were diagnosed after exploration, excision and histological examination of the specimen. Following the presentation of the five cases of leiomyomas of the genitourinary tract, we reviewed the literature with special emphasis on the modern imaging techniques, differential diagnosis and treatment approach. CONCLUSION Complete excision followed by histological examination is the most reliable means of distinguishing leiomyoma from other more common and usually malignant tumors of the genitourinary tract.Objective: To review our experience and the literature with respect to leiomyomas of the genitourinary tract with special emphasis on the role of the clinical presentation and imaging studies in the differential diagnosis. Material and methods: During a period of 35 years in our department, five patients were treated with symptomatic leiomyomas, originating from the renal pelvis, bladder, urethra and epididymis. All the cases were diagnosed after exploration, excision and histological examination of the specimen. Following the presentation of the five cases of leiomyomas of the genitourinary tract, we reviewed the literature with special emphasis on the modern imaging techniques, differential diagnosis and treatment approach. Conclusion: Complete excision followed by histological examination is the most reliable means of distinguishing leiomyoma from other more common and usually malignant tumors of the genitourinary tract.

Gonadotropin-Releasing Hormone Specific Binding Sites in Normal and Malignant Renal Tissue

Renal cell carcinoma has been reported to contain estrogen and progesterone receptors. Thus, it has been suggested that these tumors are hormone dependent in a similar manner described for the breast and prostate cancers. It has been recently shown that mammary and prostate tumor cells contain gonadotropin-releasing hormone (GnRH) receptors and are growth inhibited directly by GnRH antagonists. In this study we examined for the presence of GnRH, estrogen and progesterone receptors in normal and malignant renal tissues. Estrogen receptors were found both in the normal and malignant kidney while progesterone receptors were present only in the normal tissue. Specific binding of [125I]buserelin, a GnRH agonist, was evident in renal carcinoma and in normal kidney and was displaced with equal efficiency by unlabeled buserelin and by D-Trp6-GnRH, but not by unrelated peptides such as thyrotropin releasing hormone and oxytocin. The non-linear scatchard curve obtained for buserelin binding, suggests the presence of at least two binding sites, one with high affinity in the nanomolar range and another in the micromolar range.

Influence of Age on the Prognosis of Patients with Renal Cell Carcinoma (RCC)

Objective: Aim of this study was to analyze the prognostic value of age in patients with renal cell carcinoma (RCC). Patients and Methods: A group of 15 patients (age ≤ 40 years, group I) and a group of 103 patients (age ≧ 50 years, group II) with sporadic RCC who underwent radical nephrectomy between 1985 and 1997 were compared. The two groups were analyzed with respect to histologic cell type, tumor grade, stage and outcome. Results: In group I low-stage tumors (stage I and II) were diagnosed in 93% of patients and in group II in 65% of the patients (p = 0.017). High-grade tumors (stage III and IV) were diagnosed in 7% and 35% of patients in group I and group II, respectively (p < 0.01). In group I only one patient (7%) with stage II disease died of cancer. In group II the distribution of cancer-specific mortality was as follows: 6 patients (100%) with stage IV, 13 patients (42%) with stage III, and 12 patients (17%) with stage I and II died of disease. The 5-year-survival in group I was 93% and in group II was 77% (p = 0.05). Conclusion: According to our data we conclude that RCC is diagnosed at a lower stage in young patients than in the older patient group. RCC may exhibit a more favorable prognosis in young patients, possible due to the lower stage at time of diagnosis.

Spontaneous perirenal hematoma: a complication of polyarteritis nodosa.

Polyarteritis nodosa is a rare cause of perirenal hematoma owing to rupture of 1 of the aneurysms. Eleven cases have been reported previously in the English literature, including 5 with a preoperative angiographic diagnosis. Our case, which was diagnosed angiographically before a successful conservative operation, is the first report of a patient who survived 3 years. The pathology is discussed.

Non contrast Computerized Tomography and Dynamic Renal Scintigraphy in the Evaluation of Patients with Renal Colic: Are Both Necessary?

OBJECTIVES To determine the value of the combined use of non contrast computerized tomography (NCCT) and dynamic renal scintigraphy (DRS) in the evaluation of patients with renal colic. METHODS Forty-nine consecutive patients with renal colic were evaluated with abdominal plain films (KUB), NCCT and DRS with Tc-99m DTPA or MAG-3. NCCT results showed size and location of the urolithiasis, as well as secondary signs of obstruction. DRS was used to determine the degree of obstruction in the affected renal unit. Patients were submitted to urologic intervention or followed, decision made on the basis of clinical symptoms, degree of obstruction, size, and location of the stone. RESULTS Three patients had other etiologies than stone for their symptoms and were excluded from the study. Of the remaining 46 patients, KUB detected stones in 24 (52.2%), while NCCT in all. NCCT showed secondary signs of obstruction in 35 patients (76%). Seven patients in this group (15%) had severe hydronephrosis on NCCT and complete obstruction on DRS. Twenty-eight patients (61%) showed moderate hydronephrosis and/or peri-renal and peri-ureteral stranding on the NCCT. In this latter group, DRS diagnosed complete obstruction in 5 (18%) patients, partial obstruction in 16 (57%) and no signs of obstruction in 7 (25%) patients. Overall 34% (12/35) of the patients with secondary signs of obstruction on NCCT had complete obstruction on DRS. NCCT revealed no secondary signs of obstruction in 11 patients (24%) with partial obstruction diagnosed by DRS in one of them (9%). All 12 patients with complete obstruction on the DRS underwent early intervention. Of the 16 patients with partial obstruction of the DRS, two patients (12.5%) necessitated ureteric stent insertion. Three patients with no obstruction on the RNS underwent elective extracorporal shock wave lithotripsy (ESWL) while the rest of the patients were followed and passed their stones spontaneously. CONCLUSIONS The combination of non-enhanced helical CT and DRS assesses both anatomy and function. When NCCT shows no secondary signs of obstruction, NCCT as the sole imaging study performed may be adequate. If there are secondary signs of obstruction on NCCT, DRS can distinguish patients with different degrees of obstruction and together with the clinical course, size, and location of the lithiasis may help in selecting patients who need earlier intervention from those who may be safely observed.

POSTERIOR URETHRAL VALVES AND VESICOLITHIASIS IN CHILDREN

Although posterior urethral valves is a well known and important entity in paediatric urology, its association with bladder calculi is not well documented and this condition is not discussed commonly in the literature. Association between posterior urethral valves and vesicolithiasis is presented in three children.

Carcinoma of the bladder in patients under 25 years of age

A review of our records between 1971 and 1995 identified 6 patients (4 male and 2 female) with transitional cell carcinoma of the bladder who were less than 25 years of age (mean age 18.6, range 10-22). Five patients presented with gross haematuria, one with microscopic haematuria, and two presented with recurrent urinary tract infection. All tumours were low grade and low stage and were associated with excellent prognosis. Transurethral resection or fulguration was the treatment of choice. This study supports the contention that transitional cell carcinoma of the bladder is a less aggressive disease in patients under 25 years of age.

Fibroepithelial polyp of the renal pelvis.

Benign tumors of the renal pelvis are rare, with less than 10 cases reported in the literature. The fibroepithelial polyp, a benign mesodermal tumor, seems to be the most common type. We report a case of a fibroepithelial polyp of the renal pelvis, and discuss its clinical features and diagnostic pitfalls.

Congenital anterior urethral diverticulum.

Congenital anterior urethral diverticulum (CAUD) was diagnosed in 7 male subjects, of whom 3 cases were neonates, 3 cases were school aged and 1 case was adolescent. Varying degrees of urinary obstruction, often associated with urinary tract infection, were the main presenting symptoms. Urinary ascites, a rare manifestation of CAUD, was presented in a neonate associated with severe upper urinary tract changes. In 6 cases the diverticulum was of the wide-mouthed saccular type, and in 1 case of the narrow neck globular type. The clinical presentations, methods of diagnosis and the treatment modalities are discussed.

Malignant Fibrous Histiocytoma of the Spermatic Cord

We report a case of malignant fibrous histiocytoma of the spermatic cord and review 11 previously reported cases. Radical orchiectomy along with wide local excision is the treatment of choice. The rate of local recurrences and distant metastases is 33 per cent (4 of 12 cases) and the 5-year survival rate is 57 per cent (4 of 7 cases).