Ossi Lindell

The Occurrence of Vasculitis in Perianeurysmal Fibrosis

The histological findings of retroperitoneal fibrosis in 17 operated patients are described. Of these patients 6 showed a simultaneous aneurysm of the abdominal aorta verified either by computerized tomography, ultrasound, arteriography or during an operation. Of the patients 14 were operated on primarily because of ureteral obstruction, 2 because of aortic aneurysm and 1 because of rupture of the abdominal aorta. Advanced fibrosis with varying amounts of inflammation was detected in all 17 patients. The same histological pattern was present in patients with aneurysm of the abdominal aorta and in those without aneurysm. Accompanying vasculitis with destruction of the vascular wall was noted in 8 patients, including 6 with an abdominal aortic aneurysm. In 3 patients who underwent aneurysm resection as well as in 1 patient with aortic rupture the process extended into the aortic wall. The only patient with vasculitis and no aortic process suffers from severe rheumatoid arthritis. On the basis of the different histological findings we suggest that retroperitoneal fibrosis with vasculitis and aneurysm may represent a distinct pathological entity.

Urethral stricture repair : results in 179 patients

From 1977 till April 1990 169 operative reconstructions of urethral strictures were carried out in this clinic. 49 patients with a short stricture (less than 2 cm) underwent excision and end to end anastomosis. In 18 patients with a long stricture (2-6 cm) one stage urethroplasty with a transverse distal penile or preputial island of skin flap was used. 102 patients with extensive or otherwise problematic strictures were subjected to two-stage mesh skin graft urethroplasty. In 10 patients with a short stricture we have recently implanted a new urethral stent in the strictured area after visual urethrotomy. During a long-time follow-up a good anatomical and functional result was achieved in all but 2 patients who underwent an excision and end to end anastomosis. In the island flap urethroplasty group a restricture occurred in one patient, and mesh graft urethroplasty was successful in all but 3 patients. In the urethral stent patients the primary results are excellent.

Detection of messenger RNA for the β-subunit of chorionic gonadotropin in urinary cells from patients with transitional cell carcinoma of the bladder by reverse transcription-polymerase chain reaction

We studied whether detection of messenger‐RNA (mRNA) for the beta‐subunit of chorionic gonadotropin (CGβ) in urinary cells from bladder cancer patients could be used as a marker of disease activity. Sixty‐eight urine samples from patients under follow‐up for bladder cancer and 23 samples from patients with other malignancies and non‐malignant surgical conditions, as well as 14 samples from healthy controls were analyzed. RNA was isolated from urinary cells collected by centrifugation. Reverse transcription‐polymerase chain reaction (RT‐PCR) was used to detect CGβ mRNA. The results were compared to those obtained by cystoscopy and urinary cytology. For comparison, we determined CG and CGβ in serum and urine and the core fragment of CGβ (CGβcf) in urine by immunofluorometric assays. CGβ mRNA was detected in 29 of 68 urine samples from patients with a history of bladder cancer, whereas all 14 samples from healthy controls tested negative. Elevated levels of CGβ were observed in serum in 18 of 45 bladder cancer patients, but the association with CGβ mRNA was weak. However, CGβ mRNA expression in the absence of detectable cancer also occurred in some conditions associated with cellular atypia such as urinary tract infection, instrumentation and certain therapies. There was a highly significant association between histologically verified transitional cell carcinoma of the bladder and CGβ mRNA in urine (p = 0.0014), implying CGβ mRNA expression in tumor tissue. We conclude that CGβ mRNA is a potential new marker for monitoring of bladder cancer. Further studies are needed to evaluate whether it provides independent clinical information. Int. J. Cancer (Pred. Oncol.) 84:304–308, 1999.

Radical Prostatectomy for Localized Prostatic Carcinoma in a Renal Transplant Patient

Long-term immunosuppression increases the incidence of many forms of malignancies. We present a case report of a renal transplant patient who developed a prostatic cancer 4 years after transplantation. Radical prostatectomy is a suitable option in the treatment of localized prostatic cancer in a renal transplant patient.

Metabolic evaluation and medical management of upper urinary tract stone disease. Guidelines from the Scandinavian Cooperative Group for Urinary Stones.

A set of simple guidelines for metabolic evaluation and medical/dietary management of patients with urolithiasis is presented. The evaluation scheme is based on the documented risk factors in the Nordic area and the results of controlled clinical trials, and takes its basis in the severity of the stone disease in the individual stone patient. The initial evaluation in all patients aims at diagnosing conditions with a definitive metabolic, infectious or anatomical/functional cause of stone formation (MIAF urolithiasis). Patients with MIAF urolithiasis are treated according to the nature of the underlying disease. Having excluded/diagnosed MIAF urolithiasis, patients with idiopathic calcium nephrolithiasis remain, and in this group, which comprises approximately 85% of the total stone population in the Scandinavian region, only those with a complicated stone disease are subjected to additional evaluation, which aims at identifying underlying pathophysiological derangements for which medical therapy has been proven to be effective in controlled clinical trials.

Neurofibromatosis of the Bladder

Multiple neurofibromatosis, von Recklinghausens disease, is a rare disease of the neurilemmal cells. It is an inherited disorder transmitted as a mendelian dominant and characterized by multiple subcutaneous tumours and café-au-lait spots. The first time its symptoms were described was by Smith in 1849.

A New System for Descriptive Classification of Stones in the Upper Urinary Tract

A descriptive classification is proposed to stratify upper urinary tract stones by their number, size and location. The system considers the minimal but most important factors regarding the choice of surgical treatment and its success. Its principle is adaptable to more complex staging systems already existing. Practical use of the system has shown it to reflect clinical events, and its simplicity offers an opportunity for compliance in routine clinical study. It facilitates easy computerized stratification of stones in the upper urinary tract.

Opposite renal Pelvic metastasis of renal adenocarcinoma

We report on a 72-year-old patient who was nephrectomized because of renal adenocarcinoma and who developed five years later a tumour in the contralateral renal pelvis. Histological study of the completely resected tumour revealed a metastase from the renal cell carcinoma. A short review of the literature concerning the rare cases of contralateral renal pelvic or ureteral metastases of renal carcinoma is made

Reconstructive urology in the nordic countries--a hospital questionnaire survey.

A hospital survey of adult reconstructive urologic surgery in the Nordic countries is presented. The response rate was 80% and included most general hospitals and university clinics. Despite similarities between the healthcare systems of the various countries several differences were found. Cystectomy was performed in a large number of institutions in all countries except Denmark. The annual number of orthotopic bladder substitutions per institution was calculated as three to four (range of medians for each country) and the number of continent cutaneous diversions as two to seven. Open urethral procedures were performed more frequently in Sweden than in the other countries. Surgery for penile curvature and implantation of three-component prostheses for erectile dysfunction was more commonly performed in Denmark and Iceland compared to Sweden.A hospital survey of adult reconstructive urologic surgery in the Nordic countries is presented. The response rate was 80% and included most general hospitals and university clinics. Despite similarities between the healthcare systems of the various countries several differences were found. Cystectomy was performed in a large number of institutions in all countries except Denmark. The annual number of orthotopic bladder substitutions per institution was calculated as three to four (range of medians for each country) and the number of continent cutaneous diversions as two to seven. Open urethral procedures were performed more frequently in Sweden than in the other countries. Surgery for penile curvature and implantation of threecomponent prostheses for erectile dysfunction was more commonly performed in Denmark and Iceland compared to Sweden.

Adenocarcinoma of the Renal Pelvis in an Elderly Woman

Adenocarcinoma of the renal pelvis is so rare that many reviews of renal tumours fail to include any instance of this lesion. We present a 75-year-old female patient with no previous history of urological disease in whom a renal pelvic tumour was diagnosed. Histological examination after radical nephroureterectomy proved the tumour to be a rare adenocarcinoma. The course of the disease, the possible predisposing factors, the treatment of the tumour and the prognosis are discussed.