R. Klän

Residual tumor discovered in routine second transurethral resection in patients with stage T1 transitional cell carcinoma of the bladder.

When a second transurethral resection was routinely performed 8 to 14 days after the initial transurethral resection in 46 patients for stage T1 bladder tumors residual disease was found in 20 despite the surgical report of complete resection in 40. In only 13 patients was residual tumor noted at repeat resection by the senior urologist performing the operation and residual tumor was confirmed histologically in 10 of them. The extent of the lesion is easily misjudged even by experienced surgeons. Early cystoscopy cannot exclude residual tumor. Residual tumor is an important cause of early recurrence and repeat resection of stage T1 lesions is recommended.

Is routine excretory urography necessary at first diagnosis of bladder cancer

PURPOSE We determined whether routine excretory urography (IVP) at initial diagnosis of bladder cancer is useful in screening the upper urinary tract for clinically inapparent urothelial tumors. MATERIALS AND METHODS IVPs and ultrasound findings of 314 patients with bladder cancer were reviewed retrospectively. RESULTS Only 1 silent upper urinary tract tumor was detected with IVP (0.3%), resulting in nephroureterectomy. IVP had no further therapeutic consequences except for destruction of an asymptomatic prevesical stone. IVP was followed by ureterorenoscopy in 5 patients with negative results. Upper urinary tract obstruction could be documented equally well by sonography in all cases. CONCLUSIONS Routine IVP at first diagnosis of bladder cancer is unnecessary.

Transplantation in Autosomal Dominant Polycystic Kidney Disease without Nephrectomy

Some transplantation centers still suggest nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) before kidney transplantation at least in selected cases. We wanted to learn whether prior nephrectomy is beneficial. The outcome of kidney transplantation in 47 consecutive ADPKD patients without prior nephrectomy was compared with that in matched controls with respect to complications of ADPKD. Although ADPKD patients were older than controls (mean, 50.1 vs. 40.3 years), there was no statistically significant difference in 1- and 5-year allograft survival between ADPKD patients and controls: 76.6 and 68.0%, respectively, in ADPKD patients, and 83.9 and 56.3% in controls. After a mean follow-up of 66.5 months 3 patients with ADPKD had cyst infections and were managed with antibiotics. Two patients had episodes of hematuria; neither required invasive therapy. There was no renal malignancy and clinical sign of urolithiasis in any patient. No posttransplantation nephrectomy was required. With only few indications remaining, there is no rationale for routine pretransplantation nephrectomy in patients with ADPKD.

Acetylsalicylic acid inhibition of n-butyl-(4-hydroxybutyl) nitrosamine-induced bladder carcinogenesis in rats

We examined the effect of acetylsalicylic acid (ASA) onn-butyl-(4-hydroxybutyl)nitrosamine (BHBN)-induced bladder carcinogenesis in male Wistar rats. Of 29 rats that received 0.05% BHBN in their drinking water for 9 weeks, 8 developed bladder cancer. Only 1 out of 29 rats that received 0.1% ASA in their diet for 20 weeks, including the period of BHBN consumption, developed a tumor. That difference is statistically significant. Bladder weight was significantly higher in rats given BHBN than in controls and in rats given both BHBN and ASA. We conclude that ASA inhibits BHBN-induced bladder carcinogenesis.

Sensitivity of Urinary Quantitative Immunocytology with Monoclonal Antibody 486 P3/12 in 241 Unselected Patients with Bladder Carcinoma

We investigated the sensitivity of quantitative immunocytology with our monoclonal antibody 486 P3/12 in 241 unselected patients with transitional cell carcinoma. Immunocytology yielded a sensitivity of 91.8%, 89.4% and 92.9% for grade 1, 2 and 3 tumors, respectively. Standard cytology was positive in 59.2%, 63.8% and 84.7%, respectively. Deoxyribonucleic acid flow cytometry, used in the first 69 patients, was positive in only 27.7%, 48.6% and 57.1%, respectively.

Rescue of Renal Transplants with Distal Ureteral Complications by Pyelo-Pyelostomy

Secondary ureteroneocystostomy is the procedure most commonly used for repair of ureteral stenosis or necrosis in renal transplant patients. However, when the transplant ureter available for reconstruction is too short, ureteropyelostomy is the standard procedure. Another option is pyelo-pyelostomy, which has been used infrequently to date. Between 1979 and 1988 we managed 6 patients (4 men and 2 women 42 to 62 years old) with renal allografts who required repair of the transplant ureter for long segmented ureteral necrosis (3), long segmented ureteral stenosis (2) and an iatrogenic lesion of the ureter (1) with pyelo-pyelostomy. Of the 6 patients 2 had undergone previous rescue operations. Pyelo-pyelostomy with the renal pelvis of the graft was performed as first described by Gil-Vernet and Caralps in 1968. Median followup was 6 years (range 3 to 12 years). Two patients died of chronic rejection and pulmonary embolism, respectively. Four patients are still alive with functioning transplants and serum creatinine levels of less than 210 mumol/l. According to our experiences with 6 patients, we believe that pyelo-pyelostomy is a promising rescue maneuver that is worth consideration in cases of total or subtotal ureteral necrosis and long segmented ureteral stenosis after renal transplantation.

Nitric oxide donor, linsidomine chlorhydrate (SIN-1), in the diagnosis and treatment of erectile dysfunction: Critical appraisal and review of the literature

Recent experimental work has demonstrated that nitric oxide (NO) is the neutrotransmitter responsible for cavernous smooth muscle relaxation. Different studies on the performance of the direct NO-donor linsidomine chlorhydrate (SIN-1) in patients with erectile dysfunction have come to conflicting results ranging from highest praise to complete dismissal. We reviewed all published studies on the use of SIN-1 for intracorporeal injection in erectile failure including our own. To this date, 3 groups published their data. Only the uncontrolled data from Hannover claim good results. The controlled data from Hamburg and Berlin on patients with erectile failure due to venous leakage, to a mixed aetiology in a double-blind fashion and to mixed aetiology with drug increase (1 mg versus 2 mg of SIN-1) showed a significantly worse performance of SIN-1 compared to the standard drug for penile injection, prostaglandin E1. We conclude that there is no place for linsidomine chlorhydrate in either the diagnosis or the treatment of erectile dysfunction.

Prostaglandin E1 versus linsidomine chlorhydrate in erectile dysfunction.

Recent experimental work has demonstrated that nitric oxide (NO) is the neurotransmitter responsible for cavernous smooth muscle relaxation. Different studies on the performance of the direct NO donor linsidomine chlorhydrate (SIN-1) in patients with erectile dysfunction have had conflicting results. We performed a single-blind cross-over trial in 20 patients with erectile dysfunction of mixed etiology comparing prostaglandin E1 (PGE1) to SIN-1 at two different dosages (1 and 2 mg, respectively) in order to determine the effectiveness of SIN-1. PGE1 always achieved the best response, SIN-1 performed statistically significantly poorer irrespective of the dosage used. There were only a few side effects with no significant difference. SIN-1 is not a useful alternative to PGE1 in the treatment of erectile dysfunction.

Evaluation of Acute Scrotal Pain by Color-Coded Duplex Sonography

In light of the high sensitivity of color-coded duplex sonography (CCDS), we analyzed a group of patients with acute scrotal pain to evaluate the use of CCDS in routine clinical examination. During March 1988 through April 1991, CCDS was used in 31 patients with acute scrotal pain before they underweight surgery in our department. In 15 patients, the structural and perfusion changes of the scrotal contents were such that a definitive diagnosis was possible. In the rest of the patients, the pathologic changes seen with CCDS were more complex, and the correct interpretation needed more expertise; this was especially true in patients with partial torsion, posttorsion status, and torsion of hydatids. CCDS with the simultaneous display of anatomic scrotal structures and blood flow over the entire scan field is an excellent method for evaluating patients with acute scrotal pain. However, apart from the classical case of no perfusion (as in testicular torsion) and increased perfusion (as in inflammation), more complex changes are more difficult to interpret. The correct diagnosis in the latter cases requires considerable experience and evaluation of all facts, including clinical history, results of palpation, and structural and perfusion changes of the scrotal contents.

Seminoma Testis and Concomitant Ipsilateral Renal Cell Carcinoma

An unusual case of synchronously arising renal cell carcinoma and seminoma testis is presented. A literature review revealed six similar cases. The likelihood of a chance coincidence is discussed.