S. Pettersson

Combined treatment with temporary short-term high dose rate Iridium-192 brachytherapy and external beam radiotherapy for irradiation of localized prostatic carcinoma

PURPOSE To evaluate the treatment outcome after radical radiotherapy of localized prostate cancer in 50 patients (38 patients with stage T1-2 and 12 patients with stage T3) after a median follow-up time of 45 months (range 18-92 months). METHODS The treatment was given by combination of external beam radiotherapy (50 Gy) and brachytherapy (2 x 10 Gy). The brachytherapy was given using TRUS-guided percutaneously inserted temporary needles with a high dose rate remote afterloading technique with Ir-192 as the radionuclide source. Three target definitions and dose levels inside the prostate gland were used. Local control was evaluated by digital rectal examination, TRUS-guided biopsies and serum PSA evaluations. RESULTS Clinical and biopsy verified local control was achieved in 48 of the 50 (96%) patients; for stage T1-2 in 37 of 38 (97%) patients and for stage T3 in 11 of 12 (92%) patients. A posttreatment serum PSA level < or =1.0 ng/ml was seen in 42 (84%) patients, values from >1.0 to < or =2.0 ng/ml were seen in four (8%) patients and values exceeding 2.0 were seen in four (8%) patients. The late toxicity was minimal. CONCLUSION The local control results and the minimal toxicity after the combined radiotherapy treatment are promising. However, long term results are necessary before general use.

The effects of urease in undiluted human urine.

Undiluted human urine and synthetic urine were inoculated with urease. No inhibitory activity against urease enzymatic activity could be detected in human urine. The urease-induced crystallization of both calcium phosphate and magnesium ammonium phosphate differed markedly, however, between the individuals studied, and it was less pronounced in human urine than in synthetic urine. This supports the observation made in experiments using diluted urine that human urine possesses an inhibitory activity against urease-induced crystallization and suggests that it has a large interindividual variation.

The Use of Biodegradable PGA Stents to Judge the Risk of Post-TURP Incontinence in Patients with Combined Bladder Outlet Obstruction and Overactive Bladder

OBJECTIVE For patients with the combination of severe bladder outlet obstruction (BOO) and severe overactive bladder (OB), no straightforward and safe treatment exists due to the risk of urge incontinence after TURP. In this study we have used a biodegradable polyglycolic stent to simulate the status after TURP and register the risk for urge incontinence. METHODS A total of 37 patients with severe OB, combined with moderate to severe BOO, were asked if they wanted to participate. Under cystoscopic vision a polyglycolic biodegradable stent was inserted in the prostatic urethra. RESULTS Twenty-five of the patients noticed no or only minor leakage and 19 of these have been subjected to TURP with good results. Three patients are on the waiting-list for TURP. Twelve of 37 patients were found to have major leakage after stent insertion. During the stent period, we noted five cases of complications, due to UTI, stent crash and irritation. All of these patients recovered within three weeks. CONCLUSIONS A biodegradable PGA stent seems to be a new and unique tool to test the risk for post-TURP incontinence in patients with combined BOO and severe OB.

The Bacteriology of Operated Renal Stones

In a group of patients consecutively operated on for renal stones, more than half of the patients had urinary tract infection. In a significant number of the patients with infection stones containing magnesium ammonium phosphate, no urease-producing microorganism could be cultured. Escherichia coli was on the other hand rather frequently cultured from the stone in these patients. This suggests the possibility that E. coli might be involved in stone formation. The correlation between stone and voided urine cultures was incomplete. It is thus important to perform stone cultures. This could be done without loss of accuracy by culturing crushed stones.

Half Century of Followup After Ureterosigmoidostomy Performed in Early Childhood

PURPOSE We studied clinical outcomes, especially regarding colorectal adenocarcinoma, in patients who underwent ureterosigmoidostomy in early childhood between 1944 and 1961. MATERIALS AND METHODS A total of 25 consecutive patients underwent ureterosigmoidostomy at a mean age of 3.1 years. The most common indication for ureterosigmoidostomy was bladder exstrophy-epispadias complex. The study period ended in 2010. Patient files were retrospectively evaluated, personal telephone interviews were performed and colorectal histology was reevaluated. One girl who died 4 days postoperatively was excluded. RESULTS Of the 24 patients 17 were alive in 2010 with a mean age of 59 years (range 48 to 67), and 2 still had a functioning ureterosigmoidostomy. A total of 20 patients with a mean age of 33 years had undergone re-diversion at a mean of 30 years postoperatively. Invasive colorectal adenocarcinoma developed in 7 patients and colorectal adenocarcinoma in situ in 1. Five patients died due to generalized colorectal adenocarcinoma. Mean time from ureterosigmoidostomy to diagnosis of invasive colorectal adenocarcinoma was 38 years (range 23 to 55). Three cases were diagnosed at 1, 21 and 25 years after re-diversion. One patient with colorectal adenocarcinoma in situ was 22 years old at polyp resection, which was 20 years after re-diversion. A carcinoid tumor developed in 1 patient. Of the 7 cases of invasive colorectal adenocarcinoma 6 were low differentiated. CONCLUSIONS After a half century of followup in 25 individuals undergoing ureterosigmoidostomy during childhood 17 were still alive and 20 had undergone re-diversion. Compared to the general Swedish population, the risk of colorectal adenocarcinoma was increased 42 times and the incidence of low differentiation was extremely high.

Rapidly Recurrent Renal Calculi Caused by Ureaplasma Urealyticum: A Case Report

We report on a patient operated upon 8 times for recurrent bilateral struvite stones. Multiple conventional bacterial cultures had been negative. No etiological agent for the rapidly recurring concrements could be detected until Ureaplasma urealyticum cultures were performed at the time of the seventh operation. Ureaplasma urealyticum was found in the bladder and renal pelvic urine, and in the stones. That operation was followed by appropriate antibiotic treatment (doxycycline), which eradicated the microorganism and no stones recurred for 6 months. The urinary pH, which constantly had been highly alkaline before treatment, was normal as was the ammonium loading test. However, 1 year after the seventh operation the Ureaplasma infection recurred, probably due to sexual transmittance, and a new renal stone was discovered. These findings strongly suggest that Ureaplasma urealyticum can induce the formation of infection concrements.

Nephron-sparing surgery for renal cell carcinoma--long-term results.

Objectives: Renal cell carcinoma (RCC) is most often treated using radical nephrectomy. However, in patients with only one kidney or with bilateral RCC, nephron-sparing surgery (NSS) is mandatory. NSS may also be undertaken in patients with a normal contralateral kidney, providing that the tumour is fairly small and not unfavourably located. The aim of the present study was to determine the long-term results in patients treated with NSS for RCC. Material and Methods: We reviewed the records of 87 patients with RCC subjected to NSS between 1980 and 1999. The survival rate was determined, as well as the tumour grade (Skinner classification) and stage (1992 World Health Organisation classification). Results: Cancer-specific survival, in patients with no demonstrable distant metastases and regardless of stage and grade, was 80% and 75% at 5 and 10 years, respectively. Long-term survival was significantly dependent on tumour stage and grade. Conclusion: In this patient series, long-term survival did not differ from the results obtained using radical nephrectomy, judging from the available literature. An exception was found in patients with high-stage RCC, where NSS appeared to be a less favourable procedure. We therefore recommend that NSS should be performed in cases with bilateral tumour disease or an absent/malfunctioning contralateral kidney. NSS may also be considered in cases of low-stage RCC with a normal contralateral kidney, especially in patients with local or systemic conditions that may adversely affect renal function in the future.

Pressure-Flow Studies for Patient Selection in the Treatment of Symptomatic BPH A One-year Follow-up Study

Objective: Many different treatments for lower urinary tract symptoms (LUTS) due to bladder outlet obstruction (BOO) are available today. To select the most suitable method for each patient is therefore a delicate task. The aim of this study has been to use a standardised systematic investigation schedule including pressure flow studies (pQS) in order to try to use graded treatment according to obstruction. Methods: Ninety-nine patients were systematically examined with routine investigations and pQS to select between 3 treatment options, TURP, TUMT 2.0 (low energy) and watchful waiting (WW). Patients with severe BOO were recommended TURP, patients with moderate BOO were treated with TUMT and patients with no or minor BOO were recommended WW. Results: TURP produced the best improvement in maximum free flow (Q-max), IPS-score and PVR, but only TURP had serious complications. TUMT treatment produced a more moderate improvement in flow rate, IPS-score and PVR, and all of the complications were minor. WW did not improve PVR or Q-max but the IPS-score decreased significantly. One UTI was the only complication in the WW group. Conclusions: pQS can be used to allocate patients with LUTS due to suspected BOO into different treatment arms; TURP, TUMT, WW, all with known different effects of BOO and with different severity of complications. Good symptomatic effect in Q-max, PVR and IPS-score with less serious complications and at low failure rate can thereby be obtained.OBJECTIVE Many different treatments for lower urinary tract symptoms (LUTS) due to bladder outlet obstruction (BOO) are available today. To select the most suitable method for each patient is therefore a delicate task. The aim of this study has been to use a standardised systematic investigation schedule including pressure flow studies (pQS) in order to try to use graded treatment according to obstruction. METHODS Ninety-nine patients were systematically examined with routine investigations and pQS to select between 3 treatment options, TURP, TUMT 2.0 (low energy) and watchful waiting (WW). Patients with severe BOO were recommended TURP, patients with moderate BOO were treated with TUMT and patients with no or minor BOO were recommended WW. RESULTS TURP produced the best improvement in maximum free flow (Q-max), IPS-score and PVR, but only TURP had serious complications. TUMT treatment produced a more moderate improvement in flow rate, IPS-score and PVR, and all of the complications were minor. WW did not improve PVR or Q-max but the IPS-score decreased significantly. One UTI was the only complication in the WW group. CONCLUSIONS pQS can be used to allocate patients with LUTS due to suspected BOO into different treatment arms; TURP, TUMT, WW, all with known different effects of BOO and with different severity of complications. Good symptomatic effect in Q-max, PVR and IPS-score with less serious complications and at low failure rate can thereby be obtained.

The Influence of Locally Deposited Fibrin on the Biomechanical Properties of Developing Granulation Tissue in Rats

A recently developed method for the occlusion of fistulas with a fibrin clot has stimulated studies concerning the effects of deposited fibrin on the formation of granulation tissue (g.t.). In this study the influence of artificially implanted fibrin on the biomechanical properties of developing g.t. was investigated in rats. Perforated Teflon cylinders either empty or fibrin filled, were implanted subcutaneously for two weeks. The g.t. from fibrin filled cylinders was found to adhere significantly better to the cylinder walls which is an important property in the case of fistula closure with fibrin. Mechanical testing, however, showed that the maximum load and the maximum strain were significantly higher in cylinders implanted empty. However, the collagen concentration was no higher in cylinders implanted empty suggesting that in the newly formed g.t. studied, factors other than the collagen concentration determined the strength of the tissue.

The effects of citrate and zinc on urease-induced crystallization in synthetic and human urine

In vitro experiments have indicated that the crystallization of magnesium ammonium phosphate and calcium phosphate (carbonate apatite) is influenced by as yet unidentified components of human urine (2). This study was performed to investigate the influence of two urinary components, citrate and zinc, of potential interest in this context. The urinary citrate concentration is known to vary markedly between individuals (7) and can be anticipated to influence the process of urease-induced crystallization. Zinc has been described as inhibiting urease enzymatic activity and may act as an inhibitor of calcium phosphate crystallization (4,5). A previously described experimental model (2) was utilized and the studies were performed in synthetic and whole human urine.