W. Lutzeyer

Prognostic Parameters in Superficial Bladder Cancer: An Analysis of 315 Cases

A retrospective study of 315 patients with superficial transitional cell carcinoma (stages Ta to T2) and an adequate followup of 3 years or longer is reported. Transurethral resection was done in 80 per cent of the patients and open excision or resection was done in 20 per cent for cure or control. We herein demonstrate that, in addition to grade and stage, multifocal tumor growth and whether the tumor is primary or recurrent influence the frequency of recurrences and tumor progression. The over-all recurrence rate after resection of stages Ta, T1 and T2 tumors within 3 years was 60 per cent. Recurrences after a primary tumor were noted in 45 per cent of the patients and were followed by a second recurrence in 84 per cent, with solitary tumors occurring in 46 and multifocal tumors in 73 per cent. Tumor progression was observed in 24 per cent of patients with solitary tumors, 44 per cent of those with multifocal tumors, 20 to 25 per cent of those with primary and recurrent stage Ta and primary stage T1 tumors, and 56 per cent of those with recurrent stage T1 tumors. Therefore, when therapy is planned stage, grade, multifocal tumor growth and whether the tumor is primary or recurrent should be considered. Stage Ta tumors can be treated sufficiently by transurethral resection even in the case of several recurrences. More aggressive therapy should be considered when multifocal or recurrent stage T1 or T2 tumors recur as invasive carcinomas.

Alloplastic Replacement of the Urinary Bladder

PURPOSE The loss of a functioning bladder is nowadays mostly managed by replacement with gastrointestinal segments. Management of these urinary diversions is difficult and the long-term effects are unknown. We developed a silicone rubber prosthesis for alloplastic replacement of the urinary bladder and tested it in an animal experiment. MATERIAL AND METHODS Two artificial bladders were implanted into subcutaneous pockets on each side of the anterior abdominal wall. Cystectomy was performed and each prosthesis was connected to one kidney. Distally, a Y-shaped tube sutured to the urethral stump joined the two bladder outlets. The whole system was successfully implanted in 5 sheep with a mean follow-up of 11.5 months (5-19 months). RESULTS Adequate capacity, effective and reliable mechanical function and patent anastomoses to the renal pelvis and the urethra could be achieved. Blood chemistry and renal ultrasound were performed at regular intervals demonstrating neither morphological nor functional deterioration of the renal parenchyma. Histopathological examination in the end of the experiment confirmed the excellent clinical results. CONCLUSIONS The positive outcome of these animal experiments suggests this system would be useful for human bladder substitution. Standardized industrial production of the prostheses will be needed prior to implantation in humans.

Pacemaker Process of Ureteral Peristalsis in Multicalyceal Kidneys

The mechanical activity of isolated strips from different areas of the pyeloureteral system was investigated in 10 pigs: calyx, renal pelvis, pyeloureteral junction and ureter. Additionally, electrical activity was measured in some pyeloureteral preparations using the sucrose-gap technique. Regular spontaneous activity with an average frequency of 9.5/min was recorded in calyceal strips, decreasing to 5.4/min in renal pelvis, 5.7/min in pyeloureteral preparations and to 1.2/min in ureteral preparations. The activity of renal pelvis, pyeloureteral and ureteral preparations was less regular, and bursts of fast activity (near 10/min) could be observed in all these preparations. The membrane potential of pyeloureteral strips showed spontaneous generator oscillations of about 10/min. Variations in the pattern of ureteral peristalsis are due to different coupling ratios of membrane potential oscillations to contractions. Adrenaline (10(-5) mol/l) increased the frequency of the oscillations and enhanced their manifestation in the mechanical recordings, whereas tetraethylammonium (5-20 mmol/l) only increased the coupling ratio. The following concept for the generation of ureteral peristalsis in multicalyceal kidneys is developed: several (primary) oscillators exist in the calyces; in the pyeloureteral junction a (secondary) pacemaker exists which has an intrinsic frequency similar to that of the calyceal pacemakers; both processes cooperate in the generation of ureteral peristalsis.

Sequential Events in Prostatic Obstruction

The urinary tract is designed to collect and transport the continuously produced urine volume. Storage and voiding are controlled voluntarily. This complex system has to fulfill various important functions: protection against ascending infection, prevention of crystallization and stone formation, and limitation of maximal pressure, which might disturb glomerular and tubular function. The pelvis, ureter, bladder, and urethra form an interesting physiological system. The calyx, pelvis, and proximal ureter collect the urine from the various papillae and collectively act as an intermediate storage space. When a certain amount of distension of the pyeloureteral junction is reached, an excitation wave from the calyces is conducted down the ureter by rhythmic peristalsis that does not completely empty the pelvis.

Effects of Beta-Adrenergic Stimulating and Blocking Agents on the Dynamics of the Human Bladder Outlet

The alpha-adrenergic innervation of the functional urethra is a well-known fact, while beta-adrenergic influence is rather unknown until now. We studied the influence of beta-stimulating and beta-blocking agents on the human urethra by the urethral pressure profile (UPP). A decrease of the UPP under orciprenaline sulfate and an increase under propranolol could be mentioned.

Fournier’s Gangrene in Hypersensitivity Vasculitis

Fourniers gangrene in IgE positive hypersensitivity vasculitis demands concurrent high dose immunosuppression, radical surgery and intensive treatment of septic sequelae. Even extended autologous skin grafting is possible with immunosuppression. A case of fulminant necrotizing infection of the genitalia, perineum and abdominal wall during the acute generalization phase of IgE positive hypersensitivity vasculitis is described. Apart from the radical surgical approach, medical treatment demands a different strategy than in classical Fourniers gangrene. The favorable outcome in a 21-year-old man after several months of intensive care could be realized only by close cooperation of internal specialists, urologists and plastic surgeons.

Clinical diagnosis of bladder cancer

The minimum requirements of the International Union against Cancer (UICC) to assess the TNM-classification of urothelial bladder cancer include since 1978 the clinical examination, urography, cystoscopy, bimanual palpation under anesthesia and biopsy or transurethral resection of the tumor. The single biopsy of the tumor should be supplemented by multiple biopsies of all bladder walls in combination with the resection of the tumor to diagnose multifocal tumor growth. The exfoliative urinary cytology should be included in the routine diagnostic regimen: cytology is helpful in detection of severe dysplasia and controls the histologically determined grade of the tumor. In selected cases computer tomography improves the accuracy of clinical evaluation of the depth of tumor infiltration. In our hands the lymphangiography can not assess the regional lymph node metastases: therefore, the staging operation is recommended before radical cystectomy is performed.

Interaction of Hyperuricuria and Hyperoxaluria on Renal Calcium Oxalate Stone Formation

There is increasing evidence that excessive urinary excretion of uric acid plays a role in the genesis of renal calcium oxalate stones. 17 percent of our stone formers show a hyperuricuria, a much higher frequency than in normal people. Robertson (1) describes an inhibitory effect on acid mucopo1ysaccarides, which serve as inhibitors of crystal aggregation.

[Value of screening for early detection of urological tumors (author's transl)].

Screening for early cancer detection is of value if (i) appropriate tests are available, (ii) the detected tumor can be treated, and (iii) the treatment improves the quality of life or the mortality rate of the patients. It is demonstrated whether carcinomas of the prostate and urinary tract, renal cell carcinoma, penile carcinoma and testicular tumors satisfy these conditions. Screening for early cancer detection may be indicated in prostatic and urinary tract carcinomas. The clinical examination should include the male genitalia. The indication for sonography of the kidneys to detect renal cell carcinomas is investigated at the moment. Instruction to perform self-examination of the testes should be given to all males older than 20 years.

Detrusor Contractility and Its Relationship to Different Degrees of Tension

Bladder function and its modulation have been the topic of much experimental work ever since Budge (1958) described the bladder innervation for the first time. Special contributions have been achieved by the use of neurohistochemical and pharmacological methods.