[Ectopic ureter. Description of a clinical case with appearance of stress urinary incontinence]. / Uretere ectopico. Descrizione di un caso clinico in seguito alla comparsa di incontinenza urinaria da sforzo.

A case of ectopic ureter in a 45 year old woman arising after the onset of stress incontinence is reported. The patient presented complete pyeloureteral duplication with an ectopic ureter whose orifice drained into the proximal urethra. The embryology, diagnostic and therapeutic problems of the case are discussed with emphasis on the tardive appearance of the symptoms.

[Technical solution for single kidney patients with multiple ureteral neoplasms]. / Soluzione tecnica per paziente monorene con neoplasia ureterale multipla.

When ureteral length is extensively compromised, preservation of the kidney without recurring to external urinary diversion may be attempted by various techniques. The choice depends on the extension and localization of the defect. We report a technique solution performed in a patient with multiple ureteral tumors and solitary kidney. A 70-years old underwent TURB for superficial bladder cancer and right nephroureterectomy for upper urinary tract tumor. He was admitted for hematuria and renal failure which need a percutaneous nephrostomy. Urography and pielo-RMN showed multiple and irregular defects of proximal left ureter. We performed a left ureterectomy with ureteral substitution by tailored and retroperitonealized ileal segment with simultaneous ileal bladder augmentation. The six months follow-up including serum creatinine, sonography, urodynamic evaluation, urinary cytology, excretory urogram and pielo-RMN shows good results. Ureteral replacement with ileum is indicated only for extensive ureteral diseases in which ureteroneocystostomy or vesical Psoas hitch and/or Boari bladder flap are not feasible. With particular attention to surgical aspects as tailoring ileum (to improve propulsion of urinary bolus, limit the absorbing surface area and decrease mucus formation) and the use of an ileal segment longer than 15 cm (to prevent reflux) and with an accurate patient selection, we think that this procedure can assure satisfactory results also in difficult cases.

Imperative indications for conservative surgery for renal cell carcinoma: 20 years' experience.

INTRODUCTION: Radical nephrectomy is the treatment of first choice for unilateral renal cell carcinoma (RCC) with a healthy contralateral kidney; however, the current standard for dealing with RCC in patients with a solitary kidney, bilateral tumor and renal or systemic disease inducing a progressive impairment of renal function is nephron-sparing surgery. MATERIALS AND METHODS: Between January 1974 and July 1996, 62 patients (39 men and 23 women, 33-77 years old, mean age 60.6 years) with RCC underwent nephron-sparing surgery. The patients were divided in to two groups according to treatment indication: 46 patients with bilateral tumor (n = 21) or solitary kidney (n = 25) and 16 patients with renal or systemic disease that could damage the contralateral kidney. Survival curves were calculated according to the Kaplan-Meyer method. RESULTS: In the first group 3 patients died postoperatively, and 3 were lost to follow-up; 12 patients (27.9%) had malignant recurrence and 5 (11.6%) died of local recurrence or systemic diffusion. The probability of local or systemic tumor recurrence was 9.9% at 2 years, 20.2% at 5 years and 24.7% at 10 years; the probability of survival was 100% at 2 years, 91.9% at 5 years and 81.9% at 10 years. In the second group 3 patients died of unrelated causes and 1 was lost to follow-up; 4 patients (25%) had a malignant recurrence and 2 (12.5%) died of systemic diffusion of RCC. The probability of tumor recurrence was 13.0% at 2 years, 19.7% at 5 years and 26.4% at 10 years, the probability of survival was 100% at 2 years, 93.3% at 5 years and 86.1% at 10 years. CONCLUSIONS: In our experience nephron-sparing surgery seems justified in patients with a solitary kidney, bilateral tumor or a disease that potentially damages renal function. Tumor diameter and stage, incidental or symptomatic tumor presentation and specific indication for conservative surgery determine the prognosis.

Orthotopic ileal bladder: clinical, urodynamic and metabolic evaluation.

Since January 1985, orthotopic ileal bladder substitution after radical cystectomy was performed in 64 male patients. The Camey I procedure was performed in 35 patients (group 1) and the Studer procedure in 29 (group 2). Clinical, metabolic and urodynamic evaluation was performed at regular intervals with a mean follow-up of 27 months for group 1 and 13.6 months for group 2. Patients with a Camey I bladder reconstruction presented smaller capacity and higher intraluminal pressure resulting in shorter voiding intervals and a practically uniform presence of enuresis, as opposed to those reconstructed with the Studer procedure. The incidence of ureteral reflux was also higher in group 1. Metabolic studies in both groups revealed a slight metabolic acidosis which was treated with oral alkalinization. It is concluded that detubularization of the terminal ileum creates a more favorable low-pressure reservoir.