Synchronous bilateral multilocular renal cell carcinoma. A rare case.

A rare case of multilocular primary renal cell carcinoma (two sites in each kidney) in a 48-year-old woman is presented. The preoperative diagnosis was based on the computerized tomography findings. The patient underwent bilateral total nephrectomy and subsequently maintained renal dialysis.

Extracorporeal shock wave lithotripsy monotherapy for bladder stones.

This report presents our initial experience in 36 patients with bladder stones, treated by extracorporeal shock wave lithotripsy. Minute fragmentation and uncomplicated evacuation occurred in 26 patients (72%). Mean treatment duration was 55 minutes. Mean number of shock waves was 3600 and electrical discharge averaged 24 kV per shock wave. No morbidity, during or after treatment, was encountered in these patients. The treatment was performed without the use of anaesthesia on an outpatient basis.

Contribution of transcutaneous ultrasonography to the evaluation of urethral strictures.

The aim of our study was to investigate the accuracy and sensitivity of ultrasound in detecting urethral strictures. Between 1992 and 1994, 117 patients with stricture of the anterior urethra were evaluated by retrograde urethrography, ultrasonography and urethroscopy.

Extracorporeal shock wave lithotripsy in paraplegic and quadriplegic patients.

As it is known, paraplegic and quadriplegic patients are at an increased risk for urolithiasis. We have studied the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in 15 patients with spinal cord dysfunction who were treated in our ESWL unit. A total of 23 treatments were performed. The number of shock waves ranged between 1500 and 3000 per treatment. Only 1 and 3 patients were stone-free at one-month and 3-month follow-up, respectively. Ten of 15 patients with long-term follow-up of 6 to 20 months were stone-free. The remaining 5 patients with residual fragments had staghorn calculi or stones larger than 2.5 cm. We conclude that ESWL is an effective and well tolerated method for this population but the fragment clearance is delayed and below that for unselected patients.

One-session bilateral ureteroscopy: is it safe in selected patients?

The aim of this study was to investigate the possibility to perform bilateral ureteroscopy in one session and to determine the procedure's indications and complication rate. Twenty-two patients underwent bilateral ureteroscopy in one session. Eighteen patients had bilateral lithiasis of the lower ureteral third, three patients had unexplained haematuria and one had unexplained bilateral hydronephrosis. The rigid ureteroscope was used in cases with stones and the flexible one in cases with haematuria and hydronephrosis. Ureteral catheters were placed in all patients. The overall stone-free rate was 83.3%. The procedure failed to confirm a diagnosis in 2 patients with unexplained haematuria. Follow-up included IVU and retrograde cystogram 3 months after the procedure and a renal scan one year later. No major complication was observed. It is concluded that bilateral ureteroscopy in one session can be performed safely in selected patients. The method does not yield major complications and saves patients from a second procedure and a second anaesthesia.

Stimulation of the obturator nerve during extracorporeal shock wave lithotripsy.

This paper presents eigth patients with lithiasis of the lower third of the ureter that were treated by extracorporeal shock wave lithotripsy (ESWL). All the procedures were performed with a Dornier HM4 lithotriptor in the sitting position. In all cases clinical signs of stimulation of the obturator nerve were presented. Because of the continuing movement of the patient and the possibility of damage to the obturator nerve, the lithotripsy was interrupted in the sitting position and was performed successfully with patients in the prone position. One possible explanation for the above phenomenon is that the increased abdominal pressure in the sitting position pushes the ureter with the stone towards the side walls of the pelvis and the obturator nerve. In this way, both obturator nerve and stone were included either in the zone of the high concentration of the shock waves, or in the secondary focal point, with the final result of stimulation of the nerve. By placing the patient into the prone position, the abdominal pressure is reduced, the ureter moves towards the center line, the obturator nerve gets away from the shock waves and the ESWL is completed freely without stimulation of the nerve.

A rare case of gigantic calyx dilatation manifested as renal ectopia.

We present a very rare case of gigantic hydrocalycosis which was caused by an obstructed stone. It was so large that it displaced the rest kidney into the contralateral lumbar fossa giving the appearance of a crossed ectopic kidney.

Tuberculosis of the prostate.

We present five cases of tuberculous prostatitis. In all cases this was an incidental histologic finding after transurethral prostatectomy. The patients were all treated with an antituberculous drug regimen. A literature review of this rare condition is included.

[Treatment of stress urinary incontinence by the Raz vaginal colpopexy]. / Traitement de l'incontinence urinaire d'effort par colpopexie vaginale selon Raz.

In this study we present our experience from the application of the bladder neck suspension as modified by Raz on 37 patients. All patients had severe genuine stress incontinence. Twenty of them had undergone previous surgery for the same problem, and 16 patients had had a previous hysterectomy. In addition 15 patients had a small cystocele. In all cases, the Raz procedure was performed by the same surgical team. The follow-up ranged from 8-32 months (mean follow-up 15.4). The overall success rate was 86.5%. Patients with no history of previous surgery and all patients with cystocele were cured. The 5 failures occurred in patients with previous surgery and hysterectomy. The complications were few. It is concluded that the Raz bladder neck suspension is a safe and effective method for the treatment of stress incontinence, especially in cases with cystocele or failure after primary treatment.

[Ureteroscopy under local anesthesia with or without intravenous analgesia]. / Urétéroscopie sous anesthésie locale avec ou sans analgésie intraveineuse.

We report our experience on performing ureteroscopic procedures using local anaesthesia with or without intravenous analgesia. During a two year period 334 ureteroscopic procedures were performed in our hospital. 159 of them were begun but only 138 completed without the use of general or regional anaesthesia. In 9 patients ureteroscopy was performed with lindocaine jelly in the urethra only, and in 129 with additional intravenous analgesia Fentanyl, a synthetic morphine derivative, was used for intravenous analgesia. Ureteroscopy was performed for stone fragmentation or extraction in 119 patients for taking away a double J catheter which showed migration into ureter in 8 and for diagnostic purposes in 11. Ureteric lesions were observed in 7 patients (5%). The findings suggest that ureteroscopy when performed without general or regional anaesthesia does not increase the risk of complications or compromise the results of treatment.

[Fournier's gangrene: etiology, treatment, and complications]. / La gangrène de Fournier: etiologie, traitements et complications.

We report our experience in the treatment of Fournier's gangrene. Ten male patients suffering from necrotising fasciitis of the genitalia were treated by extensive surgical debridement and broad spectrum antibiotic administration. Four were alcoholic and six diabetic. The possible cause was perirectal abscess in 3 cases, urethral stricture in two, traumatic urethral catheter insertion in two, epidydimo-orchitis in one and finally herniorraphy in another case. An average of 2.3 operations was required per patient and the average hospital stay was 38.1 days. Three of them underwent bilateral orchidectomy, two colostomy and a suprapubic catheter was inserted in four cases. Four patients developed acute renal failure and three adult respiratory distress syndrome. Three patients died. Reconstruction using skin flaps was necessary in 4 patients. We conclude that Fournier's gangrene is a true urologic emergency, potential lethal, which requires aggressive antibiotic and surgical treatment.

Selenium concentration in serum of healthy Greek adults.

Serum selenium levels of 160 healthy Greeks were determined by Zeeman-effect background-corrected atomic absorption spectrometry. Mean value for 101 men (70.7 +/- 16.2 micrograms/L) tended to be higher, but not statistically significant, compared to the mean value for 59 women (64.9 +/- 14.7 micrograms/L). When the subjects were divided into various age groups there appeared to be some increase as a function of age. Compared to the extensive literature data on serum Se levels for various countries healthy Greeks proved to be at the lower concentration range. The scarce, but conflicting literature data on serum Se values for Greeks is discussed.

Small lesions of the kidney: CT evaluation comparison with ultrasound.

Small lesions of the kidney: CT evaluation. Comparison with ultrasound. The main idea of this study is to demonstrate the usefulness, sensitivity and specificity of the CT method for the detection of small lesions of the kidneys. Simple cysts of kidneys were excluded from the study, which is a very frequent finding in patients examined with the new imaging methods of CT and US. Also the cases of small tumors which can add in establishment of diagnosis by CT are analysed. In this report 33 patients were examined with computed tomography (CT) and 36 small renal lesions (less than 4 cm) were found. Ten of these lesions were small angiomyolipomas (0.7-3.2 cm), 9 hemorrhagic renal cysts (0.8-3.5 cm), 5 adenomas of kidneys, 3 small Grawitz, 1 hydatid cyst, 1 lymphomatous deposit, 2 secondary tumors from the intestine, 2 oncocytomas, a small tumor 1.38 cm in size, who was not rendered a diagnosis, and 2 with false positive in ultrasound examination.

The source of urinary nitrosamines in patients with enterocystoplasties.

OBJECTIVE: To assess the factors influencing urinary nitrosamine production in patients with enterocystoplasties. PATIENTS, SUBJECTS AND METHODS: The study comprised 100 patients with an enterocystoplasty, 20 patients with interstitial cystitis, 30 with infective cystitis and 120 control subjects drawn from hospital staff and out-patients. Urinary nitrosamine levels were measured and the urine samples cultured for microorganisms. RESULTS: Nitrosamine levels were significantly higher only in patients with enterocystoplasties who also had higher urinary white cell counts or significant bacteriuria. CONCLUSION: Patients with an enterocystoplasty and significant bacteriuria are most at risk from potential nitrosamine-induced epithelial injury.

The Swiss lithoclast: an ideal intracorporeal lithotripter.

We report our early experience with a new device for endoscopic stone disintegration: the Swiss lithoclast. This device was used to treat 200 patients with stones in kidney, ureter, and bladder. Its effectiveness was 100% when the stone could be approached irrespective of size or composition, and no complication was encountered.

Subcapsular hematoma due to ESWL: risk factors. A study of 4,247 patients.

A study of 4,247 shockwave lithotripsy treatment was performed to identify and analyze the risk factors for the development of post-extracorporeal shock-wave lithotropsy hematomas. The Dornier HM-3 and HM-4 lithotriptors were used. We recognized 23 hematomas in 23 patients (0.54%). Various factors were examined to identify the certain predisposing risk factors. There was no correlation of sex, age, stone number, stone size, stone location, number of shock waves and voltage used with the occurrence rate of hematoma. We found that patients with pre-existing hypertension and especially those with poor control of it had a significantly increased incidence of perinephric hematoma.

The contribution of the obturator nerve block in the transurethral resection of bladder tumors.

This study was designed to evaluate the efficacy of local block of the obturator nerve to avoid it's stimulation during transurethral resection (TUR) or tumors localised on the lateral bladder wall. Forty-five patients were studied, in whom the TUR operations were performed under spinal anaesthesia. The patients were divided into two groups: in the first group a local block of the obturator nerve was done, while the second group served as controls, and the stimulation of the nerve was avoided by reduction of the electrocoagulation voltage, incomplete bladder filling and resections of smaller ships. In the first group no stimulation was observed while in 5 patients of the second group was not possible to totally resect the tumor due to the persistent stimulation of the obturator nerve. In conclusion the local block of the obturator nerve is an effective method to avoid it's stimulation, easily performed and without complications.

Complications of renal angiomyolipomas: CT evaluation.

Complications from angiomyolipomas are rare but often severe depending on the size and content of the angiomyolipoma. In this study, we describe 10 cases from 63 patients with renal angiomyolipomas in whom computed tomography revealed the following complications: compression of pyelocalyceal system in three cases, intratumoral bleeding in two cases, rupture in four cases with subcapsular, perirenal, or pararenal hematoma and extensive intrarenal/parapelvic hematoma, cystic degeneration in one case.

Extracorporeal shock wave lithotripsy for renal stones in children.

The aim of our study is to determine the efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) as a method of treatment of nephrolithiasis in childhood. Between 1986 and 1994, 50 children with renal calculi were treated by ESWL in our department. The age of the children ranged from 8 months to 14 years. Thirty-three of them were boys and 17 girls. The stone location was in the renal pelvis in 38 cases, in the upper renal calyx in 4 cases, in the lower calyx in 2, while 6 children had staghorn calculi. The stone size ranged between 3 and 39 mm. All treatments were performed with Dornier HM4 except 12 children, all older than 10 years, who underwent ESWL with Dornier HM3. All ESWL procedures took place under general anesthesia or sedation with ketamine. The number of shock waves varied between 400 and 2,000 per treatment and the standard maximum generator voltage was 18 kV. The overall stone clearance rate at 1 month was 66%. Fourteen children with large residual fragments underwent a second ESWL procedure 3 months later. With a mean follow-up of 33 months, 41 children (82%) are stone-free. Ten children developed urinary tract infection and 5 Steinstrasse. Twelve children had a pre- and post-ESWL DMSA scan and no permanent impairment of renal function was observed. We conclude that ESWL is the treatment of choice for urinary tract lithiasis in childhood. It is a low-risk method, without serious complications, which yields as high a success rate in children as in adults. We believe that as the stone fragmentation and clearance is much higher in children that in adults, the method must be the initial approach and may be the monotherapy even in staghorn or complex stones.

Is cystoplasty a safe alternative to urinary diversion in patients requiring renal transplantation?

The study aimed to assess the methods of urinary drainage in patients requiring renal transplantation in whom the native lower urinary tract was unsuitable. Twenty-one patients had a transplant into an abnormal urinary tract. Eight of them into a cystoplasty, 8 into an ileal conduit and 5 had a cutaneous ureterostomy. All patients transplanted into an ileal conduit (mean follow-up 4.6 years) and into a cutaneous ureterostomy (mean follow-up 3.2 years) have had a satisfactory outcome. Five of 8 patients transplanted into a cystoplasty have had a satisfactory outcome, 2 patients suffered graft loss due to rejection and 1 developed necrosis of cystoplasty following transplantation. In terms of graft survival, excellent results in the medium term were obtained for transplantation with an ileal conduit or cutaneous ureterostomy. Cystoplasty was less successful but was not the direct cause of graft loss in any patient and as such is as safe a technique in patients with end-stage renal failure so long as care is taken to avoid the vascular pedicle at the time of transplantation.