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.

Transrectal needle aspiration versus transperineal needle biopsy in diagnosis of prostatic carcinoma.

Fine-needle aspiration of the prostate was compared to transperineal biopsy in 86 patients with suspected prostatic carcinoma. Aspiration was found to have a sensitivity of 98.6% while no complications were seen. Initial core needle biopsy compared to the final histological diagnosis in this study showed a sensitivity of 84.5%. Fine-needle aspiration of the prostate is a safe, inexpensive and accurate diagnostic method in prostatic carcinoma. Our findings suggest that prostatic aspiration should be used more widely as an initial diagnostic procedure for suspected prostatic cancer.

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.

A case of epidermoid cyst of the testis role of conservative surgery.

We report one case of an epidermoid cyst of the testis in a 15 year-old boy. Pre-operative testicular ultrasound may help to establish the diagnosis without resorting to orchiectomy. In such a selected case local excision alone should be considered adequate without violating accepted surgical principles.

Uterine prolapse and urinary tract obstruction.

A case is presented of total uterine prolapse accompanied by moderate bilateral hydroureteronephrosis which was diagnosed after evaluation for fever of unknown origin.

Primary localized amyloidosis of the urinary bladder.

A case is presented of a woman aged 78 with a primary location of amyloidosis of the bladder. The clinical symptoms and the cystoscopy initially suggested a vesical carcinomatous infiltration.

Extracorporeal shock wave lithotripsy of middle ureteral calculi: ventral shock wave application.

A total of 150 patients presenting with stone in the middle iliac ureter were treated with extracorporeal shock wave lithotripsy using a Dornier HM-4 lithotriptor. For adequate radiological stone visualization and excellent fragmentation, the prone position was used in all patients. In 45 patients (30%) an ureteral stent was placed before treatment. The overall success rate was 82% (123 of 150 patients). All patients were treated on an outpatient basis without anesthesia.

Renal cell carcinoma presenting as a large abdominal mass with an extensive peritoneal metastasis.

We report a case of renal cell carcinoma with an extensive intraperitoneal metastasis at the time of diagnosis. This type of metastasis is very rare for renal cell carcinoma and is identified in only 1% of the metastases at autopsy. The findings of computed tomography are presented.

Extracorporeal shock wave lithotripsy of radiolucent urinary calculi using the Dornier HM-3 and HM-4 lithotriptors.

Between September 1992 and June 1995, 33 patients with radiolucent urinary calculi were treated in our hospital using Dornier HM-3 and HM-4 lithotriptors. There were 11 caliceal stones, 13 in the renal pelvis, and 9 in the ureter. Stone localization was achieved in only 30 patients using intravenous urography or retrograde urography through a ureteric catheter during the procedure. All patients were treated on an outpatient basis, without anesthesia. During the 1st month following extracorporeal shock wave lithotripsy, the patients received alkalization. The overall stone-free rate at 3 months was 90%. The time of radiation exposure was in the range of the opacified stones. Extracorporeal shock wave lithotripsy using Dornier HM-3 and HM-4 lithotriptors proved to be an effective procedure to treat radiolucent urinary calculi when localization of the stone is possible.

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.

Influence of digital examination, cystoscopy, transrectal ultrasonography and needle biopsy on the concentration of prostate-specific antigen.

The influence of various prostatic manipulations, including digital rectal examination, cystoscopy, transrectal ultrasonography and transrectal needle biopsy, on the serum prostatic-specific antigen (PSA) levels in 170 men, were examined. We found that digital rectal examination, cystoscopy and transrectal ultrasonography had no significant effect on PSA levels, except for transrectal needle biopsy, which caused an immediate increase of serum PSA in 96.2% of the patients lasting more than 2 weeks in 42.3% of the cases. In conclusion, serum PSA determination after digital rectal examination, after cystoscopy and after transrectal ultrasonography is accurate and reliable. On the other hand, we must wait about 6 weeks after needle biopsy before measuring PSA in the serum of patients with prostatic diseases.