Giant renal calculus in a solitary functioning kidney.

We report a case of giant renal calculus 230 x 140 mm in size and weighing 1,350 g in a solitary functioning kidney treated by nephrolithotomy. A 47-year-old man presented with right lumbar pain, abdominal mass and microscopic hematuria. Physical examination revealed a stony hard mass on the right side of the abdomen, extending from the subcostal region to the iliac crest. A giant renal calculus in his right kidney and atrophic nonfunctioning left kidney was diagnosed by ultrasonography, IVP and CT scan. Right nephrolithotomy was performed. Analysis revealed a calcium phosphate stone. This case is the largest and the heaviest stone reported in the literature in a solitary functioning kidney.

Impact of the level of muscle invasion in organ-confined bladder cancer.

OBJECTIVE: We evaluated whether there is a survival difference between patients having pT2a and pT2b invasive bladder carcinomas without nodal involvement and distant metastases. PATIENTS AND METHODS: Three hundred and thirty-six patients with invasive carcinomas of the bladder underwent radical cystectomy. Seventy-five patients with organ-confined disease were evaluated. The pathological stage was used as predictor of survival. Kaplan-Meier method and log-rank test were used to evaluate survival rates. Cox proportional-hazard models were used to identify whether pathological stage, grade, diversion type, age, and gender affect the outcome. RESULTS: Thirty-five patients were in the pT2aN0 group with a mean age of 57.8 +/- 1.4 (range 37-76) years, and 40 patients were in the pT2bN0 group with a mean age of 59.5 +/- 1.1 (range 37-76) years. There were 2 female patients. The mean follow-up period was 27.41 +/- 20.5 (range 3-80) months. The disease-specific 5-year survival rate of the pT2N0 cases was 80.3%. The disease-specific 5-year survival rates for the pT2aN0 and pT2bN0 patients were 84.3 and 66.0%, respectively. The disease-specific mean survival times of pT2aN0 and pT2bN0 cases were 76.2 +/- 4.7 and 56.3 +/- 7.7 months, respectively. There was no statistically significant survival difference between pT2aN0 and pT2bN0 patients by log-rank test (p = 0.1767). According to the Cox multivariate regression analysis, stage, grade, diversion type, age, and gender were not predictive of the survival in patients with organ-confined bladder cancer (p > 0.05). CONCLUSIONS: The level of muscle invasion in organ-confined bladder cancer does not have an influence on the patient survival. Also stage, grade, diversion type, age, and gender are not predictive of survival in patients with organ-confined muscle-invasive bladder cancer.

Prevalence of metabolic syndrome and its association with erectile dysfunction among urologic patients: metabolic backgrounds of erectile dysfunction.

OBJECTIVES: To identify the prevalence of metabolic syndrome (MS) and its association with erectile dysfunction (ED) among urologic patients. METHODS: The study population consisted of 393 male patients aged 40 to 70 years, who were admitted to the urology clinics of four different institutions from February to March 2005. The waist circumference (WC) and triglyceride (TG) and high-density lipoprotein (HDL) cholesterol levels were measured. Patients were divided into two groups: group 1 consisted of patients with a WC greater than 102 cm, and group 2 consisted of patients with a WC of less than 102 cm. The erectile status of the two groups was compared. RESULTS: Of the 393 patients, 157 (39.9%) had MS. Of the 393 patients, 124 with MS (79%) and 146 without MS (61.9%) had ED. The presence of MS was significantly associated with ED (P <0.001). In the presence of an increased WC with normal serum HDL and TG levels, the relative risk of ED was 1.94. If the patient with an increased WC had a pathologic level of HDL or TG, the relative risk of ED increased up to 2.97-fold. The relative risk of ED in the presence of an increased WC, together with pathologic levels of HDL and TG, was 3.38. CONCLUSIONS: In our study, MS was strongly associated with ED. Fasting blood glucose levels, hypertension, and WC are the most significant risk factors predicting the risk of ED. A more pronounced increase in ED risk in the presence of abdominal obesity, together with altered TG and HDL cholesterol levels, may indicate a special metabolic background of ED regarding lipid metabolism.