[30th anniversary of the Urology Clinic at the Dérer University Hospital in Bratislava--Kramáre (1968-1998)]. / Tridsat rokov urologickej kliniky LFUK v Dérerovej NsP v Bratislave --na Kramároch (1968-1998).

Description of a decisive part of the results of the Department of Urology reached in the period 1968-1998, and of the conditions under which these results have been obtained. The results refer particularly to the field of oncology, transplantology, pediatric urology, urolithiasis, andrology, urological gynaecology and some novel surgical procedures. The prerequisite for accomplishing the programme of the Department of Urology successfully was its location in a modern hospital with possibilities of wide multidisciplinary co-operation, mutual linking of medical and scientific work, team work including creation of working groups for essential areas of work, stays of staff members at foreign clinics after predefining their fields of study, and life-long education of the staff by means of postgraduate studies. The paper summarizes only the most important results of the Department of Urology, which reached a level corresponding to contemporary international trends and, hereby, also international recognition. The quoted literature corresponds to the bearings of the paper as well. Only those papers are referred to which enable the reader to check the data given in the text. The reason for such a balance is not only the 30th anniversary of the Department of Urology in a modern hospital but also the fact that for two decades before 1968 the Department had no possibilities for multilateral activities because of its isolated location and its limited technical and personal facilities. (Fig. 12, Ref. 114.)

The incidence of tumours in renal transplant recipients with long-term immunosuppressive therapy.

INTRODUCTION: The incidence of cancers after renal transplantation is significantly higher than in population that have not undergone transplantation. It is increased by a long-term survival of functional graft requiring long-term immunosuppressive therapy. MATERIAL AND METHODS: Since 1972, 620 renal transplantations have been performed for different causes of end stage renal disease. The authors report a group of 18 renal transplant patients (2.9%) who had cancer. Patients with malignancies are reviewed according to their age, sex, type of immunosuppression, interval between transplantation and the diagnosis of cancer, method of treatment and survival. RESULTS: All patients received cadaver kidneys, and secondary transplantation was performed in two patients. Five patients received conventional immunosuppression--azathioprine with prednisone, another 13 patients received cyclosporine with prednisone and/or azathioprine. In 13 males and 5 females (mean age 46.1 years) the malignant disease developed about 62.4 months after renal transplantation. Six patients had epithelial skin cancers (four of them had squamous cell carcinomas and two basal cell carcinomas). Two patients had breast cancer, colorectal carcinoma, renal cell carcinoma and bladder cancer, respectively, one patient had gastric cancer, thyroid carcinoma, carcinoma of tonsilla, and monocytic leukaemia with blastic transformation, respectively. The average survival of patients with malignancies was 20.3 months. Of 17 patients with cancer, 13 underwent surgical treatment, four patients with advanced disease received radiotherapy, hormonal treatment or only symptomatic therapy. In one patient the malignant disease was only discovered at autopsy. Five patients died of progressive malignant disease, four of intercurrent disease. Nine (50%) patients are alive, with no evidence of disease (NED), 31.9 months in average following the diagnosis of malignancy. Three patients returned to dialysis treatment, other 6 patients live with well functioning graft. CONCLUSIONS: In patients surviving long time after kidney transplantation the possibility of development of malignant disease should be considered. Preventive evaluation should guarantee early detection of cancer. Appropriate treatment, without cessation of immunosuppressive therapy, is indicated with the intention to prolong the patients' life with a functional graft and without dialysis treatment.

[Problems posed by asymptomatic pheochromocytoma and malignant tumors of the adrenal medulla]. / Problèmes posés par les phéochromocytomes asymptomatiques et les formes malignes de tumeurs de la médullo-surrénale.

The authors analyse a group of 38 patients with a diagnosis of pheochromocytoma, in particular the topics of atypical symptomatology and malignancy. Three patients did not suffer from any subjective symptoms or other signs of pheochromocytoma ("incidentalomas"). Another three patients, although having giant tumours, only complained of atypical symptoms. Signs suspicious of malignancy were detected in 6 out of 38 patients. The authors recommend a practical approach to modern diagnostic and imaging tools for early primary diagnosis and for the early diagnosis of local recurrence and distant metastases.

Pre-operative management for surgery of pheochromocytoma.

The authors analyze 15 patients who underwent pre-operative management prior to the pheochromocytoma removal. The purpose of this analysis is to evaluate the relation between clinical and haemodynamic criteria evaluating the level of alpha-adrenergic blockade. The authors believe that pre-operative management based on clinical criteria does not necessarily ensure adequate alpha-adrenergic blockade. Invasive monitoring of haemodynamic variables is considered an important strategy for the quantification of actual haemodynamics status of patients with pheochromocytoma.

Tumours of the adrenal cortex.

The authors report their experience of 34 benign and 17 malignant tumours of the adrenal cortex. Both occurred more frequently in women (79.4% of cortical adenomas and 70.6% of adrenocortical carcinomas). Moreover, females were significantly younger (average age: adenomas: females 44.9 years and males 54.4 years, adrenocortical carcinomas: females 34.1 years and males 58.3 years). Some tumours presented in the form of increased hormone production, while others were hormonally inactive and did not cause clinical signs until later. Pain was the first symptom in the cases of malignant adrenocortical tumours. Adenomas occurred as frequently twice in the left adrenal gland (24 versus 12), whereas carcinomas were more than twice are frequent on the right (10 versus 7). Ultrasonography and CT were appropriate and fully sufficient methods for the diagnosis of adrenal tumours. Arteriography was valuable in the differential diagnosis of large upper abdominal masses when the organ of origin could not be identified by CT and for determination of anatomic conditions and subsequent surgical tactics. For small tumours of the adrenal cortex, the classic lumbar approach through the bed of the resected eleventh rib is adequate. For larger tumours, extended lumbotomy, laparotomy or thoracotomy is necessary.

[Detection of patients with pheochromocytoma using a cybernetic analysis method of the signs and symptoms of the disease]. / Dépistage des malades porteurs de phéochromocytome a l'aide de la méthode d'analyse cybernétique des signes et symptômes de la maladie.

The diagnosis of pheochromocytoma is established more frequently in recent years due to better diagnostic possibilities. The aim of this study was to determine whether it is possible to distinguish the diagnosis of pheochromocytoma from mild, moderate and severe hypertension by analysis of symptoms and signs of pheochromocytoma using mathematical methods such as the pattern recognizing procedure before investigation of catecholamines in serum and urine. We retrospectively analysed the presence or absence of 45 symptoms and signs of pheochromocytoma except for investigation of catecholamines in 20 randomly selected patients with mild hypertension (HT), 20 patients with moderate HT, 20 patients with severe HT, and 20 patients with known pheochromocytoma. This procedure improved screening of pheochromocytoma and allowed early detection of the disease on a large scale.

Advantages of converting incontinent to continent urinary diversion.

A modified Mainz pouch with catheterizable stoma was constructed in six patients who had originally undergone incontinent urinary diversion by ureteroileostomy 7 to 22 years previously for bladder exstrophy or neurogenic bladder with total urinary incontinence. The surgical technique differed from the standard as follows: after stomal excision, the preexisting ileal loop was detubularized and combined with additional ileal and colonic segments for pouch construction. In patients in whom the original ureteroileal anastomoses were patent and the contrast medium refluxed freely to the upper urinary tract during loopography, the ureters were not reimplanted but kept intact. In all patients the ileal valve was connected as stroma to the umbilicus. In addition, two patients underwent construction of a standard Mainz pouch. One had had primary ureterosigmoidostomy and the other one ureterostomies, 10 and 3 months previously, respectively. The urodynamic characteristics of the reservoir were normal in all. In six ureteropelvic units dilation improved significantly and in two patients the bilateral loop-ureter reflux diminished. Long-term follow-up (up to 45 months) showed no further impairment of the kidneys.

[Electrostimulation of the urinary bladder]. / Moznosti elektrostimulácie mocového mechúra.

The authors present their first results with urinary bladder stimulation in dogs by using an electronic stimulator and electrodes of their own construction. Neurostimulation was carried out by means of contactless application of electrical rectangular pulses with the voltage ranging from 1 to 10 volts, frequency from 10 to 300 Hz and pulse with 1 ms. Due to the stimulation of the branches of the pelvis plexus an isolated contraction of the bladder detrussor with an increase of intravesical pressure up to 65 cm H2O was observed with subsequent spontaneous voiding. The stimulation of the intact sacral root S2 led to detrussor-sphincteric dyssynergia caused by simultaneous contraction of the detrussor and the striated urethral sphincter. The poststimulus spurt of urine was observed at the end of each S2 stimulation. The authors inform about the further plan of experimental work before introducing the method into clinical practice. (Fig. 4, Ref. 17.).

Diagnosis and treatment of cortical tumours of the suprarenal gland.

The authors report on their own groups of benign (20 patients) and malignant (14 patients) cortical tumours of the suprarenal gland. In both kinds of tumour the occurrence is higher in females. Adenoma occurred more often in the left adrenal gland and cancer in the right one. Some tumours manifested themselves by an increased production of suprarenal hormones, others were hormonally inactive and did not become manifest until the later stage of development. In the therapy of adenomas the classical lumbar approach through the 11th intercostal space is adequate, in the case of cancer and extended lumbotomy laparotomy or thoracotomy is necessary. The need of participation of other specialists in the treatment (endocrinologist, radiologist, oncologist, anaesthesiologist) is emphasized.

["Surveillance" of non-seminomatous testicular tumors. A prospective study of 100 patients in the first stage of illness]. / La "surveillance" des tumeurs non-séminomateuses du testicule. A propos d'une étude prospective de cent malades au premier stade de la maladie.

In a prospective study, 100 patients with clinical stage I nonseminomatous testicular tumours were investigated by a surveillance policy, which consisted of regular follow-up after orchiectomy alone until disease progression was confirmed. Follow-up revealed that 65 of the 100 patients were free of disease at 25 to 90 months after orchiectomy. Disease progression was detected in 35 patients at 3 to 27 months following orchiectomy. Patients with progression were treated by PVB chemotherapy. Patients with non-seminomatous testicular tumours in clinical stage I represent a group which is not homogeneous and can therefore not be treated by means of a single modality. It is necessary to individually define optimal treatment based on prognostic factors. The surveillance policy is available in patients without risk factors and regular follow-up is mandatory. Multidisciplinary collaboration and cooperation with patients are essential.

[Surgical treatment of residual pulmonary metastasis of testicular germ cell tumors after chemotherapy]. / Chirurgická liecba reziduálnych pl'úcnych metastáz germinatívnych nádorov testis po chemoterapii.

Advances in chemotherapy achieved a high percentage of complete remission after primary cytostatic treatment in germinal testicular tumours. In 30-40% of patients in the IVth stage of the disease supplementary surgery is, however, necessary--retroperitoneal lymphadenectomy or metastasectomy of the lungs. The authors give an account of initial results of surgical removal of metastases in the lungs in seven patients of 48 treated with cytostatics on account of a germinal testicular tumour. The low risk of thoracotomy, if correctly indicated, justifies us to describe this operation not only as auxiliary but therapeutic.

[Antegrade pyeloureterography in the transplanted kidney]. / Antegrádna pyeloureterografia transplantovanej oblicky.

Antegrade pyeloureterography performed via fine puncture needle yields detailed imaging of the anatomy of the renal pelvis, calices, and ureter of the transplanted kidney. It is a simple and safe examination method providing information which, as a rule, can not be obtained by urography, radioisotope gammagraphy or ultrasonography. Puncture of the collecting system of the transplanted kidney with subsequent pyeloureterography is indicated for determining the site and nature of the obstruction in the ureter in urinary stasis in the transplanted kidney, for diagnosing urinary fistulas, for functional examination of the dilated upper urinary tract, as well as for percutaneous treatment of urological complications after kidney transplantation.

[Factors affecting the recurrence of epithelial tumors of the urinary bladder]. / Faktory ovplyvnujúce recidívu epitelových nádorov mocového mechúra.

Of the 178 patients with superficial tumors of the urinary bladder followed up over minimally three years from the onset of treatment, 137 (77%) developed relapse of the tumor. Comparison of anamnestic data and objective examination findings in patients with and without relapses yielded a statistically significant probability of relapses in patients with multiple tumors, in tumors with an increased number of cell layers, and in tumors with infiltration of the lamina propria. Patients presenting with any of these features are at risk of relapses and require prophylactic treatment.