Detection of cellular proliferation during compensatory renal growth using flow cytometry.

Compensatory renal growth (CRG) consists of cellular enlargement and a small but consistent increase in DNA content. It has been assumed that the increase in total renal DNA content was due to new cell formation, however, the possibility of nuclear polyploidy remained an alternative explanation. To test the hypothesis whether cellular hyperplasia is the cause of the increase in DNA content during compensatory growth after renal deprivation, we performed cell cycle analysis using flow cytometry. Following unilateral nephrectomy, the amount of cortical cells in the S phase increased by 12% at 10 h while the number of cells in the G2M phase increased by 7% at 120 h. Medullary cells entering the S phase increased by 26% at 24 h and those in G2M increased by 12% at 168 h. DNA synthesis and replication occurs during CRG following unilateral nephrectomy as evidenced by an increase in cells entering both the S and G2M phases of the cell cycle. The increase in DNA content during CRG is a result of cellular proliferation and not polyploidy.

Urinary tract reconstruction in children.

Urinary tract reconstruction and continent urinary diversion in children present a significant technical challenge. A major commitment is mandated from both surgeon and patient. We believe that although the principles and objectives of total bladder replacement rely on basic surgical and physiological tenets, the attainment of a successful outcome also requires patient involvement and cooperation.

Eosinophilic cystitis in children.

Eosinophilic cystitis is an uncommon inflammatory disorder of the urinary bladder which causes irritative voiding symptoms and may mimic rhabdomyosarcoma radiographically. In children, eosinophilic cystitis has been previously reported to be self-limiting and requires no specific therapy. Reported herein is a case of a nine-year-old girl in whom eosinophilic cystitis recurred following antireflux surgery, raising the question of an association of eosinophilic cystitis with local trauma such as bladder surgery. Consideration should be given to pretreatment with steroids and antihistamines prior to surgery in these patients.

Enhanced detection of bladder cancer using the epithelial surface marker epithelial membrane antigen: a preliminary report.

The flow cytometry (FCM) technique allows for the rapid quantitative analysis of the DNA content of individual cells. In a variety of genitourinary tumors, DNA ploidy has a significant impact upon prognosis and ultimate patient survival. In patients having transitional cell cancer (TCC) of the bladder, FCM of voided urine and bladder barbotage specimens is highly correlated with cytologic analysis in the detection of malignant cells. One problem with this technique has been decreased sensitivity in samples containing large numbers of inflammatory cells. To improve FCM detection of TCC in bladder wash specimens, we developed a technique using a monoclonal antibody (Mab) specific to human, epithelial membrane antigen (EMA). The EMA cell-surface marker enabled us to differentiate bladder epithelial cells from lymphocytes and cellular debris. In combination with DNA analysis using propidium iodide, the EMA Mab increased the sensitivity and specificity of FCM compared to conventional analysis using propidium iodide alone. We conclude that epithelial cell-surface antigen staining using both EMA Mab and DNA staining can increase the FCM detection of TCC in bladder wash specimens.

The flow cytometric analysis of undescended testes in children.

Flow cytometric analysis was performed on the testicular aspirates of 45 consecutive children with unilateral cryptorchidism undergoing elective orchiopexy or orchiectomy. Concomitant histological analysis was performed on the testicular tissue obtained from either biopsy or orchiectomy specimens. In all cases deoxyribonucleic acid histograms appeared to correspond with microscopic appearance. Histograms from prepubescent patients demonstrated 85 to 95% of cells in the diploid (2c) peak and less than 10% of cells in the tetraploid peak (4c), representing prepubertal testes without active spermatogenesis. Three distinct patterns of ploidy were identified in postpubertal children corresponding to the histological appearances of normal spermatogenesis, maturation arrest and the Sertoli-cell-only syndrome, respectively. In addition, we identified an aneuploid cell population in the specimen from 1 patient, suggesting that this testis may be at risk for future malignant degeneration. We conclude that flow cytometry of testicular aspirates is an easy and effective means of testicular evaluation, which may permit predictions regarding the fertility and malignant potential of undescended testes in postpubertal children.

Flow cytometric analysis of localized adenocarcinoma of the prostate: the use of archival DNA analysis in conjunction with pathological grading to predict clinical outcome following radical retropubic prostatectomy.

Fifty-four specimens from patients undergoing radical prostatectomy for clinically confined prostate cancer between 1983 and 1987 were reviewed to determine the potential for flow cytometric (FCM) analysis of DNA ploidy and replication rate to predict disease recurrence. Each specimen was deparaffinized for FCM analysis and the pathology slides were reviewed by a single pathologist. FCM characteristics were correlated with pathological grade and stage, and both were correlated with disease status. In this series of patients, routine FCM analysis of DNA ploidy and replication rate failed to significantly enhance the ability of standard histopathological grading to predict disease recurrence in patients having clinically localized prostate cancer. Aneuploid tumors pathologically confined to the prostate did not appear to negatively affect prognosis.

Ureteral reconstruction and bypass: experience with ileal interposition, the Boari flap-psoas hitch and renal autotransplantation.

A total of 18 patients underwent an operation for extensive ureteral loss from 1980 to 1986. The indications included recurrent calculi, retroperitoneal fibrosis, surgical trauma and tumor. Of the patients 10 had construction of an ileal ureter (4 had bilateral reconstruction), 6 had creation of a psoas hitch with a Boari bladder tube and 2 were treated by autotransplantation. Mean duration of followup was 4.8 years. The procedure was successful in 17 patients. There were no apparent differences among the groups. Selection criteria and potential complications are discussed with regard to each technique. These procedures provide an excellent means for reconstruction of the urinary tract in patients who have failed other treatments.

Meconium hydrocele: an unusual etiology of a scrotal mass in the newborn.

The in utero leakage of meconium from the gastrointestinal tract into the peritoneal cavity results in the clinical entity known as meconium peritonitis. A patent processus vaginalis in the male fetus may lead to the migration of meconium into the scrotum, and these infants can present with soft meconium-filled hydroceles at birth. Local tissue reaction during the first several weeks of life results in calcification of these hydroceles into hard tumor-like lesions that may mimic testicular neoplasia. We report an atypical case of meconium hydrocele in a newborn.