Renal malacoplakia: an important consideration in the differential diagnosis of renal masses in the presence of Escherichia coli infection.

Renal malacoplakia is an uncommon condition with a variety of radiological characteristics which may initially suggest an alternative diagnosis. Three cases of renal malacoplakia were diagnosed in our hospital during a 2 year period. This apparent cluster of cases probably reflects the increased use of imaging and biopsy in the investigation of elderly hospitalized patients. It is important to make a definitive diagnosis as correct management may result in cure.

The effect of intravesical mitomycin C on recurrence of newly diagnosed superficial bladder cancer: a further report with 7 years of follow up.

PURPOSE: We determined the role, if any, of 1 and 5 instillations of intravesical mitomycin C in the treatment of newly diagnosed superficial bladder cancer. MATERIALS AND METHODS: A multicenter randomized clinical trial was done involving 502 patients with newly diagnosed superficial bladder cancer. After complete transurethral resection patients with newly diagnosed superficial bladder cancer. After complete resection patients were randomized into 1 of 3 treatment arms: no further treatment, 1 instillation of mitomycin C at resection and 1 instillation at resection and at 3-month intervals for 1 year (total 5 instillations). The dose of mitomycin C used was 40 mg./40 ml. water. End points were interval to first superficial recurrence, recurrence rate (defined as the number of positive cystoscopies per year) and progression-free interval rate (progression defined as the development of muscle invasive or metastatic disease, or death from bladder cancer). RESULTS: After median followup of 7 years 1 and 5 instillations of mitomycin C resulted in decreased recurrence rates and increased recurrence-free interval. The benefit of mitomycin C was observed in patients at low, medium and high risk for subsequent recurrence. There was suggestive but not conclusive evidence that 5 instillations of mitomycin C offered a slight advantage over 1 instillation. CONCLUSIONS: Our analysis confirms the positive benefit of mitomycin C to decrease the number of subsequent recurrences and increase the recurrence-free interval.

The value of the pre-clinic intravenous urogram in the earlier diagnosis of the cause of haematuria.

The early treatment of patients with bladder cancer reduces mortality. By arranging a pre-clinic intravenous urogram we reduced the time from receipt of the General Practitioner's referral letter to making a diagnosis from 85 to 67 days and saved on clinic time and resources. A further reduction to 52 days was made by not using any out-patient time at all. Significant saving of time and resources is possible without any disadvantage to the patient.

A computer program for urology.

Modern information technology offers new opportunities for the storage and manipulation of clinical data within hospital departments. We have designed and put into use a microcomputer system for urology. Its basic structure and main functions are described.

Scheduling in the operating theatre.

The effect of scheduling on the use of operating theatre time has been studied. Scheduling involved determining the average length of common operations and fitting them into the calculated available operating time. The technique has been shown to reduce significantly the variation in length of operating sessions, and it ensures the best use of available operating time.

Optical urethrotomy--a 3-year experience.

One hundred and thirty-seven patients underwent optical urethrotomy and have been followed up over a period of 3 years. The overall improvement rate was 66%. The results were unrelated to the length of history, the number of previous dilatations or the site of the lesion. However, traumatic strictures did significantly less well than the others. Although the procedure can be repeated, the chance of failure following the third or subsequent urethrotomy was much greater than after the first or second procedure. Urethrotomy for post-prostatectomy membranous strictures was followed by incontinence in 31% of patients. Otherwise the procedure was safe and should be the first choice of treatment for most patients with urethral strictures.

Partial nephrectomy for stone disease.

The results of 227 partial nephrectomies for stone were reviewed. Radiologically visible calcification remaining in the kidney at the end of the operation increased the risk of further stone formation. Ipsilateral and contralateral true recurrence rates after partial nephrectomy were the same, and increased with time up to 34% at 20 years. Ipsilateral recurrence rates after partial nephrectomy were half those found in a similar study of nephrolithotomy, pyelolithotomy and ureterolithotomy. Anatomical factors are important in stone formation, and partial nephrectomy is of value in the management of renal stones.

Renal stone formation. The inhibitory effect of urine on calcium oxalate precipitation.

The mechanism of renal stone formation is not fully understood. This report describes an investigation into the effect of urine on the precipitation of calcium oxalate from dilute solution. Over 33 min a 5 per cent solution of urine caused considerable inhibition of precipitation. The degree of this inhibition was related to the concentration of the original urine. An "artificial urine" composed of 12 solutes present in normal urine had some inhibitory effect, but less than that of equiosmolar true urines. Inhibition was also related to the percentage of urine present. This inhibitory effect may be important in the prevention of renal stone formation in normal people by delaying crystallization until urine reaches the lower urinary tract.