Downstaging of TURBT-Based Muscle-Invasive Bladder Cancer by Radical Cystectomy Predicts Better Survival.

Differences between clinical (cT) and pathological tumor (pT) stage occur often after radical cystectomy (RC) for muscle-invasive bladder cancer. In order to evaluate the impact of downstaging on recurrence and survival, we selected patients from a large, contemporary, population-based series of 1,409 patients with MIBC. We included all patients who underwent RC (N=643) and excluded patients who received (neo)adjuvant therapy, those with known metastasis at time of diagnosis, and those with nonurothelial cell tumors. Disease outcomes were defined as recurrence-free survival (RFS) and relative survival (RS), as a good approximation of bladder cancer-specific survival. After applying the exclusion criteria, 375 patients were eligible for analysis. Tumor downstaging was found to be common after RC; in 99 patients (26.4%), tumor downstaging to non-muscle-invasive stages at RC occurred. Hydronephrosis at baseline and positive lymph nodes at RC occurred significantly less often in these patients. In 62 patients, no tumor was left in the cystectomy specimen. pT stage was pT1 in 20 patients and pTis in 17 patients. Patients with tumor downstaging have about a 30% higher RFS and RS compared to those without. Consequently, tumor downstaging is a favorable marker for prognosis after RC.

A late manifestation of testicular seminoma in the bladder in a renal transplant recipient: a case report.

An unusual case is presented of a renal transplant recipient on immunosuppressive medication who underwent orchiectomy for a testicular seminoma. Since the surgical resection plane showed seminoma cells, radiotherapy was applied to the para-aortic and inguinal regions. Tumor recurred in the bladder 3 years later as demonstrated by urine cytology and later by bladder biopsies. After chemotherapy, repeated bladder biopsies were normal and a complete remission was achieved. The possible metastatic pathways are discussed.

Lethal Fournier's gangrene following vasectomy.

A case is presented of a healthy young man who had Fournier's gangrene after standard bilateral vasectomy. Despite maximal treatment, including extensive necrectomy and broad-spectrum antibiotics, this complication was lethal. To our knowledge a lethal complication of vasectomy has not been reported in the literature.

PIP: A health practitioner performed a standard bilateral vasectomy on a 33-year old male who did not suffer from an immunodepressed state. No complications arose and bleeding was minimal during the vasectomy. 2 days later, he visited a physician with a fever of 39 degrees Celsius and wound reaction. The physician prescribed oral floxacillin, but the following day he suffered acute septic shock and was admitted to a hospital. The incision site was red due to congestion of capillaries, purple, swollen, and painful. Physicians ruled out prostatitis, abscess formation, and a pulmonary source as causes of the fever. The white blood cell count, potassium, creatinine, and glucose levels were very high. Physicians administered parenteral broad spectrum antibiotic treatment (imipenem/cilastatine and metronidazole) even though the blood, urine, and sputum cultures grew no pathogens. They found and evacuated hematoma and necrotic tissue from the vasectomy sites. They placed silicone drains in the sites. Within the next 24 hours, necrosis developed in the scrotum while his clinical condition declined rapidly. He suffered a cardiac arrest. They transported him to the University Hospital in Leiden, the Netherlands where physicians did a necrotomy of the scrotal, penile, and perineal skin and removed both testes. 100 colonies of Streptococcus hemolytic group A, 10-100 colonies of Escherichia coli, and 10 colonies of Staphylococcus epidermidis grew in the cultures of tissue removed at the other hospital. Yet cultures from tissue removed at the University Hospital were negative. No anaerobic bacteria colonies grew. The physicians administered penicillin, ceftazidime, and floxacillin based on antibiotic sensitivity testing results. They also began hemodialysis. 24 hours after necrotomy and bilateral orchiectomy, the necrotizing process had not spread. Yet 13 hours later and 5 days after the vasectomy, the patient succumbed. This case was the 1st known fatal complication of vasectomy. The diagnosis was scrotal gangrene of Fournier.

[The STING procedure: subureteral teflon application in vesico-ureteral reflux]. / De 'STING'-procedure: subureterale teflon-applicatie bij vesico-ureterale reflux.

Apart from open surgical correction of vesicoureteral reflux an endoscopic technique exists in which teflon paste is injected under the refluxing ureteral orifice; this is known as the STING procedure. We describe this technique, which if necessary may be repeated. The results in our patients are comparable with results from literature, with 21/23 (91%) of the ureters without reflux after treatment. The advantages and disadvantages of this technique are discussed. The good results, the short hospital stay, and the minimal perioperative morbidity favour the STING procedure when compared with the open surgical technique, and make it applicable as a good alternative to open surgical technique.