Blood loss during and following transurethral resection.

Blood loss measurement in transurethral prostatic surgery (TUR) has been studied with the following objectives: (1) to measure the total lost volume (during surgery and 48 hours postoperatively); (2) to compare surgical bleeding and coagulogram alterations in benign prostatic hypertrophy (BPH) and prostatic carcinoma (CaP); (3) to establish the relationship between blood loss, duration of the procedure, and amount of resected tissue. The method of Jansen was used to measure blood loss, and the "coagulogram" included the following parameters: hematrocrit; prothrombin, recalcification, thrombin, and partial thromboplastin times; fibrinogen; platelets and fibrin split products. The study is based on TUR performed on 75 patients from whom a mean weight of 25.68 grams was resected resulting in a mean total bleeding volume of 305 ml. Blood loss over 400 ml was associated with surgical durations of 60 minutes or with resection of over 40 grams of tissue. There was a slight tendency for fibrinolysis in prostatic cancer, which could explain the relatively higher amount of blood loss observed in these cases.

Sacral agenesis: why is it so frequently misdiagnosed?

Thirty-four patients with sacral agenesis were seen from 1954 to 1983, cases of meningomyelocele excluded. Five recognizable and consistent patterns of bone malformation were identified. Urodynamic examinations were done in 10 of the 34 patients. Their evaluation and response to treatment are analyzed; we tried to determine and establish the possible causes for its late diagnosis and consequences regarding the upper urinary tract.

Vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum for advanced germ cell testis tumors: Brazilian experience.

Disseminated germ cell testicular cancer proved to be highly sensitive to platinum-containing chemotherapy regimens. We present data concerning the treatment of advanced seminoma and nonseminomatous tumors in a developing country. We treated 30 patients with advanced germ cell testis tumors with 3 or 4 cycles of vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum. Surgical resection of residual masses was done 30 days after completion of chemotherapy in 18 patients. The histology of the primary tumor was seminoma in 13 patients and nonseminomatous tumors in 17. Toxicity was mild and no treatment-related deaths occurred. All 13 patients (100 per cent) with seminoma and 12 of 17 patients (71 per cent) with nonseminomatous tumors had a complete response to chemotherapy, and 1 of 17 patients was free of disease after a debulking operation and additional chemotherapy. A total of 3 patients with seminoma and 2 with nonseminomatous tumors had recurrences 5 to 8 months after an initial complete response and received additional chemotherapy (VP-16 regimen) with or without radiotherapy. Complete clinical response was achieved in 4 of 5 patients. Median followup was 24 months (range 8 to 38 months) in the 13 patients with seminoma and 28 months (range 9 to 58 months) in those with nonseminomatous tumors, and 13 (100 per cent) and 12 (71 per cent), respectively, are alive without evidence of disease. These data suggest that the protocol of vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum is highly effective and minimally toxic in the treatment of disseminated germ cell testicular cancer, inducing an 83 per cent long-lasting clinical remission. Seminomas seem to be equally or even more sensitive than nonseminomatous tumors to this platinum-containing chemotherapy regimen. Recurrence after initial complete response can be treated successfully with regimens containing VP-16.

[Vesicostomy: a temporary urinary diversion in childhood]. / La vésicostomie: dérivation urinaire temporaire dans l'enfance.

The authors report on 21 pediatric cases of tubeless cystostomies (19 males and 2 females). 15 cases of posterior urethral valves (septic condition and very narrow urethra). 3 primitive vesico-renal refluxes (small bladder, severe impairment of renal function and extensive dilatation of the upper urinary tract). 2 prune-belly syndromes. 1 neurogenic bladder. (Impracticable intermittent catheterization). 19 of the 21 cases showed dramatic improvement (narrowing of the upper urinary tract, disappearance of infection and resumption of staturo-ponderal thrive). Only 1 child with valves had to be put on cutaneous ureterostomy. The improvement in the upper urinary tract, as seen on the IVP, is very rapid in valve cases without reflux. The improvement is visible earlier on isotopic renal scans than on IVP. 11 children suffered acute pyelonephritis during vesicostomy. There were no cases of cutaneous peristomal modification. Simultaneous closure of the derivation and surgery of the primitive disease were performed in 10 cases after a 1-3 year period of vesicostomy. Vesicostomy will succeed in those babies who have shown clinical and biological improvement after a short period of trans-urethral or suprapubic catheterization. The suprapubic endoscopis treatment of the valves becomes possible through the vesicostomy hole excluding urethral trauma.

Steroid therapy in idiopathic retroperitoneal fibrosis: report of two successful cases.

We report 2 patients in whom regression of ureteral obstruction due to recurrent idiopathic retroperitoneal fibrosis was obtained with steroids. Steroids are a valid alternative to surgery in the initial treatment of biopsy-proven benign (idiopathic) retroperitoneal fibrosis.

Modified meatal advancement and glanuloplasty repair of distal hypospadias.

Meatal advancement with glanuloplasty is indicated in cases of distal hypospadias. The principles of this operation are safe. Incorporation of urethroplasty with meatal advancement and glanuloplasty enables treatment of the more severe cases of distal hypospadias. We have used this modified operative technique in 10 boys with only 1 complication, which probably was related to the wrong choice of urinary diversion.