Effect of flutamide on cortisol metabolism.

The effect of flutamide on cortisol metabolism was studied in eight patients with prostate cancer. Flutamide markedly decreased the formation of 3 alpha, 17,21-trihydroxypregnane-11,20-dione (THF), and the 11-oxy-17-ketosteroid metabolites by 72%, 50%, and 46% respectively; however, 3 alpha, 11 beta, 17,21-tetrahydroxy-5 alpha- pregnan-20-one was increased by 46%. The 24-h mean plasma cortisol concentration was not altered. The cortisol production rate decreased by an average of 53% (from 32.7 to 15.5 mg/24 h). The effect of the drug on plasma cortisol kinetics was studied in three patients. This showed that flutamide increased the t1/2 (from 80 to 108 min) but decreased the distribution volume (from 17.8 to 13.8 liters) and the MCR (from 222 to 130 liters/24 h). The changes in THE and THF formation and in the t1/2 and MCR of [C]cortisol are similar to the effects observed in patients with intrahepatic cholestasis. It is suggested that in the case of flutamide these changes were also due to a cholestasis-producing effect of the drug on the liver. As the clinical response to the drug did not correlate with the cortisol metabolic changes, its therapeutic effect was probably not mediated by its effects on cortisol metabolism.

Nephrectomy for renal cell carcinoma with metastases.

The percentage of patients with renal cell carcinoma who also have identifiable metastases when first seen is increasing. In the past metastases were considered justification for excluding nephrectomy in the management of the patient. However, numerous opportunities for therapy which are abetted by removal of the primary tumor are presented. It is concluded, depending on several variables, that the advantages of nephrectomy usually justify the procedure.

Bacteria in enucleated prostate.

The controversial nature of prostatitis is compounded by questions concerning the incidence and significance of bacteria within the prostate. Criticism of bacteriologic studies of expressed prostatic secretion, ejaculate, needle biopsy, and transurethral chips led us to culture the core of enucleated prostates. Of 65 prostates, 26 (40 per cent) were positive: 15 pathogens (23 per cent) and 11 nonpathogens (17 per cent). This was correlated with preoperative urinary infections, anterior urethral infection, and postoperative infectious complications. Prostatic pathogens were usually found when the urine and anterior urethra were infected.

Nonpapillary carcinoma in situ and atypical hyperplasia in cancerous bladders: further studies of surgically removed bladders by mapping.

Complete mapping of epithelium has been performed in 10 bladders surigcally removed for cancer. In all cases, in areas adjacent to or distant from the visible tumors, nonpapillary carcinoma in situ and related lesions such as atypical hyperplasia could be demonstrated. More importantly, in 5 of the 10 bladders, areas of occult invasive carcinoma derived from such abnormal epithelia have been recorded. These findings fully confirm prior observations and raise the number of totally mapped bladders to 20. The histologic findings in the entire series of 20 cases are discussed and the distribution of cancer and precancerous lesions tabulated. It is suggested that the areas of the bladder most frequently affected by precancerous lesions are the left and right lateral walls and the posterior wall. The trigone and the dome are less frequently involved. The need for aggressive assessment of bladder epithelium in patients with tumors of the bladder and/or early radical treatment for patients with non papillary carcinoma in situ is discussed in light of these observations.

Follow-up of patients after nephrectomy for renal cell carcinoma.

Follow-up of patients after nephrectomy for renal cell carcinoma is often inadequate. The sooner secondary lesions are identified and treated the better. Routine annual admission of these patients is urged for abdominal angiography, bone scan, chest roentgenograms, and specialized diagnostic procedures as indicated.

Hydatid disease of kidney.

A case of hydatid infestation of the kidney is presented. The natural history of the disease, the diagnostic workup including computerized tomography, and treatment are reviewed.

Retroperitoneal fibrosis associated with retroperitoneal abscess.

A case of retroperitoneal fibrosis associated with retroperitoneal abscess is reported. The causation and treatment of idiopathic and nonidiopathic retroperitoneal fibrosis are discussed.

Detection of tumor angiogenesis factor in adenocarcinoma of kidney.

Implantation of human renal adenocarcinoma in the rabbit cornea has resulted in new vascular growth from the limbus toward the tumor implant. This suggests that renal adenocarcinoma elaborates tumor angiogenesis factor (TAF) which stimulates endothelial cell growth. Such a substance could conceivably be responsible for the luxuriant vascularity of most renal adenocarcinomas. Conversely, absence or diminished secretion of TAF may be responsible for the hypovascular papillary renal adenocarcinomas and their recognized relatively benign clinical behavior.

Complications of renal cyst puncture.

One hundred nineteen renal cyst punctures have been reviewed. There have been four complications (3.4 per cent), three requiring surgery. This should be expected, as all invasive diagnostic procedures are accompanied by some morbidity. The relative benefit of nonoperative diagnostic procedures in differentiating benign renal cyst from adenocarcinoma is discussed.

Unstable bladder: urodynamic diagnosis and observations in evaluating urinary incontinence in the female.

Unstable bladder in the female has been the subject of controversy with regard to its etiology, identification, and treatment. One hundred thirty consecutive female patients referred with incontinence were evaluated as to their symptoms and urodynamic findings. A stress cystometrogram, systematically done, was introduced and observations were made regarding certain findings on the urodynamic examination. These criteria were used subsequently for making a diagnosis of unstable bladder. Forty per cent of these patients were found to have an unstable bladder. History of frequency and urgency correlated best with a diagnosis in 70 to 80 per cent of our cases, and the new stress cystometrogram proved to be the most sensitive urodynamic test (78%) for detecting this condition. A systematic approach such as we describe is advocated as a first step toward gaining a better understanding of this puzzling entity.

Influence of indwelling urinary tract stones on twenty-four-hour urine chemistries.

Twenty-two patients with ureteral stones underwent twenty-four-hour urinary excretion studies of calcium, phosphorus, and uric acid before and after stone elimination from the urinary tract. Comparison of pre- and post-stone elimination studies showed no significant differences suggesting that the presence of stones in the urinary tract has little influence on the twenty-four-hour urinary excretion of calcium, phosphorus, and uric acid.

On percutaneous drainage of retroperitoneal collections: when is primary surgical drainage preferable?

Percutaneous drainage of retroperitoneal collections is a method employed with an ever-increasing frequency. The indication for primary surgical drainage of these collections is rapidly decreasing. Herein we describe what we consider to be the indications for primary surgical drainage of retroperitoneal collections illustrated by the recurrence of the abscess in 3 of our patients following adequate primary percutaneous drainage.

Role of urodynamics in management of urethral diverticulum in females.

This report deals with 10 female patients with urethral diverticula, 8 of whom were also found to have findings of stress incontinence. This association was proved by urodynamic studies. Three patients were seen with incontinence postdiverticulectomy. Seven patients were evaluated prior to diverticulectomy, and of these 5 had anatomic changes of stress urinary incontinence. Those patients in whom the preoperative evaluation considered them to be at risk for development of stress incontinence postdiverticulectomy were treated with a prophylactic urethropexy. Patients so treated were continent and voided well and were probably spared having a postoperative problem with incontinence. The role of urodynamic techniques in the detection of any association between the diverticulum and a possible risk of postdiverticulectomy incontinence, and how to recognize the problem and its correction before it becomes clinically manifest are the stated purposes of this report.

Emergency cadaveric donor en bloc nephrectomy by in-corpora perfusion technique.

A rapid and safe technique of donor nephrectomy using in-corpora perfusion is described. This technique has the advantages of minimizing the warm ischemic time, avoiding damage to the accessory renal arteries, as well as providing aortic cuffs for small pediatric donor renal arteries.

Effect of ureteral stent on urinary tract infections in renal transplantation.

A retrospective study was carried out to determine the effect of ureteral intubation during renal transplantation. We noted urinary tract infections in 76 per cent of those patients whose ureters were intubated during transplantation, as opposed to 45 per cent in those transplant recipients without ureteral stents. The incidence of recurrent urinary tract infections also increased from 18 to 34 per cent with the use of ureteral catheters. Ten separate episodes of bacteremia, indirectly related to indwelling catheters, are noted.

Is there a urodynamic equivalence to anterior urethra in the male?

To evaluate the role of the anterior urethra in the male in micturition dynamics, 9 patients with urethral strictures who were undergoing a two-stage Turner-Warwick urethroplasty were evaluated with flow and pressure flow measurements, pre- and post-second-stage urethroplasty. Any decrease in flow or increase in resistance after closure would suggest an anterior "urethral effect." None was found, indicating that the anterior urethra in the male functions as an inert conduit.

Sex-dependent variations in natural history of transitional cell carcinoma of bladder.

The records of 196 patients with transitional cell carcinoma of the bladder diagnosed up to 1975 were analyzed for age, sex, tumor histology, and survival parameters. Analysis of the series as a whole showed it to be comparable to literature controls in the male to female ratio, average age at presentation, and in survival data. Sex stratification combined with parametric analysis showed that females had longer recurrence-free survivals and died less frequently of bladder cancer than their male counterparts. In addition, the incidence of high-grade tumors was lower in females. These facts and the comments that follow point to a probable less aggressive natural history of transitional cell carcinoma of the bladder in females.

Urachal remnants in adults.

Urachal disorders are uncommon and present with varied appearances. Three cases of urachal disease, one congenital and two acquired, are reported. Each case is representative of the symptoms and findings of its respective category. A review of the literature is presented. A basic understanding of urachal development is necessary to suspect a diagnosis of urachal disease.

Androgen receptors in bladder tumors.

Cytosol androgen receptor content of transitional cell bladder cancer tissue was found to be substantially higher than its content in normal bladder mucosa and lower than in control benign prostatic hypertrophy tissue. Tumors arising in female patients had a lower androgen receptor content than those arising in male patients. High-grade tumors had a lower androgen receptor content than low-grade tumors.

Ileal segment replacement of ureter. I. Effects on kidney of refluxing vs nonrefluxing ileovesical anastomosis.

Unilateral partial ureteral obstruction was induced in 32 dogs followed by total ileal replacement of the obstructed ureter. The morphologic and functional effects on the kidney using a freely refluxing versus a nonrefluxing ileovesical anastomosis were compared, as well as the effect of total tapering of the reimplanted ileal segment. The tapered ileovesical anastomosis proved more reliable for prevention of reflux than the nontapered technique. Reflux prevention does not appear necessary for maintaining renal morphology and function when bladder function is normal and the observation period short. Total tapering of the ileal segment did not prove to be advantageous in protecting against hyperchloremic acidosis in this short-term canine study.