Biphasic sarcomatoid carcinoma (carcinosarcoma) of the renal pelvis with heterologous chondrogenic differentiation.

A case of a man with biphasic sarcomatoid carcinoma of the right kidney with chondrosarcomatous foci and with invasion of the pelvic mucosa and submucosa into the peripelvic adipose tissue is presented. In situ carcinoma of the urothelium of the right renal pelvis and proximal ureter was also noted. Comments on the nomenclature of malignant tumours with apparently mixed carcinomatous and sarcomatous phenotypes and a hypothesis on the histogenesis of these tumours are presented. Cytokeratin and p53 protein expression patterns, and the results of angiogenesis quantification are consistent with an epithelial-to-mesenchymal conversion induced by the stroma.

Paraperitoneal indirect inguinal bladder hernia: MR demonstration.

Inguinal or inguinoscrotal herniation of the bladder is not uncommon and has been estimated to comprise 1% to 3% of all inguinal hernias. The appearance of hernias on ultrasonography, intravenous pyelography, cystography, and computed tomography has been described previously but no instance of correlation with magnetic resonance (MR) imaging has been documented. Nevertheless, herniated bladders can be encountered fortuitously during abdominal MR imaging, and the radiologist should be familiar with their appearance. We present a case of unsuspected paraperitoneal indirect inguinal bladder herniation demonstrated by MR. Appearance on MR is characteristic, and this modality may be useful for differentiating the several types of inguinal hernias of the bladder because of its superior soft tissue contrast. In addition, MR imaging can be used to perform imaging in any plane and dynamic examinations during straining.

Bilateral ureteral inverted papilloma with synchronous transitional cell tumor of the bladder.

Inverted papillomas are benign urothelial tumors. The majority of cases occur in the bladder, while inverted papillomas of the upper urinary tract are very rare. The association of inverted papillomas of the bladder and urothelial malignancy is documented, but the incidence is low. Inverted papillomas of the upper urothelial tract coexist frequently with urothelial malignancy. Close follow-up with urography and cystoscopy is mandatory in such patients. We describe a case with synchronous bilateral ureteral inverted papilloma and a transitional cell tumor of the bladder, illustrating the strong association of upper urothelial tract inverted papilloma and urothelial malignancy.

Fracture of the penis: role of ultrasonography in localizing the cavernosal tear.

Fracture of the penis is a rare surgical emergency. A case is presented where a 7.5 mHz ultrasonography probe was used to demonstrate the tear in the corpus cavernosum. Ultrasonography was able to identify the site and extent of the injury. Preoperative ultrasonography shows the best place for surgical incision and can be used to avoid negative surgical exploration.

Angiokeratoma: a cause of scrotal bleeding.

We report a case of Fordyce angiokeratoma which presented with bleeding from the scrotum. The difference between Fordyce's angiokeratoma and Fabry's angiokeratoma corporis diffusum is described. The diagnosis, treatment and prognosis of scrotal angiokeratoma are discussed.

The role of bladder biofeedback in the treatment of children with refractory nocturnal enuresis associated with idiopathic detrusor instability and small bladder capacity.

PURPOSE: Not all children with primary nocturnal enuresis, an unstable detrusor and small bladder capacity can be treated successfully with anticholinergics and bladder drill. We report our use of bladder biofeedback in patients who did not respond to 3 months of such treatment. MATERIALS AND METHODS: A total of 24 patients (median age 10.4 years) were studied. For bladder biofeedback a transurethral catheter was placed and connected with a 3-way connector. The bladder was slowly filled through this catheter and the intravesical pressure could be seen on a vertical tube, which was also connected to the transurethral catheter. The perineal bulbar detrusor inhibiting reflex was used in cases of involuntary bladder contraction. During the day patients retained urine as long as possible and completed a micturition chart. RESULTS: Of the 24 patients bed-wetting stopped completely in 17 and decreased in 6, and treatment failed in 1. All patients were followed for at least 6 months after treatment. There were 2 cases of recurrence in the group that was cured. CONCLUSIONS: Intravesical biofeedback can successfully treat patients with refractory primary enuresis associated with unstable detrusor and small bladder capacity.

Bladder biofeedback for the treatment of refractory sensory urgency in adults.

OBJECTIVE: Evaluation of bladder biofeedback in patients with sensory urgency refractory to medication and classical bladder training. METHODS: In 12 such patients a non-electronic technique of bladder biofeedback was used. Ambulatory treatment sessions were done once a week for 4 weeks, as opposed to every 14 days, with a mean total treatment period of 8 weeks. Micturition charts were completed before, during and 14 days after treatment by the patient. Before starting, patients had a mean of 15.8 micturitions/day, 2.3 micturitions/night, and a mean functional bladder capacity of 96 ml (26-172 ml). Urodynamic investigation showed a low-capacity bladder, hypersensitivity in some patients, and normal urodynamic parameters in others. RESULTS: At the end of biofeedback, patients had a mean of 5.7 micturitions/day, 0.3 micturitions/night, and a mean functional bladder capacity of 296 ml (163-470 ml). The results 9 months after completing the treatment were unchanged. Quality of life improved substantially in all. CONCLUSIONS: Bladder biofeedback is a valuable treatment for sensory urgency refractory to classical treatment.

Inflammation in prostate biopsies of men without prostatic malignancy or clinical prostatitis: correlation with total serum PSA and PSA density.

OBJECTIVE: Inflammation is a frequent histological finding in prostate biopsies, performed on men without prostatic malignancy or clinical prostatitis. We investigated the relationship between morphological parameters of inflammation in prostatic tissue and total serum prostate-specific antigen (PSA) and prostate-specific antigen density (PSAD) levels to determine if subclinical inflammation can cause elevation of PSA and PSAD. METHODS: We reviewed 268 prostate biopsies, performed on 238 men with elevated PSA and/or abnormal digital rectal examination of the prostate. All premalignant and malignant biopsies and cases of clinical prostatitis were excluded. The inflammation in the remaining 145 prostate biopsies was scored for extent of inflammation and aggressiveness of inflammation, using the four-point scale designed by Irani and co-workers. In this prostatic inflammation scoring system, extent of inflammation is graded from 0 up to 3 according to the degree of invasion of inflammatory cells in prostatic tissue. Aggressiveness of inflammation is graded from 0 up to 3 according to the degree of contact or disruption of prostatic glandular epithelium by inflammatory cells. RESULTS: Each of the studied biopsies showed inflammatory cells. Median PSA levels in grades 1, 2 and 3 of extent of inflammation were, respectively, 5.7, 6.8 and 13. 0. Median PSAD levels in these groups were 0.13, 0.16 and 0.33. There was no significant difference between these grades for PSA nor for PSAD. Median PSA levels in grades 0, 1 and 2 of aggressiveness of inflammation were, respectively, 3.9, 5.9 and 8.9. Median PSAD levels in these groups were 0.12, 0.18 and 0.17. For both parameters, there was a significant difference between grades (respectively, p = 0.0028 and p = 0.0330). CONCLUSION: Inflammation of the prostate is a histological finding in almost every set of prostate biopsies, even when there are no signs of clinical prostatitis. This subclinical inflammation can cause PSA elevation. Not the extent of inflammation is of importance, but the disruption of epithelial integrity caused by the inflammatory infiltrate. When confronted with a patient with an elevated PSA level whose prostate biopsies reveal no malignancy but only inflammation, this concept can help in determining the need for quick repeat biopsies.

Elevated serum prostate specific antigen (PSA) related to asymptomatic prostatic inflammation.

Prostatic subclinical inflammation is associated with elevated serum prostate specific antigen (PSA) level when there is contact with and disruption of the glandular epithelium of the prostate. This aggressiveness of the inflammation was graded on a 4-point scale proposed by Irani (1). Patients with an elevated serum PSA level and no malignancy in their transrectal prostate biopsy, have a lower risk of biopsy missed prostate carcinoma when there is an inflammation with a high aggressiveness score. The density itself of the inflammatory cells in the prostatic tissue was not associated with the serum PSA level. We believe that both issues should be considered when interpreting a prostate biopsy.