Carcinoma of the prostate in young patients: a report of two cases

Carcinoma of the prostate is rare in young patients and has an aggressive biological behavior and rapidly fatal outcome, irrespective of the treatment modality. Presentation and clinical course of the carcinoma in 2 patients 28 and 31 years of age are described with a brief review of the relevant literature.

Primary repair of colorenocutaneous fistula in patients with genitourinary tuberculosis

Two cases of colorenocutaneous fistula due to genitourinary tuberculosis are presented. They were successfully managed by single-stage surgery (nephroureterectomy, fistulectomy, and primary repair of the colon) and antitubercular treatment. The literature is briefly reviewed.

Clinical profile and problems of management of 108 cases of germ cell tumours of testis at Institute Rotary Cancer Hospital, All India Institute of Medical Sciences New Delhi 1985-1990

A retrospective analysis of 108 cases of primary germ cell tumours of testis seen over a 6 year period at Institute Rotary Cancer Hospital of All India Institute of Medical Sciences, New Delhi is presented. There were 45 (42%) cases of seminoma and 63 (48%) of non-seminomatous germ cell tumours (NSGCT). The median age at presentation was 35 and 30 years respectively. Almost half (56) patients presented in advanced stage (stages IIc-IV). Tumours in undescended testis formed an important subgroup (14%). The standard approach of treatment was radiotherapy in stages I & II seminomas and chemotherapy in bulky seminomas and metastatic NSGCT. Chemotherapy protocols used were VAB-6 and PVB. Although a policy of surveillance has been practised for stage I NSGCT, it is debatable whether it is universally suitable for our patients. The results of treatment in low volume disease are comparable to that in the west but the management of bulky disease requires a more aggressive approach. Unfortunately only 74 out of 108 (68.5%) patients were able to complete the treatment prescribed. Most of the defaulters were from the chemotherapy group because of inability to afford the drugs. The probability of survival of those who completed treatment was 0.77 at 4 years. Since testicular tumours are largely curable, a more vigorous policy of detection, follow up and treatment needs to be pursued. Better screening of children with undescended testis will reduce cancer in this group. Failure to provide chemotherapy to all patients is particularly unfortunate for a curable disease like testis cancer.

Urinary bladder carcinoma as apparent cause of antepartum haemorrhage in pregnancy

A 34-year-old multipara presented with painless profuse genital bleeding during the third trimester of pregnancy in a state of hemorrhagic shock. Haematuria because of urinary bladder carcinoma was found to be the cause of bleeding. Cystoscopy was useful for accurate diagnosis as well as for achieving haemostasis. This case emphasizes the possibility and importance of haematuria when dealing with a patient with antepartum haemorrhage.

Retroiliac ureter with contralateral transverse malrotation of kidney: treated by crossed ureterocaliceal anastomosis

We report a case of congenital bilateral urinary tract anomalies presenting as an abdominal mass with chronic renal failure. The anomalies comprised a retroiliac ureter with grade IV vesicoureteral reflux on the right side, which resulted in a nonfunctioning pyonephrotic right kidney, and a transversely malrotated hydronephrotic left kidney with a calculus. An initial attempt to improve the drainage of the left kidney by posterior transposition of the ureter failed. Subsequently, right nephrectomy and crossed ureterocaliceal anastomosis with the right ureter were performed. The reflux was treated by a ureteral tunnel advancement technique.

Skeletal anomalies associated with unilateral renal agenesis

Unilateral renal agenesis is sometimes associated with skeletal anomalies. The skeletal malformations are easily detectable and, if found, should suggest further urological investigations. The embryological aspect of the association is explored. Two cases are presented and the relevant literature is reviewed.

Core-through optical internal urethrotomy in management of impassable traumatic posterior urethral strictures

During a 2 1/2-year period 10 patients with a traumatically obliterated posterior urethra underwent core-through optical internal urethrotomy 3 to 6 months after pelvic fracture. After 6 to 24 months of followup the peak urine flow rate was more than 15 ml. per second in 6 patients and 8 to 15 ml. per second in 2. Six patients were continent and 2 had transient stress urinary incontinence. Of the 10 patients 2 were failures because of peak urinary flow rates less than 8 ml. per second and/or urinary incontinence. Subsequently, 1 patient underwent successful scrotal flap urethroplasty. Core-through optical internal urethrotomy is an attractive alternative to urethroplasty when the impassable stricture is short.

A high risk factor score in the management of benign prostatic hyperplasia

To evaluate high risk factors in the management of benign prostatic hyperplasia, a scoring system has been devised which includes associated medical diseases and such complications as retention, infection and uraemia. A score of 1 to 3 was given for each high risk factor. Patients with a total score of 1 to 3 were regarded as grade 1, 4 to 6 as grade II and more than 7 as grade III. Three hundred and fifty cases of benign prostatic hyperplasia were evaluated and the patients' hospital stay, complications and mortality compared.

A simple loop catheter for ureteric calculus retrieval

The fabrication and use of a simple looped catheter for ureteric stone retrieval are reported. In a series of 46 patients the loop was passed successfully in 28 and the stone dislodged in 20 (71.4%). This device can be made by any urologist, using cheap, readily available materials. Complications are few and the success rate is high.

Management of patients with renal and ureteric calculi presenting with chronic renal insufficiency

Of 403 patients with renal and ureteric calculi treated during the last 4 years, 64 presented with features of chronic renal insufficiency: 59 of these underwent surgery. Good pre-operative preparation and conservative renal surgery restored normal renal function in 14 patients and 27 improved significantly. The remainder either did not improve or continued to have progressive renal failure. It is emphasised that these patients are considerably worse off compared with their counterparts with normal renal function. The overall mortality rate was 17%. Patients whose post-operative serum creatinine levels did not stabilise to less than 884 mumol/l seemed to make poor progress in the follow-up period.

Replication of non-respiratory viruses in tracheal organ cultures

Employing Hoorn's technique, tracheal explant cultures were set from adult hamsters, rabbits and human foetuses. To determine the susceptibility of these cultures they were infected with nine different mainly non-respiratory viruses. Assay of virus was carried out in susceptible cell lines. The results of these studies indicated that herpes simplex type I (HSV-1) and vaccinia viruses multiplied in these cultures and caused ciliostasis. Herpes simplex type 2 (HSV-2) although multiplying in all, produced ciliostasis only in human foetal tracheal cultures. However, Chandipura (CHP), West Nile (WN), sandfly fever (SF-N) and polio-1 viruses multiplied without ciliostasis. These cultures did not support multiplication of Japanese encephalitis (JE) and Chikungunya (CHIK) viruses. The studies indicated that mammalian tracheal cultures support replication of the non-respiratory viruses. The continued and undiminished multiplication of viruses over long periods without ciliostasis suggests a role for the trachea in the transmission of viral infections by aerosol.

The management of renal and ureteric calculi in renal failure

The management of 50 patients with renal failure and renal and ureteric calculi is described. Following dialysis and appropriate surgical intervention, renal function improved in 86%. Patients with acute and acute on chronic renal failure improved to nearly normal and remained so on follow-up. Eight per cent of those treated by surgery had retained calculi and 2% developed a recurrence of stones. Sixty-eight per cent showed improvement in hypertension. The mortality rate was 8%.