The role of endoscopic bladder tumour assessment in the management of patients subjected to transurethral bladder tumour resection

Despite complete resection, non-muscle invasive bladder cancers tend to recur. Therefore, their risk stratification was implemented to select adjuvant therapy. Immediate intravesical chemotherapeutic instillations were shown to decrease the risk of recurrence in those with low-risk disease. The purpose of the study was to determine the role of endoscopic assessment in the management of patients subjected to transurethral resection of the bladder tumour (TURBT). In 262 patients submitted to TURBT due to primary bladder tumour, the size and the number of the lesion(s) were noted and the stage as well as the grade of the tumour(s) were typed. The individual features were then scored according to the European Organisation of Research and Treatment of Cancer 'Bladder Calculator' and the lesions were classified into the low, intermediate and high risk of recurrence group. Clinical evaluation was then compared with pathological report and final triage. Based on the clinical data, 95 (36.25%), 105 (40.07%) and 3 (1.14%) patients were endoscopically assigned to the groups of low, intermediate and high risk of recurrence respectively. After pathological report, correct risk stratification was confirmed in 86 (90.5%), 95 (90.5%) and 3 (100%) patients respectively. Endoscopic assessment of bladder cancers allows to accurately establish the risk of recurrence and may facilitate implementation of adjuvant therapy before histological evaluation.

Vacuum removal of the template in MCM-41 silica studied by the positron annihilation method

Positron annihilation lifetime spectra were measured for ordered silica before template (octadecyltrimethyl ammonium) removal. An intermediate lifetime component, well pronounced in the spectra, indicates the presence of structural defects in the template being the size of a surfactant molecule. At the temperature near 420 K a radical change of template structure occurs, consisting in appearance of disorder and the degradation of template; evaporation of the fragments begins. It seems that moderate heating (up to about 500 K only) in vacuum for several hours is an effective and simple method of template removal, leaving no pure carbon residue in the pore structure. The results are compared with the data from the liquid nitrogen adsorption/desorption method and elemental analysis, confirming the positron annihilation results.

The lack of effect of a prophylactic dose of enoxaparin on thrombin generation in patients subjected to nephrectomy because of kidney cancer

It is assumed that major surgery, connected with extensive tissue dissection, brings about the release of tissue factor into circulation and subsequent activation of coagulation system. This activation results in the thrombin generation, which is supposed to be suppressed by the low-molecular-mass heparins (LMMH), administered to the surgical patients as the prophylaxis against postoperative venous thromboembolism. We have estimated the concentration of circulating thrombin-antithrombin (TAT) complex in patients subjected to transperitoneal nephrectomy and randomized into controls and who received 40-mg enoxaparin 12 h before and 12 h after the operation and then once daily for 7 days. We have observed a sharp rise of TAT concentration at the end of surgery and it corresponded to the simultaneous drop of antithrombin (AT) activity. TAT concentration gradually decreased and AT activity increased up to the end of observations on the seventh postoperative day, but there were no differences observed between the groups of patients. We have also observed a biphasic increase of plasmin-plasmin inhibitor (PPI) complex concentration in our patients. Again, there were no differences in PPI between the groups of patients. It is our conclusion that under the conditions of this study, the well-known prophylactic effect of enoxaparin against the venous thromboembolic complications was not mediated by the inhibition of intraoperative thrombin generation. The anti-inflammatory or biophysical influence of LMMH may be rather taken into account in surgical patients receiving prophylactic doses of these heparins.

Magnetic resonance urography: initial experience of a low-dose Gd-DTPA-enhanced technique

Contrast-enhanced magnetic resonance urography (MRU) is a promising tool in the evaluation of the renal collecting system, but it can be limited by T2* effects resulting from hyperconcentrated gadolinium chelates. The aim of this study was to evaluate a low-dose dimeglumine gadopentetate (Gd-DTPA) MRU technique consisting of a dynamic fast low-angle-shot (FLASH) 2D sequence and a static fast imaging in steady state precession (FISP) 3D sequence for depicting the kidneys and urinary tract. The Gd-DTPA dose (0.01 mmol/kg) was established experimentally in a healthy volunteer study. Ninety-one patients presenting with various renal disorders were examined with a low-dose Gd-DTPA MRU and a T2-weighted turbo spin echo (TSE) MRU technique on a 1.5-T system. Image quality and diagnostic value were considered at least satisfactory in 98.9% of the FLASH 2D studies, 83.5% of the FISP 3D studies and 78.5% of the TSE T2-weighted studies. Typical enhancement patterns were established for the renal cell carcinoma and transitional cell carcinoma. The major limitations were motion artefacts and insufficient hydration of the patients. Low-dose Gd-DTPA MRU appears to be a useful technique in the evaluation of the kidneys and urinary tract, especially in cases of renal tumours.

[Analysis of clinical symptoms of renal clear cell carcinoma]

An analysis of the clinical symptoms has been carried out in the group of 110 patients who underwent nephrectomy for a clear-cell carcinoma. Total hematuria (47.3% of patients) has been a predominant symptom of the tumour. Pain felt in the back has been noted in 39.1% of patients. Palpable tumour has been noted in 34.5% of patients. Such symptoms have been present simultaneously (Israel's triad) in 12.3% of patients. Tumour has been diagnosed accidentally, mainly with USG, in 37.3% of patients. It has been found that classic clinical symptoms of this cancer are nowadays less frequent than before introducing ultrasound examination.

[Sigmoid-vesical fistula as a consequence of sigmoid tumor]

Because of unusual rarity of neoplastic sigmoid-vesical fistula in young patients the case of 43 years old woman, in whom the fistula was the consequence of sigmoid adenocarcinoma infiltration of urinary bladder, was presented. The patient was treated radically by resection of the sigmoid and partial resection of the urinary bladder within healthy tissue. After operation the patient was exposed to radiotherapy, after which chemotherapy followed (6 courses of 5-day chemotherapy with fluorouracil and calcium folinate). 18 months after operation, 16 months after radiotherapy and 14 after chemotherapy patient's general condition was good and control laboratory tests did not indicate the relapse of the neoplasm.

Resection of the liver in a metastatic disease caused by renal carcinoma

Two patients are presented who had their livers resected because of the metastasis of the kidney tumour. It is a contribution in the discussion on the possibility of treatment of a well-advanced cancer disease. The treatment chosen was possible because of the close co-operation between two different teams of surgeons.

[Evaluation of the effectiveness of prazosin in conservative treatment of benign prostatic hypertrophy]

Prazosin--a selective blocker of alpha 1-adrenergic receptors--was administered to 30 patients with benign prostatic hypertrophy. Twenty four patients (80%) reported an improvement in voiding and observed more potent urinary stream after the treatment. Average and maximum flow rates increased in 18 patients (60%). Therapy had to be discontinued in 2 patients because of the adverse reactions (hypotension and syncope in one and exacerbation of the coronary disease symptoms in another patient).

[Early results of endoscopic treatment of vesico-ureteral reflux in children]

Endoscopic treatment of vesicoureteral reflux (VUR) is based on transurethral injection of Teflon paste or collagen gel into the submucosa of the bladder wall beneath the distal ureter, resulting in support of the intramural part. This endoscopic procedure was performed in 75 children with VUR of varying severity. Altogether 111 ureters were treated, 94 with injections of Teflon paste and 17 with collagen gel. Improvement of VUR in the early postoperative period was achieved in 91.5% of the ureters treated with Teflon and in 82.4% of the ureters treated with collagen. No complications were observed. Endoscopic treatment of VUR seems to be an worthwhile alternative to open surgery. However, since long-term follow-up has not been completed, the efficacy of the method cannot yet be finally assessed.

Calicocystostomy in the treatment of giant hydronephrosis

Calicocystostomy or calicopyelocystostomy was performed for the treatment of hydronephrosis of ectopic or transplanted kidney into the region of the iliac fossa. To the best of our knowledge there is no description of this treatment modality for hydronephrosis in a normally situated kidney. This prompted us to present 2 such cases observed in our clinic.

Retrigonization of the bladder neck and its influence on the prostatic cavity after prostatectomy

Retrigonization of the bladder neck consists in suturing the posterior lip of the bladder neck to the posterior wall of the prostatic cavity near the urethral stump. An evaluation of retrigonization was made on the basis of a comparison of results obtained in 101 patients operated for adenoma of the prostate who underwent retrigonization and 99 patients in whom no retrigonization was performed. It was found that retrigonization by decreasing bleeding from the prostatic cavity shortened the duration of indwelling catheterization, thus reducing the hazard of urinary infection. Retrigonization ensures a wide junction between the bladder and the prostatic cavity and reduces the risk of post-prostatectomy urethral strictures.

Supracystic urine diversion in patients with bladder carcinoma treated by cystectomy preceded by "short radiotherapy" (2000 R)

The authors assessed the results of supracystic urine diversion in 50 patients treated by cystectomy for bladder carcinoma who had "short radiotherapy" (2000 R) before the operation. It was found that preoperative radiotherapy caused no difficulties during subsequent cystectomy and the observed postoperative complications should be related rather to the surgical technique. It seems that indications to urine diversion by the method of Goodwin or Coffey should be considered with greater caution. In patients past the age of 65 years and those with more advanced neoplasms (T-3, T-4) bilateral ureterocutaneostomy should be performed more frequently for suprapubic urine diversion.

Diverticula of renal calyces

The authors present results of the treatment of 31 patients with calyceal diverticula. Conservative therapy was applied in 19 cases, whereas in 12 patients surgical treatment was performed. Surgery was mandatory in patients with persistent pains and/or in whom the infection of the urinary system did not respond to conservative therapy, as well as in cases of nephrolithiasis. Diverticulectomy was performed in eight patients, and resection of the lower or upper renal pole ws done in four patients. In all cases the results of treatment were good.

Analysis of urinary tract infections in patients undergoing prostatectomy

Analysis is presented of 260 patients on whom in the years 1974--1976 an operation for adenoma removal was performed. 115 patients (44.2%) had a permanently placed catheter or were repeatedly catheterized before operation, and 145 (55.8%) were able to urinate without any need for catheterization. In the group of preoperatively catheterized patients infection of the urinary system was demonstrated in 84 cases, which amounts to 75%. Among patients not catheterized before operation, infection already existed in 29 cases (20%). Operation by Millin's method was carried out in 181 patients; non-infected urine was postoperatively found in 40 cases, which amounts to 22.3%. 79 patients were operated on by the transvesical method; in this group non-infected urine was found in four cases, i.e. 5.1%. Calculated x2 indicated a significant connection between the investigated items, consisting in a much more frequent occurrence of urinary system infection in patients operated on by the transvesical method. The duration of catheter reposition in the urinary bladder after prostatectomy considerably influences the number of postoperative infections of the urinary system.

Involuntary ureteral micturition resulting from the ectopic opening of the single ureter into the urethra

The ectopic opening of the single ureter is a rare developmental defect of the urinary system. The authors present a case of the opening displacement of the single ureter to the urethra resulting in ureteral micturition. The successful treatment is a result of the transplantation of the ureter into the bladder.

Asymptomatic kidney tumors incidentally diagnosed in two patients

In the years 1962--1975, at the Urological Department of the District Hospital in Warsaw, 1607 patients were operated on because of nephrolithiasis. In two cases coexistence of nephrolithiasis with renal tumour was demonstrated during operation. Physical and preoperative X-ray examinations suggested neither tumour nor metastatic foci in these two patients. The coexistence of nephrolithiasis and tumour of the kidney is a rarity (in our material 0.12%). Lumbotomy carried out because of nephrolithiasis makes possible a precise evaluation of the kidney condition and early discovery of tumour producing no clinical symptoms or X-ray changes.