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We report a case of a 1.5 cm cystine staghorn calculus of the right lower pole in a 32 year female known cystinuric patient. With a 200 microns Holmium laser probe through a 9,5 F flexible ureteroscope the calculus was fragmented in small particles. An internal ureteral stent was inserted at the end of the procedure. All but one small residual fragments were evacuated spontaneously after removal of the stent. This case shows that flexible ureteroscopy combined with the Holmium laser is a safe and efficient procedure to treat medium size renal cystine calculi. It can be repeated in case of recurrence with minimal trauma to the urologic tract.

Urinary incontinence following prostate surgery was evaluated in 489 consecutive patients: 216 patients underwent a transurethral resection, 98 patients a transvesical prostatectomy for benign prostatic hyperplasia and 175 patients a radical prostatectomy for localized prostate cancer. In the first group incontinence was present in 19% of the patients immediately after catheter withdrawal, 16% after 1 month, 8% after 3 months, 3% and 2% after 6 and 9 months, 1.5% after 1 year and 0.5% after 15 months. In the second group incontinence was present in 15% immediately after catheter withdrawal, 12% after 1 month, 5% after 3 months, 2% after 6 months and 1% after 9, 12 and 15 months. In the last group the incontinence rate was higher, 66% were incontinent immediately after catheter withdrawal, 53% after 1 month, 33% after 3 months, 12% after 6 months, 8% after 9 months. After 12 and 15 months still 2% had problems with persistent incontinence. These results compare favourably with the results from the literature. The fact that a rehabilitation program was introduced for the patients with post-operative incontinence, may have been a contributing factor.

Sarcomatoid renal cell carcinoma (SRCC) is an uncommon tumor of the renal parenchyma, representing one to five percent of all primary kidney tumors. The major symptoms are the same as in the classic renal cell carcinoma: haematuria and flank pain. The tumor consists of a bimorph feature of clear cells with areas of spindle cells and giant cells, resembling a sarcoma. Immunohistochemistry and electronmicroscopy are often necessary to prove the epithelial origin of these spindle cells. Therapy is essentially surgical but in some cases there can be a benefit of chemotherapy.

The pancreaticoduodenocystostomy has become the most acquired technique to perform a combined pancreas-kidney-transplantation. This operation shows some disadvantages. There sometimes are urological problems. In this article, we describe two patients, who showed urethral problems due to this operation. At the same time, we would like to describe the possible causes and the preferable treatment of this rare complication. We advise to start with a conservative treatment and, if problems persist, to consider an intestinal conversion.

The early diagnosis of bladder cancer is central to the effective treatment of the disease. Presently, the detection of bladder tumors relies on cystoscopy and there are no methods available to easily and specifically identify the presence of bladder cancer cells. A variety of new technologies and potential tumor markers are being studied in bladder cancer and some are being translated into clinical use. It is important to realise that all available results on the diagnostic value of tumor markers do not allow firm clinical recommendations, but tests based on biomarkers will undoubtedly influence the management of bladder cancer in the near future.

As long as advanced prostate cancer remains androgen-dependent, it can be treated by castration in combination with anti-androgens. When despite maximal androgen blockade (MAB), progression occurs, the anti-androgen withdrawal can result in partial remission. Otherwise corticosteroids can be used in low doses in order to suppress the androgens originating from the adrenal gland: total androgen suppression (TAS). The minimal side effects and the low cost price of this treatment are important advantages, given the fact that only few efficient cytostatic agents are actually available for hormone-escaped prostate cancer. About 30% of the patients with advanced prostate cancer that became androgen independent will show a secondary remission under low doses hydrocortisone or prednisone.

Renal cell carcinoma has a very heterogeneous behavior. Nearly 30% of the patients are metastatic at the time of diagnosis and approximately 50% of the patients will develop metastases or recurrence after nephrectomy for an apparently localized disease. No prognostic factor is at the moment absolutely reliable in predicting the outcome for an individual patient. Nephrectomy in the presence of metastases is often performed by urologic surgeons in an attempt to prolong life or to improve the quality of life. Induction of spontaneous regression of metastases is very rare and it is still not proven that nephrectomy enhances the response to any systemic therapy. The resection of a solitary metastasis can be beneficial to a few patients although cure remains uncommon. Since no other effective treatment is actually available, metastasectomy can be advocated in a selected group of patients.

Fluorescence tagging of tumors by sensitizing agents such as hematoporphyrin derivatives is an efficient method for diagnosing tumors but presents, even at low doses, a number of serious drawbacks for the patients. We demonstrate a fiberoptic instrument for the diagnosis of bladder cancer, based on a tripled frequency Nd YAG laser, without need for sensitizing agents, based on the autofluorescence of tissues. The contrast demarcation obtained for CIS and TCC respectively is 2.2 and 2.7, which is about 30% higher than what can be obtained after photosensitizing. The integration of the diagnostic method with a reliable therapeutic technique for tumor cell destruction, opens the way for cost-effective preventive care of high risk patients.

We have studied the histopathology of 87 dorsal penile veins, obtained from patients who underwent a resection of the deep dorsal penile vein because of proven venous leakage. The amount of muscle tissue and of collagenous connective tissue has been numerically quantified. Special attention has been focused on the muscular/collagenization ratio. We show that this ratio is not correlated to age neither with the outcome of the operation and that no differences exist between veins in venous leakage patients and in potent patients. This study confirms that the reduction of venous outflow-the so called corporeal veno-occlusive mechanism-is probably a secondary passive phenomenon, due to smooth muscular relaxation, and mainly located within the corpora cavernosa, between the expanding sinusoidal wall and the noncompliant tunica albuginea. Our findings also strongly refute the hypothesis that polsters or other venous wall characteristics contribute to the normal physiology of the deep dorsal penile vein.

A prospective study was done on 76 patients who underwent surgical correction by corporeal plication of the penile deformity secondary to Peyronie's disease. Nocturnal penile tumescence and rigidity were recorded by RigiScan during three consecutive nights, before and after the operation. A significant number of patients developed erections of better quality especially at the tip, after this corporeal plication procedure. These data indicate that corporeal plication does significantly enhance the quality of erectile episodes, by increasing penile rigidity.

127 patients with a clinical stage T2b and T3 prostate cancer were randomized in order to undergo either a radical prostatectomy alone or a radical prostatectomy after hormonal treatment (560 mg of estramustine phosphate daily for 6 weeks) in a prospective multi-center study. The clinical or radiological evaluation of an eventual downstaging being extremely difficult, the authors compared in the 2 groups the influence on the surgical act and the number of positive surgical margins at pathological examination of the resected specimen. There was no significant difference between the 2 groups concerning the surgery (duration of the procedure, blood transfusion, degree of difficulty). For clinical T2 prostate tumors the number of positive surgical margins was significantly lower in the group that had preoperative hormonal treatment. In the group with clinical T3 prostate cancer this difference was not found. The influence of positive margins on the later development of local or systemic recurrence and on survival still has to be awaited. At this moment one could conclude that only patients with a T2 prostate cancer benefit of a preoperative hormonal treatment.

A patient, in which unsuccessful venous leakage procedure followed by revascularisation of the penis, lead to a hypervascularization of the glans and important oedema of the penis is presented. After embolization of the epigastric artery, these symptoms disappeared and the patient had normal erectile function.

Sixty-eight patients who underwent radical prostatectomy without or after neo-adjuvant hormonotherapy for B2 or C stage prostate cancer were evaluated as concerned to the ease of the surgical procedure. Although it is difficult to assess this parameter, we experienced more difficulties and blood loss was higher in patients who had preoperative hormonal deprivation. Ongoing randomized trials could demonstrate an oncological benefit of neo-adjuvant hormonotherapy before radical prostatectomy. This eventual benefit will have to be balanced against an increased surgical difficulty.

A case of a female patient with an adenocarcinoma of the bladder emerging from ectopic colonic epithelium is reported. Although urothelial metaplasia in itself is not a premalignant lesion, patients with metaplasia of the bladder epithelium should be followed up very strictly since malignant degeneration has been proved to occur.

A case of pseudotumor of the urinary bladder secondary to intramural lithiasis is reported. Computer tomography, cystoscopy of the mass and cytology suggested a malignant tumor. A transurethral biopsy from the tumor was therefore performed, but it showed tissue covered with normal transitional cell epithelium but no signs of malignancy. Pseudotumoral edema of the bladder is easily mistaken for a malignant neoplasm (1, 2, 3).

A case of a man with a cystic tumor destroying the corpus cavernosum at the penile basis is described. A surgical excision was performed. The real nature and the origin of the cyst is not elucidated.

A retrospective study of 70 patients who underwent a radical prostatectomy in 1989 and 1990 was done. The significance of CT-scan in preoperative lymph node assessment should be reconsidered. The correct examination of the resection margins is very important: the pathologist should clearly distinguish between capsular invasion and capsular penetration or transgression. The etiology of local failure and its treatment are discussed.

A female patient, undergoing a radical cystectomy and a continent urinary diversion in the umbilicus (after multiple gynecological interventions and 40 Gy radiotherapy) presented a stenosis of the left ureter. After 6 months a uretero-pyelostomy (left-right) was performed mediating a bilateral lumbotomy. This approach has prevented a nephrectomy or a laparotomy which could compromise the continence mechanism of the pouch.

Transureteroureterostomy in 17 consecutive cases is reviewed. Our technique of the operation (with retroperitoneal approach) is described. Stenosis of the recipient ureter or other complications did not develop in any of our cases. Based on our experience we continue to regard this procedure as an excellent means of urinary diversion for patients with unilateral lower ureteral lesions.

Total serum testosterone, serum testosterone binding globulin and free androgen index were determined before and during treatment in 14 patients with previously untreated disseminated prostatic cancer. Six patients received estramustine phosphate and six other patients underwent orchiectomy. Two further patients received estramustine phosphate because of tumor progression one and two years after orchiectomy. The result of the study indicates that estramustine phosphate is significantly more effective than orchiectomy in eliciting low levels of free androgens. This complete androgen ablation is produced by a depression of total testosterone and a concomitant increase of total serum testosterone binding globulin which yields a free androgen index an average 4.6 times lower in estramustine phosphate treated patients than in patients who underwent orchiectomy.