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SummaryVarious prognostic factors which could be implicated in late complications associated with intraurethral stents and coils were evaluated. A consecutive series of 107 subjects with BPH or prostatic cancer who required intraurethral stents and randomly received either the Prostakathr` or Urospiralr` type were followed for 2–7 years. Data on stent-associated complications were collected. Factors directly associated with the complication rate were the pre-treatment presence of an indwelling catheter and asymptomatic bacteriuria, as well as post-treatment low urinary flow rate. Stent type and length did not influence outcome. It is concluded that in selected patients, either of the two studied intraurethral stents is a feasible and durable treatment. Men with indwelling catheters and/or bacteremia are at high risk of complications (e.g. migration, stone formation, strictures), as are those with post-stent insertion low uroflow. Although stents may be left in situ for years, these subgroups of men should...

Melatonin, secreted by the pineal gland at night, inhibits pubertal development of rats and presumably men. In addition, it may directly suppress prostate growth in the adult rat. To investigate the possibility for a causal relationship between the age-related decline in melatonin production and increase in prevalence of benign prostate hypertrophy (BPH) in man, the presence of melatonin binding sites in human BPH tissue was examined. In vitro autoradiography indicated specific 125I-labeled melatonin (125I-melatonin) binding in the prostate, localized to the glandular epithelium. Separation and subcellular fractionation indicated that these sites were associated with the microsomal fraction of the epithelial cells. Kinetic and equilibrium 125I-melatonin binding experiments revealed that the binding was time dependent and reversible, with an apparent half saturation at 140 pmol/L. Competition experiments indicated high and low affinity melatonin binding sites; binding was inhibited by melatonin (IC50 1 nmol/L and 1 micromol/L, respectively) and partially by the putative melatonin antagonist, N-(2,4 dinitrophenyl)-5-methoxytryptamine (ML-23; IC50 0.1 nmol/L). Serotonin and 6-hydroxymelatonin were less potent, whereas up to 0.1 mmol/Lol/L of 5-methoxytryptamine, 6-methoxymelatonin, and tryptamine caused only a partial reduction in specific binding. The guanine nucleotide analogs, guanosine 5'-O-[3-thiotriphosphate] and guanosine 5'-O-[2-thio-diphosphate, inhibited specific 125I-melatonin binding, whereas 5'-guanylyl imidodiphosphate was less potent. The results indicate putative melatonin receptors in the human prostate epithelium.

If renal colic is suspected in the patient presenting with acute flank or lower abdominal pain it must be established whether or not the affected kidney is obstructed and whether there is functional impairment that may require urological intervention. The radionuclide renal study developed in this hospital and used routinely for over 10 years can reveal obstruction when the results of commonly used tests are negative. It also provides information on renal function, morphology and blood flow. It is a cost-effective, safe and reliable procedure for the initial investigation of patients presenting with suspected renal colic.

Chronic administration of GnRH agonists "down regulates" the pituitary and decreases LH and FSH serum levels. Changes in the bioactivity of FSH have not been adequately assessed under such treatment, for lack of a proper test. We examined serum changes under GnRH agonist treatment among 12 healthy elderly men suffering only from benign prostatic hypertrophy, for up to one year, using a modification of a granulosa cell bioassay for the determination of FSH bioactivity. While radioimmunoassay-FSH decreased, we noticed a significant increase in the bioactivity of this hormone. The clinical importance of this increase is discussed.

We measured follicle-stimulating hormone (FSH) by both standard radio-immunoassay (RIA) and bioassay (Bio) methods in 56 men, using a modification of a previously described in vitro granulosa cell bioassay for the determination of the bioactivity of FSH. Thirty-four were young (mean age 25 years), and 22 elderly (mean age 72). No interfering factors such as disease or alcoholism could be identified. The elderly men had higher RIA-FSH levels compared with the younger ones. Bio-FSH demonstrated a similar trend and therefore the Bio/Immuno ratio was practically constant (3.3 +/- 0.6 vs. 2.7 +/- 0.4). We conclude that the age-associated decline in testicular function seen in normal ageing cannot be attributed to a chronic change in FSH activity. Not only is the RIA-FSH elevated among the elderly, it is of the same biological quality as in the younger men. The underlying cause for the testicular function decline is probably at the level of the testis itself.

To summarize the endocrine approach for the treatment of BPH: much clinical data have accumulated over the past forty years. Until recently, scientists and physicians mainly concentrated on the reduction of androgens as a possible solution. We have come a long way from surgical castration, through the administration of hormones such as estrogen and progesterone, gonadotropin-releasing hormone agonists to the inhibition of an enzymatic reaction reducing testosterone to DHT--the now recognized active intracellular androgen metabolite. Recently, the role of estrogens has been emphasized with the finding that stromal hyperplasia is the main change occurring in BPH. Lately, research has been initiated to examine the clinical effect aromatase inhibitors would have in the treatment of human BPH. Since there is enough evidence that both the epithelial and stromal components of the human prostate undergo hyperplasia in BPH, and individuals vary with respect to their relative epithelial/stromal components, both structures would have to be reduced for therapy to be successful. Therefore, the combination of an antiandrogenic and antiestrogenic effect is theoretically promising. Indeed, prostates of beagles shrunken after treatment with an aromatase inhibitor, further decreased in weight after additional treatment with cyproterone acetate, an antiandrogen. We are now approaching the stage where these "antihormones" are both enzyme inhibitors with actually no side effects that preclude the use of the earlier generation's "antihormonal" hormonal drugs. Furthermore, it has recently been reported that the aromatase inhibitor, 4-hydroxy-androstenedione also inhibits human prostatic 5-alpha reductase, at least in vitro. The in vivo relevance of this finding awaits further classification. Thus, a good hormonal treatment that will be both scientifically sound, and clinically safe and effective, seems feasible in the near future. Two main factors have encouraged our interest and research into methods of inhibiting prostatic growth or reducing its obstructive symptomatology: the enormous cost of prostatic operations for outlet obstruction secondary to BPH, and the natural aging process of the population accompanied by deteriorated health precluding anesthesia and prostatic surgery. Medical treatment of BPH has to result in symptomatic improvement, elimination of residual urine, and improvement of flow to be considered successful. These are usually accomplished by surgery and results at least as good as those obtained by operation should be aimed at, if medical treatment is to replace surgery. Although indications for surgery and outcome of operations are well-defined, this is not the case when alternatives to prostatectomy are chosen.(ABSTRACT TRUNCATED AT 400 WORDS)

Thirteen patients with advanced adenocarcinoma of the prostate were treated withbuserelin-a gonadotropin-releasing hormone (GnRH) analogue. Follow-up period extended to thirty-six months during which 8 patients were considered either responsive or stabilizing, in terms of pain relief and clinical tumor regression, and 5 were categorized as suffering from progressive disease. Urinary symptoms were ameliorated in the majority of cases (11/12). Prostatie size was measured by rectal ultrasound, an accepted accurate new modality. In 12 patients a decrease in size was demonstrated, and only in 1 progressive case the prostate grew larger on a six-month follow-up. Thus prostatic size and clinical responsiveness are not correlated. The clinical value of recording urinary symptomatology and measuring prostatic size in prostatic carcinoma patients is discussed with regard to the latest communications that GnRH analogues acting by decreasing testosterone levels, can cause amelioration in benign prostatic hypertrophy (BPH) cases, too. It is suggested that prostatic size has little clinical value concerning tumor responsiveness in the follow-up of patients with prostatic carcinoma.

Summary— Local deep microwave hyperthermia has been introduced recently for the treatment of benign prostatic hypertrophy (BPH). We report the results of treatment in 114 patients divided into 2 groups. The first group included 83 patients with severe obstructive symptoms. Although some improvement was found in the scoring of both subjective and objective parameters, the number of patients benefiting was small, with only 28% showing improvement in both parameters. Approximately 50% reported subjective improvement but in only 25% was this significant. In 42% there was objective evidence of improvement. Prostatic volumes did not change as a result of treatment. The second group comprised 31 patients with indwelling catheters because of acute urinary retention. After treatment, 19 patients (61%) were able to dispense with the catheter. The difficulties of interpreting an open trial of treatment for BPH and assessing its impact on objective parameters and symptomatology are discussed. Our results should be regarded cautiously in view of these reservations.

Local hyperthermia to the prostate has initially been found to be of considerable beneficial value in cancer of the gland and later also in benign prostatic hypertrophy (BPH) and in chronic prostatitis. The Prostathermer has been especially developed and used for this purpose. 124 patients with BPH, who have been treated by this method, were reevaluated after 1 year. This thermotherapy was well tolerated, and no noticeable complications were encountered. A sustained definite improvement in objective and subjective obstructive symptoms and signs was seen in 51% of the cases. Such definite and persistent improvement was best obtained when treatments were performed twice weekly for 60 min over a period of 3 weeks. Those patients with the more severe obstructive symptoms fared best. A full explanation for the effectiveness of this treatment of BPH has yet to be found. Although local hyperthermia cannot, at this stage, be considered as a radical form of treatment of BPH, it may offer definite relief to about 50% of the cases, particularly to those unwilling or unsuitable for surgery.

The use ofthe intraurethral prostatic spiral metal catheter (Prostakath) is rapidly gaining its deserved place as an alternative to the indwelling Foley catheter in alleviating the distress of the obstructed elderly patient with benign prostatic hyperplasia. Our experience extends over a period of 6 months in 23 patients: 16 with indwelling catheters and 7 without but suffering obstruction from hyperplastic prostates. Good to excellent objective and subjective results were obtained in all 19 patients who had successful insertion of the device. In four cases, the attempted insertion failed because of technical difficulties. We propose several modifications in the mode of insertion, mainly concerning more vigilance in the introduction procedure. We advocate urethroscopy before and after successful insertion, in addition to the ultrasonic guidance suggested by the manufacturer. More clinical experience is still needed, but for the present, the device seems to be a good alternative to the traditional indwelli...

Testosterone and androstenedione are metabolized by 5 alpha- and 5 beta-reductases to androsterone (A) and etiocholanolone (E), respectively. These are excreted in the urine as conjugates, and the A/E ratio in normal men is usually greater than or equal to 1.5 (as opposed to 1 in women) because of the high 5 alpha-reductase activity in the prostate. The A/E ratio can be determined simply by gas chromatography after acid hydrolysis of a urine sample, extraction of steroids, and formation of trimethylsilyl derivatives. A timed collection of urine is unnecessary because the ratio of A/E is used rather than absolute values. In men suffering from benign prostate hypertrophy who are treated with Finasteride (a 5 alpha-reductase inhibitor), the A/E ratio decreases to less than 0.5. The A/E ratio decrease can be detected long before there is clinical improvement.

The present study was designed to determine whether the administration of superoxide dismutase (SOD) can alleviate ischemic kidney damage and whether there is a relationship between oxygen free radicals and thromboxane (Tx). In 17 dogs, the right kidney was removed and the vascular pedicle of the left kidney was clamped for 75 min. Prior to reperfusion, the ischemic kidney was rinsed with 5 mg SOD and an additional 20 mg SOD was infused systemically. Blood samples were drawn from the renal vein before ischemia and after reperfusion to determine serum levels of thromboxane B2 (TxB2). All eight untreated dogs died within 1 week of renal failure, and the nine treated dogs demonstrated transient renal failure, with a significant difference (P less than 0.001) being found between the two groups. A significant difference (P less than 0.001) in TxB2 levels was found in the untreated dogs before and after ischemia and between the two groups following reperfusion. Animals that are treated with SOD after the ischemic event has occurred but before reperfusion exhibit a favorable clinical course in terms of survival and renal function. Tx synthesis in the kidney can be blocked by the administration of SOD.

Summary— Local hyperthermia of the prostate was used to treat 72 patients who had an indwelling catheter because of urinary retention caused by benign prostatic hypertrophy. One month after completion of treatment 50% of patients were able to dispense with the catheter and 1 year later 40% remained catheter-free. The best results were achieved in patients who underwent 6 to 10 treatment sessions in conjunction with cyproterone acetate 50 mg tid administered during the treatment period only.

An association between diminution in the quality of male sexual function and ischemic coronary disease has been suggested. Patients with ischemic heart disease who underwent coronary angiography participated in this study which aimed to document the impact of the extent of coronary disease upon sexual function in 40 patients (mean age 56.6 y). The 11-questions accepted questionnaire addressing sexual drive, erectile function, and ejaculation was used. Information regarding, age, medications, hypertension, diabetes, relevant risk factors, medical history, and the number of occluded coronary vessels was retrieved from the patients’ records. A statistically significant correlation was demonstrated between erectile function and the number of coronary vessels involved. Patients with one-vessel disease had more (P

Objective To examine changes in the free-to-total (f/t) serum prostate-specific antigen (PSA) ratio among men treated with finasteride for benign prostatic hypertrophy. Patients and methods Blood samples were taken from 20 men (mean age 71 years, range 61-87) before and after a minimum of 9 months of treatment with finasteride and the f/tPSA ratio determined using the Immulite assay system. Results Although mean total and free PSA levels decreased significantly, the mean f/tPSA ratio increased only slightly and not significantly ; the ratios remained unchanged in men with an initially low or high ( 10%) ratio. Conclusions Concern has been expressed over the loss of the discriminatory power of serum PSA in a patient receiving treatment with finasteride. The f/tPSA ratio, currently used to help differentiate benign from malignant processes in the prostate, remains valid during treatment with finasteride ; it does not affect the f/tPSA ratio.

Melatonin, secreted nocturnally by the pineal gland, affects gonadal growth and pubertal development in rodents and, presumably, in humans. Recently, we have found, using 125I-labeled melatonin as a probe, specific melatonin binding sites in the human benign prostate tissue; these sites were primarily associated with the microsomal fraction of the epithelial cells. In the present study, we have explored 125I-melatonin binding sites in human benign prostate epithelial cells in culture and investigated the effects of melatonin on growth and viability of these cells. 125I-melatonin bound to the prostate cells with high (K(d) = 68 pM) affinity. Competition experiments revealed that specific binding was inhibited by subnanomolar concentrations of melatonin and 2-iodomelatonin, whereas serotonin and 5-methoxytryptamine reduced the binding only partially. Melatonin (10 pM-10 nM) inhibited the incorporation of 3H-thymidine and 3H-uridine into the prostate epithelial cells in a dose-dependent manner. Inhibition was transient, and the incorporation recovered to control levels within less than 24 h. Protein synthesis as measured by the incorporation of 35S-methionine into cell proteins decayed to minimal levels about 2 h after addition of melatonin, and its recovery was slower compared with that of 3H-thymidine or 3H-uridine incorporation. Melatonin treatment (1 nM) for 2-7 days inhibited cell growth and markedly increased the percentage of non-viable cells in culture, measured by the trypan blue exclusion assay. The results demonstrate high affinity melatonin receptors in the human benign prostate epithelial cells, which may affect cell growth and viability.

Twenty-six elderly patients with obstructive symptomatology and an initial low peak urinary flow rate (< 15 ml/s) were observed for 6 to 12 months. Repeated assessments were made of flow rates and residual volumes. Within patients variation of the maximal urinary flow was significant; the standard deviation (SD) varied from 0.8 to 5.5 ml/s. The SD varied with the mean peak flow rates and this suggests that the precision of a single determination of a patient's peak flow is inversely related to the peak flow itself. In all, 333 determinations of peak flow were obtained. Only 80% were below 2 SD of the mean Siroky nomogram. Multiple determinations were used to estimate the sensitivity rate for each patient, i.e. the proportion of peak flows that were less than 2 SD below the mean of Siroky's nomogram. The average sensitivity for all of the flow values was 0.813 when applied to voided volumes and increased only slightly to 0.838 when applied to total bladder volume. Given a prevalence of 0.70 of obstruction ascribed to benign prostatic hyperplasia (BPH) among elderly men, the positive predictive value of an abnormally low peak flow was 0.97. A single low peak flow based on assessment of voided volume may serve as an almost sure indication of obstruction. If a patient has a single normal peak flow rate, he still has a 0.31 probability of having evidence of obstruction in his following uroflow determinations. Using total bladder volume does not make a difference in most patients and is not worth the effort and discomfort. The only patients who require accurate residual measurements are those with a normal uroflow but clear-cut obstructive symptomatology or with borderline peak flow. The results of this study are relevant to everyday clinical practice and to the evaluation of studies on alternatives to surgery in BPH.

The prognostic value of various subjective and objective noninvasive urological parameters was evaluated for their possible role in the prediction of post-hernioplasty urinary retention. In a prospective study, 35 patients aged 55-85 years without previous micturition complaints or urological surgery were evaluated 1 day prior to inguinal hernioplasty. This included medical history for modified Madsen subjective scoring profile, physical examination and uroflowmetry. Bladder capacity, residual urine and prostatic volume were measured by ultrasound. All patients underwent a similar method of hernioplasty, were closely followed 48 h postoperatively and any voiding difficulties or urinary retention were noted. Urinary retention occurred in 12 patients. None of the remaining 23 patients had urination difficulties. Comparing these two groups, we concluded that patient age, bladder capacity and prostatic volume have no prognostic value for potential postoperative urinary obstruction. On the other hand, obtaining a good anamnesis of obstructive and irritative symptoms for scoring, measuring maximal flow rate on urinary flowmetry and estimating residual urine volume may predict patients who are potentially at high risk for posthernioplasty urinary retention.

In a prospective randomized double-blind study among 50 males undergoing surgery we evaluated the possible role of transdermally applied scopolamine (Scopoderm) in the prevention of post open prostatectonay bladder contraction and pain. Patients were evaluated by subjective report of their pain, urination sensation while having indwelling catheter, amount of narcotic administration, and bladder pressure measurements. No significant dif ferenccs were noted with regard to the occurrence of pain or overall analgesia requirements. However, on postoperative day 2, a significant decrease in analgesia requirements was found among the treated patients. We suggest that the use of Scopoderm may lead to a reduced demand for narcotics by patients from postoperative day 2 onward.

The phenotypic distribution and immune reactivity of T lymphocyte subpopulations from peripheral blood of 50 patients with urological cancer were determined. Included were 36 patients with bladder transitional cell carcinoma, 7 patients with renal cell carcinoma and 7 patients with prostatic carcinoma. Thirty-eight age-matched patients with benign urological disease served as controls. A depression in immune competence was found in the group of male patients with infiltrating bladder cancer. In more than 50% of the patients with infiltrating bladder carcinoma, the T helper (CD4) subset was reduced with a concomitant inversion in the CD4/CD8 ratio and impairment in the T cell function as determined by the ability to proliferate upon phytohemagglutinin and concanavalin stimulation. Patients with superficial bladder carcinoma, as well as those with renal cell carcinoma had an immune profile similar to that of the control group. The group of patients with prostatic carcinoma had higher mean CD4/CD8 ratios than the control group, resulting from decreased suppressor/cytotoxic cells. Our results have indicated that the characterization of T cell subset and lymphocyte activity correlated well with the histopathologic state of patients with bladder carcinoma. Thus, the determination of the CD4/CD8 ratio may prove a valuable method for monitoring patients with bladder carcinoma, in addition to serial urine cytology, random urothelial biopsies and flow cytometry.

The levels of immune reactivity of peripheral and blood T-lymphocytes were evaluated in 37 bladder cancer patients and 31 age-matched controls. T-lymphocyte subsets were quantified by monoclonal antibodies, and the immune reactivity was measured using stimulation with phytohemagglutinin (PHA), concanavalin A (ConA), and pokeweed mitogen (PWM). Comparing the patients before and after treatment revealed significant changes in the stimulation index of proliferative response to PHA, PWM, in the PWM% (the patient response compared to the control), and in the percent of T8 cells from the total count of blood lymphocytes. Further significant differences were found among the disease stages in the numbers of T3, T4 lymphocytes subpopulations and the total lymphocyte count. A significant interaction was found between the treatment and patient's sex regarding the T4:T8 ratio. Also, a higher prevalence of T4:T8 less than 1 was found among the patients compared to the controls before and after treatment regardless of the disease stage. This T4:T8 less than 1 ratio can serve as an indicator of immune competence in bladder transitional cell carcinoma patients.

Of 435 patients treated with local hyperthermia to the prostate 27 had 29 complications, for an over-all complication rate of 6.6%. Urinary tract infections (7 cases), hematuria (6), and epididymitis (2) accounted for roughly half of the complications and could be attributed to the insertion of a catheter rather than the treatment itself but this remains to be proved. Most of the complications occurred within the first 3 treatment sessions. Despite the complication, 9 patients continued and completed the treatment course. Mean age of the study group was 73 ± 8.3 years. Given the age of these patients, high incidence of accompanying diseases and low rate of complications, local hyperthermia should be considered a viable low risk treatment option in patients with benign prostatic hyperplasia.

Extracorporeal shock wave lithotripsy has become the treatment of choice for upper urinary tract stones. We evaluated the impact of a new lithotripter on the kidneys of 14 nonobstructed patients treated for renal stones, using several physiological parameters and renal ultrasonography. Glomerular filtration rates (GFR) were estimated from the renal scan. Complete disintegration of the stone was accomplished in all but one patient. Treatment did not alter the serum parameters or the renal ultrasonography. Also, no changes were found in the GFR on the follow-up renal scans in both kidneys. The implications of these findings are discussed.

Recombinant interferon alpha-C is a new strain of the alpha interferon family. It was given to 33 patients with measurable metastatic renal cell carcinoma of whom 31 were evaluable. Protocol consisted of 3 million U/d for 2 weeks, then 3 million U/m2 every other day until progression. No complete response was observed. Three patients (9.7%) had partial response for a mean duration of 5.6 months and eight patients (25.8%) were stabilized for a mean of 4.3 months. Responsive sites were mainly lung, bone, and kidney, while side effects were generally mild. better results were observed in previously nephrectomized patients who had not received chemotherapy or hormonotherapy for recurrent or metastatic disease (p less than 0.05), and also in patients with a brief disease-free interval and short delay from presenting symptoms of the primary tumor until interferon treatment (p less than 0.05). Median survival was significantly longer in responders than in progressors (p less than 0.05). We suggest that the efficacy of recombinant interferon alpha-C in a low-dose regime versus other types of interferon as first-line therapy for inoperable, metastatic, or locally recurrent renal cell carcinoma should be investigated in a prospective, controlled, randomized study.

Thirteen patients with advanced adenocarcinoma of the prostate were treated with buserelin-a gonadotropin-releasing hormone (GnRH) analogue. Follow-up period extended to thirty-six months during which 8 patients were considered either responsive or stabilizing, in terms of pain relief and clinical tumor regression, and 5 were categorized as suffering from progressive disease. Urinary symptoms were ameliorated in the majority of cases (11/12). Prostatic size was measured by rectal ultrasound, an accepted accurate new modality. In 12 patients a decrease in size was demonstrated, and only in 1 progressive case the prostate grew larger on a six-month follow-up. Thus prostatic size and clinical responsiveness are not correlated. The clinical value of recording urinary symptomatology and measuring prostatic size in prostatic carcinoma patients is discussed with regard to the latest communications that GnRH analogues acting by decreasing testosterone levels, can cause amelioration in benign prostatic hypertrophy (BPH) cases, too. It is suggested that prostatic size has little clinical value concerning tumor responsiveness in the follow-up of patients with prostatic carcinoma.

Twenty-eight patients with benign prostatic hypertrophy were observed in a controlled study to determine the effectiveness of low-dose phenoxybenzamine. No statistically significant benefit on flow rate, residual urine, or urethral profile pressure was shown. It is concluded that phenoxybenzamine in low doses is ineffective in reducing the physical obstruction of the enlarged prostate gland.

The role of prolactin in the progress of prostatic carcinoma still is obscure. It is known to modulate testosterone metabolism and may have a prognostic value in determining disease progression. Prolonged treatment with a GnRH analogue has been introduced recently as a therapeutic alternative to surgical castration in advanced prostatic carcinoma. It has been reported that prolactin levels remain unchanged or even decrease in GnRH analogue treatment. By contrast, in this series of 15 prostatic carcinoma patients treated with GnRH analogue, a significant rise was demonstrated in clinical responders as well as nonresponders. In the latter group, prolactin rise was more pronounced. These results suggest that frequent prolactin determinations might be of prognostic value in determining early disease progression under GnRH analogue treatment.

Acute urinary retention in herpes genitalis infection is reported to be infrequent. We report 4 cases of acute urinary retention caused by neurologic complication of herpes infection. The urodynamic finding and follow-up results are presented.

Previous studies have indicated that local hyperthermia applied to the prostate may be of considerable help in the relief of obstructive signs and clinical symptoms in patients with cancer of the prostate as well as in cases with benign hyperplasia and chronic abacterial prostatitis. The purpose of the present study was to conduct a prospective, randomized multicenter trial to evaluate the clinical benefit of this thermotherapy on patients suffering from benign enlargement (BPH). Of 140 patients who were treated, the majority obtained definite relief of obstructive symptoms and signs. Further studies are in progress to clarify various aspects of this new treatment modality and its potential value in clinical practice.

Three new cases of a rare benign proliferative lesion of the urothelium (nephrogenic adenoma) are hereby added to the existent 58 reported cases. All 3 lesions occurred in the bladder. Two of the 3 cases presented with a history of surgical interventions on the bladder, and the third patient had a history of chronic cystitis and pyelonephritis, and was on chronic dialysis. Diagnosis was made on histologic examination of cystoscopic biopsy of the lesions. Transurethral resection and/or fulguration was the treatment of choice. There was no recurrence of the lesions on follow-up cystoscopic examination.

Two hundred six patients were examined with urine flowmetry and residual urine measurements to determine if a relationship exists between pathologic urine flowmetry determinations and specific subjective patient complaints. A statistical correlation exists in men with the complaint of frequency and in women with the complaint of frequency and incontinence. Possible explanation for these findings is discussed.

We report a case of bilateral metachronous xanthogranulomatous pyelonephritis (XGP) in a hemodialyzed patient with end-stage renal failure due to bilateral nephrolithiasis. The XGP was initially diagnosed by computed tomographic (CT) scan, and right nephrectomy was performed. The patient remained clinically stable for the next year. Involvement of the contralateral kidney was again confirmed by CT examination. Both kidneys showed histologic changes compatible with XGP. A coexisting nephrogenic adenoma of the bladder has been attributed to chronic urinary tract infection.

The importance of Kaposi's Sarcoma, known for over a century, resides in its relation to AIDS. The localisation on the shaft of the penis is very rare even in the generalised forms, more so when the lesion is primary and localized. The basic lesion appears as a reddish-violet nodule. The authors report a case of a primary Kaposi's Sarcoma in a 58 year-old patient where the tumor appeared as a pedunculated 2 X 2 cm lesion with a necrotic surface. The tumor was excised. A search for internal foci of KS was negative. The complete cure was proven by decreased lymphocyte proliferative responses and defective natural-killer cell activity.

Concomitant concentrations of ciprofloxacin in serum, urine, and prostatic tissue were determined in 15 patients after single oral doses of 750 mg. Levels in tissue ranged from 0.6 to 4.18 micrograms/g, and therapeutic concentrations were demonstrable for up to 9 h after administration. The mean ratio of tissue to serum concentration was 0.93 +/- 0.08 (standard error).

Sarcomatoid renal carcinoma is an uncommon renal malignancy with an aggressive biological behaviour and very poor survival rate. We treated lately 4 patients, three of which died shortly after the operation. The case reports are presented and the histology and the clinical implications are discussed.

Ligation or embolization of the hypogastric arteries for control of intractable hemorrhage from the bladder has been used in the past with equal results and without ill effect. Gluteal pain following hypogastric embolization is common and was reported to be resolved in less than 48 hours. A 57 year old man in our ward underwent a bilateral hypogastric embolization. The bleeding decreased considerably but a severe gluteal pain and claudication ensued. The pain persisted over a month necessitating frequent Morphine injections. We propose to use superselective catheterization technique in the future sparing the superior gluteal artery.

Circular prolapse of the urethral mucosa in the elderly female is rarely reported in the literature, but is a common clinical entity. During the years 1972–1983 thirteen women with urethral prolapse were operated upon in our department, in all of whom differentiation of the benign lesion from malignancy could not be done on clinical grounds only. The following survey is meant to draw attention to the entity and its clinical implications.

A case of secondary anuria following the insertion of a double pigtail stent to treat an anuria due to a tumoral obstruction of the ureter is presented. Washing of the stent through a second ureteral catheter parallel to it proved the patency of the stent. Diuresis ensued at last by the administration of diuretics and leaving both the stent and the ureteral catheter in place. The literature is reviewed and discussed.