Urinary Tract Lesions Research Articles

Clinical significance of urodynamic studies in neurogenic bladder dysfunction caused by intervertebral disk hernia

To discuss the clinical significance of urodynamic studies in neurogenic bladder dysfunction caused by intervertebral disk hernia. Thirty patients with neurogenic bladder dysfunction caused by intervertebral disk hernia were divided into three groups according to the category of detrusor muscle activity: neurogenic detrusor overactivity without detrusor sphincter dyssynergia (DSD), neurogenic detrusor overactivity with DSD, or detrusor underactivity. The patients were divided into three groups according to the condition of urinary retention and incontinence: urinary retention, urinary incontinence, or neither urinary retention nor urinary incontinence. Also they were divided into three groups according to the location of the intervertebral disk hernia: cervical hernia, thoracic hernia, or lumbar hernia. All patients underwent computer tomography (CT), magnetic resonance imaging (MRI), and urodynamic study. The results were analyzed statistically. There was significant correlation between the category of detrusor muscle activity, bladder compliance (BC, P < 0.05), and the pressure at maximum flow (P(det,Qmax), P < 0.01). There were significant differences in post void residual (PVR), cystometric capacity (CC), and maximum flow rate (Qmax) between the three groups of urinary retention, urinary incontinence, and the group of neither retention nor incontinence (P < 0.05). There was statistical correlation between the location of the intervertebral disk hernia and the urodynamic results. There was significant correlation between the BC (the threshold was 15 ml/cmH(2)O), detrusor pressure (Pdet, the threshold was 40 cmH(2)O), DSD, the location of intervertebral disk hernia, and the upper urinary tract lesion (P < 0.01). Urodynamic studies are indispensable in the classification, diagnosis, treatment, and prognosis of the neurogenic bladder dysfunction caused by intervertebral disk hernia.

A comparison of the pathology of transitional cell carcinoma of the bladder and upper urinary tract

To clarify the histopathological patterns of upper and lower urinary tract transitional cell carcinomas (TCCs), as previous reports suggest that upper urinary tract TCCs have a greater tendency towards high-grade disease than bladder TCCs, of which most are low-grade and low-stage tumours. All patients presenting with TCC of bladder or upper urinary tract between February 1991 and December 2001 at one institution were identified. Further patient information was obtained from the hospital database and case-note review. In all, 164 patients with upper urinary tract TCC and 2197 with bladder TCC were identified. There was a correlation between grade and stage of both upper urinary tract and bladder TCCs. 35% of the upper tract TCCs were classified as grade 2 and 44% as grade 3, while for bladder TCCs, 31% of lesions were classified as grade 2 and 35% as grade 3 (P = 0.003). Of the upper urinary tract lesions 33% were stage pT2-T4, compared with only 20% of bladder TCCs (P = 0.001). Upper urinary tract TCC is a higher grade and stage disease than bladder cancer, a finding that emphasizes the need for aggressive treatment of upper urinary tract TCC. If endourological management of upper urinary tract TCC is considered, histopathological determination of tumour grade before treatment is essential.

Cystoscopy: Techniques and clinical applications

Cystoscopy is a powerful tool for characterization of lower urinary tract disease in dogs and cats. Current applications of cystoscopy include diagnostic and interventional techniques. This article reviews cystoscopy equipment, procedures, and common applications of cystoscopy. A review of normal anatomy and common lower urinary tract lesions identifiable with cystoscopy is also presented.

Improved detection of renal pathologic features on multiphasic helical CT compared with IVU in patients presenting with microscopic hematuria

Objectives To examine the virtues of multiphasic helical computed tomography (CT) in the diagnosis of upper urinary tract lesions refractory to identification by intravenous urography (IVU). Methods A total of 86 patients (59 men and 27 women), 27 to 88 years old, with microscopic hematuria and negative IVU findings were examined with multiphasic helical CT consisting of a pre-enhancement, late arterial–early cortical–medullary, nephrographic, and excretory phase helical CT of the kidneys, using 3 to 5-mm collimation and 7.5-mm/s table feed. Results The multiphasic helical CT was conclusive in 84 lesions. Twenty-five cases of early papillary and medullary necrosis, 7 of 8 inflammatory lesions, 3 caliceal diverticula, 1 lupus nephritis, 26 small calculi, 2 medullary sponge kidney, 5 vascular anomalies, and 3 infarcts presented with characteristic manifestations on CT but lacked findings on IVU. Similarly 8 of 9 small malignant neoplasms, 2 small benign neoplasms, and 2 small cysts produced no detectable findings on IVU but were readily diagnosed on helical CT. Conclusions Characteristic findings, particularly on late arterial, early corticomedullary, parenchymal, and excretory phase helical CT make possible the diagnosis of early inflammatory disease, small masses and neoplastic lesions, and vascular abnormalities. Limited resolution (needed to identify small calculi) and the lack of ability to capture phases significantly reduce the diagnostic ability of IVU.

Current status of multidetector computed tomography urography in imaging of the urinary tract

Curr Probl Diagn Radiol 2002;31:210-21.

Differential Immunocytochemical Staining Patterns of Uroplakin Observed on Neoplastic and Nonneoplastic Tissue Fragments Obtained from Upper Urinary Tract Brush Specimens

To discern any differences in the distribution of uroplakin expression on neoplastic and nonneoplastic upper urinary tract lesions. Thirty-seven representative 95% ethanol-fixed direct smears of brush specimens, which were subsequently diagnosed histologically as 10 reactive and 27 transitional cell carcinomas (TCCs), were stained with polyclonal uroplakin antibodies utilizing the avidin-biotin-peroxidase method. In order to ascertain any differences in diagnostic accuracy between conventional cytomorphology and uroplakin immunocytochemical staining, the results were compared to the original final cytologic diagnoses for all 37 cases. The linear staining pattern on the luminal surface of umbrella cells was the dominant pattern expressed on tissue fragments from all 10 reactive lesions. Tissue fragments from low grade TCC demonstrated a weaker and less continuous superficial membrane staining pattern along with a variably intense, diffuse, membranous staining pattern throughout the tumor cell groups. This staining pattern was seen in all 17 (sensitivity = 100%) histologically confirmed low grade TCCs, of which only 13 of the 17 (sensitivity = 76.5%) were diagnosed as TCC on the original final cytology report. Tissue fragments from 10 high grade TCCs lacked the superficial linear staining pattern seen in reactive cell groups. Instead, all 10 high grade TCCs displayed a strong diffuse membrane staining pattern in all the cells in the fragment and also demonstrated microluminal structures within the tumor cell groups. The distinctive patterns of uroplakin antigen expression observed in nonneoplastic and neoplastic upper urinary tract lesions in the present study can greatly enhance the accuracy of diagnostic interpretation of upper urinary tract lesions in conventional cytologic specimens.

Xanthoma of urinary bladder.

Sixty-three year-old-man presented with macroscopic haematuria and passage of debris per urethra. His prostate was suspicious of a T2a tumour and his PSA was 11.1 μg/l but his trans rectal ultra sound scan (TRUS) and biopsies were negative for malignancy. In the past, he had trans urethral resection (TUR) of prostate for benign hyperplasia, excision of nasopharyngeal fibroma and superficial spreading melanoma of the thigh and had supraventricular tachycardia but no ischaemic heart disease. Investigations for haematuria revealed normal upper tracts on USS. On urethroscopy, there was an annular bulbar stricture requiring urethral dilatation. Residual prostate was oedematous, vascular but non-occlusive. In the bladder, there was a yellowish white solitary plaque up to 1.5 cm on the posterior wall (Figure 1) Cold cup biopsy showed collection of macrophages with foamy cytoplasm (foam cells) in the lamina propria with a normal overlying urothelium. There was no dysplasia or neoplasia. Appearances were those of a xanthoma (Figure 2a, 2b) Blood counts, renal function, random blood sugar and LFTs were normal as was the thyroid and lipid profile. Urine cytology was normal. Follow-up cystoscopy at 6 months revealed no further lesions in the lower urinary tract and no change in the appearance of the original xanthoma. There was no evidence of transitional cell carcinoma of the bladder. There were no other xanthomatous lesions.

Ultrasonography of urinary tract lesions caused by bilharziasis in Yemeni patients.

To evaluate abnormalities detected by ultrasonography in Yemeni patients with active Schistosoma haematobium infection. As part of a co-operation between a private hospital and the Schistosomiasis Control Project in Yemen, laboratory and ultrasonographic examinations were undertaken in 158 patients (eight female, 150 male, mean age 17 years) with active S. haematobium infection. Upper urinary tract dilatation, lower ureteric changes and bladder wall abnormalities (thickness, hyper-echogenicity and polypoid lesions) were recorded. Laboratory findings and ultrasonographic changes were evaluated and categorized according to the age of the patients. Twenty-eight patients (18%) showed no morphological lesion on ultrasonography. Bladder abnormalities (thickness, hyper-echogenicity and polypoid lesions) were found in 130 patients (82%) and upper tract lesions in 86 (54%). There were no upper tract lesions seen without an associated bladder abnormality. There were polyps within the lower ureteric lumen in four patients; in these patients there was a higher incidence of severe infection. One patient had a urinary bladder tumour. Urinary bilharziasis has typical ultrasonographic features, but may occur with no morphological lesion detectable on ultrasonography. Upper tract lesions seem to develop only with lower tract abnormalities.

CRITICAL ANALYSIS OF SUPRACOSTAL ACCESS FOR PERCUTANEOUS RENAL SURGERY

Percutaneous renal surgery is currently performed for complex renal calculi as well as for various other endourological indications. In many patients an upper pole nephrostomy tract allows direct access to most of the intrarenal collecting system. Upper pole percutaneous access may be obtained via the supracostal or subcostal approach. The preferred route depends on the location and size of the specific stone or lesion. Previously others have cautioned against the supracostal approach above the 12th rib and many have discouraged an approach above the 11th rib due to concern about the increased risk of intrathoracic complications. We retrospectively assessed the morbidity associated with supracostal percutaneous renal surgery and compared and analyzed the morbidity of the supracostal and subcostal approaches. The records of all patients who underwent upper pole percutaneous renal surgery between November 1993 and July 1999 were retrospectively reviewed. A total of 240 patients underwent percutaneous renal procedures, including 225 for managing symptomatic renal or ureteral stones, that is nonstaghorn calculi in 157, staghorn calculi in 41, proximal ureteral calculi in 12, calculi within a caliceal diverticulum in 6, calculi associated with primary ureteropelvic junction obstruction in 5 and calculi associated with a retained ureteral stent in 4. An additional 15 procedures were done for ureteropelvic junction obstruction (7), intrarenal collecting system tumors (5), a caliceal diverticulum without stones (1), a retained ureteral stent (1) and a ureteral stricture (1). A total of 300 nephrostomy tracts were placed to obtain access to the intrarenal collecting system via the supracostal approach in 98 (32.7%) cases and the subcostal approach in 202 (67.3%). Of the supracostal approaches 72 (73.5%) tracts were above the 12th and 26 (26.5%) were above the 11th rib. The overall complication rate irrespective of percutaneous approach was 8.3% (16.3% for supracostal and 4.5% for subcostal access). Complications included blood transfusion in 7 patients, intraoperative hemothorax/hydrothorax in 5, sepsis/bacteremia in 3, atrial fibrillation in 2, delayed nephropleural fistula in 2, renal artery pseudoaneurysm in 2, deep venous thrombosis/pulmonary embolus in 2, pneumothorax in 1 and subcapsular hematoma in 1. Seven of 8 intrathoracic complications (87.5%) developed in supracostal cases. Percutaneous renal surgery remains an important option for managing complex renal calculi and other upper urinary tract lesions. In our experience it is generally associated with low morbidity. The supracostal approach is often preferred for obtaining intrarenal access to complex renal and proximal ureteral pathology. Because supracostal access tracts are associated with significantly higher intrathoracic and overall complication rates compared to subcostal access tracts, this approach must be used with caution when no other alternatives are available.

Introduction: Pediatric End-Stage Renal Disease

The field of pediatric nephrology requires an understanding of fetal physiology, developmental biology of the kidney, pharmacotherapeutics tailored to an altered metabolism, and the biophysical and psychological effects of normal growth and developmental processes that occur through young adulthood and are often superimposed on the course of chronic kidney disease. In addition, practitioners in this field must be acutely aware of how chronic kidney disease alters the normal course of sexual differentiation during adolescence. We believe that this issue of Advances in Renal Replacement Therapy, which is dedicated to the pediatric patient on maintenance dialysis, represents a state-of-the-art approach as it pertains to several of these important issues for children with kidney failure. Fully one third of children developing kidney failure have an anatomic lesion of the urinary tract, often developmentally acquired. Professor Adrian W 001£ and Nikesh Thiruchelvam present a coherent story of the regulation of kidney development, as but part of an emerging area of translational science about obstructive uropathy. Their review clearly shows how, in the future, both better diagnostic criteria for such lesions and perhaps even genetic modulation of developmental anomalies may be a component of the therapeutic armamentarium of the pediatric nephrologist and urologist. The extrarenal morbidity associated with end-stage renal disease (ESRD) in pediatrics is a topic that demands the utmost attention because of the impact it has on the long-term outcome of this young population. Drs Blanche Chavers and H.William Schnaper collaborate to discuss the recent clinical evidence of and scientific basis for the dramatic alterations of the cardiovascular system that can characterize the child with kidney failure. Dr Uri Alon follows with a comprehensive analysis of the profound effects that chronic kidney disease produces on the growing skeleton. He provides a theoretical and practical framework on which he proposes relevant clinical questions that can be answered only in the setting of multicenter studies. Both discussions are intended to stimulate innovative strategies to

SCROTAL METASTASIS FROM URETERAL CANCER

No AccessJournal of UrologyCLINICAL UROLOGY: Case Reports1 May 2001SCROTAL METASTASIS FROM URETERAL CANCER T. IIYAMA and H. WATANABE T. IIYAMAT. IIYAMA More articles by this author and H. WATANABEH. WATANABE More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)66374-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "SCROTAL METASTASIS FROM URETERAL CANCER." The Journal of Urology, 165(5), p. 1637 References 1 : Clinical management of non-testicular intrascrotal tumors. J Urol1976; 116: 476. Link, Google Scholar 2 : Zosteriform inflammatory metastatic carcinoma from transitional cell carcinoma of the renal pelvis. J Am Acad Dermatol1994; 31: 284. Google Scholar 3 : Cutaneous metastases from transitional cell carcinoma of the bladder and renal pelvis. Br J Urol1997; 79: 292. Google Scholar From the Department of Urology, Kochi Prefectual Aki Hospital, Aki-shi, Kochi-ken, Japan© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 165Issue 5May 2001Page: 1637 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.Keywordsureteral neoplasmsscrotumcarcinoma, transitional cellneoplasm metastasisureterMetricsAuthor Information T. IIYAMA More articles by this author H. WATANABE More articles by this author Expand All Advertisement PDF downloadLoading ...

Transitional-cell carcinoma of the renal pelvis: ureteroscopic and percutaneous approach.

There are a variety of publications advocating the ureteroscopic or the percutaneous approach for the treatment of transitional cell carcinoma of the renal pelvis. The diagnostic tool of choice for the upper urinary tract and collecting system is the flexible ureteroscope. One of the major concerns about ureteroscopic management of renal disease initially was the lack of flexibility of the instruments and therefore the inability to deal with demanding sites. The advent of new ureteroscopic techniques, as well as the continuous evolution of the technology, have paved the way for safe and effective access to the upper urinary tract. In the hands of an experienced urologist, such procedures can provide reliable treatment options for small upper urinary tract lesions. Coupling minimal morbidity with ever-improving optics and flexibility, the ureteroscope of today leaves no area of the urinary tract unseen. In patients with bulky tumors or in whom easy access and resection is not possible ureteroscopically, the percutaneous approach to the renal pelvis, although more invasive, provides a better working environment. Clearly, the most difficult aspect of ureteroscopic access to the lower pole is not just visibility but the loss of deflection caused by passage of various instruments through the working channel. Direct access via percutaneous approach with a large resectoscope avoids these problems.

TREATMENT OF GRADE 4 RENAL STAB WOUNDS WITH ABSORBABLE FIBRIN ADHESIVE BANDAGE IN A PORCINE MODEL

In a porcine model we evaluated the efficacy of the absorbable fibrin adhesive bandage and other novel fibrin products for treating major renal stab wounds. In commercial swine we produced an almost lethal, grade 4 renal stab wound via a 3.5 cm. sagittal, centrally located, through-and-through laceration. Each pig then received treatment in random fashion, including conventional oversewing of capsular defects with absorbable gelatin sponge and horizontal mattress sutures in 6, external absorbable fibrin adhesive bandage that was pressure held for 60 seconds in 6, external and internal absorbable fibrin adhesive bandage that was applied externally, inserted into the renal defect and pressure held for 60 seconds in 6, liquid fibrin sealant that was placed in the laceration and held for 60 seconds in 8, fibrin foam that was applied in the same manner as liquid fibrin in 5 and closing of the peritoneum over the lacerated kidney without further treatment in 6. Blood loss and time to hemostasis were recorded. Animals were sacrificed at 6 weeks to evaluate the injured renal unit. Compared with conventional therapy the absorbable fibrin adhesive bandage applied externally alone or externally and internally resulted in significantly less bleeding and significantly less time to hemostasis (p <0.001). Liquid fibrin and fibrin foam did not reliably achieve hemostasis. Postoperatively computerized tomography and histological sectioning suggested that the absorbable fibrin adhesive bandage results in a stable, durable clot and healing is at least as successful as with conventional treatment. The absorbable fibrin adhesive bandage appears to be a safe, rapid means of renal salvage after injury.

DISTINCT MICROSATELLITE ALTERATIONS IN UPPER URINARY TRACT TUMORS AND SUBSEQUENT BLADDER TUMORS

Although synchronous and/or metachronous tumor development is common in urothelial cancer, genetic and biological differences in upper urinary tract and bladder tumors are unclear. We compared the genetic alteration pattern in multifocal disease in patients with upper urinary tract and subsequent bladder tumors, and those with recurrent bladder tumor. Using 21 microsatellite markers on the 8 chromosomal arms 2q, 4p, 4q, 8p, 9p, 9q, 11p and 17p we analyzed 34 tumors from 15 patients with upper urinary tract and subsequent bladder disease, and 70 tumors from 22 with recurrent bladder disease. Judging from the patterns of genetic alterations multifocal tumors were considered to have derived from an identical progenitor cell in 7 of 13 evaluable patients (54%) with upper urinary tract and subsequent bladder tumors, and 16 of 19 (84%) who were evaluable with recurrent bladder tumor. These data confirm the view that seeding or intraepithelial spread is a major mechanism for the multifocal development of urothelial cancer in general. However, a discordant microsatellite alteration pattern in multifocal tumors was observed in 6 of 7 patients (86%) with upper urinary tract and subsequent bladder lesions but in 2 of 16 (13%) with recurrent bladder cancer (p <0.005). Our results imply that upper urinary tract neoplasms may be genetically more unstable than bladder neoplasms. The implantation of tumor cells from upper urinary tract to bladder may involve additional and diverse genetic alterations. Furthermore, a considerable number of multifocal upper urinary tract and subsequent bladder lesions may arise independently via field cancerization mechanism. Our study indicates that the factors contributing to multifocal development are different in the 2 groups.

Fluorodeoxyglucose positron emission tomography studies in diagnosis and staging of clinically organ-confined prostate cancer

Objectives. To determine the value of 18-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) studies in the evaluation of patients with organ-confined prostate cancer. This imaging method has previously found little usefulness in localized prostate tumors because of excretion of the isotope into the urine, masking any lower urinary tract lesions. We evaluated this imaging modality using hydration, furosemide, and bladder emptying before the procedure to evacuate the nonspecific isotope in the urine. Methods. FDG PET scans were performed on 24 patients diagnosed with clinically organ-confined prostate cancer. No patient had received any prior treatments for the cancer. FDG PET scans were performed 1 hour after injection of 15 mCi of F-18 deoxyglucose. Patients were scanned from the base of the skull through the inguinal region (including the pelvis). Additional signal attenuation-corrected images of the inguinal region were acquired 30 minutes after intravenous injection of 40 mg of furosemide. The final diagnosis was made by histologic examination, correlative imaging studies, and/or clinical follow-up. Results. FDG PET studies were negative in 23 of the 24 organ-confined prostate cancers and the study was only faintly positive in 1 tumor (4.0% sensitivity). Conclusions. FDG PET is not a useful test in the evaluation of clinically organ-confined prostate cancer.

Management of kidney injuries in children with blunt abdominal trauma

Background/Purpose: The authors analyzed the incidence and the course of renal injuries encountered in a cohort of pediatric patients with blunt abdominal trauma. This review focuses on the early diagnostic and therapeutic approach rather than the long-term outcome and draws conclusions for an effective initial management. Methods: From 1976 to 1996, the charts of 308 children with blunt abdominal trauma that were admitted to the authors' department were reviewed. The patients initially were evaluated using urinalysis, ultrasonography, and abdominal paracentesis (until 1984) and in specific cases iv-urography, computed tomography (CT), and angiography. The authors retrospectively classified the renal trauma after the widely used Organ Injury Scaling (OIS) into 5 grades and correlated the diagnostic value of various techniques as well as the diagnostic approach. Results: Sixty-nine serious abdominal traumas were encountered. Thirty-six patients suffered renal lesions grade 2 (G2) or higher; 20 children were polytraumatized. There were 67 renal lesions including 28 G1, 22 G2, 8 G3, 5 G4, 1 G5, and 3 lesions of the lower urinary tract. Ultrasonography and urinalysis were found to be the optimal diagnostic methods for screening and following the course of renal injury. CT scan proved to be most reliable for detecting and exactly classifying renal lesions grade 2 or higher and superseded consecutively iv-urography. In cases in which CT scan failed to show renal excretion of contrast agent, angiography was performed. Ten patients proceeded to operative therapy. Conclusions: Ultrasonography and urinalysis proved to be the optimal initial evaluation tool for excluding renal injury both as a screening method and for further controls. Exact classification was possible by CT scan. During the reviewed time period a shift from surgical to conservative management was notable. If lesions were G4 or G5, surgical treatment with tendency toward minimally invasive therapy always was indicated. J Pediatr Surg 35:1326-1330. Copyright © 2000 by W.B. Saunders Company.

Laparoscopic treatment of lymphocele after kidney transplantation.

Laparoscopic treatment of pelvic lymphocele secondary to kidney transplant has gained popularity in the last few years, although lesions of the urinary tract (ureter, renal pelvis, and bladder) have been reported frequently. To evaluate the result of this treatment and the associated risk of urinary tract lesions, we reviewed our experience and reports in the medical literature on open and laparoscopic surgery. From 1991 to 1999, we laparoscopically treated 12 patients (7 men and 5 women; median age, 43 years; range, 17-59 years) with symptomatic pelvic lymphocele causing a deterioration of renal function because of compression on the ureter in 10 of the 12 patients and lymphocele compression of the iliac vein in the other 2 patients. In nine patients, the lymphocele wall was opened and sutured to the peritoneum to keep the window open. In two patients, an omentoplasty was performed, and in the remaining patient, both techniques were used. All patients were followed up clinically with ultrasound and biochemistry for a median period of 33 months (range, 1-96 months). Using Medline, we reviewed the medical literature from 1980 to 1998 and collected 252 cases in which operations had been performed to drain an internal lymphocele secondary to kidney transplantation. Laparoscopic treatment was successful in 11 of the 12 patients. One patient was converted to open surgery because of a lesion in the transplanted ureter. One patient needed repeat laparoscopy 24 hours after the operation because of bleeding from the peritoneal window. The median duration of the operation was 120 min (range, 70-200 min), and the median postoperative hospital stay was 5 days (range, 2-12 days). None of the patients needed to discontinue oral cyclosporine assumption. The serum creatinine level dropped significantly after surgery (p < 0. 05). No symptomatic recurrences were observed. Of the 252 patients found in the medical literature, in 129 the procedure was performed with open surgery and in 123 laparoscopically (our 12 patients included). The prevalence of iatrogenic lesions to the urinary tract increased threefold with the use of laparoscopic surgery (from 1.6% in open surgery to 7% in laparoscopy). The recurrence rate of symptomatic lymphocele, however, decreased from 15% to 4%. Laparoscopic drainage of posttransplantation lymphocele is a relatively simple method for treating this complication, although it bears the burden of an increased incidence of urinary tract lesions, as confirmed by a review of the literature. The major advantage of the laparoscopic approach is the absence of postoperative ileus with the opportunity to continue the enteral immunosuppressive regimen and a lower recurrence rate. These data suggest that laparoscopic lymphocele treatment might be considered the therapy of choice, provided the iatrogenic lesions of the urinary tract diminish as more experience with this technique is gained.

Neuronal nitric oxide synthase in the neural pathways of the urinary bladder.

Nitric oxide (NO) is a unique biological messenger molecule. It serves, in part, as a neurotransmitter in the central and peripheral nervous systems. Neurons containing NO have been identified histochemically by the presence of nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) reactivity or immunohistochemically by the antibody for neuronal NO synthase (n-NOS). Previous histochemical or pharmacological studies have raised the possibility that NO may play an important role in the neural pathways of the lower urinary tract. There is also considerable evidence to suggest that n-NOS is plastic and could be upregulated following certain lesions in the lower urinary tract. The present review summarises the distribution of n-NOS containing neurons innervating the urinary bladder and the changes of the enzyme expression in some experimentally induced pathological conditions.

Argyrophilic nucleolar organizer region (AgNOR) technique: a helpful tool for differential diagnosis in urinary cytology.

The aim of this study was to investigate whether the AgNOR technique could be helpful for the cytologic diagnosis of neoplastic and non-neoplastic urinary tract lesions. We analysed the AgNOR pattern in urinary cytology in samples from 70 patients. In every case the average number of silver precipitations per nucleus was counted and the range between the minimum and maximum AgNOR value calculated. Furthermore we noted whether the AgNOR precipitations had a homogeneous or heterogeneous distribution. The diseases were classified in three groups: non-neoplastic lesions, low grade and high grade carcinoma. Linear discriminant analysis (with jack-knife procedure) was performed with the AgNOR parameters as independent variables. The final diagnosis of each patient had been established by histological analysis of bladder biopsies. We obtained a correct classification in 84.3% of the cases. All patients with normal or reactive lesions were correctly classified and only two cases of low grade malignancy were erroneously diagnosed as non-malignant. Five high grade neoplasms had been classified as low grade and four low grade carcinomas had been over-diagnosed as high grade neoplasms. We conclude that a combined qualitative and quantitative AgNOR analysis can be useful in the differential diagnosis of urinary cytology.

Endoscopic management of upper urinary tract disease using a 200-μm holmium laser fiber: initial experience in japan

Objectives. To study the clinical effectiveness of the 200-μm holmium laser fiber for endoscopic management of upper urinary tract lesions. Methods. From January 1997 to March 1998, we performed retrograde endoscopic treatment in 25 patients with urinary tract lesions using a 200-μm holmium laser fiber. Nineteen patients had 20 stones (16 ureteral, 3 lower calyx, and 1 middle calyx), 4 had bleeding lesions in the lower calyx, 1 had transitional cell carcinoma involving the renal pelvis and upper calyx, and 1 had a ureteral stricture associated with an impacted ureteral stone. We used a 7.5F flexible ureterorenoscope for renal and upper ureteral lesions, and a 6.9F rigid ureteroscope for mid and lower ureteral lesions. For treatment, we used a holmium:yttrium-aluminum-garnet laser generator and a 200-μm flexible quartz fiber. Results. All stones were successfully fragmented, including three lower caliceal stones. Lower caliceal bleeding spots were successfully cauterized for hemostasis in all 4 patients, and the pelvic tumor was successfully vaporized and ablated. In 1 patient, we had previously failed to treat a ureteral stricture with a 365-μm fiber because of inadequate visualization, but it was successfully incised using the 200-μm fiber. There were no significant complications such as ureteral obstruction or stenosis. Conclusions. The improved flexibility of the new 200-μm holmium laser fiber facilitates treatment of stones, tumors, strictures, and lesions in the lower calyx, where access is difficult when using the previously available 365-μm fiber.