Prognostic role of lymphovascular invasion in patients with urothelial carcinoma of the upper urinary tract: an international validation study.

Background: Lymphovascular invasion (LVI) identified following pathologic slide review has been shown to be an independent predictor of recurrence-free survival (RFS) and cancer-specific survival (CSS) in a multicenter series of patients undergoing radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC). However, the validity of LVI in everyday practice, where pathologic re-review of all slides is uncommon, has not been assessed.

Objective: Our aim was to evaluate the prognostic role of LVI in an international cohort of patients treated with RNU for UTUC without pathologic slide review.

Comparative outcomes following endoscopic ureteral detachment and formal bladder cuff excision in open nephroureterectomy for upper urinary tract transitional cell carcinoma.

Purpose: The introduction of laparoscopic nephroureterectomy highlights the need for the critical appraisal of approaches to the distal ureter at surgery for upper tract transitional cell carcinoma. We compared differences after endoscopic ureteral detachment and open bladder cuff excision in nephroureterectomy.

Materials And Methods: A total of 138 patients underwent open nephroureterectomy for upper urinary tract transitional cell carcinoma from 1982 to 2005 with a median followup of 43 months.

Epithelioid perineurioma: an unusual variant.

An unusual epithelioid variant of perineurioma of the groin occurring in a 53-year-old man is described. The lesion appeared to be associated with a femoral nerve branch. The tumour was characterised by the presence of a syncytial proliferation of epithelioid cells, mimicking a meningioma of syncytial type.

Holmium: YAG lasertripsy for ureteric calculi: an experience of 300 procedures.

Objective: To assess the success of holmium:YAG lasertripsy in the management of ureteric calculi and to audit the complications of the procedure, with special reference to strictures in the ureter.

Patients And Methods: A total of 300 ureteroscopic laser procedures were carried out on 265 patients (204 male and 61 female, median age 51 years, range 2-95) with ureteric calculi. At ureteroscopy, the calculi were present in the upper ureter in 44%, mid-ureter in 37% and lower ureter in 19% of patients; most calculi were > 5 mm.

Peri-urethral silicone microimplants (Macroplastique) for the treatment of genuine stress incontinence.

Objective: To establish the safety and efficacy of the periurethral injection of silicone microimplants (Macroplastique) for the treatment of genuine stress incontinence in women.

Patients And Methods: Forty women (median age 50 years, range 27-74) with genuine stress incontinence confirmed on medium-fill video-cystometry were recruited to the study. Macroplastique (3-7 mL) was injected periurethrally 1 cm distal to the bladder neck at three or four points 'around the clock' under cystoscopic control.

Urinary bladder dysfunction following anterior lumbosacral spine fusion: case report and review of the literature.

A 34-year-old woman suffering from chronic degenerative low back pain involving L5-S1 disc space, refractory to conservative treatment, underwent spinal fusion. A combined instrumented posterolateral, followed by anterior, interbody allograft fusion through a left retroperitoneal approach was performed. Postoperatively, the patient was unable to evacuate her bladder and control her micturition.

Long-term results of intermittent low-friction self-catheterization in patients with recurrent urethral strictures.

Objective: To ascertain the duration of intermittent low-friction self-catheterization (ILSC) required to cause stricture stabilization.

Patients And Methods: Over a 4 year period, 101 patients with a median age of 62 years (range 16-85) with recurrent urethral strictures were recruited to the trial. All the strictures were treated by internal urethrotomy and the patients were then randomized to perform ILSC twice weekly for either 6 months (group 1) or 36 months (group 2).

Ureteric stricture formation following ureteric instrumentation in patients with a nephrostomy drain in place.

Objective: To determine what effect the presence of a nephrostomy, left on free drainage, might have on the rate of occurrence of ureteric strictures after ureteric instrumentation.

Patients And Methods: Eighteen patients were identified in this unit who had had ureteric instrumentation while a nephrostomy was in place.

Results: Eight of 11 patients in whom the nephrostomy was left open developed ureteric strictures.

Clam enterocystoplasty in general urological practice.

A series of 45 patients (31 female) underwent clam enterocystoplasty for urgency and incontinence. The majority had detrusor instability. Prolonged conservative treatment had failed in all cases.

Oestrogen dosage in prostatic cancer: the threshold effect?

We present the results of a prospective randomised trial of Estradurin, a long-acting oestrogen preparation (polyoestradiol phosphate), 160 mg per month, compared with bilateral orchiectomy in patients with advanced prostatic carcinoma (T3M1; T4MO/M1). The dose was lower than that usually recommended to induce a consistent fall in serial plasma testosterone levels to within the castrate range. Most patients treated with oestrogen showed an initial clinical and biochemical response equal to that obtained for patients undergoing orchiectomy.

Ureteric stone surgery in practice.

From 1983 to 1986 140 patients underwent surgery for ureteric calculus. In approximately 30% "blind" basket extraction was considered appropriate and continued to be effective. Increasing expertise with the rigid ureterorenoscope led to a considerable reduction in open ureterolithotomy (15% in 1985-86), the majority following failed ureteroscopic extraction.

Bone imaging and serum phosphatases in prostatic carcinoma.

One hundred and twenty-seven patients with locally advanced prostatic cancer were evaluated for the presence and progress of bone metastases before and during hormonal therapy, by serial radionuclide imaging and frequent measurement of plasma acid (tartrate-labile) and alkaline phosphatase. For comparison, serial changes in imaging and phosphatases were classified in each patient into one of six groups. Of 71 patients with negative imaging before treatment, 82% had normal alkaline phosphatase levels and 83% had normal acid phosphatase levels.

Nesbit's operation for Peyronie's disease.

Nineteen patients with Peyronie's disease were treated by a modification of Nesbit's operation. The deformity was completely corrected in 18 patients. Potency was restored to 4 of the 6 impotent patients and satisfactory coitus became possible for 15 patients, whereas it had been possible for only 3 before operation.

Carcinoma of the prostate of ductal origin.

Thirty-nine patients with ductal prostatic carcinoma have been reviewed. Their mode of presentation, initial stage, plasma phosphatase levels and response to hormone therapy were found to be similar to those in a group of 124 patients with the common acinar prostatic cancer. Histochemical examination demonstrated prostate-specific antigen in all ductal carcinomas.

Popliteal artery aneurysm.

Fourteen patients with atherosclerotic aneurysms of the popliteal artery, which were bilateral in 13, have been managed in a vascular unit where ultrasound, xerography, and isotope angiography are available for investigation. Although these methods are useful in confirming a suspected diagnosis, they cannot replace an awareness of the condition and clinical methods of examining the ischaemic lower limb. Reconstructive vascular surgery was effective in preserving the presenting leg in 5 cases and amputation was needed in 6, while no operation was needed in 3.

Radionuclide angiography of the popliteal arteries in occlusive vascular disease.

Before undertaking a femoro-popliteal bypass graft it is important to know whether the popliteal artery is patent to receive the distal end of the graft. Patency was assessed in 48 studies of 46 patients with peripheral vascular disease by radio-nuclide angiography. The procedure consists of imaging the popliteal arteries using a gamma camera after a bolus injection of 99mTc-sodium pertechnetate.