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OBJECTIVE: To analyze the efficacy ofthe BTA Trak test as a diagnostic marker for bladdercancer, determine its correlation with tumor grade andstage, compare its sensitivity with urinary cytology and itsutility in urological conditions other than bladder cancer.METHODS: 77 patients comprised the study; 33 withbladder cancer and 44 without. A urine sample wasobtained from all patients for the BTA Trak test andanother three samples for urinary cytology from each ofthe 33 patients with bladder cancer. Of the 44 patientswithout bladder cancer, 36 had conditions involving theurinary tract and 8 presented conditions without urothelialinvolvement. The BTA Trak test was repeated three monthsafter treatment in 11 of the patients with bladder cancerand three months after the first test in 13 patients withoutbladder cancer.RESULTS: Using BTA Trak threshold values of 14 U/ml as first reference and 50 U/ml as the value indicatingclinical warning, these were found to be higher in 24 of 33patients with bladder tumor (sensitivity 72.7%). By tumorstage, BTA trak was positive in 12 of 21 pT1 (sensitivity57%) and in 11 of 11 pT2 (sensitivity 100%). Concerningtumor grade, values were higher than threshold in 13 of 22GI-II (sensitivity 59.9%) and 10 of 10 GIII (sensitivity100%).Urinary cytology was positive in only 8 cases (sensitivity24.4%). In the patients without bladder cancer, values erehigher than threshold in 3 of 8 patients with urologicalconditions without urinary tract involvement and 14 of 36with a probable urothelial involvement without tumor,accounting for an overall sensitivy of BTA Trak of 61.4%.The BTA Trak test three months after treatment showedlower value in 7 of 8 patients with bladder tumor andpretreatment values higher than threshold.CONCLUSIONS: The BTA Trak test is a simplequantitative method with a high sensitivity for the diagnosisof bladder tumors, especially those in the advancedstages and grades. It is superior to cytology, although ithas a lower specificity, particularly in conditions withurinary tract involvement.
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OBJECTIVES: To describe the tensionfreevaginal tape procedure (TVT) for treatment of femalestress urinary incontinence and the short-term results.METHODS/RESULTS: From November 1998 to May1999, the TVT procedure was performed in 20 patientswith genuine stress urinary incontinence. All patients hada bladder catheter for 24 hours after surgery. Only onepatient required intermittent catheterization for one monthdue to high quantities of post-void residual urine. Therewere no intraoperative complications. Earlypostoperatively one patient presented a hematoma in theposterior rectal aspect which was managed conservatively.At 4.5 months mean follow-up, 95% of the patients arecontinent and one is incontinent due to incorrect positioningof the prolene band.CONCLUSIONS: Although the initial results appear tobe encouraging, further studies are warranted to determinethe long-term efficacy of this technique.
Review
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OBJECTIVE: To present three illustrative cases of pyeloureteritis cystica and review the literature.METHODS: Three illustrative cases diagnosed at our department are described. Patient history, clinical features, diagnostic procedures and treatment are analyzed and the literature is reviewed.RESULTS: Our patients had no specific symptoms. All three patients had urinary tract infection with pyeloureteral involvement, which was bilateral in two cases. One of these patients had a long-indwelling catheter.CONCLUSIONS: Pyeloureteritis cystica is a benign and uncommon condition whose etiology is not well-known. It is generally associated with chronic infection and inflammation, and may be difficult to distinguish from other filling defects of the urinary tract. Due to its benign nature, treatment must always be conservative and close follow-up is recommended.
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OBJECTIVE: To compare the sensitivityand specificity of the BTA stat test, NMP-22 and voidedurine cytology in the diagnosis of bladder cancer.METHODS: The study comprised 100 patients or followupor with a suspicion of bladder cancer. A voided urinesample was obtained and alliquoted in three samples forthe BTA stat test, NMP-22 and cytology. The patients weresubsequently evaluated by cystoscopy and TUR wasperformed when cancer was suspected. The bladder cancerwas classified according to TNM stage and WHO grade.The McNemar test was utilized to compare the results. Thecut-off level used for NMP-22 was 10 U/ml. ROC curveswere plotted to determine the NMP-22 values for optimalsensitivity and specificity in our seires.RESULTS: Two patients were excluded from the study. The overall sensitivity was 76.47% for cytology, 78.43%for the BTA stat test and 84.31% for NMP-22 (p = n.s.).The specificity was 91.49%, 87.23% and 87.23%respectively (p = n.s.). By grade and stage, NMP-22showed the best results followed by the BTA stat test andlastly cytology, although the differences were notsignificant. The ideal cut-off for NMP-22 in our series was6 U/ml and not the generally recognized 10 U/ml.CONCLUSIONS: NMP-22 is superior to the BTA stattest and cytology in the diagnosis of bladder cancer,although the differences were not significant. The idealcut-off in our series was 6 U/ml. The BTA stat test has theadvantage of being easy to perform and provides theresults in 5 minutes. In our view, NMP-22 and BTA stat testcan replace cytology in the diagnosis of bladder cancer.
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OBJECTIVE: To analyze the prognosticsignificance in bladder carcinoma of DNA ploidy and cellphase fractions measured by bladder wash flow cytometry.METHODS: Samples were obtained from 25 patientsby bladder irrigation; 16 before surgery and 9 duringfollow-up cystoscopic examination. Cells were stainedwith propidium iodide and analyzed with the FacScanflow cytometer and Cellfit 2.01 (Becton-Dickinson).RESULTS: The number of cells obtained was sufficientfor flow cytometric analysis in all cases. In 13 tumorsamples (8 superficial and 5 invasive tumors), aneuploidycells were detected in 3 cases that had a worse outcome;the only superficial tumor in which aneuploidy was detectedpresented a recurrent bladder carcinoma 15 months later.Of the 5 patients with invasive tumors, two patients withaneuploidy died within 6 months from tumor metastases.Of the patients without macroscopic tumor, only oneshowed an increase in the percentage of the S phasefraction (19.5% of cells in S phase). A recurrent bladdercarcinoma was detected in this patient 6 months after theanalysis. In patients with macroscopic tumor, analysis ofthe S phase fraction was not relevant for prognosis.CONCLUSIONS: Analysis of DNA ploidy and cellphase fractions by flow cytometry of bladder washings canincrease the prognostic information in bladder carcinoma. Aneuploidy was associated with a worse prognosisand an increase in the S phase fraction predicted arecurrent bladder carcinoma months before it manifestedclinically.
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OBJECTIVE: To report on three patientswith partial graft renal vein thrombosis diagnosed byultrasound.METHODS: The vascular complications diagnosed byultrasound in 400 transplants performed from 1995-1998were reviewed.RESULTS: Three patients with partial graft renal veinthrombosis were found. Two patients were treated with anticoagulant therapy. No thrombosis could be detectedin all three patients on subsequent US control evaluation.CONCLUSIONS: Unlike complete thrombosis, partialgraft renal vein thrombosis presents late, without significantclinical features and can be managed conservatively
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OBJECTIVES: A number of predictionfactors on the outcome of cadaver renal transplants havebeen recognized, particularly the influence of recipientresponse to the first graft. Howerver, the influence of HLAcompatibility and of repeated recipient and donor antigenmismatches remain a controversy. The importance of theforegoing on the survival of the second renal graft isanalyzed in this study.METHODS: The clinical records of 80 patients whohad undergone a second cadaver renal transplantationfrom 1985 to 1995 at the Hospital 12 de Octubre (Madrid,Spain) were reviewed. Data on the recipient, donor andgraft characteristics and outcome of the first and secondtransplants were collected for multivariate analysis ofgraft survival using the Cox regresssion method. Theimportance of the overall HLA compatibility and of eachHLA locus, and the effect of antigenic re-exposure on thesurvival of the second renal graft were analyzed.RESULTS: The multivariate analysis showed asignificant increase of the survival of the second graftwhen there were at least three compatible antigens betweendonor and recipient (p=0.02). Compatibility of the HLAA and DR loci appeared to improve the outcome, althoughthe differences were not statistically significant. However,a significant improvement in the survival of the secondcadaver renal allograft was found for repeated HLAmismatches between the recipient and donors (p=0.006).CONCLUSIONS: Our data corroborate the benefits ofassigning renal grafts according to the degree of HLAcompatibility also for the second renal transplant.Furthermore, our data show that re-exposure to previousmismatched antigens need not be hazardous for the secondrenal transplant in the cyclosporine era.
Case Report
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OBJECTIVE: To report a case of liposarcoma of thespermatic cord in a young male, with special reference to thedifficulties encountered in making the clinical and histopathologicaldifferential diagnosis.METHODS/RESULTS: A 43-year-old patient underwent surgeryfor a tumor (8 x 7 cms) in the left spermatic cord. Pathologicalanalysis demonstrated a well-differentiated liposarcoma with myxoidareas. Radical orchidectomy was performed. The patient is well,with no tumor recurrence or metastasis.RESULTS/CONCLUSIONS: Paratesticular liposarcoma is rare.It is therefore difficult to establish the guidelines for treatment,prognosis and differential diagnosis. Similarly, difficulty isencountered when making the preoperative diagnosis, although USand CT can be useful. As in liposarcomas localized to other sites, thehistological type and grade of the lesion are useful for the prognosis.Radical inguinal orchidectomy is the treatment of choice.
Case Report
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OBJECTIVE: To report an additional case of smallcell (oat cell) carcinoma of the bladder.METHODS/RESULTS: A 78-year-old patient who consulted forhematuria is described. A TUR biopsy demonstrated small cellundifferentiated carcinoma. The patient received neoadjuvantchemotherapy and subsequently underwent surgery, but died 6months postoperatively.CONCLUSIONS: Regardless of the treatment utilized, this tumortype maintains its aggressive behaviour and can be associated withother carcinomatous components (papillary transitional cell carcinomaand carcinoma in situ).However, after treatment with CDDP + VP-16 and partialcystectomy, our patient was asymptomatic for 5 months.
Case Report
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OBJECTIVE: To report a case of hemosiderin-rich,pigmented renal cell carcinoma.METHODS: A 70-year-old patient referred several episodes ofgross hematuria during the last few weeks, without any othersymptoms. CT demonstrated a renal mass compatible with carcinoma.A right renal nephrectomy was performed.RESULTS: Anatomopathological analysis revealed ahemosiderin-rich, pigmented, papillary renal cell carcinoma localizedto the renal capsule that stained blue with the iron staining method.The postoperative period was unremarkable and the patient isasymptomatic one year postoperatively.CONCLUSION: Papillary renal cell carcinoma can present as apigmented lesion due to the accumulation of iron in the cytoplasm.This peculiar form must be distinguished from neuromelaninpigmentedlesions.
Case Report
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OBJECTIVE: To emphasize that urological symptoms and signs can be the presenting features of Crohn’s disease. METHODS: A case of enterovesical fistula in a patient with Crohn’s disease is described. The patient presented with hematuria and mild voiding symptoms, but there were no GI or other symptoms. The clinical aspects, diagnostic methods (ultrasound, cystoscopy, rectosigmoidoscopy) and treatment are discussed. RESULTS/CONCLUSIONS: Although Crohn’s disease is rare, it should be considered when making the differential diagnosis in patients who present with voiding symptoms and hematuria.
Case Report
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OBJECTIVE: To report a case of giant diverticulum of the bladder associated with inguinal hernia.METHODS/RESULTS: An uncommon case of giant diverticulum associated with inguinal hernia is presented and the literature reviewed. The enormous size of the diverticulum and the associated lower urinary tract obstruction arising from hyperplasia of the prostate required resolution of both conditions. This was achieved by diverticulectomy with herniorrhaphy and TURP.CONCLUSIONS: Diverticula of the bladder are associated with lower urinary tract obstruction that are generally caused by a prostatic condition. Hernia with bladder diverticulum is uncommon. The symptoms are usually scanty and cannot be distinguished from the voiding symptoms arising from prostatic involvement. Apart form the clinical findings, US, cystography or IVP are useful for diagnosis. Treatment is usually by surgical correction of both the bladder diverticulum and voiding obstruction from prostatic hyperplasia.
Case Report
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OBJECTIVE: A case of balanopreputial abscess containing gas in a patient with adhesion of the glans penis to preputial mucosa is presented. METHODS: The clinical features, diagnostic methods (penile ultrasound) and treatment (debridement + step (staged?) circumcision) are described. RESULTS/CONCLUSIONS: Severe phimosis and balano- preputial adhesions can cause urological complications as shown in the case described. Ultrasound demonstrated the presence of abscess and gas.
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OBJECTIVE: To report a case of renal cell carcinoma associated with carcinoma of the colon.METHODS: A right renal mass was detected during US control evaluation of a patient that had undergone surgery for rectosigmoid carcinoma 4 months earlier. A previous abdominal CT scan revealed a renal mass with characteristics of malignancy. Fine-needle aspiration biopsy showed clear cell renal carcinoma. This case was considered as two different and synchronous primaries, and the patient was submitted to surgery.RESULTS: Intestinal adhesions secondary to radiotherapy were found intraoperatively, but there was no evidence of local intestinal recurrence, and therefore nephrectomy was performed. The histopathological study demonstrated clear cell renal carcinoma with intranuclear inclusions.CONCLUSIONS: Although the patient may have a previous history of carcinoma at another site, the finding of a renal mass excludes synchronous tumors and nephrectomy should be the treatment of choice. The finding of clear cells in the cytological study supports the interpretation that these lesions were different primaries. Renal carcinoma should be included among the neoplasms with intranuclear inclusions.
Case Report
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OBJECTIVE: We report a case ofembryonal carcinoma stage IIB arising from the righttestis that subsequently underwent chemotherapy andretroperitoneal lymph node dissection and presented withan early cystic recurrence in the obturator fossa.METHODS: This case is reanalyzed retrospectivelyand literature is reevaluated for the early recurrences oftesticular tumors at atypical locations. We discuss therarity of obturator fossa as a location for early recurrencesof testis tumors.RESULTS: Only one case of recurrence in obturatorfossa has been reported.CONCLUSIONS: This case provides an example of thepossibility of recurrence in an unpredictable short intervalsubsequent to proper therapies and underscores theimportance of close follow-up.
