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INTRODUCTION: The present study was carried out to compare the efficacy of transabdominal ultrasonography and intravenous urography in the diagnosis of bladder carcinoma in those patients presenting painless hematuria. MATERIALS AND METHODS: Medical records of 100 patients who had both ultrasonography and intravenous urography were studied. The reported findings of these investigations were correlated with those of cystoscopy. RESULTS: Ultrasonography was significantly more sensitive (96%) in the detection of bladder carcinoma compared to urography (87%). By applying the test of equality of proportions, the value of Z is 2.28, which is statistically significant (p < 0.01). In addition, ultrasonography was more sensitive in clarifying the pathology in upper renal tracts i.e. ureteric obstruction secondary to bladder carcinoma when urography failed due to none or poor excretion of contrast. COMMENTS: We recommend the use of ultrasonography as the initial radiological investigation for detection of bladder carcinomas in patients presenting hematuria. Ultrasonography is safe, easily available, cost effective and provides images of both upper and lower renal tract. Patients diagnosed to be suffering from bladder carcinoma by ultrasonography should be scheduled directly and promptly for cystoscopy and bladder tumor resection.

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PROPOSAL: The authors present their initial experience with a selected group of patients who underwent laparoscopic partial cystectomy for treating bladder cancer. MATERIALS AND METHODS: In the period from June 1997 to April 2000, 6 patients, aged between 38 and 76 years, having transitional cell carcinoma of the bladder, were identified as candidates to partial cystectomy. The procedure employed consisted in laparoscopic partial cystectomy and lymphadenectomy with exclusive intracorporeal suture technique. RESULTS: The proposed procedure was completed in all cases. Mean surgical time was 205 minutes and mean blood loss was 200 mL. There were no significant complications during both intra- and post-operative period. Two patients (33%) presented urinary extravasation of less than 50 mL, with spontaneous resolution. Mean hospitalization period was 4 days (2 to 6). The histological analysis of the resected specimens revealed transitional cell carcinoma, stage pT1G3 in case 1, pT2aG2 in cases 2 to 4, pT2bG2 in case 5 and pT3aG3 in case 6. The resection margins, as well as lymph nodes, were free of neoplasia. One patient developed local and metastatic disease, and was treated with salvage chemotherapy. No other case of local or systemic recurrence was observed with a mean follow-up of 30 months. CONCLUSIONS: Laparoscopic partial cystectomy can be an alternative surgical method for treating selected cases of patients with transitional cell carcinoma of the bladder.

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OBJECTIVE: Surgical correction of the deformity and plaque caused by Peyronie's disease has some important disadvantages and extracorporeal shockwave therapy (ESWT) emerged as a new promising therapy. We evaluated prospectively the efficacy and safety of the association of high dose vitamin E and ESWT as a non-invasive treatment for the disease. MATERIALS AND METHODS: Twenty-five patients 42 to 68 years old (mean = 54) presenting penile deviation and sexual distress caused by Peyronie's disease were treated in a non-invasive manner. The time of penile deviation ranged from 16 to 52 months (mean = 30). All patients had previous unsuccessful treatment for Peyronie's disease. The angulation's deformity of the penis was assessed by photography at home. The patients received vitamin E (l.200 mg daily) during 3 months and underwent 3 to 6 sessions (mean = 3) of ESWT (3,000 to 4,000 shockwaves) at a power level of l to 2 at 1-week intervals. RESULTS: From 25 patients treated, 16 (64%) reported an improvement in penile angulation, with a mean reduction of 21 degrees (10 to 40). Eight patients reported improvement in their spontaneous erections. Overall, the patients presented only minimal bruising at the site of treatment and skin hematoma. Four patients presented urethral bleeding. The mean angulation after treatment in the control group was 48.67 degrees (30 - 70) and in the study group was 24.42 degrees (0 - 70), statistically significant. CONCLUSION: Considering the common complications and the unsatisfactory outcome of the surgical correction for Peyronie's disease, the association of high dose vitamin E and ESWT represents a good option for a non-invasive, effective and safe treatment of the penile deformity.

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PURPOSE: To study the changes in calcium oxalate crystal morphology induced by different levels of supersaturation (SS) in human urine. MATERIALS AND METHODS: Twenty-four hours urine samples from 5 normal men were collected. Each specimen was centrifuged and filtered. About 200 mL of each sample was dialyzed overnight. Aliquots of 2 mL of urine was then added to a 24-wells tissue culture plate and checked for crystal absence. Calcium oxalate crystals were precipitated from each sample by adding sodium oxalate and calcium chloride in sufficient quantities to induce spontaneous crystallization. Finally, each plate hole was examined with an inverted polarized microscope (X500 magnification). Initial SS of each sample relative to calcium oxalate was calculated using an iterative computer program. RESULTS: Crystal formation was connecte to relative calcium oxalate (CaOx) SS. At SS of 10, small crystals of similar shape were formed, mainly CaOx dihydrate morphology. At SS of 30, there was an enormous increase in the number of crystals, that kept the same size. SS greater than 50 produced larger crystals with different shapes and multiple crystalline aggregates. Urine was able to tolerate, i.e., to avoid crystal formation, until SS ratios of approximately 10. CONCLUSIONS: Relative CaOx SS and the concentration ratio of calcium to oxalate are important determinanting factors of crystal morphology. Non-dialyzable urinary proteins can act as inhibitors and influence the structure of formed crystals. Additional studies from patients with kidney stones are needed in order to establish whether crystal size and habit distribution are different from crystals in normal urine.

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Primary synovial sarcoma of the kidney is a rare tumor that is difficult to diagnose. We present one case that was not diagnosed through fine needle aspiration, requiring a morphologic and immunohistochemical analysis of the incision biopsy. Since the tumor was surgically unresectable, chemotherapy was employed previously to definitive radical surgery.

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INTRODUCTION: Liposarcoma is a malignant mesenchymal tumor frequently located in retroperitoneum, and rarely presenting an isolated lesion in kidney. CASE REPORT: Female, Caucasian, 49-year old patient, with family history of renal polycystic disease, was selected for organ donation. During preoperative examinations a renal pleomorphic liposarcoma was detected. She was treated with radical nephrectomy and remains asymptomatic, without evidences of recurrence in control ecographic examinations after a 4-year follow-up. COMMENTS: Renal liposarcoma is a rare tumor. We report one case incidentally diagnosed during a routine pre-transplantation assessment in renal donor.

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INTRODUCTION: Renal hemangioma is a relatively rare benign tumor, seldom diagnosed as a cause of hematuria. CASE REPORT: A female 40-year old patient presented with continuous gross hematuria, anemia and episodic right lumbar pain, with onset about 3 months previously. The patient underwent multiple blood transfusions during her hospital stay and extensive imaging propedeutics was performed. Semi-rigid ureterorenoscopy evidenced a bleeding focus in the upper calix of the right kidney, with endoscopic treatment being unfeasible. The patient underwent right upper pole nephrectomy and presented a favorable outcome. Histopathological analysis of the surgical specimen showed that it was a renal hemangioma. COMMENTS: Imaging methods usually employed for diagnostic investigation of hematuria do not have good sensitivity for renal hemangioma. However, they are important to exclude the most frequent differential diagnoses. The ureterorenoscopy is the diagnostic method of choice and endoscopic treatment can be feasible when the lesion is accessible and electrocautery or laser are available. We emphasize the open surgical treatment as a therapeutic option upon failure of less invasive methods.

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Foreign bodies of the urethra and bladder are seen with iatrogenic injury, self-insertion, and rarely migration from adjacent sites. Treatment is focused on foreign body extraction, diagnosing complications, and avoiding compromise of erectile function. With advances in endourology, the majority of cases can now be managed endoscopically. We present a case of a man with multiple foreign bodies located both above and below the urogenital diaphragm. Advancing the posterior objects intravesically and extracting with a stone basket accomplished successful removal.

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INTRODUCTION: The laparoscopic radical prostatectomy is a continually developing technique. Transperitoneal access has been preferred by the majority of centers that employ this technique. Endoscopic extraperitoneal access is used by a few groups, nevertheless it is currently receiving a higher acceptance. In general, the antegrade technique is used, with dissection from the bladder neck to the prostate apex. The objective of the present paper is to describe the extraperitoneal technique with reproduction of the open surgery's surgical steps. SURGICAL TECHNIQUE: With this technique, the dissection of the prostate apex is performed and, following the section of the urethra while preserving the sphincteric apparatus, the Foley catheter is externally tied and internally recovered, which allows cranial traction, similarly to the way it is performed in conventional surgery. The retroprostatic space is posteriorly dissected and the seminal vesicles are identified by anterior and posterior approach, obtaining with this method an optimal exposure of the posterolateral pedicles and the prostate contour. The initial impression is that this technique does not present higher bleeding rate or difficulty level when compared with antegrade surgery. Potential advantages of this technique would be the greater familiarity with surgical steps, isolated extraperitoneal drainage of urine and secretions and a good definition of prostate limits and lateral pedicles, which are critical factors for preserving the neurovascular bundles and avoiding positive surgical margins. A higher number of cases and a long-term follow-up will demonstrate its actual value as a technical option for endoscopic access to the prostate.

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The renal cell carcinoma (RCC) rarely occurs in childhood. We report here 3 cases of RCC in children. Two girls and 1 boy aged 14, 8 and 13 years old, respectively, presented with gross hematuria as their main complaint. They underwent ultrasonography and computerized tomography, which revealed unilateral renal tumor with lymph nodal involvement in all 3 cases. They were treated with radical nephrectomy associated with regional lymphadenectomy, with histopathology of RCC. Incomplete adjuvant radiotherapy was performed in 2 cases and no complementary treatment in the other one. All are disease-free in a period ranging from 9 to 77 months after diagnosis. Radical nephrectomy associated with regional lymphadenectomy is the best treatment for RCC in childhood. The disease appears to have a less aggressive behavior in children.

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INTRODUCTION: Surgery represents the main therapeutic modality for stress urinary incontinence. In incontinent patients with urethral hypermobility, the retropubic colposuspension by Burch technique is one of the surgeries that present better long-term results. Current trends towards performing minimally invasive techniques led proposing the Burch surgery through videolaparoscopy. The laparoscopic technique's long-term efficacy is a highly controversial issue. However, even if late results turn out to be satisfactory, the assumed advantages of laparoscopy (faster recovery, less pain, early return to daily activities, etc.) must be evident, in order to justify the use of this minimally invasive surgical access. MATERIALS AND METHODS: We reviewed our records and analyzed the medical charts of 26 female patients who underwent Burch surgery by open approach and 36 female patients by laparoscopic approach, between May 1999 and February 2001. The satisfaction level, surgical complication rates, surgery length, hospital stay and return to daily activities were analyzed. RESULTS: Mean age was 42 years, ranging from 27 to 68 years. Epidemiological data from both groups were not statistically different. Patients operated by laparoscopic route had a shorter hospital stay (p = 0.002) and a faster return to their daily activities (p < 0.001). However, there were no statistical differences in the following parameters: surgical time (p = 0.11), surgical complications (p = 0.98), patient satisfaction immediately (p = 0.77) and 90 days following surgery (p = 0.84), surgery acceptance (p = 0.85), indication of this surgery to a friend (p = 0.93) and score given to the procedure (p = 0.68). CONCLUSIONS: Even if the efficacy of both methods is similar, we did not observe significant advantages of laparoscopic surgery over open surgery, concerning the recovery in recent post-operative period.

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OBJECTIVE: To assess the value of the silicone modeler in preventing graft retraction in dogs undergoing bladder replacement with de-epithelialized ileum. MATERIALS AND METHODS: Twelve female dogs underwent total cystectomy and bladder replacement by neobladder made of demucosalized ileal segment, comparing the group with modeler (group I) and the group without modeler (group II). Cystometry data, graft epithelization and radiological assessment (cystography and excretory urography) were analyzed. RESULTS: Neobladder capacity, at 2 months, ranged from 50 to 250 mL (mean 191 mL) and from 5 to 60 mL (mean 22 mL) and at 6 months, from 60 to 270 mL (mean 202.5 mL) and from 5 to 75 mL (mean- 30.5 mL), respectively in groups I and II, with a statistically significant difference between groups. After 30 days, postoperatively the presence of transitional epithelium was observed in all fragments obtained by biopsy. CONCLUSION: The use of the intravesical silicone modeler prevented the retraction of the neobladder of de-epithelialized ileum.