The flexible cystoscope

We have been using the flexible cystoscope since 1987. Detailed information is given concerning the technique of flexible cystoscopy, its indications, advantages and disadvantages. A comparison is made with the results obtained using the rigid cystoscope in an initial series of 100 patients, yielding false negative results in only 8% of cases during the learning period. The flexible scope can be successfully employed for Neodymium YAG laser coagulation of superficial bladder tumours. The conclusion is reached that once the urologist has learned how to use it, he will consider the flexible cystoscope as a fundamental tool in his diagnostic armamentarium and false negative results will decrease almost to zero, especially if additional investigations, namely cytology, are routinely adopted.     

Papillary adenocarcinoma in a seminal vesicle cyst associated with ipsilateral renal agenesis: a case report.

Cysts and tumors of the seminal vesicle are uncommon, and their coexistence is extremely rare. We report a case of multiple papillary tumors inside a seminal vesicle cyst associated with ipsilateral renal agenesis in a 17-year-old man. Surgical excision of the cyst and tumors was performed without any morbidity and histology revealed well differentiated papillary adenocarcinoma.     

Considerations for the Use of Cytokine-Secreting Tumor Cell Preparations for Cancer Treatment

Limited efficacy of chemotherapy in most solid tumors has revived interest in immunotherapeutic approaches for cancer. One novel form of immunotherapy is the use of cancer vaccines consisting of tumor cells genetically engineered to secrete cytokines. The rationale for this immunization strategy is based on the existence of tumor-specific antigens, on the importance of the cellular arm of the immune system in mediating an effective antitumor response, and on the role of cytokines in regulating the cellular immune response. Such tumor vaccines showed considerable promise in various animal models and induced potent antitumor immunity in the host, which led to regression of established tumors and, moreover, produced immunological memory protecting animals from a subsequent tumor challenge at a distant site. Translated to the human patient, this implies that genetically modified tumor vaccines may be able to eradicate or reduce existing tumor deposits to subclinical levels as well as provide long-term protection from regrowth of tumor cells. This report will review and discuss the concept and rationale for the use of cytokine-secreting tumor vaccines for the treatment of human malignancies.     

Benign prostatic hyperplasia and growth factors.

A great deal of work has been accomplished in the attempt to determine the cause of benign prostatic hyperplasia (BPH). Early work by morphologists suggests that BPH starts as a stromal disease and that the hyperplastic stroma secretes a substance that stimulates the growth of epithelial cells. The quantitative morphometric data also suggest that BPH is primarily a stromal disease. Experimental embryology data have shown that the basic fibroblast growth factor, bFGF, is involved in early embryogenesis and is the primary inducer of mesodermal tissue. Work in mouse embryos has shown that a powerful inducer for prostatic epithelial growth is elaborated by the urogenital mesenchyme. Both of these findings fit the hypothesis that stromal hyperplasia may be initiated by a growth factor and that a second growth factor stimulates epithelial growth. Work in our laboratory has established that bFGF is the primary growth factor present in human BPH. We have also found that bFGF is synthesized by prostate fibroblasts and bFGF may be in higher concentration in the periurethral tissues of BPH. At this time, no definite link between growth factors and hyperplastic growth of the prostate has been established. However, circumstantial evidence has lead us to formulate several hypothesis regarding the role of growth factors in BPH. Hopefully, these hypothesis will be of some assistance in guiding future work on growth factors and BPH.     

Alpha-glucosidase activity and sperm motility

We correlated the activity of alpha-glucosidase in seminal plasma with the motility and differential motility of sperm. Significant positive correlations were found between the alpha-glucosidase activity and both motility and the percentage sperm with good forward progression. This supports the use of alpha-glucosidase in semen as a marker of epididymal function and specifically of the development of motility.     

Circulating prostate specific antigen-positive cells correlate with metastatic prostate cancer.

Analytical flow cytometry was used to study circulating prostate specific antigen (PSA)-positive cells in 40 consecutive patients with newly diagnosed, untreated prostate cancer; 25 patients (63%) had metastatic disease confirmed by a positive bone scan. Cell suspensions were prepared for each patient from both the primary tumour and peripheral blood samples. The cells were stained with a monoclonal antibody against PSA, and analysed by flow cytometry; PSA-positive cells were sorted according to their immunofluorescence and light scatter properties. The cellular deoxyribonucleic acid (DNA) content of each specimen was also analysed to establish ploidy status. PSA-positive cells were detected in the peripheral blood of 33 patients (83%). The presence of these cells in the circulation showed a higher degree of sensitivity and specificity in predicting positive bone scans than did serum PSA levels. Circulating PSA-positive cells may represent either a subpopulation of tumour cells with distinct metastatic properties or, alternatively, host immunocytes which take up PSA in an active or passive manner.     

Surgical male contraception.

After giving a short account on the possible ways of male contraception, the authors outline the administration of surgical sterilization and its professional follow-up based on their own experience. Their suggestions concerning legal regulations aim, on the one hand, at the extension of the topic, on the other hand at supporting the specialists interested in surgical contraception.     

Hilar fusion: a rare renal malformation. Description of a case in association with lithiasis and tubular precalyceal ectasia in an adult patient

An uncommon case of a 42-year-old man with hilar renal symphysis in association with lithiasis and 'tubular precalyceal ectasia' is described.     

Cystitis as a correlate of female urinary incontinence

The objectives of the research were to study the association between prevalent urge and stress urinary incontinence (UI) and a history of cystitis in adult females. A cross-section of the adult female population, aged 30–59 years, in the Municipality of Aarhus, Denmark, was studied, using self-reported data based on postal questionnaires. The sample consisted of 3114 women, out of whom 2613 (84%) delivered the information requested. The main outcome measures were period prevalence in 1987 of episodes of UI provoked by physical stress and UI associated with a feeling of urge, prevalence of experience of episodes of cystitis and UI related to cystitis in adult life, and prevalence of relative risks, as indicated by odds ratio (OR), of UI conditional on cystitis experience. Results indicated that the 1987 period prevalences of UI provoked by physical stress and UI associated with a feeling of urge were 15% and 9%, respectively. Forty-five per cent reported a history of cystitis and 10% of UI during episodes of cystitis. Both UI provoked by stress and UI associated with a feeling of urge were significantly correlated to cystitis (OR 2.1, P<0.0001, and 1.8, P<0.0001, respectively) and to UI during episodes of cystitis (OR 7.1, P<0.0001, and 5.7, P<0.0001, respectively). When corrected for the stress aspect, UI being associated with a feeling of urge showed no association of its own to a history of cystitis. However, stress and urge aspects were both correlated to the experience of UI during episodes of cystitis. The prevalence of experience of cystitis increased with increasing number of urologic (per operation OR 2.1, P<0.0001) and gynecologic operations (per operation OR 1.5, P<0.0001), e.g. curretage (per operation OR 1.2, P<0.001), but not with the number of abdominal operations or the number of childbirths. It was concluded that cystitis may be an important component of UI etiology. Stress and not urge UI seems to be the key type related to a history of cystitis in general. The experience of UI during cystitis is connected to both stress and urge UI. A history of cystitis may possibly itself by initiated by surgery.