Prostatic adenomectomy in dialysis patients

A case of a 55-year old patient is presented with terminal renal insufficiency and a massive prostatic adenoma causing urinary tract obstruction. The case history of the patient on mandatory dialysis was complicated by recurrent, therapy resistant urinary tract infections accompanied by septic fever outbreaks and anemic relapses. Following suprapubic transvesical adenomectomy, no fever episodes, negative urine cultures and improvement in the anemic condition were all noted. Due to the fact that the upper age limit for acceptance into a hemodialysis program and possible kidney transplantation has been raised, it is important to note that patients with prostatic adenomas may be frequently encountered. Dialysis patients require successful treatment of urinary tract obstructions prior to transplantation. Immunosuppressive therapy which follows transplantation increases risk of infection which can endanger the graft and the patient's life.     

Metastasis of cancer to cancer: report of a case.

A case of primary, widely disseminated prostatic carcinoma causing bilateral urinary tract obstruction, hydronephrosis, and papillary necrosis and metastasizing in the substance of an unusual histologic variant of renal cell carcinoma and tubular adenoma of the same kidney is presented. Unusual incidental findings include isolated cardiac amyloidosis and myocardial abscesses. A brief review of the literature is presented. The peculiar tendency for renal cell carcinoma to be the host tumor for other primary carcinomas and various theories to account for this phenomenon are commented upon briefly.     

The overlooked cause of benign prostatic hyperplasia: prostatic urethral angulation

Benign prostatic hyperplasia (BPH) is one of the most common problems faced by aging men and can be associated with bothersome lower urinary tract symptoms that affect quality of life by interfering with normal daily activities and sleep patterns. Despite the clinical importance of BPH, its pathogenesis is still poorly understood. Previously, our understanding of BPH was centered on bladder outlet obstruction being secondary to benign prostatic enlargement. However, prostate size itself is not correlated with the urine flow rate and symptomatology. The prostatic urethra is a bend tube and the increased prostatic urethral angulation shows a higher bladder neck on cystoscopic examination. Although some urologists suspected that the higher bladder neck might be a causal factor for BPH, the clinical significance of prostatic urethral angulation was previously underestimated. In this study, we propose a new hypothesis that prostatic urethral angulation is a causal factor for BPH. By applying the concept of fluid dynamics to the process of urination in the prostatic urethra, we show that the energy loss in this bending tube (the prostatic urethra) can occur during micturition and it increases proportionally to prostatic urethral angulation; this energy loss results in a decrease of the urine velocity and accordingly, the urine flow rate is inversely associated with prostatic urethral angulation. We also propose that BPH involves prostatic urethral angulation as well as the classical BPH triad of prostatic enlargement, bladder outlet obstruction, and symptomatology. Our hypothesis suggests that prostatic urethral angulation is an overlooked cause of bladder outlet obstruction and is a causal factor of BPH, and provides novel insight into the pathogenesis of BPH. Ultimately, the relationship between prostatic urethral angulation and urine flow rate, and other clinical factors including urodynamic parameters, the symptomatology, the response to treatment, and disease progression, need to be investigated in a clinical setting.     

A hypothesis for anti-nanobacteria effects of gallium with observations from treating kidney disease

Nanobacteria, 100-fold smaller than common bacteria, have been purported to exist in urine, and by precipitating calcium and other minerals into carbonate apatite around themselves, induce the formation of surrounding kidney stones. Nanobacteria-like structures have also been shown in blood, within arteries, aortic aneurysms, and cardiac valves. Gallium has antibiotic properties to iron-dependent bacteria and has potent anti-inflammatory, anticancer and anti-hypercalcemic properties, and it readily reverses osteoporosis. It was hypothesized that gallium nitrate might have benefit in treating kidney stones. Gallium nitrate (120mg gallium) was mixed with water making two liters of a gallium mineral water drink to treat chronic, treatment-resistant kidney stone pain and urinary tract bleeding in a 110 pound woman. On the third day of gallium mineral water treatment, the urine appeared snow white, thick (rope-like) and suggestive of a calcific crystalline nature. After release of the white urine, the urine returned to normal in color, viscosity and pH, kidney pain was no longer present, and there was no further evidence of blood in the urine. There were no treatment side effects or sequela. For a one year observation period thereafter, no kidney stones, white urine, kidney or urinary tract pain or blood in the urine was noted. The hypothetical susceptibility of nanobacteria to gallium treatment also suggests application to atherosclerosis and other diseases. Although some support for gallium in treating kidney stones is presented, this hypothesis is built upon another hypothesis, is extremely speculative, and alternative explanations for the white urine exist. Further research into gallium's effects on kidney disease and other nanobacteria-induced diseases such as cardiovascular diseases is suggested.     

Renal dysplasia: Part I A clinico-pathological study of 76 cases

The clinical and pathological findings in 150 children submitted to partial or total nephrectomy have been reviewed. Histological examination of the kidney removed at operation showed evidence of renal dysplasia in 76 (51%). These 76 patients were divided into three main groups on the basis of the pathological changes found in the kidney and the associated urinary tract anomalies. In group 1, gross cystic renal dysplasia was associated with absence or atresia of the renal pelvis and ureter. In group 2, renal dysplasia was segmental; the ureter, although patent, had some anatomical or functional abnormality which resulted in urinary stasis or reflux. In many of these patients dysplasia was confined to the upper pole of a ;duplex' kidney which was drained by an ectopic ureterocele. In group 3, renal dysplasia was associated with obstruction of the lower urinary tract, most commonly by posterior urethral valves. In group 1 dysplasia was total, involving the whole kidney, whilst in groups 2 and 3 dysplasia tended to be segmental; in the majority some normal renal tissue was present. Pyelonephritis was a very common complication, but was present only in patients from groups 2 and 3, in whom a lumen was present in the draining ureter, and not in patients from group 1 in whom the ureter was atretic or absent, and the kidney not functioning. It appears that urinary obstruction, stasis, or reflux are the principal factors predisposing to and promoting pyelonephritis in dysplastic kidneys. There seems to be no reason to suppose that dysplastic renal tissue is abnormally susceptible to infection since pyelonephritic changes were lacking in those cases in which dysplasia was most severe.     

Soluble forms of the adhesion molecule E-cadherin in urine.

The adhesion molecule E-cadherin is essential for maintaining epithelial intercellular adhesion. Loss or reduced expression of E-cadherin has been related to invasive behaviour in a wide range of carcinomas. Using immunoblotting techniques, the existence of multiple soluble forms of E-cadherin was demonstrated in urine from healthy volunteers and patients with benign urinary tract disorders or bladder cancer. The existence of soluble forms of E-cadherin in the urine may reflect shedding from the urinary tract epithelium as part of the normal turnover of this molecule. The possibility that enhanced shedding may contribute to the loss of E-cadherin expression/function in malignancy is discussed.     

当代前列腺动脉栓塞术的文献回顾

前列腺动脉栓塞术作为一种崭新的放射介入技术,用于治疗良性前列腺增生继发下尿路症状的患者。良性前列腺增生症是一种常见于中老年男性患者的临床病症,它常导致典型的下尿路症状,包括夜尿、尿频、尿急、尿流率下降、排尿踌躇、不完全排空感等。通常在排除肿瘤、炎症、中枢神经系统疾病等病因后,由良性前列腺增生所引起的轻中度下尿路症状可行观察疗法或药物治疗,而对于中重度症状患者,则多建议手术治疗。自早期偶然发现选择性地前列腺动脉栓塞术能治疗因前列腺增生继发的恶性出血,且可缓解下尿路症状之后,该方法被越来越多的临床学者所接受,并积极探索该技术的实用性、安全性及有效性。目前,前列腺动脉栓塞术仍未成为良性前列腺增生症的标准疗法。本文将重点回顾关于前列腺动脉栓塞术的相关文献,包括个案、动物研究、回顾性或前瞻性队列研究等,对该技术进行总结。     

Production of beta-human chorionic gonadotropin by prostatic adenocarcinoma and transitional cell carcinoma of the upper urinary tract.

Ectopic production and secretion of hormones by a wide variety of tumours has been known for many years. Recently human chorionic gonadotropin (HCG) production and/or secretion have been noted in 15 cases with prostatic adenocarcinoma (Fukutani et al. 1983; Papapetrou et al. 1980: Broder et al. 1977; Menon & Stefani 1980; McManus et al. 1976) and in two with upper urinary tract transitional cell carcinoma (Fukutani et al. 1983; McManus et al. 1976). In this study we utilised the indirect immunoperoxidate technique to demonstrate beta-HCG production in prostatic adenocarcinoma and upper urinary tract urothelial tumours. Of 100 cases of prostatic adenocarcinoma beta-HCG production was demonstrated in nine cases, eight of which were poorly differentiated, and of 14 urothelial tumours of the upper urinary tract beta-HCG production was present in two high grade transitional cell carcinomas.     

Production of beta-human chorionic gonadotropin by prostatic adenocarcinoma and transitional cell carcinoma of the upper urinary tract

Ectopic production and secretion of hormones by a wide variety of tumours has been known for many years. Recently human chorionic gonadotropin (HCG) production and/or secretion have been noted in 15 cases with prostatic adenocarcinoma (Fukutani et al. 1983; Papapetrou et al. 1980: Broder et al. 1977; Menon & Stefani 1980; McManus et al. 1976) and in two with upper urinary tract transitional cell carcinoma (Fukutani et al. 1983; McManus et al. 1976). In this study we utilised the indirect immunoperoxidate technique to demonstrate beta-HCG production in prostatic adenocarcinoma and upper urinary tract urothelial tumours. Of 100 cases of prostatic adenocarcinoma beta-HCG production was demonstrated in nine cases, eight of which were poorly differentiated, and of 14 urothelial tumours of the upper urinary tract beta-HCG production was present in two high grade transitional cell carcinomas.     

Tamm-Horsfall protein outside the kidney

Tamm-Horsfall protein is the main protein in normal urine and readily precipitates. Previously there has been little study of the protein outside the kidney. An antiserum to the protein was used in an immunohistological investigation of human tissues. No Tamm-Horsfall protein was detected in normal organs other than the kidney. The protein was detected outside the kidney in abnormal organs in three general sites: (i) in ulcers of epithelial surfaces exposed to urine, (ii) deep in the wall of a bladder that had had previous surgery and (iii) in lymph nodes at the hilum of kidneys that had been obstructed or contained extra-tubular deposits of the protein. There was little evidence of a cellular response to the deposits of Tamm-Horsfall protein. The antiserum to Tamm-Horsfall protein is a good immunohistological marker of extravasated urine and is useful in the study of such conditions as fistulas of the urinary tract, operations on the urinary tract and reflux of urine into lymphatics and lymph nodes.     

Urogenitales Altern

In the industrial Western world, 8 % of the population suffer from urogenital discomfort. Epidemiologic studies show that the incidence rises with age. In light of the steadily increasing longevity in the female population, clinically manifested irregularities such as urogenital atrophy, recurrent urinary tract infections, irritable bladder, and incontinence pose a challenge to the attending physician. To this day, urinary incontinence in later life is considered “normal” and “caused by old age.” However, among other age-related reasons, the main cause of this disorder is postmenopausal hormone deficiency. Thus, following thorough diagnostics, pathological changes in the urogenital tract can often be reduced or altogether eliminated by simple conservative measures such as topical hormone administration, which rapidly enhance patients’ quality of life. The present study gives an overview of the physiology of urogenital aging and the diagnostic and therapeutic means available to physicians to alleviate patients’ discomfort.     

Quantitative studies of urinary immunoglobulins in hospital patients including patients with urinary tract infection

The 24-hr urinary excretion and clearances of IgA, IgG, siderophilin and albumin have been determined on specimens from twenty-one hospital patients, nine of whom had urinary tract infection. Patients with normal creatinine clearance and urinary tract infection had significantly increased urinary excretion and clearances of all four proteins, compared to patients with normal creatinine clearance and no urinary tract infection. IgM was found in the urine of five patients with urinary tract infection, and in three of these IgD was also present. There was no evidence that the presence of IgM and IgD in the urine of these patients was a direct result of infection.     

Villous adenoma of the urinary tract: a lesion frequently associated with malignancy

Villous adenomas arising in the urinary tract are rare. We identified 18 cases of villous adenomas of the bladder, urachus, and prostatic urethra. Patients ranged in age from 53 to 93 years with an average age of 69.6 years and a male preponderance of 67%. In six cases (33%), the lesion was pure villous adenoma. In three cases (17%), there was villous adenoma with in situ adenocarcinoma. In six cases (33%) there was villous adenoma with in situ and infiltrating adenocarcinoma. One case (6%) had villous adenomas with in situ (noninvasive) papillary urothelial carcinoma. One case (6%) had villous adenomas with in situ adenocarcinoma and in situ papillary (noninvasive) and infiltrating urothelial carcinoma. The remaining case (6%) had villous adenoma with in situ and infiltrating adenocarcinoma and in situ (noninvasive) papillary and infiltrating urothelial carcinoma. Clinical outcome was available in eight of the cases, with a mean follow-up of 4.6 years. No evidence of recurrence was found in two patients with pure villous adenoma or in two patients with villous adenoma and only in situ adenocarcinoma, all of whom were treated by nonradical excision. However, two of three cases with infiltrating cancer developed distant metastases despite radical surgery; the remaining patient was disease-free 11 years after transurethral resection. The case with villous adenoma and in situ urothelial carcinoma progressed to sarcomatoid urothelial carcinoma following partial cystectomy. Eight of 10 villous adenomas cases studied expressed the epitope for mAbDas1, found on colonic epithelium and primary adenocarcinomas of the bladder and urachus but not on normal or neoplastic urothelium. This study expands the spectrum of histologic features accompanying villous adenomas of the urinary tract. Coexisting infiltrating adenocarcinoma is often present, necessitating thorough sampling of any lesion diagnosed by biopsy as villous adenoma. Pure villous adenoma and those well-sampled lesions also containing in situ adenocarcinoma portend a favorable prognosis, even without radical treatment. Coexisting in situ or infiltrating carcinoma suggests a more aggressive course. Histologically, immunohistochemically, and prognostically, these lesions appear analogous to their counterparts in the intestine.     

Further evaluation of the test for detection of antibody-coated bacteria in urine sediment.

To assess the reproducibility of the test for detection of antibody-coated bacteria in urine sediment as it might be used in a diagnostic laboratory for classification of urinary tract infections, multiple urine specimens from 83 patients were tested. The results were reproducible and consistent, or if inconsistent potentially explainable, in all but four patients. The explanation for inconsistencies include the immune response to the infecting bacteria, nonspecificity of the antibody coating the bacteria, antibody in prostatic secretions, and antibody-coated bacteria contaminating the urine specimens.     

Cytological and immunocytochemical study of prostatic carcinoma cell in voided urine. Usefulness of prostate-specific antigen in cytology specimen]

The presence of prostatic carcinoma cells in voided urine was seldom noticed and these cells might be hardly distinguished from transitional cell carcinoma cells of the urinary tracts on the Papanicolaou-stained slides. We investigated the cytological findings and the localizations of prostate-specific antigen (PSA) in 7 cases of prostatic carcinomas (4 adenocarcinomas, 2 squamous cell carcinomas, and 1 undifferentiated carcinoma) which showed tumor cells in voided urine. The cytological findings of each histological types were as follows: adenocarcinoma cells were observed in small clusters of round or columnar cells with eccentric nuclei and prominent nucleoli with occasion, squamous cell carcinoma cells were characteristically well-differentiated keratinizing ones varying in shape and in staining reaction, and undifferentiated carcinoma cells were polyhedral and large ones with dense cytoplasm. After destaining of the Papanicolaou-stained slides, the positivity for PSA was demonstrated by immunocytochemical stain with PSA antiserum in cytoplasms of the tumor cells of 6 cases except for 1 undifferentiated carcinoma. We recognized that immunocytochemical detection of PSA was a useful mean in cytological detection for prostatic carcinomas in voided urine.     

Dietary iodine intake and urinary iodine excretion in patients with thyroid diseases

This study was conducted to examine the usual iodine intake in patients with thyroid diseases and to compare iodine status with normal subjects. The dietary iodine intake was assessed using a semi-quantitative food frequency questionnaire, and urinary iodine excretion was measured in 184 patients diagnosed with thyroid diseases and 207 normal subjects. The average usual iodine intake of patients with thyroid diseases was 673.8 +/- 794.9 ug/day and that of normal subjects was 468.9 +/- 481.9 ug/day. Among the patients with thyroid diseases, higher values were found in the patients with thyroid cancer (1460.6 +/- 1044.8 ug/day) and lower values were found in patients with simple goiter (443.5 +/- 470.4 ug/day). The urinary iodine excretions of patients and normal subjects were 4.33 +/- 5.70 mg/L and 2.11 +/- 0.69 mg/L, respectively. The iodine intake and urinary iodine excretion of patients with thyroid diseases were significantly higher than those of normal subjects (p < 0.05). The dietary iodine intake and urinary excretion of patients with thyroid cancer were significantly higher than other patients with thyroid diseases and normal subjects because of the use of seaweed or seaweed-containing dietary supplements (p < 0.01). This study suggests that the habitual ingestion of seaweed-containing dietary supplements in addition to dietary iodine intake will have adverse effects due to its excessive iodine intake.     

The effects of ureteral occlusion and renal venous constriction on kidney kallikrein-kinin and prostaglandin systems in dogs

Olsen , U. B. The effects of ureteral occlusion and venal cenous constriction on kidney kallikrein-kinin and prostaglandin systems in dogs. Acta physiol. scand. 1978. 104. 443–452. The intrarenal pressure was raised to 40–50 mmHg by ureteral occlusion or by renal venous constriction in anesthetized dogs loaded with 10% mannitol in saline and with a urine flow of approximately I ml/min/ kidney. Both manoeuvres produced vasodilation and decreased urine creatinine excretion (GFR). Ureteral occlusion was associated with a marked antinatriuresis, which contrasted the variable decrements in sodium excretion during renal venous constriction. Ureteral occlusion did not affect urine excretion of kallikrein or kinins, whilst renal venous constriction decreased urinary kallikrein excretion, yet markedly increased urinary kinin excretion. Ureteral occlusion and renal venous constriction comparably increased urine prostaglandin (E-like) excretion by a presumably pressure dependent mechanism. Inhibition of prostaglandin synthesis by indomethacin abolished the vasodilation during renal venous constriction and this was accompanied by marked reductions of urinary creatinine (GFR) and kallikrein excretions. whilst the kinin excretion was enhanced as observed before the administration of indomethacin.