Percutaneous nephrolithotomy in children: experience with 138 cases in a developing country

Our aim was to evaluate our experience with percutaneous nephrolithotomy (PCNL) in children in the Republic of Yemen. Between January 1993 and December 1998, 135 children underwent 138 percutaneous nephrolithotomies in Yemen. The patients age ranged between 8 months and 14 years (average 8.9 years). There were 117 boys and 18 girls (male:female ratio 6.5:1). The stone size ranged between 124 and 624 mm² (average 507 mm²) . A 26 F adult nephroscope was used. The stone free rate was 98.5% (136 out of the 138 cases). Two patients had clinically insignificant fragments. A second session had to be performed because of residual stone in one patient. No severe intra- or postoperative complications were observed. We conclude that percutaneous nephrolithotomy is a safe and effective method for the treatment of kidney stones in children. It reduces morbidity and hospital stay and thus the cost of treatment. To our knowledge, this is the largest reported series.     

Minimally invasive percutaneous cystolithotomy: an effective treatment for bladder stones in infants aged <1 year

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To present our experience with minimally invasive percutaneous cystolithotomy (MPCCL) for the treatment of bladder stones in infants aged <1 year.

PATIENTS AND METHODS

From 1 January 2003 to 31 October 2008, 15 boys with a mean (range) age of 8.2 (3.0–11.5) months underwent MPCCL. The mean (range) stone diameter was 1.4 (0.9–2.2) cm. Ten infants had a solitary stone while five had more than one stone. MPCCLs were performed under general anaesthesia. A 16 F peel‐away sheath was introduced as a working tract after dilatation with percutaneous nephrolithotomy dilators (8–16 F) under fluoroscopic control. After dilatation, an 8–9.8 F ureteroscope was introduced into the bladder, and the stones were fragmented with a shock wave lithotriptor. After the MPCCL, a 14 F suprapubic catheter was left in situ and fixed to the skin, and removed 1 or 2 days after MPCCL. The urethral catheter was removed 2 or 3 days after MPCCL. The absence of stone fragments on plain X‐ray/ultrasonography was considered as a ‘stone‐free’ status.

RESULTS

All infants were stone‐free after one MPCCL; no recurrent stones developed. The mean MPCCL procedure time was 25 min and intraoperative blood loss was scant. Perioperative complications were few. The mean hospital stay was 2.8 days.

CONCLUSION

MPCCL is a safe and effective treatment option for bladder stones in infants, reducing postoperative complications and shortening hospital stay.     

Percutaneous nephrolithotomy (PCNL) in patients with previous open stone surgery

Objectives  Our objective was to investigate the effects of previous open nephrolithotomy on technical features, outcomes, and morbidities of subsequent percutaneous nephrolithotomy (PCNL). Methods  One hundred and sixty patients underwent PCNL between December 2004 and September 2006. The patients were divided into those who had previous open nephrolithotomy on the same kidney (group 1: 55 patients) and those who had no previous open surgery (group 2: 105 patients). Technical features encountered during operation and outcomes were compared between groups. Results  There were no significant differences between groups with respect to mean age (group 1: 42.6 ± 10 years vs. group 2: 45.5 ± 9.6 years), body mass index (24.8 ± 2.11 vs. 24.6 ± 2.14), and stone burden (385.6 ± 140.6 mm² vs. 401.05 ± 142 mm²). In group 1, 28 and 27 stones were located in the right and left kidney, respectively, whereas the location was 51 and 54 for the right and left kidney, respectively, in group 2. When the groups were compared, the mean operative time was significantly longer (155 ± 30 min vs. 137 ± 30 min) in group 1. But there was no significant difference with respect to requirement for secondary intervention (11% vs. 10%). Sepsis developed in two patients in group 1 and one patient in group 2. One patient in group 1 died due to septic shock. Ten (18.2%) patients in group 1 and 13 (12.4%) patients in group 2 required blood transfusion. Conclusions  When PCNL is performed after previous open nephrolithotomy, the operative time lengthens. But there is no difference with respect to success rate and morbidities.     

良性前列腺增生患者并发膀胱结石的危险因素分析

目的:探讨良性前列腺增生(BPH)患者并发膀胱结石的危险因素。方法:回顾性分析2016年4月～2017年9月我院就诊的321例BPH患者的资料,分别将其分为并发膀胱结石组(n=27)与无并发膀胱结石组(n=294),采用Logistic回归分析BPH患者并发膀胱结石的危险因素。结果:BPH患者的膀胱结石发生率为6.5%。多因素分析显示,年龄、前列腺尿道角(PUA)、前列腺突入膀胱程度(IPP)、前列腺移行带体积(TZV)是BPH患者并发膀胱结石的独立危险因素(P<0.05)。结论:年龄、PUA、IPP和TZV较大的BPH患者易发生膀胱结石。     

Percutaneous nephrolithotomy for pediatric stone disease--our experience with adult-sized equipment

OBJECTIVE: We evaluated the outcomes and complications of percutaneous nephrolithotomy (PNL) operations performed in pediatric patients using adult-sized surgical equipment at our center. MATERIAL AND METHODS: The medical and surgical records of 23 children who underwent a total of 25 PNL operations using 24 or 26 F rigid nephroscopes were evaluated retrospectively. The following aspects were considered: stone burden; duration of surgery and complications; details concerning recovery, success, residual fragments and auxiliary procedures; and follow-up details. RESULTS: The success rate of a single PNL session was 70.8%; with the use of auxiliary procedures this was increased to 91.6%. Perioperative and early postoperative complications were excessive bleeding and transfusion in two patients, hydro-pneumothorax in one, perforation of the collecting system in three and urinoma in one. Complications were more common in children aged <7 years or with staghorn stones. The mean time to catheter removal was 3.4 days and the mean hospitalization time was 4.8 days. Idiopathic hypercalciuria, hypocitraturia, cystinuria and hyperoxaluria were diagnosed in two, two, one and three patients, respectively. CONCLUSION: Performing PNL with adult-sized equipment is associated with significant complications in children aged <7 years or with staghorn stones. This treatment should not be considered in routine clinical practice. As all stone-removal methods are associated with complications, PNL should be used only if other methods fail or are unavailable.     

Neuropathic bladder as a cause of chronic renal failure in children in developing countries

Neuropathic bladder is considered a threat to the kidneys if not managed appropriately. In this study, we report our experience with neuropathic bladder at King Abdulaziz University Hospital (KAUH) as a cause of chronic renal failure (CRF) in the pediatric age group. This retrospective study included all children diagnosed with neuropathic bladder who presented with moderate or severe CRF over a 4-year period from December 2000 to December 2004 [glomerular filtration rate (GFR) at presentation <50 ml/min per 1.73 m²]. Fifteen patients were diagnosed with neuropathic bladder; group A consisted of ten patients with spina bifida and one with sacral agenesis and group B consisted of four patients with nonneurogenic neurogenic bladders (NNNB). The mean age±SD at presentation was 6.2±3.8 years, GFR was 24.2±12.4 ml/min per 1.73 m², and creatinine was 289.9±253.2 μmol/l. There were no differences in the age at presentation to a pediatric nephrologist or the degree of renal failure at presentation between the two groups. Clean intermittent catheterization (CIC) was not started in all patients before presentation to KAUH, except in two children. Five children required dialysis as they were in end-stage renal failure (ESRF). All except one received peritoneal dialysis (PD). Their mean age at the start of dialysis was 10.8±1.7 years. Neuropathic bladder due to spina bifida or NNNB is an important cause of CRF in developing countries. There was a considerable delay in the diagnosis of NNNB and a significant delay in starting CIC in all neuropathic patients.     

Giant bladder stone with squamous cell carcinoma of bladder: Case report and the literature review

Introduction and importanceConcurrent bladder neoplasm and giant bladder stone are rare in contemporary urological practice. Squamous cell carcinoma (SCC) is rare histologic diagnosis of bladder cancer.Case presentationA 45 y.o. male, with lower abdominal pain when urinating, that comes and goes in the last 35 years. He had gross hematuria a year ago. The patient comes from a rural region, which undiagnosed for years. Physical examination showed a suprapubic abdominal solid mass, sized 20 × 10 cm, without tenderness. On plain radiography, showed radiopaque lesion which fully occupies the bladder. The ultrasound showed bilateral hydronephrosis. The patient underwent vesicolithotomy, and a giant bladder stone (size of 14 × 9 cm) was found, with incidental finding of suspicious malignant mass. The patient refuses radical cystectomy. Due to mass characteristics that are manageable for complete excision and the need for histopathological studies, bladder preservative therapy was applied with complete tumor excision and biopsy. The mass pathological diagnosis is grade 2 squamous cell carcinoma with lamina muscularis invasion, staged pT3bN0M0. The patient underwent cisplatin-based chemotherapy, with regular evaluation. The possibility of future radical cystectomy remains open.Clinical discussionBy diameter, the stones found in our patient is perhaps one of the largest that ever reported being associated with bladder SCC. The bladder stones causing chronic mucosal injury, lead to the development of SCC. In limited situation, bladder preservation therapy may be considered for muscle-invasive bladder cancer.ConclusionDespite its rarity, SCC along with the chronic bladder stone is possible, and needs more attention.     

经皮肾镜超声联合气压弹道碎石术治疗肾结石（附95例报告）

目的探讨经皮肾镜超声联合气压弹道碎石术治疗肾结石的疗效与安全性。方法2007年2月～2008年9月,对95例肾结石在B超引导下行经皮肾镜超声碎石术。采用EMS三代气压弹道联合超声碎石系统,单用超声或气压弹道碎石,若结石较硬则两者联合碎石。结果95例建立皮肾通道均成功。手术时间45～170min,平均85min。术中无严重并发症发生。残石17例,其中6例行二次碎石术。11例术后明显肾出血,其中9例经保守治疗成功,2例严重出血行病肾切除术。结论经皮肾镜超声联合气压弹道碎石术治疗肾结石具有高效、微创的优点。     

小切口联合经尿道前列腺电切术治疗前列腺增生合并膀胱结石

目的探讨前列腺增生症合并膀胱结石患者同期行膀胱取石和前列腺切除的临床效果。方法回顾性分析2000年9月～2004年6月我院32例采用小切口联合经尿道前列腺电切术(transurethralresectionoftheprostate,TURP)治疗前列腺增生合并膀胱结石的临床资料,腹壁小切口取出膀胱结石,利用此切口留置膀胱造瘘,再行TURP。结果32例均一次手术成功,取石率100%。手术时间45～120min,平均60min。术中出血量50～200ml,平均100ml。术后留置膀胱造瘘管2～3d,三腔气囊尿管3～7d。术后住院5～8d,平均6d。32例随访4～16个月,8例尿道狭窄,经尿道扩张后排尿正常,术后最大尿流率>15ml/s。结论对前列腺增生症合并膀胱大结石或多发结石患者,可首选小切口开放取石联合TURP。     

经皮肾肾镜碎石取石治疗狭长盏颈型肾盏结石(附22例报告)

目的 探讨微创经皮肾穿刺取石治疗狭窄盏颈型肾盏结石的临床疗效.方法 回顾分析我院采用微创经皮肾穿刺取石治疗狭窄盏颈型肾盏结石22例患者的临床资料,总结狭窄盏颈型肾盏结石微创治疗的经验和对策.本组患者女性10例,男性12例;平均年龄35.6岁,包括肾上盏结石10例,肾中盏结石5例,肾下盏结石7例.其中左侧肾盏结石9例,右...     

Neoadjuvant therapy and bladder substitute for invasive bladder cancer: 20 years experience at Tohoku University

BACKGROUND: Neobladder, using the intestine, was performed after neoadjuvant therapy and total cystectomy as a treatment for invasive bladder cancer. METHODS: Between January 1977 and April 1997, an ileocecal neobladder was used for 23 patients and a sigmoid neobladder was chosen for use in 32 patients. For the diagnosis of invasive bladder cancer and the evaluation of neoadjuvant therapy, we used whole-layer core biopsy (WLCB) of the bladder tumor and fine needle aspiration biopsy (FNAB) of pelvic lymph nodes after bipedal lymphography. For neoadjuvant therapy, two to four courses of internal iliac arterial infusion chemotherapy (IIA) were undertaken in 32 patients. Five patients were treated with IIA combined with 40 Gy irradiation to the pelvic space. RESULTS: Pretreatment WLCB revealed a tumor of stage T2b or greater in 10 patients. After neoadjuvant therapy, three patients were down-staged to pT0. In five patients, pretreatment FNAB revealed pelvic lymph node metastases that were not detected by computed tomography or magnetic resonance imaging. Fine needle aspiration biopsy post-neoadjuvant therapy revealed tumor stage N0 in all patients and lymph node dissection revealed pN0 in four patients. Of the five patients who received 40 Gy irradiation, none had any postoperative complications, such as intestinal fistula or urinary leakage. Four male patients (10%) had urethral recurrence, but all were successfully treated by transurethral resection. Two patients treated prior to 1985 experienced local recurrence. Neither was treated by neoadjuvant therapy. Eight patients who died after 1985 had metastatic cancer, but none had local recurrence. None of the patients who received a sigmoid neobladder required clean intermittent catheterization or had bilateral vesico-ureteral reflux. CONCLUSIONS: Neoadjuvant therapy seems to reduce local recurrence in invasive bladder cancer. The sigmoid colon may be suitable for neobladder.     

Risk factors for urinary stone formation in men with spinal cord injury: a 17-year follow-up study

OBJECTIVE: To establish hazard ratios for risk of urinary stone formation in men with chronic spinal cord injury. PATIENTS AND METHODS: In all, 140 men injured before 1987 were eligible for this investigation and were followed yearly from January 1987 and December 2003. RESULTS: Over the 17 years, 39 patients (28%) and 21 (15%) were diagnosed with bladder and renal stones for a total of 59 and 25 episodes, respectively. In multivariate analysis, bladder stone was more common in patients injured when aged > or = 24 years than in those injured when aged <24 years (odds ratio 2.5; 95% confidence interval 1.1-5.7; P = 0.03). In another model, patients with complete injury had a greater risk of renal stone formation than those with incomplete injury (4.1, 1.3-12.9; P = 0.016). Renal stone was more common for patients with urethral catheterization than for those voiding spontaneously (5.7, 1.3-24.6, P = 0.021) and for patients with bladder stone than for those without (4.7, 1.5-15.1; P = 0.01). CONCLUSION: Injury characteristics are important for the development of urinary stone in chronic traumatic spinal cord injury. In addition, the present findings suggest that in men who cannot use intermittent catheterization or when the bladder cannot empty spontaneously, suprapubic cystostomy is better than urethral catheterization to avoid renal stone formation.     

经皮肾镜联合输尿管镜气压弹道碎石治疗输尿管石街

目的探讨经皮肾镜取石术（percutaneous nephrolithotripsy,PCNL）联合经尿道输尿管镜气压弹道碎石治疗输尿管石街的可行性。方法 2008年3月～2011年10月对27例经B超、KUB、泌尿系CT三维重建等检查确诊的输尿管石街,在输尿管镜下气压弹道加水冲将石街推至肾盂或输尿管上段,再行PCNL。结果 23例1次取石成功,3例2次取石成功,1例因输尿管下端闭锁无法进镜,仅行经皮肾造瘘置管引流术。19例随访3～12个月,平均6个月,8例积水完全消失,7例轻度积水,4例中度积水,无出血、输尿管梗阻、结石复发。结论 PCNL联合输尿管镜气压弹道治疗输尿管石街,疗效确切、安全。     

Laparoscopic ureterolithotomy: Our experience with 74 cases

Objectives:   We retrospectively evaluated our experience with a relatively uncommon procedure, the laparoscopic ureterolithotomy, for the treatment of ureteral stones.
Methods:   Between April 2002 and October 2006, a total of 74 patients (56 males, 18 females) with upper (54 cases), middle (18 cases) and lower (two cases) ureteral stones underwent laparoscopic ureterolithomy. The mean age was 39.4 years (range, 19–74). The stones were in the right side in 44 cases (59.5%) and in the left side in 30 (40.5%) cases. The mean stone size was 1.8 cm (range 1.5–2.8). The procedure was retroperitoneal in 66 cases (89.2%) and transperitoneal in eight (10.8%) cases. Laparoscopic guided flexible ureterorenoscopic extraction of kidney stone was carried out in one case as an adjuvant procedure. The ureter was stented and not sutured in 64 cases (86.5%).
Results:   The procedure was successfully completed in 94.6% of cases and an open conversion was carried out in four (5.4%) patients. The mean operative time was 58.7 min, and the mean blood loss was 90.6 mL. No major complications were encountered. Prolonged urinary leakage occurred in one patient. The mean hospital stay was 6.4 days. One patient developed ureteral stricture during follow up and was treated by endoscopic dilatation and stenting.
Conclusion:   In our experience laparoscopic ureterolithotomy represents a safe and effective treatment option for ureteral stones either as primary for large impacted stones or as a salvage procedure after failed shock wave lithotripsy or ureteroscopy. This procedure fulfills the advantages of minimal blood loss and analgesia requirements, good cosmetic appearance, short hospital stay and convalescence period.     

Cystectomy with prostate sparing for bladder cancer in 100 patients: 10-year experience

PURPOSE: To minimize the risk of incontinence and impotence without compromising oncological outcome, we performed prostate sparing surgery during radical cystectomy for bladder cancer. MATERIALS AND METHODS: Since 1992, 100 patients with a mean age of 64 years (range 48 to 82) underwent cystectomy for bladder transitional cell carcinoma with prostate sparing based on normal digital rectal examination of the prostate, normal prostate specific antigen (PSA), percent free PSA greater than 15 and normal transrectal ultrasound of the prostate. Prostate biopsies to exclude prostate cancer were performed on patients with an abnormal digital rectal examination, high PSA, percent free PSA less than 15 or hypoechoic lesions on ultrasound. Surgery consisted of transurethral resection of the prostate with analysis of frozen section of the prostatic urethra and transitional prostate and cystectomy with reconstruction by a Z ileal bladder anastomosed to the prostatic capsule after confirmation of the absence of prostate or bladder cancer on frozen sections of the surgical capsule specimens. Patients were followed closely with imaging and laboratory studies every 6 months and annually for 3 years thereafter. RESULTS: Perioperative death occurred in 1 patient due to septicemia, 20 patients (20%) died of cancer and 6 (6%) died of nonrelated cancer causes. Mean followup 38 months (range 2 to 111). Postoperative pathological stage was PT0 in 2 cases, PtaT1 in 22, PT2 in 48, PT 3 in 28 and N+ in 13. The 5-year actuarial global survival according to pathological stage was pTaT1N0 in 96% of cases, pT2N0 in 83%, pT3N0 in 71% and N+ in 54% (p = 0.0001). The 5-year actuarial cancer specific survival was PT0, Ta T1 in 90% of cases, PT2 in 73%, PT3 in 63% and N- in 8%. The cancer specific survival according to pathological grade was 100% for well differentiated tumors (grade I), 76% for moderately differentiated tumors (grade II) and 47% for poorly differentiated tumors (grade III) (p = 0.003). Local recurrence was pTaT1N0 in 1 of 22 cases (4.5%), pT2N0 in 2 of 40 (5%), pT3N0 in 2 of 23 (8.5%) and N+ in 0 of 13 (0%). Prostate cancer was diagnosed in 3 patients (2 errors in the diagnosis and 1 cancer de novo within 5 years of followup). At 1-year followup 86 of 88 patients (97%) are fully continent (no pad) during the day, and 84 (95%) void 1 to 2 times a night to stay dry. Of 61 patients with previously adequate sexual function 50 (82%) maintained potency with retrograde ejaculation secondary to transurethral resection, 6 (10%) have partial potency and 5 (8.1%) are impotent. CONCLUSIONS: Cystectomy with prostate sparing for bladder cancer is feasible and offers promising functional results with no additional oncological risk. Careful selection of patients is mandatory.     

开展微创经皮肾镜取石术的病例选择及治疗决策（附453例报告）

目的探讨上尿路结石的5种分型及微创经皮肾镜取石术（minimally invasive percutaneous nephrolithotripsy,MPCNL）的技巧和疗效。方法 2006年～2009年,采用MPCNL术治疗453例上尿路结石。根据结石的位置、大小、形态、结石梗阻的程度等将上尿路结石分为5种类型：Ⅰ型154例,结石位于输尿管上段或肾盂输尿管连接部（UPJ）或肾盂合并肾中度积水;Ⅱ型157例,结石位于输尿管上段或UPJ或肾盂合并肾重度积水;Ⅲ型61例,结石位于输尿管上段或UPJ、肾盂合并肾轻度积水或无积水,肾实质厚度正常者;Ⅳ型76例,肾多发结石,结石除位于肾盂外,上盏、中盏、下盏的其中一或两个肾盏有结石的病例;Ⅴ型5例,结石呈鹿角状充塞于肾盂和各肾盏内。在腋后线与肩胛下角线之间10～12肋间的范围内,根据结石的类型,在C臂X线机、B超引导下用18G肾穿刺针对目标肾盏穿刺,并建立F18～F22通道碎石。结果 453例中成功建立通道431例,不成功22例（改开放手术5例,中转经尿道留置双J管加ESWL 12例,穿刺失败放弃治疗出院5例）,无肠瘘、肾切除、死亡病例。Ⅰ型153例,手术时间20～95 min,平均45 min,首次结石清除率92.2%（141/153）,二期PCNL术12例,最终残留结石（直径〉0.5 cm）率5.2%（8/153）,选择性肾动脉栓塞2例,术后液气胸2例;Ⅱ型151例,手术时间30～102min,平均52 min,首次结石清除率90.1%（136/151）,二期PCNL术15例,最终残留结石率7.9%（12/151）,选择性肾动脉栓塞1例,术后液气胸1例;Ⅲ型52例,手术时间60～132 min,平均93 min,首次结石清除率69.2%（36/52）,二期PCNL术16例,最终残留结石率13.5%（7/52）,选择性肾动脉栓塞1例,术后液气胸2例;Ⅳ型70例,手术时间78～212 min,平均130min,首次结石清除率41.4%（29/70）,二期PCNL术38例,最终残留结石率28.6%（20/70）,选择性肾动脉栓塞2例,术后液气胸1例;Ⅴ型5例,手术时间120～286 min,平均210 min,均行二期PCNL,最终残留结石率100%（5/5）,选择性肾动脉栓塞1例,术后液气胸1例。结论上尿路结石因结石类型不同MPCNL手术难度差异大,按结石类型选择合适病例开展,能提高手术成功率,减少并发症,缩短学习曲线。     

Transurethral cystolitholapaxy with the AH-1 stone removal system for the treatment of bladder stones of variable size

Background

The treatment of large volume bladder stones by current equipments continues to be a management problem in both developing and developed countries. AH-1 Stone Removal System (SRS) invented by us is primarily used to crush and retrieve bladder stones. This study evaluated the safety and efficiency of transurethral cystolitholapaxy with SRS for the treatment of bladder stones of variable size.

Methods

SRS, which was invented by Aihua Li in 2007, composed by endoscope, continuous-flow component, a jaw for stone handling and retrieving, lithotripsy tube, handle, inner sheath and outer sheath. 112 patients with bladder stones were performed by transurethral cystolitholapaxy with SRS since 2008. We compare the surgical outcome to bladder stones of variable size, and evaluate the surgical efficiency and safety.

Results

Characteristics of patients and stone removal time in variable size were evaluated. To patients with single stone, stone size was 1.35 ± 0.37 cm and the operating time was 5.50 ± 3.92 min in Group A. Stone size was 2.38 ± 0.32 cm and the operating time was 11.90 ± 9.91 min in Group B. Stone size was 3.30 ± 0.29 cm and the operating time was 21.92 ± 9.44 min in Group C. Stone size was 4.69 ± 0.86 cm and the operating time was 49.29 ± 30.47 min in Group D. The difference was statistically significant between the four groups. Among them, 74 (66.07%) patients accompanied with benign prostatic hyperplasia (BPH) were treated by transurethral resection of the prostate (TURP) simultaneously. Compared between the four groups, the difference of the TURP time was not statistically significant, P >0.05. No significant complication was found in the surgical procedure.

Conclusions

Transurethral cystolitholapaxy with SRS appears to be increased rapidity of the procedure with decreased morbidity. It is a safe and efficient surgical management to bladder stones. This endoscopic surgery best fits the ethics principle of no injury; meanwhile, the accompanied BPH could be effectively treated by TURP simultaneously.     

Primary localized amyloidosis of the bladder: experience with dimethyl sulfoxide therapy

PURPOSE: We present our long-term experience with intravesical dimethyl sulfoxide (DMSO) for primary localized amyloidosis of the bladder. MATERIALS AND METHODS: The study included 4 males and 2 females 28 to 68 years old (mean age 54) at diagnosis of biopsy proven primary localized amyloidosis involving the bladder diffusely or extensively in 1 locale. All patients had normal upper urinary tracts. They continued to be symptomatic (hematuria in 3, irritative voiding symptoms in 1, and hematuria and irritative voiding symptoms in 2) despite conventional transurethral destructive therapy. Every 2 weeks they received 30-minute instillations of 50 ml. 50% DMSO intravesically for 3 months (patient 1), 6 months (1) and 1 year (4). RESULTS: Therapy failed at 3 and 6 months in 2 patients of whom 1 with a contracted bladder underwent cystectomy and another was stabilized for 1 year with laser therapy. In the remaining 4 patients who were followed for 6 years disease stabilized for 2 to 6 years (mean 3.5) but 3 later required additional therapy including repeat DMSO in 1 and laser therapy in 2. CONCLUSIONS: Diffuse or locally extensive bladder involvement by primary localized amyloidosis usually fails to respond to conventional transurethral destructive surgical procedures. Collectively, our experience and the literature suggest that intravesical DMSO can be a bladder saving measure and help resolve ureterovesical obstruction in some patients. High recurrence rate mandates lifelong cystoscopic surveillance.