Reduced recurrence of late hemorrhagic radiation cystitis by WF10 therapy in cervical cancer patients: a multicenter, randomized, two-arm, open-label trial.

BACKGROUND AND PURPOSE: To evaluate the efficacy and the safety of WF10 as adjunct to standard treatment in the management of late hemorrhagic radiation cystitis compared to standard treatment alone. PATIENTS AND METHODS: Cervical cancer patients with Grade 2 or 3 late hemorrhagic radiation cystitis, were randomized and treated with WF10 0.5 ml/kg body weight, diluted in physiological saline or 5% dextrose water 250 ml, intravenous infusions over 2 h on 5 consecutive days, every 3 weeks for 2 cycles plus standard treatment (WF10 group) or standard treatment alone (control group). Fifty patients in each group were evaluated by questioning; urinalysis and cystoscopy during a 1 year follow up. RESULTS: At week 7, 37 patients (74%) in the WF10 group and 32 patients (64%) in the control group showed complete resolution in objective hematuria (P = 0.28). Significantly lower use of antibiotics (P = 0.002) and antispasmodics (P < 0.001) was found in the WF10 group. Among the responders, 24 patients (77%) in the control group experienced recurrent objective hematuria, whereas in the WF10 group only 17 patients (47%) experienced a recurrence (P = 0.01). Recurrence of objective hematuria occurred significantly faster in the control group as evidenced by Kaplan-Meier and log-rank statistics (P = 0.004), suggesting a long-term effect of WF10. Cystoscopy, at the end of the treatment period and after the one year follow up showed overall improvement without significant difference between two groups. No severe toxicity was monitored. CONCLUSIONS: WF10 therapy is a safe, non-invasive and convenient method in the management of late hemorrhagic radiation cystitis. WF10 therapy, as adjunct to standard treatment, has significantly reduced recurrence of objective hematuria, compared to standard treatment alone, during a one year follow up.     

Effectiveness of low-dose and standard-dose tamsulosin in the treatment of distal ureteric stones: a randomized controlled study

Low-dose (0.2 mg/day) and standard-dose (0.4 mg/day) tamsulosin were studied in a randomized controlled trial of 75 out-patients with distal ureteroliths in Thailand. Group 1 (n = 25; control) received oral sodium diclofenac 50 mg twice a day for 10 days; group 2 (n = 25) received oral sodium diclofenac 50 mg twice a day for 10 days, with oral tamsulosin 0.2 mg once a day up to 28 days; and group 3 (n = 25) received oral sodium diclofenac 50 mg twice a day for 10 days, with oral tamsulosin 0.4 mg once a day up to 28 days. For groups 1, 2 and 3, respectively, the expulsion rates were 4%, 40% and 68% (significantly different for group 1 vs group 2, and for group 1 vs group 3) and mean expulsion times were 23.00, 9.30 and 10.76 days. Both doses of tamsulosin increased stone expulsion rate and decreased expulsion time in comparison with the control, and have been shown to be safe and effective in Asian patients.     

Previous open nephrolithotomy: does it affect percutaneous nephrolithotomy techniques and outcome?

BACKGROUND AND PURPOSE: The consequences of open nephrolithotomy are scar tissue around the kidney and in the retroperitoneum and distortion of the pelvicaliceal anatomy that may affect the techniques and outcome of percutaneous nephrolithotomy (PCNL). We compared the results and complications of patients undergoing PCNL who had and had not previously undergone open nephrolithotomy. PATIENTS AND METHODS: A total of 178 calculi in 175 patients who had previously had open nephrolithotomy (group I) and 178 calculi in 175 patients who had never had a renal operation (group II) were treated with PCNL. The average time between open nephrolithotomy and PCNL was 8.5 years (range 4 months-22 years). In both groups, PCNL was done by a standard technique with serial Amplatz dilator enlargement of the tract to 30F. Upper-pole access under fluoroscopic guidance was done in most patients. The operative time, success rate, hospital stay, and complications in the two groups were compared. RESULTS: The stone-free rates were 80.3% and 82.6% in groups I and II, respectively, and the rate of residual fragments < or =4 mm was 14.6% and 8.4%. The operative time, success rate, hospital stay, and complications did not differ significantly in the two groups. CONCLUSION: Percutaneous nephrolithotomy is effective and safe in patients who have previously had open nephrolithotomy with no more complications than are seen with PCNL of kidneys that have not been operated on.     

Intravesicle formalin instillation with a modified technique for controlling haemorrhage secondary to radiation cystitis

OBJECTIVE: Intractable haemorrhage, secondary to radiation cystitis, is a serious complication of radiotherapy for pelvic malignancies. Formalin instillation is often effective for intractable haemorrhage unresponsive to other agents, but carries the risk of significant morbidity. The placement of formalin-soaked pledgets is a modified technique for the treatment of this complication. We compare the effectiveness and complications of both techniques. METHODS: Eleven patients with intractable haemorrhage secondary to radiation cystitis were treated by intravesicle 4% formalin instillation [Group I] and eight were treated by the endoscopic placement of 10% formalin-soaked pledgets on the bleeding points for 15 minutes [Group II]. RESULTS: Cessation of bleeding was 9 of 11 [82%] and 6 of 8 [75%] in Group I and Group II, respectively. One patient in Group II required two treatments, due to recurrent haemorrhage. Four major and several minor complications were found in Group I, and only three minor complications were found in Group II. CONCLUSION: Formalin instillation is effective in controlling severe bladder haemorrhage after radiation of the pelvis, but the complications secondary to the fixative properties are severe. Topical application of formalin-soaked pledgets is as effective in controlling the haemorrhage as conventional intravesicle formalin instillation, with fewer complications. This technique should be the initial treatment for this complication.     

Tuberculosis of the genitourinary tract: imaging features with pathological correlation

The prevalence of pulmonary and extrapulmonary tuberculosis (TB) has been increasing over the past decade, due to the rising number of people with acquired immunodeficiency syndrome and the development of drug-resistant strains of Mycobacterium tuberculosis. The genitourinary tract is the most common site of extrapulmonary TB. Diagnosis is often difficult because TB has a variety of clinical and radiological findings. It can mimic numerous other disease entities. A high level of clinical suspicion and familiarity with various radiological manifestations of TB allow early diagnosis and timely initiation of proper management. This pictorial essay illustrates the spectrum of imaging features of TB affecting the kidney, ureter, bladder, and the female and male genital tracts.