摘要:

The extent of surgical therapy of urological tumors and the intensity of post-surgical or primary chemo- or radiotherapy are dependent on staging and grading. Since the proliferative activity determines the size of the tumor, the primary prognostic evaluation corresponds with the grading. The histologic, cytologic, immunohistochemical and cell kinetic methods of examinating urological tumors are discussed considering their significance. Two tumor subgroups of malignancy are differentiated, one with a low risk and one with a high risk. The tumor group of intermediate malignancy (GII) consists of a mixture of both prognostic groups. Possibilities of an easy-to-use subgrading are given in order to differentiate a particular group from other subgroups at risk. A clear distinction between two subgroups of urologic tumors, namely with high or low malignancy, is a presupposition for the successful application of a differentiated therapy nowadays. Prognostic studies have corroborated this tumor subdivision.

ISSN:0042-1138    

DOI:10.1159/000282345

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A cytogenetically detectable form of gene amplification, presumably oncogene amplification, double minute chromosomes, has been found in 11 out of 45 specimens (24%) of moderately and poorly differentiated, deeply infiltrating transitional cell carcinoma of the bladder and ureter. None of the 75 low-grade low-stage tumors contained this karyotypic anomaly. It is obvious that double minutes are not a rare and sporadic phenomenon in this type of tumors; additionally there is strong evidence that they are involved in tumor progression, i.e. they are associated with tumor aggressiveness and unfavorable prognosis.

ISSN:0042-1138    

DOI:10.1159/000282346

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Epidermal growth factor (EGF) concentration in urine was measured with a radioimmunoassay in 40 untreated patients with urothelial tumors and a comparable control group of 25 normals. The concentration of EGF in urine from the patients with bladder, renal pelvic or ureter tumors was lower than normal (p < 0.05). Patients with T4 tumors had lower concentrations of EGF compared with those of other stages. EGF concentrations after transurethral resection of bladder tumors were significantly elevated compared with the values before operation. These findings suggest that urothelial tumors are related to a low concentration of EGF and that a decrease of EGF is associated with invasion of tumors.

ISSN:0042-1138    

DOI:10.1159/000282347

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The prognostic significance of DNA ploidy, DNA index, S-phase fraction (SPF) and median nuclear size was studied in 11 patients with squamous cell carcinoma of the penis. These patients have been followed for a minimum of 7 months after diagnosis. Nuclear DNA content was determined by flow cytometry from paraffin-embedded tissue. Patients with DNA diploid cancer (n = 7, 64%) had a better survival rate than patients with aneuploid cancer, and a small SPF was associated with a favorable outcome. A statistically significant relation between median nuclear size and survival could be demonstrated. Small modal nuclear size associated with poorer prognosis. There was a significant difference in survival between metastatic and nonmetastatic groups of tumors during the follow-up period. This study suggests that flow cytometric determination of nuclear DNA ploidy from paraffin-embedded samples in penile cancer does add an additional prognostic determinant in addition to the clinical staging of tumors.

ISSN:0042-1138    

DOI:10.1159/000282348

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Ninteen patients with histologically proven superficial bladder cancer (Ta, T1) were treated with intravesical instillation of 30 mg of adriamycin (ADM) dissolved in 24 ml physiological saline plus 15 mg of verapamil (VR) (6 ml) every day for 10 days. In spite of the short period of treatment, 6 of the 18 evaluable patients (33.3%) showed complete response (CR) and a further 5 (27.8%) showed partial response (PR). Five of the 6 patients with CR were recurrent cases who had previously received prophylactic intravesical instillation chemotherapy including ADM. Irritative urinary symptoms were observed in 11 of the 19 patients (57.9%). However, these symptoms were mild in the majority of patients and the treatment was completed without interruption in all but 1 patient. There was no significant absorption of ADM and VR into the systemic circulation. No clinical evidence of systemic toxicity was observed. These results suggest that combination of ADM and VR has a possibility to be a useful prophylactic intravesical instillation chemotherapy after endoscopic resection of not only primary but also recurrent chemoresistant bladder cancers.

ISSN:0042-1138    

DOI:10.1159/000282349

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Ureterocalicostomy was performed in 8 patients following failed pyeloplasty: 2 had undergone two previous pyeloplasties, while endourological management had been attempted in 3. With a mean follow-up of 58.7 months, radio-graphic studies demonstrated resolution of the obstruction in 6 cases (75%), while two kidneys lost their function. The definitive role of endourological techniques after pyleoplasty failure still waits the test of time although they deserve to be applied first, and ureterocalicostomy remains a reliable procedure in this particular setting.

ISSN:0042-1138    

DOI:10.1159/000282350

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The contractile characteristics of pacemaker regions in the unicalyceal renal pelvis of the rabbit were examined in vitro. The amplitude and frequency spectra of spontaneous contractions of whole and separated circular and longitudinal renal pelvic strips were identified. The effect of stretch on these parameters were examined in order to establish whether the pacemaker region that generates contractions in the renal pelvis was sensitive to distention. The results show that the frequency of spontaneous contractions in the whole pelvis (65 ± 18 mHz) was significantly higher than any part of the circularly (41 × 8 mHz) or longitudinally cut (43 ± 8 mHz) pelvis. The amplitude of longitudinal strips, 52 ± 11 mg, was significantly smaller than that of the circular strips, 267 ± 52 mg. In the circularly separated pelvis the frequency of spontaneous contractions was highest in the proximal part (41 ± 8 mHz) and lowest in the pelviureteral junction (8 ± 1 mHz). No significant increase in frequency was seen upon stretch in the whole or separated pelvis although there was a decrease in the amplitude of both the whole and separated pelvis. These results show that the frequency of contraction of the whole or the segmented renal pelvis is not sensitive to stretch.

ISSN:0042-1138    

DOI:10.1159/000282351

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The circumstances facilitating hydrostatic pressure communication between the bladder and renal pelvis were evaluated. In particular, we compared active detrusor contractions occurring spontaneously during voiding and evoked contractions produced during electrical pelvic nerve stimulation with passive abdominal compression. These variables were evaluated with respect to urine flow rate and bladder capacity. Waveform analysis of the pacemaker characteristics of the renal pelvis shows that the rat pelvis has a narrow frequency band of spontaneous contraction at 0.5 ± 0.06 Hz. The baseline waveform and pressure of the pelvis is effected by urine flow and bladder capacity. Significant elevations in pelvic pressure of 25.8+ 7.9 and 28.7 ± 5.8 cm H2O were observed for bladder pressures of 30 cm H2O (n = 8) at flow rates in the range of 2.5–5.0 and over 5.0 ml/kg/h respectively (p < 0.05). At flow rates between 2.5 and 5.0 ml/kg/h, spontaneous contractions produced an increase in pelvic pressure in all rats, while electrical stimulation produced an increase in pelvic pressure in 63%. At flow rates above 5 ml/kg/h, abdominal compression produced sharp elevations in pelvic pressure in 75%. At the same flow rate, electrical stimulation produced a slow increase in 75% and spontaneous contraction produced a slow increase in 86%. These results suggest that the exposure of the upper urinary tract to vesical pressures occurring during active and passive contractions is facilitated by flow.

ISSN:0042-1138    

DOI:10.1159/000282352

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The effect of thiphenamil HCI on the urodynamic parameters of bladder filling, voiding and isometric contraction was examined in controls. Data were obtained from 25 control female subjects with a mean age of 27.6 ± 6.6 years. Three urodynamic studies were done on each subject on 3 different days. These studies were: (1) control study, (2) drug study with a single oral dose of 400 mg thiphenamil HCI and (3) another with 800 mg. Each urodynamic study involved filling and voiding cystometrograms to characterize stability, sensations of fullness and urgency, bladder capacity, urethral opening pressure, maximum flow rate, maximum detrusor pressure and residual urine. In addition, isometric detrusor pressure measurements were made at bladder volume increments of 100 ml. Each urodynamic study was done in the sitting position using medium fill water cystometry at 20 ml/min. Isometric pressures were made by catheterizing the subject with an 18-french three-way Foley catheter with a 30-ml balloon. One lumen was used to fill the bladder and the second to measure pressure. The results show that bladder capacity and the volume at which sensations of fullness and urgency are expressed are not significantly changed under the influence of thiphenamil HCI. Significant differences were seen in the maximum pressure generated by the detrusor during voiding and in the maximum urine flow rate. These differences were most pronounced at the 800-mg thiphenamil HCI dose. The isometric data show a highly significant increase in the maximum isometric pressure developed at the low bladder volumes. In the 4 subjects investigated with detrusor instability, 3 had a suppression of spontaneous activity during filling and an increase in bladder capacity from 398 to 499 ml. In addition, the maximum voiding pressure increased from 44 to 55 cm H2O. A significant reduction in posterior urethral closure pressures from 105 ± 23 to 78 ± 24 cm H2O, 0.02 < p < 0.05 was obtained with thiphenamil. It is concluded that thiphenamil HCI has a significant effect on the bladder and urethra of normal asymptomatic controls.

ISSN:0042-1138    

DOI:10.1159/000282353

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We evaluated whether sensations recorded during a medium-fill cystometry are reproducible. In 10 patients, the evaluation was done during two successive bladder distentions. In 95 patients, the results of a sensory evaluation during urodynamic tests with a mean interval of 15 months were compared. An identity of sensations was reported by 80% of the patients in the short-term study and by 73% of the patients in the long-term study. The perception of a first sensation of filling was the most variable.

ISSN:0042-1138    

DOI:10.1159/000282354

出版商:S. Karger AG    

年代:1992

数据来源: Karger