Ileum neobladder after cystectomy is mainly reserved for male patients. Female patients are normally excluded from this kind of urinary diversion for fear of incontinence following orthotopic bladder substitution. In addition as in the male, the question of urethral recurrence of urothelial carcinoma is still not settled. We report on seven cases of successful orthotopic bladder reconstruction in females by means of an ileum neobladder according to Hautmann with follow up of up to 4.5 years, One of these patients had a complicated bladder-vaginal fistula and almost complete loss of bladder function because of a shrunken bladder after radiation therapy for a cervical carcinoma and the other six had undergone radical cystectomy because of bladder carcinoma. The ileum neobladder is anastomosed with the preserved urethral stump. The original method of ileum neobladder is extended by a colposuspension plasty according to Marshall-Marchetti, which is the means of achieving continence. The first results are encouraging and open further possibilities for bladder reconstruction in the female.

Ileum neobladder after cystectomy is mainly reserved for male patients. Female patients are normally excluded from this kind of urinary diversion for fear of incontinence following orthotopic bladder substitution. In addition as in the male, the question of urethral recurrence of urothelial carcinoma is still not settled. We report on seven cases of successful orthotopic bladder reconstruction in females by means of an ileum neobladder according to Hautmann with follow up of up to 4.5 years. One of these patients had a complicated bladder-vaginal fistula and almost complete loss of bladder function because of a shrunken bladder after radiation therapy for a cervical carcinoma and the other six had undergone radical cystectomy because of bladder carcinoma. The ileum neobladder is anastomosed with the preserved urethral stump. The original method of ileum neobladder is extended by a colposuspension plasty according to Marshall-Marchetti, which is the means of achieving continence. The first results are encouraging and open further possibilities for bladder reconstruction in the female.

A man in whom urinary diversion (colon conduit) was performed after 2 unsuccessful implantations of artificial urethral sphincters for treatment of iatrogenic incontinence became continent again after implantation of an alloplastic sling. Three months later the patient underwent urinary undiversion with augmentation cystoplasty. After 3 years ureteroneocystostomy was necessary due to distal ureteral stenoses. At 7-year followup the patient is continent. He has good bladder capacity, bladder emptying and a normal upper urinary tract.

Die Xanthogranulomatöse Pyelonephritis (XGP) ist eine noch immer selten beschriebene Erkrankung. Ihre Diagnose wird präoperativ wegen meist schwieriger Abgrenzbarkeit gegenüber malignen Nierentumoren nur in wenigen Fällen gestellt. Die vorliegende Arbeit bietet neben einer ausführlichen Literaturübersicht die Darstellung der modernen diagnostischen Techniken, die angewendet werden sollten. Insbesondere wird die Immunszintigraphie als mögliche zusätzliche Technik beschrieben und anhand eigener Erfahrungen kritisch bewertet. Ferner wird ein gestuftes Therapiekonzept der XGP vorgestellt, welches nach Ausschöpfung aller diagnostischen Möglichkeiten und Stellen der Verdachtsdiagnose auf einer primären antibiotischen Therapie basiert. Die Indikation zur operativen Therapie wird in Abhängigkeit von den Ergebnissen strenger, kurzfristiger Kontrollen gestellt. Im eigenen Krankengut, wie auch in der Literatur ist auf diese Weise eine komplette Remission der XGP unter konservativer Therapie erzielt worden.

Renal clear cell carcinomas and the corresponding ipsilateral control tissues were investigated for protein kinase CK2 activity and subunit ratio. The average protein kinase CK2 activity from 21 different kidney samples was 318 U/mg and that from the corresponding tumors 610 U/mg. The subunit ratio of protein kinase CK2α in tumors/normal tissue (T/N) was 1.58 and that of the protein kinase CK2β (T/N) was 2.65. The data suggest that the generally described increase in protein kinase CK2 activity in tumor cells may to some extent result from a deregulation in subunit biosynthesis or degradation. This at least partly owing to the presence of excess enzymatically active protein kinase α-subunit but also to a significantly higher presence of the non-catalytic β-subunit.

Between 1975 and 1991, 142 patients with renal cell carcinoma and 10 with oncocytoma underwent a total of 164 kidney preserving operations. The indication for surgery was imperative (group 1, 47 patients) among those with a solitary kidney (9), renal insufficiency (17) or bilateral tumors (21). Of the patients with small or peripheral tumors and a healthy contralateral kidney 105 were selected for elective surgery (group 2). Most procedures were done either without ischemia (24%) or with warm ischemia (69%). In some patients from the imperative indication group hypothermia was achieved by in situ perfusion (5%) or ex vivo work bench surgery and autotransplantation (2%). Complication rates were 15% for group 1 and 9.5% for group 2. In group 1, 3 patients died of cancer, 5 lived with metastases and 2 had local tumor recurrence. No patient in group 2 had recurrences or metastases. The tumor-specific survival rate of patients with kidney preservation for renal cell carcinoma was comparable to that of a control group undergoing radical nephrectomy. Due to the high reliability and efficacy, kidney preserving surgery for renal cell carcinoma should be done more often, even in patients with a normally functioning contralateral kidney.

The purpose of the present study was to compare the effectiveness of MRI, CT and radioimmunoscintigraphy in the staging and detection of bladder cancers in 28 patients. We distinguish two groups: Group I included the tumour stages CIS-T3A and the second group the deep infiltrative tumours T3B-T4. MRI was slightly superior to CT in respect of tumour staging (75% correct results as compared to 63%). No understaging occurred with MRI, whereas in 22% of the cases the stage of the tumour was underestimated using CT diagnostics. Overstaging occurred in 25% of the MRI and 15% of the CT-diagnostics, respectively. RIS cannot distinguish the tumour groups, and hence this method is useful only for the detection of the primary tumour and metastases. In 77% of cases the tumour was detected and in 15% the tumour could be safely excluded.

The purpose of the present study was to compare the effectiveness of MRI, CT and radioimmunoscintigraphy in the staging and detection of bladder cancers in 28 patients. We distinguish two groups: Group I included the tumour stages CIS-T3A and the second group the deep infiltrative tumours T3B-T4. MRI was slightly superior to CT in respect of tumour staging (75% correct results as compared to 63%). No understaging occurred with MRI, whereas in 22% of the cases the stage of the tumour was underestimated using CT diagnostics. Overstaging occurred in 25% of the MRI and 15% of the CT-diagnostics, respectively. RIS cannot distinguish the tumour groups, and hence this method is useful only for the detection of the primary tumour and metastases. In 77% of cases the tumour was detected and in 15% the tumour could be safely excluded.

Magnetic resonance tomography is a method which is sufficiently precise to demonstrate morphological changes for tumor staging of carcinoma of the urinary bladder. The stage of the tumor was correct in 68 resp. 86% of the patients. The RIS shows organ and lymph node metastases and has the capability to differentiating between scar and tumor after transurethral resection. The local spread, especially the infiltration depth of the tumor, is not visible. In 90% of the patients a primary tumor was detected, only in 5 cases a false-negative and in 2 cases a false-positive finding was made.

ZusammenfassungDie Magnetresonanztomographie (MRT) ist eine ausreichend genaue, die morphologischen Veränderungen gut darstellende Methode zum Tumorstaging des Harnblasenkarzinoms. Das Tumorstadium wurde in 68% bzw. 86% der Patienten richtig eingeschätzt; eine Unterschätzung kam nicht vor. Die Radioimmunoszintigraphie (RIS) stellt Organ- und Lymphknotenmetastasen dar und kann zwischen endovesikaler Narbe und Tumor nach transurethraler Resektion unterscheiden. Die Ausdehnung des Lokalbefundes, insbesondere die Infiltrationstiefe des Tumors, ist mit der RIS nicht beurteilbar. Bei 90% der Patienten wurde ein Primärtumor nachgewiesen, nur in 5 Fällen war ein falschnegativer und in 2 Fällen ein falsch-positiver Befund erhoben worden.

Primary hyperoxaluria is caused by an inherited autosomal recessive liver enzyme defect and leads to recurrent urolithiasis in childhood. Renal insufficiency occurs via nephrocalcinosis, Rapidly progressive extrarenal deposition of calcium oxalate crystals can cause life-threatening cardial complications. Early diagnosis in childhood, which should be initiated by the urologist, enables the timely begin of preventive measures consisting mainly of limitation of oxalate production and improvement of oxalate solubility in urine. Once renal insufficiency has occurred, early kidney transplantation should be done in order to prevent further progression of oxalosis. Presently, a well-accepted protocol of perioperative management has improved the early and late results after kidney transplantation. However, longterm dialysis and the pyridoxine-resistent form of the disease remain important risk factors. For those cases, combined liver-kidney-transplantation seems to be the future treatment of choice.

From 1976 to 1989 in 90 patients (n = 98 tumors) with renal cell carcinoma organ-preserving surgery was performed (age 25-84 years, mean 58 years). Imperative indications for organ preservation (tumor removal by partial resection with or without clamping of the artery, autotransplantation) (n = 18) were chronic renal failure, benign pathology of contralateral kidney, functional or anatomical solitary kidney, and bilateral tumors. Elective organ-preserving surgery (n = 72) was done for small peripherally located lesions and in cases of uncertain preoperative tumor dignity. Tumors removed for imperative indications were 2-11 cm (mean 6.5 cm) in size. In the elective group tumor size ranged from 1 to 6 cm (mean 3.5 cm). Follow-up was 3 months to 13 years, 1 postoperative mortality was observed in the group with imperative indication. 15/90 patients are alive without tumor, 1 patient with metastasis, 1 patient died because of metastasis and 1 for unrelated reasons. All patients beside 1 in the group with elective indication are alive without metastasis. Renal cell carcinoma has changed its clinical feature. More and more tumors are detected by ultrasound without clinical symptoms. Though radical tumor nephrectomy still is the standard operation for renal cell cancer, in cases especially with small tumors the indication for organ-preserving operation with regard to these excellent results should be given more often.

The concept of incidental carcinoma includes a range of tumors with varying degree of malignant potency. This must be kept in mind when evaluating histopathological results and drawing clinical conclusions. It is obvious that the diagnosis of an incidental prostatic carcinoma is related to the exact and complete histological examination of all prostatic material resected [2, 3, 15, 18, 19, 21, 24]. Routinely in our clinic the resection material is prepared as follows. We embed 5 g tissue per block in paraffin; the number of blocks is thus dependent on the amount of material resected. If a carcinoma is found in one block, all material in subsequent blocks is analyzed. The spread of tumor, the number of foci involved, and the grade of malignancy are determined [4, 24]. All incidental prostate carcinomas diagnosed in our clinic are classified according to Jewett [16]. A1 tumors are unifocal and well differentiated; A2 tumors are either multifocal and well differentiated or unifocal and poorly differentiated.

Operative ureteral replacement with the patient's own body tissue or by reconstructive ureteral surgery is indicated relatively often. The operative methods applied vary: they include pelvic flap pyeloplasty, caudal transposition of the kidney, interposition of the small intestine, trans-ureterostomy, calico-ureterostomy, of bladder flap transplantation and autotransplantation of the kidney. When the indications are correctly observed with reference to the kind and location of the ureteral lesion all these methods are successful. The methods of alloplastic replacement of the ureter, in contrast, have lost clinical importance and should be performed only in rare, isolated cases, mainly as a short-term solution. Possible indications are a poor general condition in patients for whom alloplastic ureteral replacement is the only alternative to permanent nephrostomy and malignant tumours requiring immediate irradiation, which cannot be postponed until definitive wound healing has taken place following a plastic operation. It is important that problems of biocompatibility have now been largely overcome. Segmental ureteral replacement with alloplastic materials is not possible, however, and the functional difficulties with urinary transport have not been solved in the long term, even in models with pumps and reflux-preventing mechanisms.

Since 1975 a total of 55 patients with vesicovaginal fistulas have undergone surgery at the Clinic of Urology, University of Saarland, Homburg/Saar. A majority (55%) of the cases were complicated. In 9 cases supravesical urinary diversion was necessary. Successful closure of the fistula was achieved in 45 patients (81.8%); only in one case is the fistula still present. In 5 patients with uncomplicated fistulas successful closure was accomplished by a vaginal approach. In the presence of complications, e.g., previous radiotherapy or accompanying lesions of the ureter or rectum, a transvesical/transabdominal approach was preferred; surgery was successful in 93.3% of such cases.

recommendations and practice at the time of publication.However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precau tions.This is particularly important when the recommended agent is a new and/or infrequently employed drug.