The aim of the present investigation was to study systemic metabolic consequences following rectosigmoid bladder (RSB) operation. RSB after cystectomy has recently been employed with increasing frequency in the Urologic Clinic of the University of Rome inasmuch as, compared with ureterosigmoidostomy (USS), it shows a lower incidence of complications. Acid base balance, serum electrolytes and renal function were studied in 22 patients submitted to RSB and in 25 submitted to USS. Urine from patients with RSB and urine-feces mixture from patients with USS was also analyzed. Metabolic acidosis occurred in 86 per cent of patients with RSB and in 80 per cent of patients with USS but was significantly less severe (p <0.01) in patients with RSB (pH 7.34 ± SD 0.04) than in those with USS (pH 7.29 ± 0.07). This finding corresponded to a significantly lower intestinal loss of HCO3- in the RSB than in the USS group. The frequency of hyperchloremia was very low in both groups of patients whereas the incidence of an increased anion gap was surprisingly high.

AbstractAndrogen (AR), estrogen (ER), and progesterone (PR) receptors have been found in human prostatic hyperplasia (BPH) and prostatic carcinoma (PC) (AR mainly in the epithelial compartment and ER in the stromal compartment). These steroid receptors have been studied in the cytosol of 59 prostatic cancers in order to select patients to be treated with endocrine therapy (orchiectomy, administration of antiandrogens). Tissues were collected through transvesical resection and needle biopsy. Tritiated metribolone (R1881), 17b‐estradiol and promegestone (R5020) with the use of exchange assay and a dextran‐coated charcoal method have been usually employed. In some specimens receptor content was also analyzed in the nuclear fraction. AR was found in the cytosol of 47 of 59 (79.66%), ER in 14 of 26 (53.85%), and PR in 13 of 15 (86.67%) tumors examined. AR was detected in the nuclear fraction of 11 of 26, ER in nine of 13, and PR in two of four tumors examined. AR was found to correlate with the histological grade of the cancers, whereas no correlation could be demonstrated between the histological grade and cytoplasmic or nuclear ER. On the basis of receptor studies, hormonal treatment was started with orchiectomy followed by the administration of cyproterone acetate (CPA) 50 mg twice a day in 26 eligible out of 38 patients available for follow‐up with tumors examined for cytoplasmic AR. The response to hormonal therapy depended strictly on the presence of AR. The endocrine treatment used seems, in our opinion, to be the most advisable form of therapy, and is capable of blocking the uptake of androgens of extratesticular origin by prostatic cells. Although the clinical advantages of progestational therapy for human PC are not yet established, the presence of PR in prostatic carcinoma leads us to believe that progestational compounds as well as the progestational activity of CPA may be effective on tumor growth of tissues that are positive for PR.

Calcium metabolism was studied in 37 patients with "idiopathic hypercalciuria" on a home diet and after 10 days of low calcium dietary intake (less than 400 mg/24h). After low calcium intake, urinary calcium excretion returned to within normal limits in 70% of the cases. In the group of patients which failed to respond to calcium restriction, TmPO4/GFR values were reduced and, furthermore, in 20% of them plasma iPTH and urinary cAMP levels were increased. These data seem to indicate that: the incidence of absorptive hypercalciuria is higher than hypercalciuria of renal origin; normocalcemic hyperparathyroidism due to primary calcium leak is present only in a limited number of cases, consequently, hypercalciuria secondary to renal phosphate leak is a rather frequent occurrence.

Estradiol receptor (ER) and progesterone receptor (PR), found in experimental renal cancer as well as in normal human kidney and in human renal cell carcinoma (RCC), have been measured in 27 RCCs from patients submitted to surgery and endocrine therapy in an attempt to predict the response to progestational therapy. Of these 27 tumors 59% were positive for ER and 59% for PR; 37% were positive and 19% negative for both ER and PR. The follow-up of 23 patients showed that progestational therapy, started in 18 patients, has given favorable results in 14 patients and negative results in 3 patients with ER-PR- renal cancer. Antiestrogenic therapy, started soon after nephrectomy in 1 patient with ER+PR- renal cancer and lung metastases, failed since the patient died 8 months after surgery.

Experience is reported on more than 700 patients submitted to rectal bladder over the last 20 years. The main indications were total cystectomy due to bladder neoplasias and palliative surgery in patients in whom cystectomy was impossible. The rectal bladder, even of the Mauclaire type, is the most useful and best accepted urinary diversion. Separation of urime from faeces avoids serious ascending infections and involvement of renal function. These observations are supported by the long survival of patients submitted to derivative surgery in the absence of neoplastic disease.

Since prostatic carcionma is hormone dependent, treatment of this tumor has been carried out in this department over the last 10 years employing antiandrogens, particularly cyproterone acetate (CPA), associated in some cases with orchiectomy. Of 500 patients thus treated, the author reports on 236 patients with a 5-year follow-up and 184 with a 7-year follow-up. Of these, 126 (53.4%) had not received hormone treatment whereas 110 (46.6%) had been treated with estrogens. The mean survival rate was 64.4% at 5 years and 56.3% at 7 years in these patients and 51 and 43%, respectively, in the estrogen-treated patients. The author emphasizes that not only is CPA of great value in the treatment of prostatic carcinoma, but it is also useful in determining the hormone dependency of the tumor which is indispensable before proceeding with hormone therapy.

Homolateral pelvic ureteroureterostomies were performed in 25 patients presenting with complete duplication of the pyeloureteric tract. The procedure was performed in 16 cases of ureteroceles, in 7 cases of reflux in duplicated ureters, in 1 case of ectopic ureter and in 1 postoperative stenosis of one segment of a double ureter. According to the authors' experience this is the surgical treatment of choice in conservative surgical treatment.

Satisfactory results were obtained in 25 patients with bladder exstrophy treated by the Heitz-Boyer-Hovelacque operation.

On the basis of experimentally induced renal cancer and clinical, statistical, and epidemiological observations, it has been hypothesized that human renal cancer is hormone dependent. Hormone therapy for this neoplasm has been proposed. Recent knowledge of the mechanism of action of steroid hormones and demonstration of steroid receptors in the kidney of various experimental animals led us to investigate normal human kidney and human renal cell carcinoma for the presence of steroid receptors. By means of agar gel electrophoresis and of protamine sulfate assay techniques, estradiol receptors (ER) and progesterone receptors (PR) were sought in the cytosol fraction of renal cancer in 23 patients. ER was found in 61% and PR in 61% of the carcinomas studied: 39% of the tumors were positive for both ER and PR; 17% were negative for both ER and PR. ER and PR were also examined in the nuclear fraction of three renal cancers: estradiol nuclear receptor was found in two and progesterone nuclear receptor in three of the three tumors examined. These findings were considered strongly supportive of the hypothesis of the hormone dependence of human renal cancer. Progestational therapy, commenced after nephrectomy in 18 of the 23 patients investigated, was considered a useful adjuvant in 14 cases; 3 of 4 patients with receptor negative cancers did not respond favorably to progestins, while one is still alive more than 33 months after surgery. One patient with ER-positive and PR-negative tumor, given antiestrogenic therapy following nephrectomy, died after 8 months of treatment. The follow-up of the remaining patients is reported.

Clinical and hormonal findings have been collected from 14 patients affected by carcinoma of the prostate observed over a 5-year period following orchidectomy. Plasma testosterone decreased significantly after surgery (62 ng +/- 21 SD/100 ml), remaining below 100 ng/100 ml even in cases showing only a partial regression or increase of the tumour. Gonadotropin FSH increased 1 year after orchidectomy to 28 mIU +/- 5/ml and remained constantly elevated up to the 5th year, whilst LH increased progressively up to the 5th year (30 mIU +/- 12/ml). Finally, plasma cortisol increased progressively up to 23.2 microng +/- 17.4/100 ml at the 5th year post-orchidectomy, especially in those cases showing partial regression or increase of the tumoral mass, indicating an adrenal hyperfunction which is probably responsible for increased production of weak androgens that can be transformed in the prostate into more active compounds. These results suggest therefore that after orchidectomy, cortisol and adrenal androgen determination may be of value in detecting the potential activation of prostatic adenocarcinoma.