A new method for determining the glomerular filtration rate was analysed prospectively. The method uses an x ray fluorescence technique to measure disappearance from the plasma of injected non-ionic iodinated contrast media. Eighty seven patients were studied. Fifty four had an intravenous dose of 100 ml iohexol (Omnipaque) and 33 had 50 ml iohexol. Clearances of chromium-51 labelled edetic acid ("Cr-EDTA) were measured simultaneously. In the patients given 100 ml iohexol there was excellent correlation with 5"Cr-EDTA clearance (r=0-90). The correlation using 50 ml iohexol was also good (r=0-85). Correlation between creatinine clearance and clearance of 5Cr-EDTA in 33 patients was less satisfactory (r=0'69). There were no adverse reactions to the contrast media. The equipment used for measuring contrast clearance was robust and simple to operate. Freezing plasma samples in 10 studies and re-examining them weekly for six weeks showed no significant variation in results; hence reproducibility was good.This new and accurate method for determining the glomerular filtration rate merits further study and might find a useful place in routine clinical practice. IntroductionDetermination of the glomerular filtration rate to measure renal function is often required in urological, nephrological, and general medical practice. Currently available methods include inulin clearance, radionuclide studies using chromium-51 labelled edetic acid ("Cr-EDTA) or technetium-99m labelled diethylene triamine penta-acetic acid ('Tc-DTPA), and creatinine clearance. Because of the complexities ofthe first two methods clinicians often settle for creatinine clearance or even simple plasma creatinine and urea concentrations as less accurate but more convenient measures of renal function in everyday practice. We present our evaluation of a new method for determining the glomerular filtration rate. This is based on the use ofcompact, purpose designed equipment currently known as the ELX 84 (Elementanalys AB, Sweden), which measures the disappearance from plasma of injected, non-ionic iodinated contrast media by an x ray fluorescence technique.

A prospective analysis of 36 consecutive cases of high pressure chronic retention presenting over a 3-year period is described. Thirty-nine per cent of patients had malignant prostates and 14% had bladder tumours (overall malignancy rate 53%). The dangers of mismanagement of high pressure chronic retention include uraemic death and hypovolaemic circulatory collapse from neglected post-obstructive diuresis. The clinician should be prepared to find a high incidence of urological malignant disease in patients presenting with this syndrome.

BackgroundBCG-RIVM strain was used in many treatment protocols for non-muscle invasive bladder cancer only as induction courses. Cho et al. (Anticancer Res 2012) compared BCG-RIVM induction and 'standard' maintenance (Lamm et al., J Urol. 2000) to mitomycin C. They found no statistically significant differences regarding disease recurrence and progression. The purpose of our study was to determine the efficacy & tolerability of this specific BCG RIVM strain, using six-weekly, induction course and single monthly instillations as maintenance for one year, in high risk recurrent, multifocal low grade and multifocal high grade pTa/pT1, CIS transitional cell carcinoma of bladder.MethodsFrom 2003 - 2012, BCG-naive patients treated with intravesical BCG-RIVM for high-risk multifocal NMIBC were identified. Transurethral resection of bladder tumor (TURBT) and re-staging TURBT within six weeks, was done for accurate staging and complete elimination of disease. A six-weekly induction course, started 2-3 weeks after the last TURBT, followed by monthly maintenance protocol for one year. Recurrence, progression, cystectomy free survivals, cancer specific and over-all survival were determined.ResultsSixty evaluable patients - median age 63, median follow-up 3.98 years. Forty-two patients (70%) completed BCG-RIVM treatment as planned. BCG termination was necessary in 18 patients (30%). Recurrence occurred in 16 patients (26.7%) at a median follow-up of 24.2 months while progression occurred in five patients (8.3%) at a median follow-up of 33 months. Recurrence-free survival and progression-free survival rates were 73% and 92% respectively. Cystectomy was performed in seven patients (12%) with a cystectomy-free survival of 88%. There were no cancer specific deaths. Two patients died of other causes (3.3%). The overall survival rate was 97%.ConclusionsOur study is the first to show the clinical efficacy and tolerability of BCG-RIVM strain in the management of high risk NMIBC when given in a schedule of six-weekly induction with monthly maintenance for one year. Our maintenance protocol, achieved equivalent recurrence-free, progression-free, disease specific survival and overall survival to the reported literature and the more intense three-years South West Oncology Group (SWOG) protocol.

Retrograde balloon incision endopyelotomy appears to be a safe and effective treatment for ureteropelvic junction obstruction.

The possibility of multiple primary malignancies should always be considered during the treatment and follow-up of cancer patients. This case series could prove helpful to clinicians faced with similar, however, exceedingly rare scenarios. Due to the realistic potential for long-term survival, we recommend aggressive treatment of these patients.