Vena caval extension of renal cell carcinoma occurs in 4 to 10 per cent of the patients and usually is considered a poor prognostic sign. To ascertain the true effect of vena caval extension on survival a retrospective analysis was done of 27 patients who had undergone radical nephrectomy and removal of vena caval thrombus between 1970 and 1980. An additional 46 cases were collected from series in the literature and composite statistics were compiled. Extension to the vena cava alone had a limited impact on prognosis (survival for 2 years--81 per cent, 5 years--53 per cent, median--81 months). Capsular invasion negatively influenced survival (2-year survival 66 per cent). Disease in the regional lymph nodes had a much greater impact on survival, with a 2-year survival rate of 35 per cent and no patient survived 5 years (median survival 24 months). Only 5 per cent of the patients with distant metastases survived 2 years and none survived 5 years (median survival 8.5 months). In conclusion, the prognosis of patients with vena caval tumor thrombus is influenced primarily by known adverse prognostic factors: capsular invasion, nodal disease and distant metastases. Aggressive surgery in patients with gross nodal involvement or distant metastases is unwarranted since it contributes nothing to survival and only 7 per cent of the patients had significant signs or symptoms secondary to the vena caval thrombus itself. Patients with vena caval extension alone have a cure rate approaching that of patients with stage I renal carcinoma following radical nephrectomy and complete removal of the vena caval thrombus.

Overnight hospitalization after transurethral prostatectomy is an appropriate, safe and cost-effective pathway of patient care that is readily applicable to any urology practice.

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Pyeloplasty for hydronephrosis secondary to ureteropelvic junction obstruction is a proved efficacious procedure. In many cases the clinical improvement effected by technically successful pyeloplasty in children has been reported to exceed substantially radiographic improvement in caliceal appearance. To address this issue in the adult population we did a retrospective review of 52 patients who had undergone pyeloplasty for ureteropelvic junction obstruction. In 91 per cent of the patients the clinical result was satisfactory, while improvement was observed in 92 per cent of the renal units that could have been expected to benefit. The caliceal appearance on the postoperative excretory urogram was normal in only 25 per cent of the cases, showed diminution of calicectasis in 65 per cent, was unchanged in 30 per cent and deteriorated in 5 per cent. Earlier appearance of contrast medium in the upper ureter on the postoperative excretory urogram was seen in all patients who had a satisfactory clinical result. Deterioration of caliceal grade or delayed appearance of contrast medium in the ureter in the postoperative excretory urogram always was associated with a poor clinical result and/or further parenchymal loss. While a salutary effect of a technically successful operation on the clinical manifestations of hydronephrosis secondary to ureteropelvic junction obstruction is not necessarily correlated with improved or normal caliceal appearance it does correlate strongly with improvement of drainage as manifested by earlier appearance of contrast medium in the ureter. Deterioration of the caliceal grade or delayed appearance of contrast medium in the ureter implies that effective drainage is not present, which presages a poor clinical outcome and further loss of renal parenchyma.

No abstract

Fine needle aspiration specimens of the prostate gland were compared to histological material in 103 patients. The sensitivity was 95 per cent, specificity 97 per cent and efficiency 87 per cent. Initial core needle biopsy compared to the final histological diagnosis in this study had a sensitivity of 76 per cent, specificity 100 per cent and efficiency 71 per cent. Fine needle aspiration by a well trained cytopathologist is less traumatic, and has fewer side effects and a higher sensitivity rate than conventional core needle biopsy.

We report on a woman with a urethral valve causing obstruction, hyperreflexia, vesicoureteral reflux and retention. The diagnosis of urethral valves in female subjects rests on endoscopy and radiographic studies. Transurethral resection of the valve is effective treatment. The literature is discussed briefly.

No abstract