The Relationship Between Prostate Biopsy Results and PSA and Free PSA Ratio Changes in Elevated Serum PSA Patients with and without Antibiotherapy

Objectives:

To evaluate the impact of antibiotic treatment on total prostate specific antigen (PSA) levels and free/total (f/t) PSA ratio and the relevance of these changes to prostate biopsy results.

Methods:

We retrospectively evaluated 1,062 patients with elevated age-adjusted serum PSA levels who underwent prostate biopsy between 2004 and 2016. A total of 303 cases with followup PSA levels and f/t PSA ratio before and after antibiotherapy were included into this study. There were 214 patients with persistent elevated serum PSA levels after antibiotic treatment followed by prostate biopsy (treatment group) and 89 patients who had prostate biopsy after a mean followup of 1 month without antibiotherapy (control group). The groups were compared with regard to both 5% and 10% cut off changes in serum PSA levels and f/t PSA ratios.

Results:

Antibiotic treatment had no impact on the relation between serum PSA levels and biopsy results at both cut off values. On the other hand, f/t PSA ratio changes at both cut off values with relevance to antibiotic treatment were found to be related with histopathologic results. While increase in f/t PSA ratio was more related with benign biopsies, decrease in f/t PSA ratio was more related with cancer (for 5% cut off value p= 0.014, p= 0.004; for 10% cut off value p= 0.026, p= 0.014).

Conclusion:

Changes at f/t PSA ratio rather than total PSA only, particularly in antibiotic treated cases appear to be more useful in decision making for biopsy.

Association between focal adhesion kinase and matrix metalloproteinase-9 expression in prostate adenocarcinoma and their influence on the progression of prostatic adenocarcinoma

Focal adhesion kinase (FAK), a member of the non-receptor cytoplasmic tyrosine kinase family, is associated with the development and progression of cancer. Matrix metalloproteinase-9 (MMP-9) is directly involved in the degradation of the extracellular matrix, and basement membrane components promote cancer cell migration and invasion. There is a functional interaction among FAK, MMP-9 and vascular endothelial growth factor (VEGF), which leads to enhanced cancer angiogenesis, cancer cell invasion and progression of malignancy. FAK, MMP-9, VEGF and CD34-positive microvessel density (MVD) were examined in 100 patients with prostate adenocarcinoma using immunohistochemistry. The relationship among these proteins and their impact on angiogenesis and clinicopathological parameters were also evaluated. The FAK expression was found to be positively correlated with the Gleason score, WHO grade group, tumour stage, extracapsular extension and perineural invasion. The MMP-9 expression was positively correlated with the WHO grade group, tumour stage, extracapsular extension, positive surgical margin and lymphovascular and perineural invasion. The FAK expression was also positively correlated with MMP-9 expression and MVD. However, no correlation between FAK and VEGF expression was identified. The MMP-9 expression was positively correlated with FAK expression and MVD. Strong MMP-9 expression was associated with shorter disease-free survival. These results suggest that strong MMP-9 and FAK expressions play an essential role in the progression of prostate adenocarcinoma. Further investigations should be conducted to determine the importance of these proteins as therapeutic targets for patients with prostate adenocarcinomas.

Clinical Use of Tumor Markers for the Detection and Prognosis of Bladder Carcinoma: A Comparison of CD44, Cytokeratin 20 and Survivin

PURPOSE

To investigate the role of CD44, cytokeratin 20 (CK20) and survivin for the detection and prognosis of patients with urothelial carcinoma of the bladder.

MATERIALS AND METHODS

The study included 82 patients who underwent transurethral resection of bladder tumors between 2009 and 2014. The patient and tumor characteristics with relevance to age, tumor size and focality, grade and stage, recurrence and progression were noted. Patients with carcinoma in situ, those who had at more than 3 sites of lesions and greater than 3 cm tumors were excluded. All cases were ex-smokers. All histological samples stained with hematoxylin and eosin were re-evaluated according to the 2004 World Health Organization/International Society of Urological Pathology (WHO/ISUP) classification system and immunohistochemically stained for CD44, CK20 and survivin.

RESULTS

The study group comprised 57 (69.5%) males and 25 (30.5%) females with a mean age of 60 years (range, 26-87 years). All were newly-diagnosed patients with bladder tumors. Immunohistochemical evaluation revealed that there was a statistically significant correlation between the grade and stage of the tumor with CK20 and survivin positivity (P < .05). As the grade and stage increased CD44 immunoreactivity significantly decreased (P = .002, P = .0001, respectively). However, relationship of protein expressions with recurrence and progression remained insignificant (P > .05).

CONCLUSION

In cases of bladder urothelial carcinoma positivity for CD44, CK20, and survivin has significant relation with the tumor grade and stage while no significant relationship was determined in terms of recurrence and progression&nbsp.

The effect of American Society of Anesthesiology scores on percutaneous nephrolithotomy outcomes

INTRODUCTION

To evaluate the effect of American Society of Anesthesiology (ASA) scores on percutaneous nephrolithotomy (PNL) outcomes.

MATERIALS AND METHODS

The records of 186 consecutive patients undergoing PNL procedures from 2006 to 2011 at a single institution were evaluated. Patients were divided into a low-risk group with a preoperative ASA of I or II and a high-risk group with ASA of III or IV. Postoperative complications were classified according to the modified Clavien classification system.

RESULTS AND CONCLUSIONS

There were 140 cases in the low-risk and 46 cases in the high-risk groups. The mean operative time was 72 min (40-120 min) and 86 min (55-125 min) and the complication rates were 17.8 and 19.5% for the low- and high-risk groups, respectively. The average duration of nephrostomy tube drainage was 3.3 ± 1 and 4.2 ± 1.5 days for the low- and high-risk groups, respectively. Stone-free rates were 85 and 82% for the low- and high-risk groups, respectively. PNL can be safely performed in the ASA high-risk patient population.

Tranexamic acid decreases blood loss during transurethral resection of the prostate (TUR -P)

Introduction

Postoperative blood loss after prostate surgery is thought to be associated with an increase in urinary fibrinolytic activity. Tranexamic acid (TXA) is both a potent inhibitor of plasminogen and urokinase activators and a low molecular weight substance that is excreted unchanged in the urinary tract and can be administered both orally and intravenously. We investigated the effect of TXA on the amount of blood loss during transurethral resection of the prostate (TURP).

Materials and methods

Forty patients with registry numbers ending in even numbers were allocated to the treatment group; those ending in odd numbers were used as controls and received no treatment. The treatment group received 10 mg/kg TXA by intravenous infusion during the first half hour of the operation, while the control group of patients received no medication. Serum hemoglobin was measured before and after surgery. The volume and hemoglobin concentration of the irrigation fluid, resected prostate weight, and duration of resection were recorded.

Results

The mean loss of hemoglobin per gram of resected prostate tissue was 1.25 g in the TXA group and 2.84 g in the control group. Total hemoglobin loss in the irrigating fluid and hemoglobin loss per 1 gram of prostate tissue was lower in the group of patients given TXA than in the control group (p = 0.018 and p <0.001).

Conclusion

Reduced bleeding during TURP as a result of TXA treatment may lead to better surgical conditions and, as a consequence, shorter operative times and lower irrigating fluid volumes.

Tailored treatment approach for emphysematous pyelonephritis

OBJECTIVE

We evaluated the clinical presentation, diagnosis and management of patients presenting with emphysematous pyelonephritis (EP).

PATIENTS AND METHODS

The clinical data of 24 EP patients diagnosed between 2000 and 2009 were retrospectively reviewed. The management strategies were discussed according to the severity of condition at presentation.

RESULTS

The mean age of the patients was 61.8 years. Diabetes mellitus was detected in 21 (87.5%) of them. Escherichia coli was the predominant pathogen. There were 6 patients (25%) who recovered with antibiotic treatment only (mild). Percutaneous drainage in addition to antimicrobial chemotherapy was necessary in 13 cases (54%) (moderate). The remaining 5 patients (21%) were treated by nephrectomy (severe).

CONCLUSIONS

EP is a serious infection that can display a fatal progression despite ablative treatment but there are also some cases with mild or moderate severity that can be successfully treated without nephrectomy.

Single injection results of endoscopic treatment of vesicoureteric reflux with different tissue-bulking substances in patients with end stage renal failure

PURPOSE

To evaluate the outcome of subureteral injections by using calcium hydroxyapatite (CaHa), dextranomer/hyaluronic acid copolymer (Dx/HA), and polydimethylsiloxane (PDS) in patients with end-stage renal failure (ESRF) who have vesicoureteral reflux (VUR).

PATIENTS AND METHODS

One hundred-one patients (166 renal units) with ESRF secondary to VUR were included in this retrospective study. The reflux was bilateral in 65 of the cases. CaHa, Dx/HA and PDS were used in 57, 26, and 18 patients, respectively. All patients were reviewed with regard to age, sex, reflux grade, type of injected materials, injectable agent volume, and outcome.

RESULTS

The reflux resolved completely in 30 patients (50/96 renal units, 52.1%), in 17 patients (27/44 renal units, 61.4%), and in 4 patients (5/26 renal units, 19.2%) with CaHa, Dx/HA, and PDS, respectively. Regression rates of reflux to grade I with these agents in the same order were 3.1% (2 patients, 3/96 renal units), 4.5% (1 patient, 2/44 renal units), and 11.5% (2 patients, 3/26 renal units). Thus, the overall success rate were noted as 55.2%, 65.9%, and 30.7%, respectively. There was no difference among these three injectables with regard to overall success rates (P = 0.062). No significant correlation with age, reflux grade, agent volume, and significant difference with sex were observed (P > 0.05).

CONCLUSIONS

In this group of patients, the success rate of the subureteral injection treatment does not appear to be affected by the type of the injectable agent. In addition, the cure rates were independent from the individual factors, reflux grades, and injected volumes.

The effect of topical synthetic prostaglandin E1 (misoprostol) on clitoral hemodynamics

INTRODUCTION

Genital blood flow plays an important role on female sexual function. Measures that increase genital blood flow may be a therapeutic approach for female sexual dysfunction.

AIM

This study aims to show the effect of topical misoprostol, a synthetic prostaglandin, on clitoral blood flow.

METHODS

Seventeen volunteers with female sexual dysfunction on the basis of female sexual function index scores were included in the study. All women were premenopausal and within their sexually active ages. Hormonal profiles were also normal. Those with suspected pregnancy, history of pelvic or vaginal surgery or radiotherapy, and diabetes or hypertension were excluded. Female sexual function index scores were determined. Clitoral peak systolic velocity (PSV) and clitoral artery diameter of all women were measured by using Doppler ultrasound. The measurements were done on two occasions as before and after placebo in one session and before and after 100 µg of misoprostol in another. This is a double-blind study where the patient and the ultrasonographist were unaware of either placebo or active drug has been applied before measurements.

MAIN OUTCOME MEASURES

Clitoral artery diameter and peak systolic velocity.

RESULTS

Misoprostol caused a significant increase in clitoral artery PSV compared to basal level (P = 0.0001), while changes in clitoral artery PSV with placebo remained insignificant. Remarkably, misoprostol caused 118.3% increase in clitoral artery PSV and 47.5% increase in clitoral artery diameter when compared to basal levels. No side effects were observed.

CONCLUSION

Topical misoprostol can significantly increase clitoral blood flow without any unwanted effects and this finding may be promising for future investigations with relevance to female sexual dysfunction.

Which factors may effect urinary leakage following percutaneous nephrolithotomy?

OBJECTIVE

To evaluate the factors that may effect urinary leakage following percutaneous nephrolithotomy (PCNL).

METHODS

Four hundred and thirty-three patients who underwent PCNL were reviewed retrospectively. The factors that may lead to leakage after surgery were analyzed as categorized into four groups according to individual variables (age, sex, body mass index); renal factors (previous surgery, extracorporeal shock wave lithotripsy history, presence of hydronephrosis); stone burden; and surgical features (access number, type of dilatation, presence of nephrostomy catheter). These data were compared for the presence and duration of urinary leakage.

RESULTS

There was no statistically significant correlation between individual factors and both the presence of leak (POL) and the duration of leak (DOL) (P > 0.05). Among renal factors, only presence and degree of hydronephrosis was significantly correlated with POL (P < 0.001) and DOL (P < 0.001). The mean cumulative stone burden neither had impact on POL nor correlated with DOL (P > 0.05). Among surgical factors, dilatation with a Nephromax dilator significantly increased incidence of POL when compared with an Amplatz dilator (P < 0.001), yet did not change DOL. Using an internal ureteral stent significantly decreased incidence of POL and DOL (P < 0.001). DOL increased with catheter diameter and stay time (P < 0.05).

CONCLUSION

Several yet simple factors appear to be effective in postoperative urine leakage from the access sites after percutaneous stone surgery. Precautions may also be simple if these factors are considered preoperatively.

The effects of hydronephrosis and stone burden on success rates of shockwave lithotripsy in pediatric population

OBJECTIVES

To evaluate the efficacy of shockwave lithotripsy (SWL) with a third-generation SWL machine in the pediatric age group and to determine the effects of stone burden and the degree of hydronephrosis on the results.

METHODS

Two hundred and sixty children with urinary system stones were treated with Siemens Lithostar Modularis Uro-Plus. The patients were divided into three groups according to stone burden (group 1: <100 mm(2); group 2: 101-200 mm(2); group 3: >200 mm(2)) and into four groups according to the degree of hydronephrosis (group 0: absent; group 1: mild; group 2: moderate; group 3: severe). These groups were compared in terms of the success rate of SWL.

RESULTS

Two hundred and seventy-nine renoureteral units of 260 patients were treated with 402 SWL sessions. The average stone burden was 98.2 mm(2) (range: 11-525). The overall success rate was 87.5%. According to stone burden, the success rate was 93.1% in group 1, 85.5% in group 2, and 60% in group 3 (p < 0.001). According to the degree of hydronephrosis, the success rate was 93.8% in group 0, 89.6% in group 1, 73.3% in group 2, and 64.3% in group 3 (p < 0.001). The average energy, number of shockwaves, number of sessions, retreatment rate, auxiliary procedure rate, and overall efficacy quotient were 1.76 units, 2260, 1.4, 33%, 8.2%, and 0.62, respectively.

CONCLUSION

SWL is an effective treatment method in selected patients in pediatric age group. However, percutaneous nephrolithotomy can be the first alternative for stones larger than 200 mm(2). It should also be kept in mind that the success rate of SWL decreases when the degree of hydronephrosis increases.

Labial fusion causing urinary incontinence and recurrent urinary tract infection in a postmenopausal female: a case report

A 73-year-old postmenopausal woman was admitted with recurrent urinary tract infection and a history of incontinence. General physical examination was normal. Complete labial fusion was noticed on genital examination. Surgical intervention was performed. This therapy alleviated incontinence and recurrent urinary tract infection.

Evaluation of video-urodynamic studies before renal transplantation in chronic renal failure patients

OBJECTIVES

To evaluate the role of video-urodynamic examination prior to renal transplantation.

METHODS

Sixty-four kidney transplant recipients were included into the study. All patients underwent video-urodynamic examination and separate uroflowmetry. Results were evaluated based on daily mean amount of urine, duration of chronic renal failure and presence of diabetes mellitus.

RESULTS

Thirty-five (54.6%) patients showed video-urodynamic abnormalities. The mean detrusor capacity was 234 ml, the mean detrusor compliance was 17.5 cm H(2)O/ml, the mean maximum detrusor pressure was 61.9 cm H(2)O and the mean Q (max) was 13.8 ml/s in all patients. Vesicoureteral reflux was detected in 15 (23%) patients. The mean detrusor compliance and detrusor capacity significantly decreased as the daily amount of urine decreased and as the duration of chronic renal failure increased. Also, there was no significant relation between presence of diabetes mellitus and detrusor capacity and detrusor compliance.

CONCLUSION

Video-urodynamic studies before renal transplantation provide earlier diagnosis of lower tract abnormalities, which are likely to cause graft dysfunction.

Renal transplant outcome after endoscopic treatment of vesicoureteral reflux using the subureteric injection of calcium hydroxyapatite

OBJECTIVES

To evaluate the results of end-stage renal failure in transplanted cases due to vesicoureteral reflux after a subureteric injection of calcium hydroxyapatite (Coaptite).

MATERIALS AND METHODS

Twenty-three patients (39 renal units) with end-stage renal failure secondary to vesicoureteral reflux were included. Reflux was bilateral in 16 cases and unilateral in 7 of the cases. There were 3 degrees of reflux according to the distribution of renal units. They were low-grade reflux (grades 1 and 2; n=10); medium-grade reflux (grade 3; n=23); and high-grade reflux (grades 4 and 5; n=6).

RESULTS

Reflux resolved completely in 17 patients (28 renal units; 71.8%). There was a regression to grade 1 in 3 patients (5 renal units; 12.8%). Twenty-one patients underwent renal transplant; however, 2 of the patients were excluded from the study as it was not possible to monitor them after transplant. Within an approximately 18.6 month follow-up (range, 3-36 months), 1 of the cases had acute, and 3 of the cases had chronic rejection.

CONCLUSIONS

Successful results can be achieved in reflux treatment by an injection of subureteric calcium hydroxyapatite before transplant in patients with end-stage renal failure that developed secondary to vesicoureteral reflux.

Renal endometriosis presenting with a giant subcapsular hematoma: case report

OBJECTIVE

To describe a case of renal subcapsular hematoma due to renal endometriosis.

DESIGN

Case report.

SETTING

Departments of Urology and Pathology, Baskent University Faculty of Medicine, Ankara, Turkey.

PATIENT(S)

A 46-year-old premenopausal woman was admitted with a left lumbar pain and mass. Ultrasonography and computerized tomography revealed a giant-sized renal subcapsular hematoma.

INTERVENTION(S)

Computerized tomography, percutaneous drainage catheter placement, surgical exploration, and excision of renal capsule.

MAIN OUTCOME MEASURE(S)

None.

RESULT(S)

Histopathologic examination revealed endometriosis located beneath the fibrous renal capsule.

CONCLUSION(S)

Renal capsular endometriosis should be kept in mind among the causes of renal subcapsular hematoma.

Do changes in a high serum prostate-specific antigen level and the free/total prostate-specific antigen ratio after antibiotic treatment rule out biopsy and the suspicion of cancer?

OBJECTIVES

To evaluate the impact of antibiotic treatment in patients with higher-than-normal prostate-specific antigen (PSA) levels in terms of changes both in total PSA and free/total (f/t) PSA ratios.

MATERIALS AND METHODS

Serum PSA and f/t PSA changes after antibiotic treatment in 85 patients with normal digital rectal examination but elevated age-adjusted serum PSA levels were evaluated with relevance to biopsy results.

RESULTS

Serum PSA levels decreased after antibiotic treatment in 47 of 85 patients. The f/t PSA ratio decreased or remained unchanged in 21 and increased in 26 of these 47 cases. Cancer detection rate in the former group was 52.4% (11/21), while it was 7.7% (2/26) in the latter (p = 0.002). There were 38 patients with increased PSA levels after antibiotics. The f/t PSA ratios decreased or remained unchanged in 20 and increased in 18 of these 38 cases. Cancer detection rates were 55% (11/20) in the former and 16.7% (3/18) in the latter group (p = 0.003).

CONCLUSIONS

The PSA and f/t PSA levels may change with long-term antibiotic treatment in patients with elevated PSA values. The f/t PSA ratio rather than total PSA appears to be more helpful in suggesting prostate cancer in these cases.

Iatrogenic ureteral injury due to lumbar sympathetic block

Lumbar sympathetic block (LSB) is used in the management of sympathetically maintained pain states. Complications of LSB may include infection, injury of spinal cord or somatic nerve, kidney trauma, hypotension, paraplegia and genitofemoral neuralgia. We present a case of a 53-year-old woman who had undergone LSB for the relief of reflex sympathetic dystrophy and subsequently a disrupted right proximal ureter. She was treated with ureteroureterostomy and an indwelling ureteral stent.

VEGF, COX-2, and PCNA expression in renal cell carcinoma subtypes and their prognostic value

OBJECTIVE

To evaluate the prognostic value of new markers such as VEGF (vascular endothelial growth factor), COX-2 (cyclooxygenase-2), and PCNA (proliferating cell nuclear antigen) and review their differences in expression by histological subtype in patients with renal cell carcinoma (RCC).

METHODS

About 99 patients who underwent radical (n = 79) or partial nephrectomy (n = 20) were included in this study. Histopathological specimens from the subjects were retrospectively analyzed immunohistochemically for the presence of VEGF, COX-2, or PCNA.

RESULTS

Mean staining ratios for VEGF, COX-2, and PCNA were 16.5, 16.8, and 31%, respectively. Correlations were evaluated among these three prognostic factors. There was no correlation between PCNA and VEGF (P = .068), but there were significant correlations between COX-2 and both PCNA and VEGF (P = .005 and P = .000, respectively). A significant correlation was found between the expression of VEGF and both pathologic stage and vascular invasion (P = .018 and P = .025, respectively). In addition, patients with conventional RCC had significantly lower VEGF and COX-2 levels than those with papillary RCC (P < .012).

CONCLUSIONS

It is obvious that prognostic factors such as VEGF, COX-2, and PCNA may vary depending on histological subtype. The level of expression of these factors together with histological subtype may provide valuable predictive information about the outcome of treatment.

Ureteroscopic treatment of proximal ureter stones with the aid of an antegrade occlusion balloon catheter

PURPOSE

To define the role of an antegrade occlusion balloon catheter in preventing migration of proximal ureteral stones to the dilated proximal ureter during endoscopic treatment.

MATERIAL AND METHODS

An occlusion balloon catheter was used in 8 of 21 patients with proximal ureteral stones who underwent ureterorenoscopy. Five of the eight patients had solitary kidneys admitting with anuria and had percutaneous nephrostomy. In the other three patients, percutaneous nephrostomy and occlusion balloon catheters were placed a day before the procedure, since these patients had total obstruction and massive dilatation of the proximal ureter and renal collecting system. The balloons of occlusion catheters were inflated with 1 ml of sterile saline proximal to the stones just before ureterorenoscopy.

RESULTS

All stones could be reached by ureterorenoscopy and treated successfully with the aid of an ultrasonic lithotripter, and no stone migration to the upper dilated collecting system was observed. Just after the operation, while the patient was still lying on the operation table, the occlusion catheter was removed. The nephrostomy catheter was removed a day later. All patients were totally stone-free after the procedures.

CONCLUSION

Occlusion balloon catheters increase the ureteroscopic treatment success rate in proximal ureter stones. This should be kept in mind especially when dilatation of the proximal collecting system is prominent and in cases with unsuccessful previous intervention with a retrograde stone cone catheter.

Sublingual sildenafil in the treatment of erectile dysfunction: Faster onset of action with less dose

BACKGROUND

The aim of the present study was to show the efficacy and safety of sublingual sildenafil and to determine whether lower doses cause the same effect with a faster onset of action in this mode of application.

METHODS

Forty consecutive patients with erectile dysfunction for more than three months were included in the study. The mean age was 55 years (range, 25-65). Serum glucose and testosterone levels, lipid profile and erectile function scores were obtained in all patients. Twenty patients received placebos and the other 20 patients received 20 mg sublingual sildenafil in a double blind randomized design.

RESULTS

The effect of sildenafil on erection was significantly higher than that of placebo. Sixty-five percent of patients (13/20) who received sublingual sildenafil achieved satisfying erections and coitus, whereas the rate was 15% in the placebo group (3/20). The mean onset of action with sublingual sildenafil was 15.5 min and lasted for an average of 40 min. Minimal headaches, sweating and flushing were noted as the side-effects.

CONCLUSIONS

20 mg sublingual sildenafil is safe and effective in the treatment of erectile dysfunction. Sublingual administration has some advantages as it is not effected by food ingestion and quickly appears in the circulation. These advantages provide a faster onset of action with a lower dose when compared to oral sildenafil. Sublingual use of sildenafil may be more cost-effective and possibly provides a more predictable onset of action.

Renal transplantation experience following endoscopic treatment of vesicoureteral reflux

The most efficacious treatment for end-stage renal disease is renal transplantation. Because high-grade vesicoureteral reflux forecasts potential future complications, the patients studied were subjected to bilateral nephroureterectomy before transplantation. The aim of this study was to investigate the posttransplantation results of a subureteral injection performed before transplantation to treat high-grade vesicoureteral reflux in end-stage renal disease patients. Renal transplantation was performed on 14 of 52 end-stage renal disease patients that had undergone prior subureteral injection. Subureteral injection had been performed in 24 refluxing renal units of these 14 patients. Ten patients had bilateral and 4 patients unilateral reflux. The treatment criterion was reflux of at least grade III; however, when low-grade reflux was present in the contralateral renal unit, it was also treated during the same session. Success was determined as no (complete) or decrease to grade I (partial) reflux. The patient ages ranged between 13 and 46 years (mean 29.3 years). The reflux resolved in 20 of 24 renal units (83%) and was reduced to grade I in 3 of the others (12%), namely resulting in a total response rate of 95%. Except for 1 patient who was lost to follow-up, the other recipients were observed for 6 to 47 months (mean 23 months). Only 1 patient experienced symptomatic urinary tract infection or asymptomatic bacteriuria after renal transplantation. Acute rejection occurred in 5 and chronic rejection in 3 patients. In conclusion, subureteral injection instead of nephroureterectomy seems to be an efficient and minimally invasive alternative for renal transplant recipients with high-grade vesicoureteral reflux.

Endoscopic treatment of complete bladder neck obstruction by transurethral Seldinger technique

Bladder neck contracture is usually a complication of prostatectomy and the treatment of choice in such a condition should be endoscopic surgery. However, in a few patients the bladder neck may be completely obstructed preventing retrograde access into the bladder. A case is presented of complete bladder neck obstruction occurring after transurethral resection of prostate, which was treated after an access was provided by using transurethral Seldinger technique.