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PubMed1990

[Imaging diagnosis of genitourinary tract tumors].

Recent advance of imaging technique have brought great advantages for management of genitourinary tract tumors. We described few examples of changes in this field from our experience. Many asymptomatic masses are discovered in the kidney and adrenal gland associated with wide clinical application of CT and US. In the kidney, the greater part of incidental masses are renal cell carcinomas (RCC) and the rate of such cases has been increasing. When small RCC is diagnosed without any clinical symptoms, better survival would be expected. Many adrenal incidental mass are also discovered by routine use of CT for abdominal workup. Since greater part of these masses are benign nonfunctioning adenomas, correct diagnosis should be made in order to avoid inappropriate surgery. Rapid development of MR also resulted in some changes in the diagnosis of urinary tract tumors. However, MR cannot be used as a screening method. For staging of RCC, intravascular or adjacent organ invasion was well determined with MR compared with CT. Differentiation of adrenal carcinomas from nonfunctioning adenomas is suggested by the difference of signal intensity on T2 weighted images. Fast spin echo scan with GD-DTPA enhancement is new MRI technique separating bladder mucosal layer from muscle layer as hyper-intensity area. Using this method, diagnostic accuracy of deep muscle invasion for bladder tumor would be improved.

Adrenal Gland Neoplasms↗

PubMed1986

Management of a fetus affected by a genitourinary tract anomaly (excluding obstructive uropathies).

The author's personal series of 23 cases of genitourinary tract anomalies is presented. The management of each lesion is briefly discussed. The importance of recognizing uniformly fatal lesions and allowing termination (or at least avoiding an unnecessary cesarean section) is stressed. Most lesions of the genital tract can safely await delivery before any intervention is required.

Delivery, Obstetric↗

PubMed1981

Primary localized amyloidosis of the genitourinary tract: immunohistochemical study on eleven cases.

Eleven cases of primary localized amyloidosis of the genitourinary tract were studied using the unlabeled immunoperoxidase method in combination with specific antisera against different chemical types of amyloid fibril proteins (AA,A lambda, and A kappa). Nine of these were shown to have A lambda antigenic fibril determinants, suggesting that the fibrils of most, if not all, of these cases are of immunocytic origin.

Adult↗

PubMedDate not supplied

Effect of 6-hydroxydopamine on neuropeptides in the rat female genitourinary tract.

The occurrence and distribution of neuropeptide Y has been determined in the rat female genitourinary tract by radioimmunoassay and chromatographic analysis. Within the bladder, higher concentrations of neuropeptide Y were found in the trigone (48.8 +/- 5.2 pmol/g) than in the dome (36.0 +/- 2.1 pmol/g). In the genital tract, highest concentrations were identified in the vagina (41.4 +/- 2.1 pmol/g). Treatment of rats with 6-hydroxydopamine resulted in significant depletion of neuropeptide Y concentrations in both parts of the bladder, together with vagina, uterine horn and fallopian tube. No change was observed in the cervix, uterine body and ovary. Concentrations of vasoactive intestinal polypeptide were unaffected by treatment with 6-hydroxydopamine except in the area of the cervix where concentrations rose from 64.1 +/- 5.7 pmol/g to 133.6 +/- 15.1 pmol/g (p less than 0.05). There was a generalised, but statistically insignificant rise in substance P concentrations.

Animals↗

PubMed1992

Color Doppler ultrasound of the genitourinary tract.

This paper discusses the role of color Doppler ultrasonography (CDU) as it applies to the genitourinary tract. CDU is beneficial in evaluating both the native and allograft kidney in the diagnosis of renal arterial and venous stenosis, arteriovenous fistulas, pseudoaneurysms, arterial and venous thrombosis, and in the characterization and staging of renal masses. CDU has redefined the role of ultrasonography in the evaluation of the scrotum as it relates to testicular torsion, inflammatory disorders and varicoceles. Early results of CDU in prostate carcinoma and benign prostate hypertrophy have shown limited success. Identifying and assessing the neurovascular bundle may have an impact on the staging of prostate carcinoma. It is hoped that the future addition of ultrasound contrast agents will further establish the role of color Doppler in the diagnosis of a variety of genitourinary diseases and disorders.

Female Urogenital Diseases↗

PubMed1986

Magnetic resonance imaging of the genitourinary tract.

This is an overview of the current applications of magnetic resonance imaging (MRI) in the genitourinary tract based on the experience with the 0.5-Tesla MR scanner (Gyroscan, Philips) at the Leiden University Hospital and on reports in the literature. MRI appears to share some of the limitations of CT. MRI cannot reliably differentiate between a malignant and a benign tumor. In the staging of ovarian malignancies by means of MRI, bowel preparation would be desirable. On the other hand, the soft-tissue contrast resolution of MRI is superior to that of CT and images can be obtained in any plane. Thus MRI promises to be an accurate method for staging malignancies. The results in the examination of transplant kidneys are encouraging. We expect that there will be a place for MRI as a complementary technique to ultrasonography in the diagnosis of scrotal disease.

Female↗

PubMedDate not supplied

Helical CT of the abdomen and pelvis: potential diagnostic pitfalls of arterial-phase imaging in the genitourinary tract.

Spiral computed tomography (CT) is the state of the art today in imaging many features of the genitourinary tract. The use of dual-phase CT imaging improves our ability to detect and stage a wide range of pathologies. However, imaging in the arterial phase has several potential pitfalls that can result in either overcalling or undercalling genitourinary pathology. This paper reviews some of the common pitfalls and presents strategies on how to avoid them.

Diagnosis, Differential↗

PubMed1986

Genitourinary tract anomalies: neonatal surgical problems.

This paper is based on our experience in managing 79 cases of genitourinary tract anomalies diagnosed in utero and treated after birth. These babies seldom present as emergencies, and the antenatal diagnosis can usually be confirmed in the first few days of life. The surgical correction of these babies requires the services of a surgeon skilled and experienced in neonatal surgery. Surgeons experienced only in adult surgery may find these procedures technically difficult. Magnification is recommended. Postoperatively careful attention to fluid and electrolyte balance and correct functioning of drainage tubes is stressed. Antibiotic prophylaxis is vital, as is long-term follow-up.

Humans↗

PubMed1979

Gray scale ultrasound and the genitourinary tract. A review of clinical applications.

Diagnostic ultrasound has many well established indications in the evaluation of genitourinary tract disease. Musch of this information complements or corroborates findings derived from other investigations. The role of ultrasound as a primary diagnostic modality is still evolving, but it appears to be useful in a variety of clinical situations, especially in azotemia, suspected hydronephrosis, and renal transplantation. Ultrasound also has a place in the evaluation of the retroperitoneum, the perirenal space, and the adrenal glands, and preliminary work suggests a role in prostatic and testicular abnormalities as well. State of the art prospective comparisons with computed tomography need to be made in many of these areas before the precise role of ultrasound can be defined.

Adrenal Gland Diseases↗

PubMed1991

Current concepts in the treatment of genitourinary tract disorders in the older individual.

Genitourinary problems, including neurogenic dysfunction, impotence, prostatism, urinary tract infections, and prostate cancer, are common in the elderly, and most of the symptoms can be alleviated through pharmacological management. Patients with neurogenic dysfunction who present with symptoms such as incontinence and urinary retention can be appropriately managed with bladder and sphincter relaxants or stimulants. Anticholinergic agents in the form of oxybutynin, flavoxate, and propantheline are effective bladder relaxants, and phenoxybenzamine, prazosin, and terazosin are commonly used as sphincter relaxants. Bethanechol chloride is the agent most commonly used to stimulate bladder contraction, but physicians should be careful when prescribing it for elderly patients with cardiovascular problems. Organic and psychogenic causes of impotence usually overlap, and oral agents have limited use in the treatment process. The use of yohimbine has increased recently, but its value and rate of success remains questionable. Testosterone is being used widely to treat impotence, but it is only helpful to patients with hypogonadism and should be used with discretion in the elderly, who have a high incidence of prostate cancer. Vasoactive intracavernous pharmacotherapy, on the other hand, is a recently discovered alternative to testosterone with promising results. Although the treatment of choice for benign prostatic hypertrophy is surgery, there have been important pharmacological advances in treating this disorder. alpha-Adrenergic antagonists and anti-androgenic agents have been found to relieve the symptoms of prostatic enlargement. The use of chemotherapeutic and antibiotic agents to treat and suppress acute and chronic urinary tract infections is reviewed; these are second only to pulmonary infections as the most frequent cause of febrile episodes in patients over the age of 65. Lower urinary tract infections can be treated with almost any antibacterial agent. Upper urinary tract infections require full genitourinary evaluation and appropriate antibiotics should be used according to the urine culture sensitivity studies. With the advent of new hormonal agents, more choices are now available for the management of prostate cancer, which is the second most common malignancy in men. Diethylstilbestrol (stilboestrol), an oral estrogen, remains a commonly used agent to achieve castrate levels of androgens in advanced prostatic carcinoma. Agonist analogues, such as goserelin and leuprorelin, of gonadotrophin-releasing hormone (GnRH) [luteinising hormone-releasing hormone (LHRH); or gonadorelin] achieve the same results as diethylstilbestrol but without the cardiovascular side effects. Antiandrogens are also being used in combination with GnRH agonists to produce complete androgen blockage, with mixed results.

Aged↗

PubMed1984

The development of infections of the genitourinary tract in the wives of infertile males and the possible role of spermatozoa in the development of salpingitis.

Genitourinary tract infections developing in wives during marital life in 1,350 infertile couples were examined. Women married to men with a history of genital tract infection had a significantly higher incidence of vaginitis, urinary tract infection, salpingitis and genital herpes when compared with women whose husbands did not have genital tract infections before the marriage. Of the variables examined, the two factors that showed the most significant association with the tendency to develop salpingitis were the sperm count and the length of time the couple had been trying to achieve a pregnancy. The wives of azoospermic males did not have pelvic inflammatory disease develop but had the same incidence of infection of the lower part of the genital tract as the other studied groups. It is suggested that the bacterial flora of the seminal fluid can play a role in developing salpingitis in the female and that spermatozoa may be involved in delivering bacteria to the higher genital tract structures.

Adult↗

PubMed1982

Major anomalies of the genitourinary tract in the neonate.

Thirty-two neonates were investigated or operated upon for major anomalies of the genitourinary tract during the ten-year period up to June 1981. The infants ranged in age from 1 to 31 days. Obstructive uropathies and conditions which appear mainly in later infancy or childhood were excluded. Diagnostic and therapeutic problems of renal dysplasia (multicystic kidney), infantile polycystic kidney disease, renal venous thrombosis, tumours, exstrophy of the bladder, combination of paediatric surgical and urological anomalies, and sex assignment in infants are discussed with some case reports.

Bladder Exstrophy↗

PubMed1991

Nonrandom cytogenetic changes in leiomyomas of the female genitourinary tract. A report of 35 cases.

Cytogenetic analysis of short-term cultures from 35 leiomyomas of the female genitourinary tract showed abnormal karyotypes in 14 cases. In 11 of 14 aberrant tumors, normal cells were also observed. Structural changes were most frequent, resulting in modal chromosome numbers in the diploid range. Our data confirm preferential breakpoint clusters at 7q, 12q14-15, and 14q23-24, mainly resulting from consistent, specific chromosome rearrangements such as t(12;14)(q14-15;q23-24) and del(7)(q21) or del(7)(q22q32). Together with previously published cases, we describe trisomy 12, ring chromosomes, and monosomy 22 as new additional recurrent findings in myomas. Statistical analyses of possible coherencies between tumor karyotype (abnormal versus normal) and clinicopathologic data, as well as age of the patients, menopausal status, and tumor size showed no correlations.

Adult↗

PubMed1975

Blastomycosis of the genitourinary tract.

In a retrospective study of 51 cases of systemic North American blastomycosis 11 patients were found to have genitourinary tract involvement, the prostate and epididymis being most commonly affected. Diagnosis was made by culture of the fungus from urine, abscess or prostate secretions, morphologic identification of the characteristic organism in urine or secretions, or histologic examination of tissue specimens. Treatment with amphotericin B reduced the mortality rate of 90 per cent to as low as 10 per cent. Long-term followup is necessary because of a relapse rate of 10 to 15 per cent.

Adult↗

PubMed1977

Vasoactive intestinal polypeptide occurs in nerves of the female genitourinary tract.

The vasoactive intestinal polypeptide occurs in a richly developed population of nerves that are abundant in the female genitourinary tract. In pigs, cats, rats, and mice these nerves seem to innervate vessels and smooth musculature. Evidence indicates that vasoactive intestinal polypeptide represents a peptide neurotransmitter. Its effects on uterine blood flow and contractility, for example, may be considerable.

Animals↗

PubMed1988

Update in cancer chemotherapy: genitourinary tract cancer, Part 5: Ovarian cancer.

An update of the state of the art of cancer chemotherapeutic treatment of genitourinary tract cancer is described in this multi-part series: included are cancers of the kidney, bladder, prostate, testicle, ovary, uterus, vulva, and gestational trophoblastic neoplasms. Part 5 is a review of treatments for cancer of the ovary.Ovarian cancer is the leading cause of gynecologic cancer deaths and the fourth most frequent cause of death from cancer in women in the United States. Ovarian carcinoma is a classical "hidden" neoplasm of the abdomen and, as such, is insidious in its onset. Combination chemotherapy and cytoreductive surgery, however, have provided improved survival for patients with ovarian cancer. As dosage schedules and other refinements are made, the overall outlook for patients with ovarian cancer is promising.

Adenocarcinoma↗

PubMed1988

Update in cancer chemotherapy: genitourinary tract cancer, Part 4: Testicular cancer.

An update of the state of the art of cancer chemotherapeutic treatment of genitourinary tract cancer is described in this multi-part series: included are cancers of the kidney, bladder, prostate, testicle, ovary, uterus, vulva, and gestational trophoblastic neoplasms. Part 4 is a review of treatments for cancer of the testicles.Testicular cancer is highly curable and responds well to both surgery and chemotherapy. Patients with stage I and stage II nonseminomatous germ-cell tumors may be cured by surgery alone or in combination with chemotherapy. In patients with pathologic stage II disease, the use of adjuvant chemotherapy with two courses of platinum-based combination drugs has been successful in preventing relapse. Further refinements in management and research could banish the problem of testicular cancer.

Antineoplastic Agents↗

PubMed1992

Localized amyloidosis of the lower genitourinary tract: a clinicopathological and immunohistochemical study of nine cases.

A series of nine cases of localized amyloidosis of the lower genitourinary tract are reported. The patients comprised six males and three females with an age range of 50-79 years at initial presentation. Clinically and on cystoscopy, the lesions were often diagnosed as neoplasms. Histologically, seven cases had typical features of localized amyloid deposits, while two cases had an unusual appearance with a florid histiocytic and giant cell reaction. Using an immunoperoxidase staining method the deposits were non-reactive with antibodies to serum amyloid A protein, prealbumin and beta 2 microglobulin, while equivocal immunoreactivity was seen with anti-light chain antibodies.

Aged↗