choroid in association with a posterior scleroid lesion 1 cm in diameter (Fig. 1). Serum prostatic specific antigen and alkaline phosphatase were markedly elevated at 74 p.g/l and 337 u/l respectively. Excision biopsy of the scleroidal nodule showed an undifferentiated adenocarcinoma which was positively stained immunocytochemically (Steffens et al., 1985) for both prostatic specific antigen and prostatic acid phosphatase, indicating a tumour of prostatic origin (Fig. 2). He was subsequently treated by a combination of radiotherapy to the left orbit and intravenous strontium micro-radiotherapy for the symptomatic bony metastases.

Comment Common sites of metastases from prostatic carcimona include the skeleton, the lymphatic system, the liver and the lungs (Samsonov, 1985). Orbital or ocular metastases (Harnett et al., 1987) are rare and scleroidal metastasis has not previously been documented. Like the cornea, the sclera is a relatively avascular part of the eye and hence bloodborne secondary deposits are uncommon. Our patient developed progression of his prostatic carcinoma despite hormone therapy and hence his prognosis is p&r. The deteriorat{on of vision was caused detachment secondary to the choroidal metastasis. The “leroid Probably originated from the vascular choroid in view of their close proximity to each other. He was treated

Fig. 2 Biopsy from the scleroid nodule ( x 250) showing an undifferentiated tumour with positive immunocytochemical staining (dark stain) for Prostatic specific antigen.

with palliative radiotherapy for his eye with the aim of preventing further deterioration of vision. Inthepresenceofothermetastases,enucleation isunnecessarily mutilating. References Harnett, P. R., Raghavan, D., Langdon, P. ef d (1987). Orbital metastasis from prostatic carcinoma. Br. J. Urol., 59, 591592. Samsonov, V. A. (1985). Metastases of prostatic cancer. Arkh. Patol., 47, 58-61. Steffens, J., Friedmann, W. and Lobeck, H. (1985). Immunohistochemical diagnosis of the metastasizing prostatic carcinoma. Eur. Urol., 11,91-94. Requests for reprints to: S. Liu, Department of Urology, King George V Block, St Bartholomew’s Hospital, West Smithfield, London EClA 7BE.

Extracorporeal Shock Wave Lithotripsy in Renal Transplant Patients M.I. WILLS and R. C. L. FENELEY, Departmentof Urology, Southmead Hospital, Bristol

Fig. 1 Ultrasound scan of the orbit showing extensive retinal detachment and tumour masses of the choroid (small arrow) and sclera (large arrow) posteriorly.

Two cases of treatment by extracorporeal shock wave lithotripsy (ESWL) with the SieInens Lithestar Lithotriptor using electromagnetic shock wave



generation and biplanar X-ray localisation are reported. Case Reports Case I. A 40-year-old lady presented with recurrent urinary tract infections in a transplanted kidney. Investigations revealed multiple renal calculi and partial obstruction. Renal function was impaired and a percutaneous nephrostomy was inserted. Four courses of ESWL, totalling 8900 shocks, were given at 18.4 kV. Clearance of fragments was prevented by a ureteric stricture revealed by a nephrostogram. At follow-up the patient remains asymptomatic with normal renal function despite retained fragments.

Case 2. A 38-year-old lady presented with rigors following recurrent urinary tract infections. IVU showed a 1 x 2 cm stone impacted in the pelviureteric junction producing hydronephrosis (Fig.). Three courses of ESWL, totalling 17,773 shocks, were given at 19.0 kV. After complete fragmentation, a subsequent IVU was normal with no residual calculus. Both patients experienced minimal discomfort during treatment and renal function returned to normal.


Calculus formation occurs in less than 1% of all transplanted kidneys (Locke et al., 1988). Predisposing factors include secondary hyperparathyroid-

ism, renal tubular acidosis, papillary necrosis, hypercalciuria, hyperoxaluria and recurrent infections. Treatment of these calculi may be by surgery, percutaneous nephrolithotomy or by ESWL (Kulb et al., 1986). The Lithostar allows treatment of calculi throughout the upper urinary tract. Using fluoroscopic imaging, accurate focusing of the shock waves is achieved by treating these patients prone. These factors enable treatment of calculi in the transplanted kidney. Lithotripsy is an effective method of treating calculi in a transplanted kidney (Ellis et al., 1989). Patients experience minimal discomfort and there is no change in renal function of the graft. However, the potential hazard of obstruction of a solitary functioning kidney (Kulb et al., 1986), together with immunosuppression, must be considered. The transplant patient represents a higher risk and requires close monitoring after ESWL. References Ellis, E., Wagner, C., Arnold, W. et al. (1989). Extracorporeal shock wave lithotripsy in a renal transplant patient. J . Urol., 141,98-99. Kulb, T. B., Lingeman, J. E., Coury, T. A. et al. (1986). Extracorporeal shockwave lithotripsy in patients with a solitary kidney. J . Urol., 136,786-788. Locke, D. R., Steinbock, G., Salomon, D. R. et al. (1988). Combination extracorporeal shockwave lithotripsy and percutaneous extraction of calculi in a renal allograft. J. Urol., 139,575-577. Requests for reprints to: M. I. Wills, Department of Urology, Southmead Hospital, Westbury-on-Trym,Bristol BSlO 5NB.

"Interstitial Ureteritis": A Rare Cause of Bilateral Hydronephrosis T. F. CHEN, A. J. MOLYNEUX and P. T. DOYLE, Departments of Urology and Histopathology, Addenbrooke S Hospital, Cambridge


The histological features of interstitial cystitis in the bladder have been well documented (HolmBentzen and Lose, 1987) but the possible changes in the rest of the urinary tract have not been described. We describe a case in which direct involvement of the ureters by the interstitial cystitis disease process resulted in bilateral hydronephrosis.

Extracorporeal shock wave lithotripsy in renal transplant patients.

BRITISH JOURNAL OF UROLOGY choroid in association with a posterior scleroid lesion 1 cm in diameter (Fig. 1). Serum prostatic specific antigen and al...
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