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Background: The aim of the present study was to assess the possible etiologic role of human papillomaviruses (HPV) in bladder tumors. Methods: Forty-two fresh biopsy specimens from different grades and stages of bladder tumor cases and 10 normal bladder mucosa biopsies were studied. Specimens were analyzed by polymerase chain reaction (PCR) with HPV-specific general primer set for the detection of viral DNA. Polymerase chain reaction-positive samples were also tested with HPV 16-and 18-specific primers by the same method. Results: We found two samples (4.8%) containing HPV DNA among the TaG1 bladder tumors. All other specimens, including the control group, were found to be negative by PCR. Neither of the two HPV-positive patients had immune deficiency and/or genital warts. Human papillomavirus 16 was detected by type-specific primers in one sample, but the other HPV-positive sample could not be typed. Conclusions:The low prevalence of HPV in this and many previous studies does not support an etiologic role of HPV in bladder carcinogenesis. We detected the virus in two early stage tumors, but none was detected in the high-grade samples. However, to clarify the positivity of HPV in these occasional cases, future studies must be designed by using in situ PCR techniques, including samples from tumors and normal bladder mucosa from the same patient.

Objective To describe the incidence, clinical characteristics, treatment methods and long‐term follow‐up of bilateral germ cell tumours of the testis (GCTT) in patients treated at one institution. Patients and methods Of 552 patients with GCTT, 11 (2%, mean age 26.9 years) developed bilateral disease; all 11 underwent radical orchidectomy. Additional treatment was planned according to the histological type and clinical stage of the tumour, and previous treatments. Intramuscular testosterone was administered periodically after total castration. The data on survival, sexual status and treatment complications were reviewed. Results Of the 11 patients, seven developed a second tumour metachronously (median interval 87 months) and four had synchronous bilateral GCTT. Cryptorchidism, infertility or atrophic testis was associated with the development of bilateral GCTT in seven of the 11 patients. All synchronous tumours and most of the sequential tumours had identical histology on both sides. Although all sequential tumours presented at an early clinical stage, three of four synchronous bilateral GCTTs presented at an advanced stage. Five patients received platinum‐based chemotherapy; three patients underwent post‐ chemotherapy resection of the retroperitoneal residual mass. Sexual libido and potency were conserved in all patients. No significant morbidity was recorded as being caused by any of these treatments. At a median follow‐up of 11.6 years, all patients were alive with no evidence of cancer. Conclusions All patients with unilateral GCTT have an increased risk of developing a contralateral testicular tumour, even decades after diagnosis. Management should be adapted to each patient. As all patients in this series survived in the long‐term, developing a second germ cell cancer does not necessarily predict a poor prognosis.

Objective To review our experience of patients with patients with advanced thoracic disease was 32% (11/34). Four patients with brain metastases at presenbrain metastases from nonseminomatous germ cell tumours (NSGCTs) and to indicate important clinical tation were alive after 3, 12, 34 and 47 months. The only patient with isolated brain relapse died within observations. Patients and methods Between 1990 and 1996, 167 7 months, despite combined treatment. Two of the five patients who developed brain metastases during patients with metastatic NSGCT were treated in our department; 11 had brain metastases (eight with the course of the disease are alive with no evidence of disease at 3 and 6 months after salvage chemotherapy. solitary metastases and three with multiple lesions, mean age 27 years, range 18-41). These patients Conclusion Patients with single brain metastasis seem to have a better prognosis in the present than in other were treated initially with either; cisplatin, bleomycin, etoposide and/or cisplatin, vincristin, methotrexate, reported series. Chemotherapy was used initially, followed by surgery and radiotherapy in those who did bleomycin, actinomycin-D, cyclophosphamide, etoposide and intrathecal methotrexate chemotherapy pronot achieve complete remission with chemotherapy.Patients with progressive disease and multiple brain tocols. Six patients received chemotherapy alone, one had chemotherapy plus radiotherapy and four had all metastasis do not seem to benefit from initial surgical resection. Importantly, a significant proportion (32%) three treatments. Patients with brain metastases were classified according to mode of presentation, and their of patients with bulky lung metastases had or subsequently developed brain metastases. Thus it is sugtreatments and outcomes analysed. Results Ten patients presented with symptoms related gested that routine cranial imaging should be performed in patients with bulky thoracic disease. to intracranial lesions, e.g. intractable headache, seizures, severe vomiting, hallucinations and hemiparesis.

Background: Vesico-ureteral reflux (VUR) is considered to be a risk factor for recurrent febrile urinary tract infections and impaired renal transplant survival. Methods: An online survey supported by the European Society for PaediatricNephrology was designed to evaluate current management strategies of VUR in native and transplanted kidneys of recipients aged <18 years.Results: Seventy-three pediatric transplant centers from 32 countries contributed to the survey. All centers performed urological evaluation prior to pediatric kidney transplantation (KTx) with subsequent interdisciplinary discussion. Screening for VUR in native kidneys (30% in all, 70% in selected patients) led to surgical intervention in 78% (11% in all, 89% in selected patients) with a decided preference of endoscopic intervention over ureterocystoneostomy. Following KTx, continuous antibiotic prophylaxis was applied in 65% of the patients and screening for allograft VUR performed in 93% of selected patients. The main management strategies of symptomatic allograft VUR were continuous antibiotic prophylaxis (83%) and surgical treatment (74%) (endoscopic intervention 55%, redo ureterocystoneostomy 26%).Conclusions: This survey demonstrates the high variability in the management of VUR in pediatric KTx recipients, points to knowledge gaps, and might serve as a starting point for improving the care for patients with VUR in native and transplanted kidneys.