Bernard Fallon

Comparison of transurethral resection to radical therapies for stage B bladder tumors

We evaluated the survival rate and time to recurrence for 114 patients in whom an initial histological diagnosis of stage B1 or B2 bladder tumor was made between 1974 and 1983. The 5-year survival rates for stages B1 and B2 disease, respectively, were 63 and 38 per cent in 43 patients treated by transurethral resection alone, 48 and 54 per cent in 40 treated by preoperative radiation and radical cystectomy, 33 and 25 per cent in 15 treated by radical cystectomy alone, and 53 and 11 per cent in 16 treated by definitive radiation therapy alone. Similar results were found among the groups with regard to time to development of metastases. The distribution of stage, grade and number of tumors was not significantly different among the treatment groups. Patients in the transurethral resection group were older, and had smaller tumors and more medical problems. Comparing transurethral resection of muscle invasive bladder tumors to standard radical surgery with or without radiotherapy yielded comparable long-term survival and time to distant recurrence.

A Comparison Between Lymphangiography and Pelvic Node Dissection in the Staging of Prostatic Cancer

On 40 consecutive patients with prostatic cancer who had pedal lymphangiography during the initial evaluation and, subsequently, underwent pelvic node dissection or biopsy, a surprisingly high number had falsely positive (59 per cent) or negative (36 per cent) x-ray findings. Initially the tumors were considered clinically to be stage B in 24 cases, stage C in 13 and stage D in 3. After lymph node dissection only 17 tumors were still considered to be stage B and 7 were stage C, while 16 tumors were actually stage D. This surgical staging is important for the further management of the patient as well as the prognosis, Pedal lymphangiogrpahy alone is unreliable for accurate assessment of the regional lymph node status in clinically localized prostatic cancer.

Incidence of surgical margin involvement in various forms of radical prostatectomy

The pathologic specimens of 64 patients who underwent radical prostatectomy for clinical Stage A or B carcinoma of the prostate were reviewed retrospectively for surgical margin involvement with cancer. Fourteen of the operations were performed by the radical transperineal method, 30 by the standard radical retropubic approach, and 20 by the nerve-sparing radical retropubic technique. Seventy-eight percent of the radical transperineal group had resection margin involvement, as opposed to 30 percent of the standard radical retropubic cases, and 45 percent of the nerve-sparing radical retropubic cases. The average tumor burden of the transperineal group was larger than that of the other two groups. Resection margin involvement in all groups was associated with a higher Gleason histologic score. No significant difference was noted between the two retropubic groups in terms of resection margin involvement (P = 0.28), suggesting that nerve-sparing radical retropubic prostatectomy does not compromise the surgical goal of radical prostatectomy for carcinoma over that of the standard radical retropubic prostatectomy.

Congenital Anomalies Associated with Cryptorchidism

We reviewed 334 patients with cryptorchidism treated at our institution during a 13-year period. Other congenital anomalies were apparent on physical examination in 102 cases and these were more common in patients with bilateral cryptorchidism. Of the 205 excretory urograms done 25 showed abnormalities and, again, these abnormalities were noted more commonly in patients with bilateral cryptorchidism. Of 232 patients with asymptomatic cryptorchidism, that is with no other congenital findings on physical examination, 141 had an excretory urogram and 4 revealed some abnormality, 2 of these warranting surgical intervention. Of the 334 patients 16 had hypospadias and 50 were mentally retarded. The literature is reviewed. It is concluded that an excretory urogram is not justified on a routine basis in patients with asymptomatic cryptorchidism.

Restoration of fertility by vasovasostomy.

Vasovasostomy was performed on 41 patients. The surgical technique is described and the results are presented. The success rate was 83 per cent for pregnancy. Reasons for failure and suggestions for improvement in results are discussed.

Locally recurrent hypernephroma treated by radiation therapy and embolization a report of two cases

Two patients who underwent radical nephrectomy for renal cell carcinoma developed local recurrence with lumbar vertebral involvement and intractable pain. Both patients were treated with a combination of radiation therapy and selective lumbar vertebral artery embolization with complete resolution of pain and no evidence of recurrence of disease after 3 years.

Urinary cytology and bladder biopsy in patients with bladder cancer

Two hundred fifty patients with bladder tumor were evaluated over a three-year period. Cystoscopy, cytology, and random bladder and tumor biopsy were part of the workup. The follow-up of these patients resulted in a total of 509 cystoscopies, 772 specimens of bladder washings and urinary cytologies, and 503 tumor or selected mucosal biopsies. The value of cytologic study of bladder washings and cystoscopic urine samples as well as the importance of selected site mucosal biopsies in detecting field changes in the bladder epithelium associated with bladder tumors are discussed.

Metastatic cervical carcinoma masquerading as bilateral renal abscesses

A case is presented of a thirty-seven-year-old woman with bilateral renal masses interpreted as abscesses on computerized tomography (CT) scan. Subsequent renal exploration revealed metastatic cervical carcinoma, which is a relatively rare entity.

Non-Specific Granulomatous Ureteritis

AbstractThe sixteenth case of non-specific granulomatous ureteritis is reported. Clinical course, pathology and treatment are discussed and the literature is reviewed.

Experience with the Jonas Penile Prosthesis

Between April 1981 and June 1983 the Jonas penile prosthesis was inserted in 57 patients. There were 10 early complications (17.5 per cent), with 8 operations for revision or removal (14 per cent). Late complications were rare and the over-all success rate was 96 per cent.