Carl T. Reese

Complications following prostate needle biopsy requiring hospital admission or emergency department visits – experience from 1000 consecutive cases

Study Type – Harms (cohort series)

Use of systemic therapy and factors affecting survival for patients undergoing cytoreductive nephrectomy

Study Type – Therapy (case series)
Level of Evidence 4

CAN STANDARD OPEN PEDIATRIC UROLOGICAL PROCEDURES BE PERFORMED ON AN OUTPATIENT BASIS

PURPOSE We questioned whether it is feasible in the current era of cost consciousness to perform standard open pediatric urological procedures on an outpatient basis while maintaining patient safety and satisfaction. MATERIALS AND METHODS We report on 51 consecutive patients 2 months to 13 years old (mean age 4 years 3 months) who underwent a standard open pediatric urological procedure between August 1999 and June 2000. The procedures included ureteral reimplantation in 22 cases (tapered in 2), pyeloplasty in 20, partial nephrectomy in 2, nephrectomy in 2, complete ureterocele reconstruction in 1 and other in 4. The expectation that the procedure would be performed on an outpatient basis was discussed with parents preoperatively. We excluded only cases requiring bowel for reconstruction. A caudal block was administered at the start of the procedure using 0.25% bupivacaine with 1:200,000 epinephrine at a dose of 1 cc/kg. The wound was infiltrated with 1 cc/kg. 0.25% bupivacaine and 0.5 mg./kg. ketorolac was administered at the end of the procedure. As soon as the child awakened, an age appropriate diet was started and 0.5 to 1 mg./kg. codeine with acetaminophen was given every 4 hours. RESULTS Of the 51 children 44 (86%) were discharged home the day of surgery. Average postoperative hospitalization was 7 hours. One of the 44 children discharged home required a single catheterization elsewhere. There were no other complications or repeat hospitalizations. CONCLUSIONS Our experience shows that standard open pediatric urological procedures may be performed safely and comfortably on an outpatient basis.

Significant activity of single agent vinorelbine against small-cell cancer of the bladder as second line chemotherapy: A case series and review of the literature

Small-cell carcinoma of the urinary bladder is an extremely uncommon form of urologic malignancy, accounting for less that 1% of new cases of bladder cancer. It is an aggressive malignancy which, like its pulmonary counterpart, tends to spread with distant metastases. This malignancy is generally chemotherapy and radiotherapy sensitive. Metastatic disease is typically treated with regimens active against small-cell carcinoma of the lung, such as cisplatin and etoposide. There are no data regarding second-line treatment of this cancer. We report our experience in 3 patients using the second generation vinca alkaloid, vinorelbine, in refractory metastatic small-cell carcinoma of the bladder. These 3 patients had extensive prior therapy but all 3 responded to weekly vinorelbine, with a complete response (CR) in 1, near CR in the second, and partial response in the third. Of note, the patient who sustained a CR has remained without disease and with excellent quality of life for nearly 4 years since starting vinorelbine. Indeed, the therapy was very well tolerated in all 3 patients with grade 2 cytopenia being the only toxicity. We conclude that vinorelbine is well tolerated and has activity in this case series in the second-line treatment of metastatic small-cell carcinoma of the bladder.

Durability of the Malone antegrade continence enema in pregnancy

The Malone antegrade continence enema (MACE) is a therapeutic option to treat chronic constipation and fecal incontinence in patients with neurogenic bowel. Previous reports have described the short-term success of this procedure, but no report has described the durability of the procedure during pregnancy. We present the case of a spinal cord injury patient who underwent an uncomplicated pregnancy after a MACE procedure with no stomal catheterization difficulties or leakage during or after the pregnancy.

Use of systemic therapy and factors affecting survival for patients undergoing cytoreductive nephrectomy: SYSTEMIC THERAPY AND FACTORS AFFECTING SURVIVAL AFTER CYTOREDUCTIVE NEPHRECTOMY

Study Type – Therapy (case series)
Level of Evidence 4

THE TRANSURETHRAL RESECTION SYNDROME: AN UNUSUAL COMPLICATION OF POSTERIOR URETHRAL VALVE ABLATION

A male prenatally diagnosed with posterior urethral valves and bilateral hydronephrosis was born elsewhere at 38 4⁄7 weeks of gestation. Voiding cystourethrography shortly after birth revealed posterior urethral valves with bilateral grade V reflux but no urinary extravasation. On day 1 of life creatinine was 0.8 mg./dl. (normal 0.6 to 1.1), while on day 2 preoperative serum electrolyte evaluation demonstrated sodium 141 mmol./l. (normal 135 to 145) and chloride 106 mmol./l. (normal 98 to 110). Transurethral valve ablation was performed on day 2 of life using water irrigation and a pediatric resectoscope. Operative time was 1 hour 15 minutes. A seizure occurred within 2 hours of the completion of this apparently uncomplicated procedure. Serum electrolyte evaluation at that time demonstrated sodium 113 mmol./l. and chloride 85 mmol./l. The neonate was treated intravenously with normal saline. During the next 2 days sodium slowly increased to 139 mmol./l. and creatinine to 2.8 mg./dl. Because of worsening renal function the newborn was transferred to our tertiary care facility. At presentation the abdomen was tense and scrotal swelling was evident. Abdom-

Utilization of Systemic Therapy and Factors Impacting Survival for Patients Undergoing Cytoreductive Nephrectomy

Study Type – Therapy (case series)
Level of Evidence 4