Charles C. Rife

Stage D1 prostate cancer treated by radical prostatectomy and adjuvant hormonal treatment. Evidence for favorable survival in patients with DNA diploid tumors

Background. Stage Dl disease is found in at least every sixth patient undergoing bilateral pelvic lymphadenectomy and radical retropubic prostatectomy (RRP) for clinically localized prostate cancer (PC). Previous recommendations for monotherapy using surgery, radiation, or systemic therapy alone for Stage Dl disease have usually been associated with a poor outcome in regard to progression and survival. Unlike other pathologic stages, D1 disease treated with RRP is mainly related to DNA ploidy pattern in regard to all end points (progression and survival) and immediate adjuvant hormonal treatment (AHT) rather than to the usual pathologic variables, including the number of positive nodes.

Perioperative and Postoperative Complications from Bilateral Pelvic Lymphadenectomy and Radical Retropubic Prostatectomy

The complications experienced by 692 consecutive patients who underwent bilateral pelvic lymphadenectomy and radical retropubic prostatectomy from 1978 through 1984 were analyzed. Four patients (0.6 per cent) died in the perioperative or early postoperative period. Pulmonary embolus developed in 19 patients (2.7 per cent) and severe to total urinary incontinence occurred in 34 (5 per cent). Our large series suggests that radical retropubic prostatectomy with staging bilateral pelvic lymphadenectomy can be performed in a safe manner with minimal postoperative morbidity.

Carcinoma in Situ of the Bladder

Central to the earlier detection and effective treatment of bladder cancer is the understanding of the basic principle that in situ cancer, evolving from epithelial atypia or hyperplasia, is the early phase in the development of invasive bladder cancer. While it may be asymptomatic, irritative bladder symptoms such as frequency, urgency, and dysuria irrespective of bacteriuria are usually evident and should be evaluated with exfoliative urinary cytology to detect the presence of this cancer. Properly collected and skillfully interpreted cytologic examination of the urine is probably the most accurate screening test for this and other important varieties of bladder cancer. Improved technologic features of cystoscopy have aided in the identification of in situ cancer, particularly when multiple random cold biopsy specimens of all quadrants, including the trigone, of the bladder and of the prostatic urethra are employed. Such investigative methods recognize that in situ cancer is a generalized urothelial malignancy that very often involves ureteral, prostatic as well as all bladder mucosa. Despite the pathologic observation that this cancer shows an intense cellular activity, the temporal aspect of its transition from a superficial cancer to an invasive one remains unpredictable, although clearly finite. Treatment is controversial. Radical cystectomy should effect cure if recommended early and before it becomes clinically apparent that the disease is already invasive in some urothelial locations. If the cancer appears to be localized to a relatively small (5 cm) area of the bladder and the patients symptoms are not excessive, intravesical chemotherapy using such preparations as Thio‐tepa, mitomycin, Adriamycin, or epodyl may result in a temporary, sometimes complete, remission.

Comparison of techniques for vesicourethral anastomosis: simple direct versus modified Vest traction sutures.

Radical retropubic prostatectomy has become a mainstay surgical procedure in the treatment of cancer of the prostate. There has been controversy, however, regarding the most appropriate method of vesicourethral reconstruction. We examined the records of 692 consecutive patients who underwent a radical retropubic prostatectomy from 1978 through 1984 at the Mayo Clinic. Of these, 416 patients underwent a modified Vest procedure, and in 276 patients a direct simple anastomosis was fashioned. In comparing these two methods, our review showed no substantial difference in complications, including the rate of urinary incontinence.

Urodynamic Evaluation of Patients After the Camey Operation

Ten patients were evaluated urodynamically 3 to 18 months after they underwent the Camey operation. Of these patients 2 had total diurnal and nocturnal continence, 1 was totally incontinent and 6 were incontinent to various degrees that necessitated the use of 1 to 3 pads or diapers per day. All but 2 of the Camey neobladders had cystoplasty contractions at a capacity of 50 to 200 ml. The 2 totally continent patients had no cystoplasty contractions. The bladder in the totally incontinent patient had good capacity, good compliance and low pressure contractions up to a volume of 400 ml. The condition in this patient may be attributed to sphincteric incontinence. Urinary flow is achieved by abdominal straining and is interrupted. Vesicoureteral reflux occurred in 3 of 20 renal units.

Reevaluation of vest technique of vesicourethral reconstruction in radical retropubic prostatectomy

Vesicourethral reconstruction after radical retropubic prostatectomy was done by the Vest technique in 36 patients and by direct vesicourethral anastomosis in 100 patients. Complications resulting from the two methods of vesicourethral reconstruction were similar. Incontinence after radical retropublic prostatectomy appears not to be related to the method of vesicourethral reconstruction but occurs because of damage during surgery or postoperative scarring of the distal sphincteric mechanism.

Neodymium:YAG Laser Treatment of Cystitis Glandularis

We report a case of severe cystitis glandularis of the entire bladder, which caused a large retrovesical mass and bilateral hydronephrosis. Treatment included whole bladder neodymium:YAG laser therapy, a technique not previously reported for this extent of disease. The etiology, diagnosis, treatment and malignant potential of cystitis glandularis are discussed.

Bladder carcinoma presenting with rectal obstruction

Two patients with bladder carcinoma that caused annular constriction of the rectum are described. A mechanism of local invasion by genitourinary malignancies (bladder and prostate) involves penetration of the rectovesical fascia of Denonvillier and circumferential rectal spread. Treatment of complete or partial obstructing lesions includes surgery, radiotherapy, or chemotherapy (or combination), as well as several new techniques, notably laser destruction and transrectal tumor resection.

PROLACTIN - ADDED DIMENSION IN MALE GENITOSEXUAL DISORDERS

Prolactin-producing pituitary adenomas known to cause amenorrhea and galactorrhea in the female have been implicated recently in male infertility and impotence. Knowledge of the pathophysiology of prolactin and of the choices of treatment for these tumors is an important adjunct to the urologists armamentarium.