Ciro Servadio

Incidental small renal tumors accompanying clinically overt renal cell carcinoma

We searched 66 kidneys with renal cell carcinoma for subcapsular or intraparenchymal small nodules in the apparently normal-appearing portion of the kidney. Differentiation between adenoma and carcinoma was done according to histological characteristics. Of the 66 kidneys 20 (30 per cent) contained a total of 58 small nodules ranging from 1 to 15 mm. in diameter. In 9 kidneys the lesions were consistent histologically with carcinoma, in 7 with adenoma and in 4 with carcinoma plus adenoma. Thus, 13 of the 66 kidneys (19.7 per cent) contained small carcinoma. In view of the high incidence of small carcinoma accompanying clinically overt renal cell carcinoma, we suggest that the indications for partial nephrectomy in the management of renal cell carcinoma should be reevaluated.

Diseases of prostate treated by local microwave hyperthermia

A new method is described for the treatment of diseases of the prostate with local hyperthermia applied transrectally by microwaves. A series of 500 treatment sessions given to 74 patients with 14 controls, is reported. Thirty patients had advanced cancer of the prostate, 37 had benign hyperplasia and were unsuitable for surgery, and 21 had chronic prostatitis. Marked objective and subjective improvement was noted in the majority in twenty-four months of follow-up.

Metachronous renal cell carcinoma metastasis to the contralateral adrenal gland

OBJECTIVES Metachronous metastasis of renal cell carcinoma to the contralateral adrenal gland is very rare. We review our experience with 5 such patients and compare it with reports in the literature. METHODS The records of all 350 patients who underwent nephrectomy for renal cell carcinoma in our center between 1975 and 1992 were reviewed. Five patients were found to have had solitary metachronous metastases to the contralateral adrenal gland on follow-up. RESULTS The adrenal metastasis was discovered 18 to 210 months (mean 66.8) after nephrectomy. In 2 patients the lesion was found incidentally on routine computed tomography scan; in the other 3 patients, diagnosis was by ultrasonography, performed because of flank pain and weight loss or routine follow-up. All patients underwent adrenalectomy. Survival ranged from 8 to 64 months (mean 36.4); 3 patients had no evidence of disease at 42, 44, and 64 months postoperatively, and 2 patients died of pulmonary metastasis at 8 and 24 months. Analysis of the clinical data of our 5 patients together with the 9 we found in the published reports revealed that the mean interval between nephrectomy and the appearance of adrenal metastasis was shorter in the patients who died. CONCLUSIONS The results of adrenalectomy for metachronous metastasis of renal cell carcinoma to the contralateral adrenal gland are unpredictable. The prognosis is somewhat better when the mean interval between the nephrectomy and the appearance of the adrenal metastasis is longer than 18 months. We recommend adrenalectomy because long-term survival is expected in some of these patients.

Further observations on the use of local hyperthermia for the treatment of diseases of the prostate in man

Hyperthermia - the sustained controlled heating of tissues to 42-43 degrees C - is being studied and used as a means of treatment, particularly to selectively destroy malignant cells. This may be achieved by heat alone, or in conjunction with other forms of treatment, such as radiotherapy or chemotherapy, thanks to a synergistic effect obtained. A new microwave apparatus has been designed and developed which permits precise, controlled and safe hyperthermic treatment of the human prostate. Following extensive laboratory and experimental studies, a first series of treatments on humans has been carried out. Initial observations on our first 192 treatments, on 32 patients, are reported.

Clinical and pathological findings in prostates following intravesical bacillus Calmette-Guerin instillations

The prostates of 36 patients who were treated with intravesical bacillus Calmette-Guerin were evaluated by digital rectal examination and transrectal ultrasonography. When abnormal palpatory and/or ultrasonographic findings were detected, core needle biopsies from the suspicious areas were performed. Of the 36 patients 20 underwent biopsies of the prostate. Pathological findings revealed typical granulomas in 8 patients (3 caseating and 5 noncaseating multifocal granulomas). Nonspecific chronic prostatitis was noted in 4 patients and benign prostatic hyperplasia was noted in 8. The number of bacillus Calmette-Guerin instillations ranged from 6 to 19. The interval from initiation of therapy to biopsy ranged from 1.5 to 14.5 months. Caseating granulomas were found during the early course of bacillus Calmette-Guerin instillations (1.5 to 3.0 months), whereas noncaseating granulomas were detected at later stages (4 to 14.5 months). These findings present a high incidence of granuloma formation in patients treated with intravesical bacillus Calmette-Guerin. The duration of therapy is a determinant factor in the induction of granuloma type.

Value of transrectal ultrasonography for diagnosis and treatment of prostatic abscess

A new diagnostic and therapeutic application of transrectal ultrasonography (TR-US) is described. TR-US demonstrated one or more well-defined hypoechogenic areas in the prostate gland of 6 patients who presented with clinical signs of urinary tract infection and had only partial response to antibiotic therapy. The presence of a collection of pus in the prostate was confirmed in 4 of 6 patients by transperineal aspiration guided by TR-US, and by prostatic massage or transurethral prostatectomy in the other 2 patients. Ultrasonography also confirmed the resolution of abscesses in 5 patients.

Is open prostatectomy really obsolete

A total of 1,066 prostatectomies treated by us from 1985 to 1989 were reviewed. The necessary comprehensive data were available on 710 cases. Open (Millins retropubic) prostatectomy (RPP) was the procedure of choice for large glands and transurethral resection (TURP) for smaller glands: 408 had had RPP and 262 TURP; 14.5 percent of the TURP group eventually needed a second procedure during a one to six-year follow-up compared with only 2.6 percent of the RPP group. Forty other patients who had been operated on elsewhere were referred to us for a second, repeat procedure; 30 also previously had had a TURP. Total hospitalization, operating time, and complications were better in the long run in the RPP group compared with the TURP group. It is believed that open prostatectomy still has a respectable place in urology and therefore, should be considered and also taught to residents for use in dealing with large glands.

Local hyperthermia for prostate cancer

Hyperthermia for treatment of cancer is known to be beneficial both in itself and in conjunction with other forms of treatment, particularly radiotherapy. We have developed a new machine for local hyperthermia (41-44 degrees C) to the prostate, by transmission of microwaves (915 MHz) via a rectal probe. Patients were treated on an outpatient basis and did not require any anesthesia or sedation. There were no complications. Good results, measured by local control, disappearance of malignancy, relief of obstructive symptoms and pain, have been obtained in a series of 44 cases. More studies with this promising new modality are in progress.

Prevention of Post-Hysterectomy Urinary Retention by Alpha-Adrenergic Blocker

Abstract. Micturition difficulties and urinary retention are common complications after abdominal or vaginal hysterectomy. Adrenergic receptors are located in the bladder neck and proximal urethra, and blocking these receptors with al‐pha‐blockers such as phenoxybenzamine (Dibenzyline) may improve micturition and prevent postoperative urinary retention. In a randomized clinical trial, 51 patients who underwent total abdominal hysterectomy, received a prophylactic dose of Dibenzyline 10 μg orally 6‐8 hours after operation and again the next day about 18 hours later. Only 2 of the 51 patients were found to have urinary retention, in comparison with 9 of 48 patients in the control group (p>0.05). Another group of patients who underwent vaginal hysterectomy were treated according to the same protocol. Eight of the 30 patients in this study group required catheterization to drain the overdistended bladder, in comparison with 16 of 26 patients in the control group (p>0.025). It seems from this clinical trial that prophylactic treatment with Dibenzyline is recommended after abdominal hysterectomy or vaginal operation in order to improve micturition and prevent urinary retention.

Changes in the sexual behavior of couples after prostatectomy. A prospective study.

Sexual behavior after prostatectomy was observed in 90 couples, with a follow-up of 3-6 years. Retropubic prostatectomy was performed on 53 patients (58.7%), transvesical prostatectomy on 12 patients (13.7%), and transurethral prostatectomy on 25 patients (27.7%). In order to have a reliable figure of the sexual behavior after surgery, all the couples underwent personal interviews separately before and 3-6 years after surgery. The interview included 4 main subjects: erection allowing sexual intercourse; antegrade ejaculation; orgasm, and libido. The separate identical double interviews were performed in order to achieve a high reliability in answer to sexual performance, this being the main unsolved question in previous studies. The results of the interviews were assessed by a computer-processing program and statistically analyzed. Our results imply that prostatectomy has an unfavorable influence on sexual activity: 33% of the potent preoperative patients became impotent after surgery.