David A. Culp

Carcinoma of the penis. Analysis of 219 cases

Carcinoma of the penis is rare in this country. A total of 219 patients diagnosed to have carcinoma of the penis were analyzed retrospectively. The primary penile lesion was treated by partial amputation in 160 patients. Forty‐two patients had inguinal node dissection. Forty‐six patients received radiation therapy to the inguinal region. Sixty‐five per cent of the patients with no palpable nodes at initial diagnosis survived for six or more years. Twenty‐eight per cent of the patients with palpable nodes survived for three to five years, and 15% for six or more years. Ten per cent of the patients died of a second primary tumor.

Morbidity from pelvic lymphadenectomy in staging carcinoma of the prostate.

A retrospective review of 150 patients with adenocarcinoma of the prostate was done to determine the morbidity associated with lymphadenectomy performed as an independent procedure. A total of 77 complications, 17 of which were considered major, was noted in 50 patients. Wound drainage and transection of the spermatic cord were associated with increased morbidity. Systemic antibiotic therapy afforded no protection against wound infections, while intraoperative irrigation was protective. Lymphoceles and lower extremity edema occurred infrequently in our series, although only a few patients underwent postoperative pelvic irradiation therapy.

Bladder Cancer: Factors Affecting Survival

The identification of factors present at the time of initial evaluation may be important to predict the prognosis in patients with bladder tumor. Attempts were made to identify predictive factors of recurrence involving comparisons based on the 12-month recurrence rate and time to recurrence in a prospective clinical investigation of 468 patients with bladder tumor observed during a 5-year interval. In newly diagnosed bladder cancer patients stage, grade and size of the largest tumor at initial evaluation were significant factors affecting survival, and these factors acted independently. Age and stage were significant factors in patients with a history of bladder tumor. We herein estimated survival curves using the product-limit estimate. Comparisons of survival curves and analyses involving more than 1 potential prognostic factor were accomplished using Coxs proportional hazards model.

Factors Influencing the Recurrence Rate of Bladder Cancer

A prospective analysis was done on 318 patients with bladder cancer observed during a 4-year period. We examined the predictive value for tumor recurrence of the initial grade, stage, number and size of bladder tumors. None of the observed parameters alone or in combination could predict tumor recurrence. Cystoscopy and cytology, as well as random bladder and tumor biopsies, were part of the diagnostic studies.

Urogenital Involvement by Malignant Lymphomas

Records of 1,068 patients with malignant lymphomas were reviewed from a more than 10-year interval for any evidence of lymphomatous involvement of the urogenital tract. Of the 1,068 patients 72 (6.7 per cent) had urologic findings related to lymphoma either at autopsy, radiographically or at operation. Of 400 cases 23 (5.8 per cent) with Hodgkins and 49 of 668 cases (7.3 per cent) with non-Hodgkins lymphoma had some evidence of urogenital involvement at some point in the course of the disease. In the total group reviewed the rate of involvement was low (6.7 per cent) and was essentially equal for patients with Hodgkins and non-Hodgkins lymphomas. We herein illustrate various forms of urogenital tract problems encountered in patients with solid lymphatic tumors.

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.

Primary adenocarcinoma of the bladder: a retrospective study of 20 patients.

A retrospective analysis is presented of 20 patients with primary adenocarcinoma of the bladder treated with non-radical procedures. The survival rate has averaged less than 1 year, regardless of the mode of therapy, with only 1 patient alive 2 years after segmental cystectomy. The male-to-female ratio of patients was only 2 to 1. All patients had deeply infiltrating tumor at the time of initial diagnosis. Chemotherapy in conjunction with irradiation therapy used in the treatment of 1 of the patients proved to be ineffective.

Nephrogenic Adenoma: A Report of 9 Cases and Review of the Literature

AbstractNephrogenic adenoma is a rarely reported tumor. With the increasing awareness of this specific pathological entity, its clinical importance cannot be overlooked.

Analysis of bladder tumor recurrence in 178 patients

The identification of bladder tumor characteristics which may affect tumor recurrence has been of interest to the clinician for a long time. Previous attempts to identify predictive factors of recurrence involved comparisons based on the twelve-month recurrence rate in a prospective clinical investigation of bladder tumor patients observed over a five-year period. A statistical regression model known as the proportional hazards model was employed to identify these factors using the disease-free interval as the outcome variable. Prior bladder cancer history, age at admission, initial tumor stage, grade, number, size, shape, and site were examined. The results confirm that a patients prior history of bladder cancer must be considered in evaluating his likelihood of tumor recurrence. The analysis then focuses on patients with no prior history for predictive factors of recurrence.

Sarcoma of the bladder and prostate.

A retrospective analysis of 30 patients with primary sarcoma of the bladder and prostate is presented. Prognosis seems to be better in adults irrespective of the type of treatment. The survival rate is poor for children with sarcoma of the prostate. Two children were cured of sarcoma of the bladder by a radical operation. Sarcomas of the bladder and prostate are more common in adults more than 50 years old. The type of treatment and the results are reviewed. The place of multimodal treatment in the management of these sarcomas is discussed.