Elmer Belt

Replacement of the Ureter by Small Intestine: Clinical Application and Results of the Ileal Ureter in 89 Patients

Partial or total replacement of the ureter by small intestine was performed at the University of California/Los Angeles Hospital and affiliated hospitals 94 times in 92 patients from 1954 to 1978. Indications included recurrent calculi, ureteral stricture, fistula, congenital obstruction of the ureter and ureteral carcinoma with a solitary kidney. A special use has been for undiversion of an ileal conduit. Followup evaluation was possible in 95% of the patients and ranged from 6 months to 23 years. Thirty-six patients were followed for more than 5 years. The operation was judged successful in 81% of the cases. Serum creatinine was unchanged or decreased in 75.7% and the pyelogram was unchanged or showed decreased dilatation in 84.6% of the patients. Although reflux was seen in 40 of 55 patients who had cystograms 39 (97.5%) were considered to be treated successfully. Indications for and results of the operation are discussed. The procedure is recommended as optimal therapy for carefully selected situations when the normal urinary tract cannot be used.

Carcinoma of the prostate: a study of 213 patients with stage C tumors treated by total perineal prostatectomy.

The effects of age, histological grade and clinical extension of carcinoma of the prostate are analyzed in a series of 213 patients with stage C carcinomas treated by total perineal prostatectomy. Survival data and the incidence of local recurrence, distant metastases and deaths from cancer of the prostate are the parameters used for comparison with 132 stage B patients, 70 patients with seminal vesicle invasion and data from the literature. Long-term survivors in the young age group and some long-term survivors with high grade lesions are good arguments for the possible curability of early stage C carcinoma of the prostate by total prostatectomy. Correct surgical staging of these tumors by previous pelvic lymphadenectomy is mandatory.