Frank J. Leary

Influence of thiotepa and doxorubicin instillation at time of transurethral surgical treatment of bladder cancer on tumor recurrence: a prospective, randomized, double-blind, controlled trial.

The influence of the instillation of thiotepa or doxorubicin hydrochloride into the bladder at the end of transurethral surgical treatment on the recurrence of bladder cancer was evaluated. We studied in a randomized, double-blind, controlled fashion 89 patients with transitional cell epithelioma (carcinoma in situ or papillary carcinoma) whose tumors were considered to have been completely removed. Of these patients 28 (the control group) received a placebo (sterile water), 30 received thiotepa and 31 received doxorubicin. By 3 to 4 months postoperatively 71 per cent of the control group, and 30 and 32 per cent, respectively, of the patients treated with thiotepa and doxorubicin had recurrences (p less than 0.01). Additional treatment during the followup interval was ineffective in all groups. Patients studied also were classified according to grade, histological findings, multiplicity of tumors and history of bladder tumor. Treatment was most effective in reducing recurrence in patients with low grade, papillary or multiple tumors and in patients with a history of bladder cancer. No effect was observed in patients with single tumors and only modest effects were found in those with high grade tumors, carcinoma in situ or new tumors. The results support the concept that recurrences may arise from tumor cell implantation at the time of transurethral management of bladder tumors and may be reduced effectively by concomitant intravesical chemotherapy.

Pyeloscopy in Urothelial Tumors

Intraoperative pyeloscopy was performed on 18 consecutive patients with indeterminate pelvic of caliceal filling defects, subsequently proved to be transitional cell carcinomas. After nephroureterectomy local tumor recurrence in the region of the renal fossa developed in 2 patients. Intraoperative pyeloscopy entails significant risks and the seeding of transitional cell carcinoma is possible.

Transureteroureterostomy with Cutaneous: Ureterostomy: A 25-Year Experience

We reviewed 67 patients who underwent transureteroureterostomy with cutaneous ureterostomy for benign (32) and malignant (35) disease in regard to the indications for and complications of the procedure. The most common complications included urine leakage at the ureteroureterostomy, stomal stenosis and calculus formation. Renal function improved or remained stable in 75% of the patients. Transureteroureterostomy with cutaneous ureterostomy is a viable alternative diversion technique in a select group of patients.

IMMUNOLOGICAL DONOR PRETREATMENT IN COMBINATION WITH PULSATILE PRESERVATION IN CADAVERIC RENAL TRANSPLANTATION

The extended experience on the efficacy of pretreating the cadaveric renal allograft donor by means of large doses of cyclophosphamide and methylprednisolone (group A, 36 kidneys) was compared with the experience regarding untreated renal allografts (group B, 32 kidneys). Kidneys in both groups were perfused by pulsatile means using cryoprecipitated plasma. There was a significant difference in allograft survival (72% in group A versus 36% in group B at 3 years by actuarial means). Also, large doses of cyclophosphamide and methylprednisolone as pretreatment did not cause any detrimental effect to the allograft kidney when used in combination with cryoprecipitated plasma and pulsatile perfusion.

Management of hypertension of renal origin

Abstract Studies as clinically warranted were accomplished in more than 2,000 patients seen from January 1964 through December 1968 because of hypertension and suspected or proved renal disease. Data from the clinical history, physical examination, laboratory investigation and results of surgical or medical treatment are reported for 100 cases each of 5 entities—glomerulonephritis, pyelonephritis, renal cyst, renal tumor and apparent primary hypertension with renal disease. Comparison is made with data included from 100 cases of renal artery stenosis and hypertension. Female patients numbered 286, and predominated in the groups with renal artery stenosis and with pyelonephritis. Ages ranged from 6 to 81 years. Hypertension was less severe in the groups with renal tumor or cyst. Hypertensive changes of the retinal arterioles were more severe in the group with renal artery stenosis and in the group with primary hypertension, and renal function was more severely impaired with glomerulonephritis and primary hypertension. Surgical treatment was given 234 patients, 71 of whom later had normal blood pressures without medical treatment. For 366 patients medical treatment was primary; 125 of these usually maintained diastolic blood pressure of less than 90 mm Hg. Sodium restriction proved a valuable part of conservative management in most cases. Dialysis or transplantation, or both, were required for 49 patients. In the 600 cases, 507 patients are alive 2 to 13 years after initial examination, and 93 have died.

Urinary tract reconstruction in renal transplantation Mayo clinic experience and review of literature

Althrough rejection remains the most frequent cause of renal allograft failure, technical problems have contributed and continue to contribute to graft loss. Urologic complications may be caused by technical errors in the donor nephrectomy or in urinary tract reconstruction. During the past decade, however, with advances in medical and surgical management, the reported incidence of urologic complications in renal transplantation has declined steadily. This may be due to (1) more extensive donor and recipient preparation and evaluation for surgery, (2) improvement of surgical technique with increasing experience in donor and recipient, and (3) more refined diagnosis and treatment of urologic and infectious complications.

Late ureteral obstruction mimicking rejection after renal transplantation

Ureteral obstruction occurring five years or more after renal transplantation is uncommon and may mimic allograft rejection. In 2 patients who had received cadaveric renal allograft, ureteral obstruction was detected six and one-half and five and one-half years after transplantation. In both patients, surgery was needed to restore normal renal function and to prevent further renal damage. Excretory urography is important in the follow-up of patients who have undergone renal transplantation, and conditions such as ureteral obstruction should be ruled out before antirejection treatment is started.

A technical aid for vasovasostomy.

Abstract We describe a technical aid for precise placement of suture material through the lumen of the vas in vasovasostomy.

Supravesical urinary diversion in renal transplantation.

Urinary diversion may be used in patients without a bladder or with irreversible, lower urinary tract abnormalities who might not otherwise be suitable candidates for renal transplantation. Three cases have been described to illustrate three different methods of supravesical urinary diversion that have been employed in association with renal transplantation.

Nephrostomy tube replacement

11. 12. 13. 14. Same size and type of sterile catheter that the patient is wearing. Sterile cotton towel. Doubled fishline (30 cm.). Tie tapes (fabricated from e-inch and l-inch adhesive tape) approximately 8 inches in length. One end should be folded over a small reinforcing piece of x-ray film in which appropriate holes may then be punched (Fig. 1). Isopropanol 22%, butyl monoester, dimethyl phthalate (United Skin Prep*) or tincture of benzoin. Alcohol or povidone-iodine (Betadine) swabs. K-Y lubricating jelly. Sterile water-filled syringe if Foley catheter is used. Sterile irrigating syringe to fit catheter. Sterile water, saline solution, or “G” solution irrigant. Sterile forceps. Two sterile 5OO-ml. pitchers. Safety pin. Ether. Replacement of the nephrostomy tube should proceed as follows: 1. Have the patient comfortably seated or in the lateral decubital position. 2. Place the new catheter on the sterile towel adjacent to the patient (if Foley catheter, test balloon). 3. Tie fishline loosely around catheter and lubricate its tip (Fig. 2). 4. Remove the old tie tapes from the patient; clean the skin and apply United Skin Prep or tincture of benzoin. Leave the existing fishline tie on the patient’s old nephrostomy tube.