Guy W. Leadbetter

Incipient germ cell tumor in a cryptorchid testis.

A 13‐year‐old male who had bilateral cryptorchid testes since birth underwent testicular biopsies and subsequent left orchiectomy following a diagnosis of malignant germ cell tumor. No tumor mass was noted although the malignant cells were seen within the seminiferous tubules and the interstitium. Five recorded cases of in‐situ or incipient germ cell neoplasms of the testes are reviewed; three were infertile, another had a cryptorchid testis, and the fifth was both infertile and cryptorchid. Two of these patients have developed frank carcinoma, which would suggest that the process represents an early phase of invasive germ cell neoplasia.

Staging of renal cell carcinoma: cost effectiveness of routine preoperative bone scans

The use of bone scans in the evaluation of renal cell carcinoma has become routine in many centers. In a retrospective analysis of 42 patients undergoing radical nephrectomy for renal cell carcinoma, we analyzed the cost-effectiveness of routine preoperative bone scans. Although these scans accurately predict metastatic disease to bone, they are not cost-effective as a routine preoperative tool because they do not alter outcome. In selected patients with bone pain and no other positive staging studies, preoperative bone scans may be of value in the decision to perform extirpative surgery.

Surgical Reconstruction for Complete Urinary Incontinence: A 10 To 22-year Followup

A 22-year followup study was performed on 27 children and 7 adults treated surgically for complete urinary incontinence. The etiology of the incontinence was iatrogenic, traumatic or congenital. The patients had undergone a urethral reconstruction that created a physiological sphincter by ureteral reimplantation and trigonal tubularization. Success was defined if a patient was dry with no leakage or stress urinary incontinence and partial success was noted if the patient wore 1 to 3 perineal pads per day that were moist to damp. Of 7 adults 4 (57 per cent) were dry and 2 (29 per cent) were considered a partial success, compared to 19 (70 per cent) and 1 (3 per cent), respectively, of 27 children. Postoperatively, no significant residual urine was present and the excretory urograms were normal. Failures and alternative treatments for failures are discussed.

Surgical Management of Persistent, Symptomatic Nonvenereal Sclerosing Lymphangitis of the Penis

Nonvenereal sclerosing lymphangitis of the penis is a rare condition involving the distal lymphatics of the penis. Its association with trauma has been shown. Although there is a minimal inflammatory response the etiology is unknown. Clinically, the patient notices a nontender, serpiginous nodular mass just proximal to the coronal sulcus. Most cases are self-limited and conservative management is indicated. Surgical excision is warranted for persistently symptomatic lesions.

Urolithiasis from stapler anastomosis.

The simplicity of operation and versatility and speed of automatic stapling devices in the creation of ileal loops have been amply documented. Three cases of stone formation in the ileal loop, secondary to encrustation about the staples, are reported herein, and the modification to the surgical technic which would obviate this problem is presented.

Skin Testing in Genitourinary Carcinoma: 2-Year Followup

Compound 2,4 dinitrofluorobenzene was used to sensitize 115 patients with genitourinary cancer to test their ability to be immunized with a newly encountered antigen. In general, patients in whom a cutaneous hypersensitivity response did not develop were more likely to have advanced stage tumors than patients whose immunocompetence was intact. A 2 to 3-year followup showed that patients with impaired cell-mediated immunity were more likely to undergo disease advancement than patients of similar stage whose immunity was normal. Unfortunately, these results cannot be extrapolated for application to a given patient.

Management of the Ureterotomy Incision in 100 Consecutive Ureterolithotomies

We reviewed retrospectively 100 consecutive ureterolithotomies in an attempt to determine if the choice of the ureterotomy closure significantly altered the postoperative course and morbidity rate. No dramatic difference was found when comparing ureterotomies left open, those closed loosely with interrupted sutures and those closed with continuous sutures. Parameters studied were the duration of postoperative urinary drainage, hospital stay and fever. Postoperative radiographic findings among the 3 groups are discussed.

Atypical germ cells preceding metachronous bilateral testicular tumors

This is the sixth reported case of metachronous testicular neoplasia in which a seminoma has preceded an embryonal carcinoma. Of particular note is the presence of atypical germ cells in the biopsy specimen of the gonad from which the embryonal carcinoma arose. There has developed recently an increasing awareness of germ cell atypia and carcinoma in situ. Pathologists examining testicular biopsies in the infertile patient should be alerted to this process.

Incidence of late ureteral obstruction after antireflux surgery in infants and children

Forty infants and children who underwent antireflux surgery for primary reflux had long-term follow-up with intravenous pyelograms (IVP). The IVPs were evaluated for the incidence of late ureteral obstruction. Although 4 cases (5.5 per cent) of early ureteral obstruction were noted, no instances of late ureteral obstruction were found. After antireflux surgery, patients should have a follow-up IVP within the first six months to rule out the possibility of early ureteral obstruction. The need for performing periodic IVPs for many years postoperatively, when obstruction is absent in the immediate postoperative period, is questioned.

Survival with stage D bladder carcinoma: Surgical improvement

Abstract To our knowledge we report the first three-year survivor of Stage D 2 bladder carcinoma. A patient with metastases to several lymph nodes within the pelvis and to a node near the left renal vein was treated with radical cystectomy and abdominal retroperitoneal node dissection.