J. Tate Mason

Risk factors for urethral injuries in men with traumatic pelvic fractures

Urethral injuries are commonly associated with pelvic fractures. The prompt recognition and appropriate management of these injuries may significantly impact subsequent morbidity, yet few studies have addressed the identification of the risk factors for urethral injury in men with pelvic fractures. We reviewed retrospectively the records of 405 men with pelvic fractures seen at our medical center, including 21 (5 per cent) with urethral injuries. Of the 21 men 14 (67 per cent) had fractures involving a pubic ramus and a sacroiliac joint, and 12 (57 per cent) had no physical signs (blood at the urethral meatus, perineal hematoma or a high-riding prostate) that would suggest a urethral injury. The likelihood for the presence of physical signs is directly related to the interval since injury. We believe that men with the combination of rami fractures and sacroiliac disruption should undergo retrograde urethrograms before urethral instrumentation, and that physical signs are unreliable indications for urethral injuries, especially soon after the injury.

The Prophylactic Use–or Misuse–of Antibiotics in Transurethral Prostatectomy

One hundred non-infected patients undergoing transurethral prostatectomy were randomized prospectively into a controlled study to determine the influence of a prophylactic aminoglycoside (kanamycin) on the clinical course. In the non-risk patient prophylactic kanamycin had no beneficial influence on the incidence of bacteriuria, fever or length of hospitalization. Its use was associated with the development of a resistant Pseudomonas super infection in 1 patient. Prophylactic kanamycin did not protect the patient with carcinoma of the prostate from bacteriuria. There was no identifiable advantage in the use of routine prophylactic kanamycin in the uninfected, non-risk patient who was undergoing elective transurethral prostatectomy.

Urological Trauma in the Pacific Northwest: Etiology, Distribution, Management and Outcome

A computer-assisted review identified 184 patients with genitourinary tract injuries among 5,400 hospitalized for trauma. Particular attention was directed to the controversial groups of patients with blunt renal and posterior urethral injuries. Management of renal injuries was based on clinical criteria. Subsequent renal exploration was necessary in only 1 of 115 patients with renal contusions, or simple or deep lacerations who underwent initial expectant management. Followup was available in all patients with severe renal injuries and in 53 per cent with renal contusions or simple lacerations. Parenchymal loss was noted on an excretory urogram in only 1 patient and none suffered hypertension, hydronephrosis or other sequelae. A staged approach was preferable to immediate repair of posterior urethral injuries. Seven patients managed by initial cystostomy drainage followed by secondary urethral repairs did well. Primary realignment was complicated by stricture, incontinence or impotence in 3 of 6 patients.

Random Mucosal Biopsies in the Evaluation of Patients with Carcinoma of the Bladder

The management of patients with recurrent transitional cell carcinoma of the bladder has posed a constant dilemma to the practicing urologist. Previously, urine cytologies have been used and have been of value only in those instances in which they have been classified as diagnostic. Cytologies that reveal atypia or a high degree of suspicion have offered little help in the management of these patients. The current procedure of doing random mucosal biopsies using the cold cup biopsy forceps provides the pathologist with a sampling of the mucosa of the involved bladder so that a tissue diagnosis of sufficient magnitude, ranging from atypia to carcinoma in situ to frank carcinoma, may be established. This information may become valuable in determining alternate forms of management in these patients and may have a greater predictive value than customary urine cytology.

Amiodarone-Associated Epididymitis: Drug-Related Epididymitis in the Absence of Infection

An atypical epididymitis syndrome developed in 6 of 56 men (11 per cent) treated with amiodarone, an effective new anti-arrhythmic agent. Of the 6 patients 5 (87 per cent) had bilateral epididymal enlargement and pain. The mean dosage in the patients with epididymitis was 700 mg. per day compared to 377 mg. per day in all patients (p less than 0.01). No infectious etiology was implicated in any patient. Temporary discontinuation or decrease in dosage is recommended for patients who suffer noninfectious epididymitis while on amiodarone therapy.

Primary adenocarcinoma of bladder

Since 1959, 10 patients with primary adenocarcinoma of the bladder were treated at the Virginia Mason Medical Center for an incidence of 1.5 per cent of all bladder cancers. This retrospective study shows that histologic grade and tumor location had a variable influence on survival whereas clinical stage appeared to have a direct effect on survival. The only long-term survivors were the 4 low-stage patients who underwent radical cystectomy.

Urinary calculous disease in Southeast Asian immigrants

Recent immigrants from Southeast Asia accounted for 39 of 149 hospital admissions for treatment of urinary tract stones. Presumptive diagnosis of a urinary calculus was possible in only 19 per cent of the refugees compared with 60 per cent of other patients treated at the same hospital (p less than 0.005). Calculi in Southeast Asian immigrants were larger (p less than 0.001), and surgical procedures were required more often (p less than 0.05) than for other patients with calculi. Urinary stones should be considered a likely cause of abdominal or urinary tract complaints in recent immigrants from Southeast Asia.