James H. DeWeerd

Renal Cell Carcinoma: Long-Term Survival and Late Recurrence

In a series of 506 patients with renal cell carcinoma survival was analyzed in terms of pathologic stage, histologic grade, and a combination of stage and grade. Data reveal that stage, grade and the combination are important prognostic indicators. Invasion of the renal pelvis is not an important factor in staging the disease. Women had a better survival rate than men. The prognosis for patients with dark cell tumors was no worse than that for patients with clear cell tumors when correlated with the more important factors of tumor stage and grade. Renal vein involvement alone, excluding concomitant capsular or nodal involvement, had an adverse effect on survival. Of the patients who survived 10 years from the date of nephrectomy 11 per cent had late recurrence.

Primary Realignment of Posterior Urethral Injuries

The records of 34 patients with posterior urethral disruptions secondary to blunt pelvic trauma who were treated with primary realignment were reviewed. Among the 29 evaluable patients there was a 38 per cent incidence of stricture (11 of 29), a 3 per cent incidence of incontinence (1 of 29) and a 15 per cent incidence of impotence (4 of 27). Primary realignment has a low morbidity and an acceptable rate of incontinence, impotence and stricture formation, and is recommended in the treatment of posterior urethral injuries.

Lipomatous retroperitoneal tumors.

Abstract The medical literature on primary lipomatous retroperitoneal tumors has been reviewed. Included are the highlights of the case reports of historical interest, a summary of published opinions and observations as to origin, etiology, symptoms, physical findings, diagnostic maneuvers and procedures, treatment and pathologic characteristics, and a presentation of such statistical information as seemed applicable. Information recorded in the clinical records and the diagnoses made on multiple microscopic sections from gross pathologic specimens were assembled in each of forty-three cases of retroperitoneal lipomatous tumor treated at the Mayo Clinic. Each of these cases fulfilled certain criteria including completeness of history, physical examination, laboratory studies, surgical exploration and availability of preserved pathologic specimens. Follow-up information was available in forty-two of the forty-three cases. On the basis of our study the following general statements regarding retroperitoneal lipomatous tumors may be made: 1. 1. They may reach astounding size. 2. 2. They usually cause few disturbing or alarming symptoms. 3. 3. A urographie survey is the greatest single aid to accurate diagnosis. 4. 4. The treatment of choice is surgical extirpation. 5. 5. Two of three of these tumors are malignant. 6. 6. Seventy per cent of those removed surgically gave suggestive clinical evidence or pathologic proof of recurrence. 7. 7. Sixty per cent of those removed surgically were followed by death of the patient within five years, in most if not in all instances as a result of recurrence. 8. 8. Of nine patients who survived surgical removal of benign neoplasms six are known to have survived beyond a ten-year period; one of the remaining three is known to have been alive and well nine years after operation; two died within ten years after operation.

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.

Regression of Renal Cell Hepatic Metastasis Following Removal of Primary Lesions

Although spontaneous regression of metastatic renal cell carcinoma occurs it is so uncommon that it should not be considered the primary basis for recommending removal of the asymptomatic primary lesion. Such a recommendation should be made when other treatment modalitis are available to augment the factors influencing the patient-tumor interface. Spontaneous regression of a documented solitary liver metastatic lesion is reported. Removal of the residual hepatic lesion failed to prolong the patients life.

Cystectomy after radiotherapeutic ablation of invasive transitional cell cancer.

Of 282 patients with invasive bladder carcinoma treated by a combined protocol of preoperative irradiation and total or partial cystectomy 84 had no residual carcinoma in the surgical specimens. Of these 84 patients who have been at risk for 12 to 149 months 59 (70 per cent) are alive.

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.

Invasive bladder carcinoma managed by irradiation and surgery

Four hundred forty-four patients with invasive vesical carcinoma were entered in a nonrandomized treatment program of preoperative irradiation and surgical extirpation of the primary lesion. Fifteen of the patients did not undergo surgery, and an additional 13 were found at operation to have an inoperable lesion. Thus, 416 patients, at risk for more than two years, were available for statistical study. Pathologic findings constitute the basis for the calculation of crude survival rates. Five-year survival for 107 patients without residual carcinoma was 66 per cent, approximating the 71 per cent for the 160 patients with low-stage carcinoma. By contrast, 149 patients with high-stage carcinoma had a five-year survival of 31 per cent. The need for a yet undefined adjuvant modality is evident.

Renal autotransplantation for upper ureteral stenosis.

In 2 cases of irreparable upper ureteral damage autotransplantation of the kidney with pelvioureteral anastomosis proved to be a satisfactory alternative to nephrostomy drainage or nephrectomy.

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.