John A. Vaccaro

Suprarenal Occurrence of an Adenomatoid Tumor

Adenomatoid tumors are rare, benign mesotheliomas that usually are associated with genito-urinary tract. The suprarenal occurrence of this tumor is uncommon. We present such a case and review the origin of the adenomatoid tumor.

Prostatic Abscess: Computerized Tomography Scanning as an Aid to Diagnosis and Treatment

In the antibiotic era prostatic abscesses are rare and the clinical picture often can be confusing. In 2 recent cases computerized tomography scanning not only proved the diagnosis easily but it also simplified greatly the definitive surgical procedure.

Traumatic Hematocele: Association with Rupture of the Testicle

Ten patients with hematoceles associated with blunt trauma have been seen during the last 4 years. In 80 per cent of the cases the hematocele was caused by rupture of the testicle. Prompt early exploration, adequate débridement, primary repair of the tunical laceration and Penrose drainage resulted in a salvage rate of 75 per cent.

Renal leiomyosarcoma: plea for aggressive therapy.

We report a case of renal leiomyosarcoma arising from the renal pelvis with immunohistochemical confirmation of the diagnosis. Treatment was extirpative surgery for both primary and metastatic lung lesions as well as adjunctive radiation and chemotherapy. This patient remains disease-free twelve months following treatment.

Eosinophilic Ureteritis Associated with Eosinophilic Cholangitis: A Case Report

Eosinophilic infiltrate of the urinary tract is rare. We report on a patient with eosinophilic cholangitis who later had eosinophilic ureteritis. This case emphasizes the potential serious nature of eosinophilic ureteritis, which often presents with complete ureteral obstruction. The literature pertaining to eosinophilic ureteritis and eosinophilic biliary disease is reviewed.

Seminal Vesicle Abscess: The Use of Computerized Coaxial Tomography for Diagnosis and Therapy

Seminal vesicle abscesses are extremely rare and worthy of report. Computerized tomography easily verifies the diagnosis and simplifies the treatment of transurethral incision and drainage.

Determination of indwelling ureteral stent patency. Comparison of standard contrast and nuclear cystography, and lasix renography

OBJECTIVE Because of the difficulty in determining patency of Double-J ureteral catheters, a study was devised at Madigan Army Medical Center to determine the best method to demonstrate stented ureteral patency. METHODS Forty-two patients requiring Double-J ureteral stenting for various clinical reasons were the study group. Outpatients underwent contrast retrograde cystography, nuclear cystography, and diuretic renography every four to six weeks during the stent duration or just prior to stent removal if the stents were indwelling for less than four weeks. In addition, four weeks after stent removal diuretic renography alone was done to evaluate for possible delayed obstructive effect of the ureteral stenting. RESULTS A total of 53 stents and 42 patients were evaluated. Seventy-seven sets of studies were obtained. In only four instances did all three imaging methods agree on the obstruction. In the remaining 73 sets of data, at least one imaging technique indicated stented ureteral patency. The contrast retrograde cystogram was positive for reflux 52 times (71%). Nuclear cystography showed patency 54 times (74%) and an unobstructed diuretic renogram was obtained 59 times (81%). In addition, five of the six diuretic renograms accomplished with patients in the supine position only and which showed obstruction were repeated with patients in the upright position, and they showed unobstructed function. The overall sensitivity for diuretic renography was 89 percent when the diuretic renogram was done with patients in the supine and upright positions. CONCLUSIONS Diuretic renography is the most sensitive test for detecting stented ureteral patency. This test needs to be performed with patients in both the supine and upright positions.

Digitally directed transrectal biopsyusing biopty gun versus transrectal needle aspiration: Comparison of diagnostic yield and comfort

A technique for digitally-directed core biopsy using the Biopty device and prospective comparison of accuracy and comfort, using this technique simultaneously with transrectal needle aspiration, are presented. To better estimate the true prevalence of carcinoma in the study population, a repeat combined procedure was performed on all subjects who did not have carcinoma confirmed on the initial core biopsies. All procedures were done by one investigator and all pathology reviewed by one senior pathologist. A total of 180 combined procedures were performed on 100 consecutive patients with palpably abnormal prostates; 30 carcinomas were detected. Digitally-directed Biopty biopsy yielded a sensitivity rate of 87 percent compared with 57 percent for needle aspiration (p less than 0.05). Using a numerical comfort scale, the Biopty device was also rated less painful than needle aspiration (p = 0.0001). The morbidity of the combined procedure was minimal, with a minor complication rate of 2.2 percent. No infections occurred.

Prostate-specific antigen and digital rectal examination in long-term follow-up of stage A1 prosttic carcinoma

Abstract Twenty-six individuals with Stage A 1 carcinoma of the prostate (≤5 %, Gleason score ≤4) diagnosed from 1969 to 1980 were evaluated with digital rectal examination (DRE) and prostate-specific antigen (PSA). This unique cohort, sixty-one to eight-two years of age (median 72 years), had a mean interval from diagnosis of thirteen years (median 12.5 years). Abnormal findings on DRE were found in 6 individuals, whereas only one elevated PSA was detected. Ninety-six percent of the PSA levels were less than 3.0 ng/mL and nearly 60 percent of the group had 1.0 ng/mL or less. These levels compare favorably with healthy control subjects under forty years of age and with the limited data available for PSA in healthy men over seventy years of age (87% and 26%, respectively). While biopsy showed persistent or recurrent carcinoma in 2 of 5 individuals, further evaluation disclosed only localized disease. Though the PSA provided little additional information to DRE in the individual patient, it appears from an overview of this group that a low level of PSA in Stage A 1 prostatic carcinoma may be associated with long-term survival.

Replacement of Nephrostomy Tube using Ureteroscopes

Replacement of a percutaneous nephrostomy tube can be a difficult task. The often time-consuming procedure involves replacement of a guide wire blindly or under fluoroscopic control, or by using ultrasound after decompression of hydronephrosis. A rigid 8.5F ureteroscope was used successfully to replace nephrostomy tubes in 3 patients with obstructive uropathy secondary to prostate carcinoma and in 1 with an ileoureteral anastomotic leak following radical cystectomy.