John N. Wettlaufer

The Role of Repeat Transurethral Biopsy in Stage a Carcinoma of the Prostate

There is a significant difference in survival of patients, with stages A1 and A2 prostatic adenocarcinoma. Therefore, it is important to distinguish focal occult adenocarcinoma from diffuse occult adenocarcinoma. However, that may be impossible from a single transurethral resection of the prostate. This study was designed to determine if repeat transurethral biopsy would be helpful in defining the extent of stage A disease. Between January 1970 and January 1976, 27 of 6) patients with stage A adenocarcinoma of the prostate were selected for repeat transurethral biopsy of the prostate 3 months after the initial diagnosis. All 27 patients had a focus or focal adenocarcinoma of the prostate at the initial resection. Seven patients (26 per cent) were found to have significant residual tumor at repeat resection and were reclassified as stage A2. Three patients were found to, have a single focus of adenocarcinoma on repeat biopsy. Thus, 37 per cent of the study group of patients had residual carcinoma after initial diagnosis by transurethral resection. Repeat transurethral biopsy is helpful in defining the extent of stage A disease and formulating a rational plan of therapy.

Ectopic ACTH production in disseminated prostatic adenocarcinoma

The second fully documented case of ACTH-producing prostatic adenocarcinoma with elevated plasma and tissue levels of ACTH is presented. The distinguishing characteristics of ACTH-producing extrapituitary neoplasms and the various modes of therapy are discussed.

Suprapubic Endoscopic Vesical Neck Suspension

Experience with 20 endoscopic vesical neck suspensions (Stamey procedure) is compared to 20 matched anterior cystourethropexies (Marshall-Marchetti-Krantz procedure) performed by the same staff. The present procedure is a transvaginal vesical neck suspension, described in 1959 by Pereyra, modified in 1973 by Stamey and further modified in 1975 by Mason. The long-term success rate for relief of urinary stress incontinence was 90 per cent with either procedure. Advantages and disadvantages of the endoscopic vesical neck suspension are discussed.

Granulocytic Sarcoma Presenting as a Diffuse Renal Mass before Hematological Manifestations of Acute Myelogenous Leukemia

Granulocytic sarcoma is a rare tumor composed of granulocytic precursor cells. The most common sites of involvement include the bones, soft tissue, lymph nodes and skin. Granulocytic sarcoma usually develops as a delayed manifestation of the disease process in patients with known acute myelogenous leukemia. To our knowledge we report the first case of renal granulocytic sarcoma presenting as the first sign of acute myelogenous leukemia. Computerized tomography and magnetic resonance imaging revealed diffuse nonspecific global tumor infiltration of the kidney and ureter. Renal granulocytic sarcoma was diagnosed on open renal biopsy and acute myelogenous leukemia on bone marrow biopsy. There has been partial response to combination chemotherapy. Renal granulocytic sarcoma may diffusely involve the kidney as the only manifestation of acute myelogenous leukemia and it should be included in the differential diagnosis of the many disease entities with global renal involvement since initial treatment is combination chemotherapy.

The management of post-prostatectomy vesical neck contracture.

Current evidence suggests that the small fibrous hyperplastic intraurethral prostate traumatized by wide extensive electroresection is the most important etiologic factor in post-prostatectomy vesical neck contracture. The preferred mode of management has not been well defined. Although transurethral resection is most often used recurrent contractures occur frequently. We report the complete objective and symptomatic relief of obstruction in 8 patients with post-prostatectomy bladder neck contracture treated with cold knife incision. This simple technique appears to obviate recurrent contracture and may well be the treatment of choice for this condition.

Stage III Germinal Testis Tumors: Aggressive Approach

We used aggressive individualized combinations of operation and cyclic actinomycin D therapy and/or irradiation for 12 patients with stage III germinal testis tumors, including 1 seminoma. Eight patients have survived free of tumor for 24 to 83 months. All but 1 survivor had retroperitoneal lymphadenectomy. Five thoracotomies and 4 neck resections were used to manage distant metastic lesions. Cyclic actinomycin D was used in 7 of 8 survivors. The experience with this series and a review of cases in the literature strongly suggest the need to eradicate the most common source of tumor seeding the distant metastatic sites from the retroperitoneal lymphatics. Eradication can best be accomplished by retroperitoneal lymphadenectomy and is indicated even in patients with a complete response to chemotherapy. A general treatment plan is suggested for stage III testis tumors: selective irradiation and chemotherapy for seminoma and an aggressive individualized combination of operation and chemotherapy with irradiation in some instances for non-seminomatous disease.

Surgically Documented Segmental Medullary Sponge Kidney: Case Report

AbstractA case of histologically documented segmental medullary sponge kidney cured by segmental nephrectomy is reported.

Thoracotomy in Re-Staging Germinal Testis Tumors

In 3 patients undergoing therapy for germinal testis tumors (teratoma with choriocarcinoma, seminoma and teratocarcinoma) solitary pulmonary lesions developed consistent with metastatic tumor. After non-diagnostic medical pulmonary evaluation thoracotomy established benign lesions in each (sarcoidosis, Cryptococcus and postoperative inflammatory cyst). Surgical pathologic restaging to obviate the institution of unnecessary chemotherapy and/or radiation with its attended morbidity in such instances is stressed.

Prevalence of Circulating HL-A Lymphocytotoxic Antibodies in Men After Vasectomy*

Thirty-two men undergoing vasectomy were studied for one year to determine presence of HL-A antibodies after surgery. Blood samples were taken prior to vasectomy and at three, six, nine, and 12 months following surgery. Twenty-six men showed no increase in antibody activity during the study when their sera were matched against a 25-member typed lymphocyte donor panel. Sera of two men showed a definite increase in positive reactions, six to 12 months after surgery. The sera of four men showed slight increases in reactivity between three and 12 months after vasectomy. The serum of one man showed a single positive reaction against his own lymphocytes three months after surgery, but no positive reactivity against the lymphocyte donor panel. These studies suggest that HL-A antibodies are not regularly formed as a result of standard vasectomy procedures, but that further long-term evaluation of vasectomized patients may be needed to make definite conclusions.

Cutaneous chordee Fact or fancy

Abstract That cutaneous chordee is the most common cause of the ventral curvature in distal penile hypospadias and in many instances of chordee without hypospadias is not common knowledge. Recognition of this fact allows for single-stage repair. Excellent results employing the Allen-Spence technique and its variants are detailed in 15 patients.