John R. Canning

The Impact of Current Staging Procedures in Assessing Disease Extent of Prostatic Adenocarcinoma

We studied 454 patients with prostatic adenocarcinoma who were assigned a preliminary clinical stage on the basis of serum acid phosphatase, routine bone survey and physical examination. Subsequently, they were assigned a final clinical stage after radioisotopic bone scanning, lymphangiography and staging pelvic lymph node dissection. Only 53, 54, 57 and 26 per cent, respectively, of patients initially assigned the preliminary clinical stage of IB, II, III or IVA remained at that stage after the additional studies.

Extended Field Radiation Therapy Versus Delayed Hormonal Therapy in Node Positive Prostatic Adenocarcinoma

This study was undertaken to determine the disease control and survival advantage of either extended field megavoltage irradiation or delayed androgen ablation in a randomized clinical trial. Comparison of the 2 treatments, using either time-to-first evidence of treatment failure or survival, demonstrates an advantage to extended field radiation.

Radiation Therapy Versus Delayed Androgen Deprivation for Stage C Carcinoma of the Prostate

Seventy-three patients with prostatic adenocarcinoma who were believed to have disease limited to the pelvis without evidence of node or bone extension were assigned randomly to either full-field pelvic radiation (40) or delayed hormonal therapy (33). The interval to first evidence of treatment failure was used as the end point of the study. Failures occurred in 13 patients who received radiation therapy and 11 who received delayed hormonal therapy. No difference in disease response could be identified between the 2 treatment groups.

Percutaneous nephrostomy for palliation of metastatic ureteral obstruction

Urinary diversion for palliation of metastatic ureteral obstruction has been associated with high rates of morbidity and mortality, especially with open surgical nephrostomies. An evaluation of percutaneous nephrostomy drainage for the palliation of metastatic ureteral obstruction in 27 patients revealed an increase in survival with decreased morbidity, and a follow-up ranging from three to twenty-five months. The mean survival of all patients was 6.63 months (N = 19), with 8 patients still alive. The histology was the main determinant of length of survival, with prostate, rectal, and cervical cancer patients surviving the longest. The perioperative mortality was 11.1 per cent (3/27), and the postoperative complications consisted of hemorrhage requiring transfusion 29.6 per cent (8/27), gastrointestinal bleeding 3.7 per cent (1/27), and dislodged nephrostomy tubes 44.4 per cent (12/27). Percutaneous nephrostomy drainage is a less morbid procedure than open surgical procedures, and the main determinant of length of survival is the histology of the primary tumor in patients with metastatic ureteral obstruction.

Idiopathic anejaculation treated by vibratory stimulation

Idiopathic anejaculation is a rare cause of infertility usually treated by psychotherapy. However, electrovibration may be a simple, noninvasive adjunct to the treatment of this disorder. In our two cases, we obtained ejaculate adequate for insemination in one patient and noted some gain in orgasmic sensation in the other. The success in these two infertile patients who had already undergone lengthy psychotherapy is promising. Nevertheless, psychotherapy will continue to be the standard of therapy until we have more experience with penile electrovibration.

Experience with intermittent catheterization in chronic spinal cord injury patients.

Intermittent catheterization was used as a method to achieve reflex voiding and a catheter-free status in 111 chronic spinal cord injury patients. Of this group 70 patients achieved reflex (automatic) voiding within 90 days, or a mean of 19 days. Five patients required transurethral incision of the external urethral sphincter after achievement of automatic voiding because of elevated residual urine. Chronic urinary tract infection persisted in 16 per cent of the patients after completion of the program. No sequelae occurred because of the coexistent urinary tract infection. An 18-month followup disclosed stability in renal function and appearance of pyelograms. Urethral, scrotal and bladder complications secondary to chronic indwelling urethral catheters have been eliminated in these patients. Patient endorsement and enthusiasm have been spectacular and have overwhelmingly contributed to an ongoing, successful program.

Bladder Dysfunction and Neurosyphilis

Neurosyphilis today is a rare problem. We describe a man who presented with organic brain syndrome, psychosis and incontinence, and diagnosis was neurosyphilis with resultant bladder dysfunction. Urodynamic studies defined the voiding dysfunction as detrusor areflexia with a positive bethanechol test. This case reminds us of the necessity of obtaining a test for venereal disease to rule out neurosyphilis in patients with idiopathic voiding dysfunction.

Exsanguinating hemorrhage from urinary ileal conduit in patient with portal hypertension

A patient with an ileal conduit diversion after cystectomy for carcinoma of the bladder is seen with cirrhosis and portal hypertension. Massive bleeding from the peristomal varices developed. Our experiences with conservative treatment is outlined.

Distal ureteral obstruction complicating percutaneous nephrolithotomy

Endourologic techniques for the treatment of surgical stone disease have proved cost-effective and safe with results comparable to open surgical procedures. Because these are new procedures, unexpected complications are going to occur. We have had 3 cases of complete distal ureteral obstruction unrelated to a ureteral calculus following a percutaneous nephrolithotomy. The obstruction resolved after extended nephrostomy tube drainage. These 3 cases and their treatment and pathogenesis are presented.

Inferior epigastric varix masquerading as a pelvic mass.

We report a case of an inferior epigastric varix as another disease entity to be considered in the differential diagnoses of pelvic masses.