Jon Kaswick

Nephrogenic metaplasia (adenomatoid tumors) of bladder

Two cases of rare nephrogenic metaplasia of the bladder (adenomatoid bladder tumor) support the theory that these tumors originate as an atypical metaplastic response of urothelium to chronic infection or irritation. That these may also represent mesonephric or mesothelial choristomas is considered. Although benign, they may recur. Therapy should consist of antibiotics and transurethral resection or fulguration.

Laparoscopic evaluation of indeterminate renal cysts: long-term follow-up.

PURPOSE We present our long-term follow-up of patients who have undergone laparoscopic evaluation for their indeterminate renal cysts, specifically reporting those patients who were found to have cystic renal-cell carcinoma (RCC) and assessing the safety and efficacy of the procedure. PATIENTS AND METHODS Fifty-seven patients with indeterminate renal cysts (28 Bosniak category II and 29 Bosniak category III) underwent laparoscopic evaluation between July 1993 and July 2000. A transperitoneal laparoscopic localization and aspiration of the cyst, cytologic analysis, and biopsy of the cyst wall and base were performed. A total of 11 patients were found to have cystic RCC. Patients with malignancy have been followed for a mean of 40 months (range 6-70 months), and five patients had 5 years or more of follow-up. RESULTS Eleven patients (19% of the total) were found to have cystic RCC. Three of these patients had Bosniak category II cysts, and eight had category III cysts. All tumors were low grade (I or II), and the stages were T1-2, Nx-0, M0. There has been no evidence of laparoscopic port site or renal fossa tumor recurrence, local recurrence, or metastatic disease to date in these patients. There is no cancer-specific mortality. CONCLUSIONS Long-term follow-up indicates that laparoscopic evaluation of indeterminate renal cysts is not associated with an increased risk of port site or retroperitoneal or peritoneal recurrence of RCC. It may save a patient from undergoing open surgery and should be considered as a diagnostic option for patients with indeterminate renal cysts.

Laparoscopic evaluation of indeterminate renal cysts

OBJECTIVES To determine the efficacy and safety of laparoscopic evaluation of indeterminate renal cysts. METHODS Ten patients with indeterminate renal cysts (5 Bosniak type II and 5 Bosniak type III) underwent transperitoneal laparoscopic aspiration of cyst fluid for cytologic analysis with examination, biopsy, and excision of the cyst wall and base. RESULTS All procedures were successful and without complications. All the lesions were benign. CONCLUSIONS Laparoscopic evaluation of indeterminate renal cysts is safe and effective. The procedure alleviates patient anxiety about the nature of the lesion and obviates years of radiologic surveillance, thus reducing costs.

Radical Retroperitoneal Lymph Node Dissection: How Effective in Removal of all Retroperitoneal Nodes?

Several large series have supported the success of retroperitoneal lymphadenectomy as a primary therapeutic modality in the management of non-seminomatous germ cell testicular neoplasms. In 1963 Tavel and associates reported on the inadequacy of this procedure in the complete extirpation of all the retroperitoneal lymph nodes. Our investigation was undertaken to test their conclusions, the sole difference in technique being that the infrarenal lumbar vessels were ligated and divided during the lymph node dissection. Results in 12 cadavers revealed that all retroperitoneal nodal tissue could be excised with the modified technique. These findings were further verified by the absence of any residual retroperitoneal lymph nodes in 3 patients who died of metastatic embryonal cell carcinoma. The extirpative efficacy of this procedure having been established, any major deleterious effects of lumbar ligation, primarily spinal cord ischemia, must be considered. Based on our experience and that of others it may be concluded that this complication represents a minimal risk that should not discourage use of this effective therapeutic procedure.

How Potent is Potent Before Nerve Sparing Radical Retropubic Prostatectomy

PURPOSE We objectively evaluated potency before nerve sparing radical retropubic prostatectomy. MATERIALS AND METHODS A total of 45 consecutive potent, neurologically normal and sexually active candidates 47 to 70 years old (mean age 62) completed a detailed questionnaire (separate from their partner), and underwent penile biothesiometry, RigiScan* testing for 3 nights, and duplex Doppler scanning of the cavernous arteries before and after prostaglandin E1 injection. RESULTS Of the patients 8 noted moderate and the remainder normal erections on the questionnaire. RigiScan testing and penile biothesiometry correlated poorly with potency status. Duplex scanning demonstrated excellent peak velocities in 93% of the patients. CONCLUSIONS This well studied prospective series underscores the importance of careful objective assessment of potent surgical candidates, and underlines a strong correlation between preoperative potency status and duplex Doppler scanning.

Anti-refluxing colon conduits for diversion of dilated upper urinary tracts

Ureteral tailoring and colonic conduit urinary diversion were performed in 10 dogs. 2 wk to 2 mo after ureteral ligation. Two to five months after urinary diversion, radiography and postmortem examination revealed reflux in only 11% of the ureters and no evidence of obstruction at the ureterocolonic anastomosis. Pyelonephritis was observed in a lower percentage of animals so diverted, as compared to control kidneys diverted by means of ileoconduits. These results support the use of anti-refluxing colonic conduits for diversion of dilated upper urinary tracts.