Lester A. Klein

The Eradication of Intraurethral Condyloma Acuminata with 5 Per Cent 5-Fluorouracil Cream

Twenty patients have had successful eradication of intraurethral condyloma acuminata by the intraurethral instillation of 5 per cent 5-fluorouracil cream. Avoidable complications are scrotal irritation and meatitis. Endoscopic examination is delayed until distal lesions have been eradicated. The method is safe, inexpensive, painless, and effective.

Urge Incontinence can be a Disease of Bladder Sensors

In many cases of urge incontinence the pathophysiology is unclear. Detrusor instability, detrusor hyperreflexia, urethral instability and poor sensory perception all have been suggested as requirements for urge incontinence. Sensory perception, as proposed recently, may be mediated by 2 bladder sensors. The first sensor, located at the trigone and posterior urethra, is sensitive to small changes in pressure and may function as an early warning system of bladder filling. In the diagnostic evaluation of urge incontinence 5 patients had a triad of absence of the first sensor, an intact second sensor, that is the urge to void when the bladder is stretched with fluid, and normal spontaneous detrusor contraction. Based upon these findings it is suggested that some instances of urge incontinence result when the early warning system fails and detrusor contraction occurs just shortly after the second sensor is stimulated. Detrusor instability was identified in 3 of the 5 patients with urge incontinence, and when present it was associated with urinary frequency. Thus, 2 forms of urge incontinence may be associated with loss of the first sensor: 1 with and the other without associated frequency, with the difference being the presence or absence of detrusor instability.

Embolization of solitary spinal metastases from renal cell carcinoma: alternative therapy for spinal cord or nerve root compression.

Four patients with a solitary vertebral metastasis from a renal cell carcinoma presented with acute spinal cord or nerve root compression. Because of the markedly hypervascular nature of the metastases it was decided to palliate the lesions by transarterial catheter embolization. The embolization reduced the venous blood pool within the tumors, resulting in progressive neurological improvement often lasting for 12 weeks or more. With such palliation, surgical decompression may be obviated, postponed, or at least made manageable.

Balloon dilatation for prostatic obstruction] long-term follow-up

Balloon dilatation of the prostatic urethra may improve the uroflow in patients with benign prostatic hypertrophy (BPH). In this study, patients were assigned blindly for balloon dilatation (5 men) or observation (3 men). A 36F balloon was inflated in the prostatic urethra with local anesthesia and fluoroscopic guidance for thirty minutes. The effects of the procedure were monitored during a two-year follow-up period. Two of the treated patients had improvement in uroflow and experienced stabilization of clinical symptoms. Two had no significant change in uroflow and required prostatectomy within the observation period. One required prostatectomy soon after dilatation. One of the 3 patients in the control group required prostatectomy in the two-year follow-up period and the other 2 continue to have obstructive symptoms. Although dilatation of the prostatic urethra by balloon may relieve some patients of urinary outflow obstruction due to BPH, it appears that a 36F balloon dilator does not produce dramatic or consistent results, and the effects of larger balloons should be evaluated.

In situ dissolution of ureteral calculus

An obstructing uric acid calculus was successfully managed by dissolution in situ. The methods used are described in detail. Perhaps not applicable in all cases, the ease of the procedure makes it worth considering especially in patients at high risk for open operative intervention.

The Comparative Medical Costs of 2 Major Procedures Available for the Treatment of Stress Urinary Incontinence

Female urinary stress incontinence is a common surgical problem. We reviewed the case records of 71 women who were operated upon for stress incontinence at our medical center from 1975 to 1980. Of these women 30 underwent the Pereyra-Stamey endoscopically controlled suspension of the bladder neck and 41 underwent the Marshall-Marchetti-Krantz repair. We compared the major components of care contributing to the cost of each surgical procedure. At current 1980 prices a significant saving of 4 days in hospital stay and of

Management of Infected Polycystic Kidneys

2,500 in total medical costs can be effected by choosing the Pereyra-Stamey technique over the Marshall-Marchetti-Krantz procedure. No important differences were noted in complications, operating room time or surgeons fees.

Signet ring cell carcinoma of bladder Evaluation of three cases with review of literature

We report 5 cases of severe uncontrolled infection of polycystic kidneys. Retrograde pyelography antedated infection in 2 of the patients. Difficulty in establishing the diagnosis was demonstrated in all cases. Each patient was treated initially with antibiotics but definitive therapy required an operation in 4 cases.

The emergency management of patients with ureteral calculi and fever.

Three cases of adenocarcinoma involving the bladder and consisting mainly of signet-ring-shaped cells are presented. Each case represents a different form that the lesion may take, and these forms are compared. This unusual neoplasm has a worse prognosis than transitional cell carcinoma of the bladder, possibly because of factors that lead to delays in management. Radiation therapy is ineffective, and the results of treatment with segmental resection of the involved area of the bladder are equivalent to those of total cystectomy.

Measurement of Trigonal Sensitivity as a Test of Bladder Function

Patients presenting with ureteral calculi and fever were treated with antibiotics, fluids and careful monitoring. An emergency operation or ureteral manipulation was withheld until the patient became afebrile. In 14 patients so treated all became afebrile and 11 required no surgical intervention. It is suggested that carefully monitored resuscitation should precede instrumentation in patients with urinary stones and fever.