Martin Schiff

Palliative Urinary Diversion for Pelvic Malignancy

Palliative urinary diversion was done in 47 cases for ureteral obstruction secondary to advanced pelvic malignancy. The average survival time was 5.3 months, with only 50 per cent of the patients alive at 3 months and only 22.7 per cent alive at 6 months. After the diversion 63.8 per cent of the survival time was spent in the hospital. Patients with carcinoma of the prostate fared better than those with other sites of tumor origin, which may reflect the natural history of this tumor.

Bladder and Urethral Injuries in Patients with Pelvic Fractures

AbstractApproximately 10 per cent of the patients sustaining a traumatic pelvic fracture will be found to have an associated lower urinary tract injury. The finding of gross hematuria after such an injury strongly suggests the presence of an extravasating lesion of the bladder or urethra but microhematuria alone does not appear to be indicative of any significant uropathology.

Treatment of Solitary and Bilateral Renal Carcinomas

Recent experience with 7 patients, as well as a review of the literature, indicates that partial nephrectomy provides satisfactory treatment of solitary and bilateral renal adenocarcinomas. Patient survival seems to be dependent on the adequacy of tumor resection and not on the fate of the contralateral kidney. Total nephrectomy, dialysis and subsequent transplantation are viable alternatives when it is technically not possible to preserve adequate renal parenchyma.

Urologic Complications of Inflammatory Bowel Disease

Urologic complications occurred in 54 of 233 patients with inflammatory bowel disease followed during a 15-year period. Urinary calculi, enterovesical fistulas and ureteral obstruction were the most common problems. Urinary tract complications may arise many years after primary bowel disease has been diagnosed. Symptoms frequently may be absent or obscured by those of the gastrointestinal disorder. We recommend that urologic evaluation be included periodically in the long-term management of patients with inflammatory bowel disease.

Antibiotic Treatment of Renal Carbuncle

Renal carbuncles in seven young males were successfully treated with long-term administration of penicillinase-resistant antibiotics. Selective renal arteriography provided an accurate means of diagnosis and permitted a trial of medical therapy. All patients experienced a prompt and sustained clincial remission; surigical exploration was thus obviated in all but one instance, in which post-treatment radiographic changes persisted.

Results of biopsy after early stage prostatic cancer treatment by implantation of 125I seeds.

We have treated 77 patients for clinically early stage carcinoma of the prostate, 9 stage A2, 63 stage B and 5 stage C, with direct implantation of 125I seeds into the prostate and pelvic lymphadenectomy. It is estimated that a minimum dose of 15,000 rad but a maximum dose of 35,000 rad is delivered to the prostate over several months. Of the 77 patients 14 (18 per cent) had metastatic disease in the pelvic lymph nodes. In 22 cases perineal needle biopsy was done 12 to 18 months after treatment and in 3 cases a second biopsy was performed after 2 to 3 years. Persistent tumor was present in 11 biopsies. Cytological changes were observed in 8 of these, primarily cytoplasmic vacuolation and nuclear pyknosis. There seemed to be no relationship between grade and stage of disease and histological evidence of persistence of tumor after radiation. One patient with persistent tumor in the postoperative biopsy has shown progression of disease after 2 years and another with a negative biopsy has a bony metastasis. The remaining 10 patients with persistent tumor have shown no sign of progression of disease during a 2 to 4-year interval.

Hemorrhagic radiation cystitis: treatment

Abstract Intractable bladder hemorrhage may be a late result of pelvic irradiation. The bleeding may be life-threatening, particularly in patients unsuited for cystectomy. Experience with non-extirpative treatment including formalin instillation and the Helmstein hydrostatic pressure balloon technique is presented. These procedures provide worthwhile alternative methods to surgery.

Nephrectomy: Indications and Complications in 347 Patients

The indications, complications and mortality rate in a recent 12-year experience with 347 nephrectomies were reviewed. Renal tumor is the most frequent condition requiring nephrectomy, probably because of the improved, non-ablative methods to treat inflammatory, obstructive, calculous and hypertensive renal disease. The over-all mortality rate was 1.4 per cent but was almost nil in the absence of malignancy.

Renal adenocarcinoma in young adults.

Survival following the diagnosis of renal adenocarcinoma in a group of young adults, twenty to forty years of age, was distinctly better than that found in adults over age forty. This disparity could not be accounted for by a larger proportion of younger patients with early stage disease, nor by a greater percentage of non-cancer deaths in the older group. Perhaps a more favorable host-tumor immunologic balance is present in younger individuals.

Management of Urinary Fistulas after Renal Transplantation

Urinary fistulas developed in 13 of 134 patients after renal transplantation. Bladder fistulas originating from the anterior suture line in 6 patients were satisfactorily managed by urethral or paravesical drainage. Fistulas arising from the donor ureter were best treated by surgical repair using the recipients own ureter. Caliceal fistulas in 3 patients were successfully treated with nephrostomy drainage. A favorable outcome was achieved in 11 of the 13 patients, with closure of the fistula and preservation of renal function.