Michel A. Boileau

Testis Tumors: The Clinical Significance of the Tumor-Contaminated Scrotum

Between 1977 and 1979 we evaluated 224 patients with testicular cancer. Of these patients 32 had undergone inadequate primary procedures, such as transscrotal orchiectomy, transcrotal exploration, biopsy or aspiration. These 32 patients were compared to a cohort population who had undergone radical inguinal orchiectomy. Differences in management, nodal metastases, local recurrences, intervals free of disease and survival by stage of disease were determined. Patients with seminoma and a contaminated scrotum received radiation therapy to the involved hemiscrotum . Partial scrotectomy without ilioinguinal node dissection was performed on most patients with nonseminomatous disease. An inguinal node metastasis developed before radiation therapy in a patient with seminoma. There were no local recurrences. No statistically significant difference in either intervals free of disease or survival between contaminated and cohort populations was found. We conclude that with prompt adequate management there is no adverse effect on prognosis due solely to scrotal tumor contamination, contrary to what has been implied in the literature.

The Use of Indwelling Ureteral Stents in Managing Ureteral Injuries Due to External Violence

Eighteen consecutive cases of ureteral injury due to external violence occurring over a 6-year period were reviewed. The diagnosis of ureteral injury was made either preoperatively on an intravenous urogram, or intraoperatively using indigo carmine. No patient had an isolated ureteral injury. Four patients with ureteral contusions were managed expectantly and needed no further therapy. Eleven patients with ureteral lacerations underwent spatulated, interrupted anastomoses of absorbable suture and placement of Silastic double-J ureteral catheters and had prompt resolution of urinary drainage and normal urograms post stent removal. Two initially nonstented patients with lacerations required delayed ureteral stent placement for massive retroperitoneal urine leakage while one patient did well with simple ureteroureterostomy without stenting. The only important complication from the use of ureteral stents was limited to a single patient, who failed to return for followup and developed a staghorn calculus on the stent. The use of Silastic double-J ureteral catheters resulted in little morbidity and allowed: relatively maintenance-free care; an extra measure of safety in multiply injured patients; and early hospital discharge.

Invasive verrucous carcinoma of urinary bladder treated by irradiation

A case of inoperable, invasive verrucous carcinoma of the urinary bladder treated by irradiation is presented. The incidence of anaplastic transformation of verrucous carcinoma after irradiation is lower and the coincidence of verrucous carcinoma and well-differentiated squamous carcinoma higher than is generally recognized. Radiation should be considered in inoperable cases. The pertinent literature is reviewed.

Evaluation of nocturnal penile tumescence with potentest

PotenTest is a standardized, hygienically packaged, and reliable stamp test, useful for differentiating organic from psychogenic sexual dysfunction. Fifteen potent control patients wore a PotenTest band on three separate nights, and during a selfinduced erection, while PotenTest reliably induced nocturnal erections and penile rigidity. PotenTest and Snap-Gauge were used to evaluate pre- and postoperative potency in twelve cystectomy patients. The result with each test was essentially the same.

Interstitial gold and external beam irradiation for prostate cancer.

We treated 65 patients with prostatic cancer confined clinically to the prostate or periprostatic area during an 8-year period. Seven patients had stage A2, 38 stage B and 20 stage C disease. All 65 patients underwent staging pelvic lymphadenectomy and implantation of gold grains into the prostate (mean dose 3,167 rad). A total of 64 patients then completed a course of external beam irradiation to a mean total tumor dose of 6,965 rad. Complications of therapy were mild and limited (less than 3 months in duration) in most patients, and they included radiation cystitis (32 per cent), diarrhea (31 per cent), extremity lymphedema (7.7 per cent) and wound infection (3 per cent). Two patients suffered urinary incontinence after therapy and 2 (3 per cent) had diarrhea more than 3 months in duration. The actuarial 5-year survival rate for all patients was 87 per cent and the 5-year survival free of disease was 72 per cent.

Metastatic Renal Cell Carcinoma Simulating Glomus Jugulare Tumor

A 59-year-old man presented with jugular foramen syndrome caused by a mass with roentgenographic and histologic features highly suggestive of a glomus jugulare tumor. However, electron microscopic examination of the surgical specimen revealed features diagnostic of a previously unsuspected renal cell carcinoma. Because primary tumors of the glomus jugulare and metastatic renal cell carcinoma may present with the same clinical and roentgenographic findings and look similar histologically, careful electron microscopic examination of the tumor and urologic screening should be performed in suspected cases of glomus jugulare tumors.

Cystoscopic transvesical placement of sutures for repair of posterior urethral strictures

Successful repair of post-traumatic posterior urethral strictures can be accomplished in several ways, and careful patient selection is of utmost importance. The two most important selection factors to consider are the length of the stricture or the gap that must be bridged and whether or not the anterior urethra has been damaged. If the anterior urethra is undamaged, it, being an elastic structure, can be mobilized and used to bridge the gap. If the anterior urethra is damaged or the gap to be bridged is greater than 1.5 cm, some form of skin substitution urethroplasty should be used.’ The two main types are the posteriorly based flap of perineal or perineoscrotal skin and the scrotal “drop back” technique.2 The primary rule of urethroplasty is complete excision of all scar and reapproximation of normal urethra to normal urethra or skin substitution inlay that extends into at least 2-3 cm of overtly normal urethra.2 This frequently requires placement of sutures deep in the perineum, occasionally extending across the sphincter and into the prostatic urethra itself. Proper placement of these sutures is critical and can be difficult even when using the special curved needles and other instruments developed by Turner-Warwick.2 In difficult cases involving a small patient or an exceedingly narrow pelvis, we have simplified placement of these deep sutures by utilizing the suprapubic cystotomy tract. The loaded urethroplasty needle is passed alongside the cystoscope through the tract. The tip of the scope is passed through the bladder neck into the prostatic urethra, and the stitch is placed under direct vision in the distal prostatic urethra (Fig. 1). Proper placement and a secure “bite” are assured. An assistant grasps the suture from below under direct vision and secures Sumawbic