Nand S. Datta

Marital status and survival following bladder cancer

Background: Marital status has been implicated as a prognostic factor in bladder cancer survival. However, few studies have explored potential mechanisms through which this might occur. Methods: The study identified 19 982 bladder cancer patients from the SEER-Medicare database (1992–8) and constructed sex-specific Cox proportional hazard models to assess the relation between marital status and 5-year survival, while sequentially adding covariates to test possible mechanisms. Results: Multivariable Cox analyses suggest that at every stage, married men had better survival than unmarried men independent of age, race, ecologic socioeconomic status, comorbidities, any or aggressive treatment (assessed separately), and accessing a teaching hospital (hazard ratio (HR) 0.80; 95% confidence interval (CI) 0.74 to 0.87). Among women with stages II–IV bladder cancer, age and the presence of comorbid conditions explained the association between marital status and survival. However, among those diagnosed with stage I bladder cancer, none of the covariates explained the association between marital status and decreased mortality (fully adjusted HR 0.72; 95% CI 0.62 to 0.84). Conclusion: The lack of evidence of mediation through treatment, overall health, SES, or quality of healthcare institution among married men and women with stage I disease suggests they may be benefiting from something other than these factors, perhaps practical or social support.

Division of Spermatic Vessels in Orchiopexy: Radionuclide Evidence of Preservation of Testicular Circulation

Satisfactory intrascrotal position of the testicles was achieved by dividing the spermatic vessels, leaving the vas deferens intact, in 3 patients with undescended testes. A postoperative scrotal scan provided objective means of evaluating the adequacy of testicular circulation. To determine the efficacy of various procedures for orchiopexy for undescended testes we suggest that postoperative evaluation include radionuclide imaging of the scrotum.

Megalophallus in Sickle Cell Disease

A case of megalophallus in sickle cell disease with repeated episodes of priapism is reported. A possible cause of penile hypertrophy with preservation of potency is discussed. Corpus cavernography was helpful in the diagnostic evaluation.

Corpus cavernosography in conditions other than Peyronie's disease.

The value of corpus cavernosography in the management of conditions other than Peyronies disease is discussed. The procedure should be done under fluoroscopic control.

Percutaneous transvesical antegrade ablation of posterior urethral valves

A technique of ablation of posterior urethral valves in a neonate is described. It involves two useful modifications of antegrade suprapubic approach. These modifications include the use of a matured percutaneous suprapubic tract for antegrade fulguration of valves and the utilization of a small urethral catheter as a guide for the valve ablation. The urethral catheter also protects the urethra from fulguration injury.

A New Technique for Creation of a Cavernoglandular Shunt in the Treatment of Priapism

A new cavernoglandular shunt technique for the treatment of priapism is described. The shunt is created by use of a skin biopsy punch, which establishes a large and effective communication between the glans and corpus cavernosum, and provides efficient means of venous drainage from the corpora cavernosa. Since free communication exists between the corpora cavernosa through the median septum, the shunt is performed only on 1 side. However, if this method fails to resolve the problem the procedure is performed on the other side as well. This technique was performed successfully in 4 patients with satisfactory results.

O6-2.6 Bladder cancer survival disparities in the United States: results from SEER-Medicare

Introduction Black patients have lower bladder cancer survival rates than White patients, but previous studies have not been able to explain this difference. Recent work has found that racial disparities in bladder cancer survival persist after adjusting for sex, age, and tumour characteristics. The objective of this study was to assess the association of insurance status, comorbidities, marital status, the receipt of radical cystectomy and being qualified for federal assistance (a marker for low individual-level SES) with disparities in bladder cancer survival. Methods We identified 15 666 (592 Black and 15 074 White) bladder cancer cases diagnosed between 1992 and 1999 (follow-up through 2003) from the SEER-Medicare database, and constructed relative survival models to assess 5-year survival disparities. Results The relative survival ratios (RSR) for Black patients vs White patients were as follows: unadjusted, RSR 2.22 (95% CI 1.90 to 2.59), adjusting for year of diagnosis, registry, age, sex, stage, and grade, RSR 1.54 (95% CI 1.32 to 1.81); additionally adjusting for comorbidity score, marital status, and receipt of radical cystectomy, RSR 1.45 (95% CI 1.25 to 1.70); additionally adjusting for SES, RSR 1.26 (95% CI 1.08 to 1.48). Lower comorbidity score, being married, higher SES and receipt of radical cystectomy were independently associated with increased bladder cancer survival. Conclusions Racial disparities persist after adjusting for comorbidity score, marital status, receipt of radical cystectomy and SES in this insured population. As the SES variable used in this study does not capture the diversity across the SES gradient and it is strongly associated with race, further studies investigating the influence of SES and its correlates may provide further explication of this disparity.