Paul H. Lange

Understaging and undergrading of prostate cancer Argument for postoperative radiation as adjuvant therapy

This report reviews the staging and grading errors that occurred in a consecutive series of 14 patients treated for prostate cancer by radical prostatectomy and of 58 patients treated by both radical prostatectomy and pelvic lymphadenectomy. Almost half of the patients who were in Stages A2, B1, or B2 by clinical criteria were in pathologic Stage C when both capsular perforation and seminal vesicle invasion were used as the criteria for Stage C disease. Seminal vesicle invasion was the more important prognostic factor. Moreover, the pathologic grade of cancer, as determined by needle or transurethral biopsy, was underestimated in 39 per cent of the cases; when the grade was corrected, the patient often was in a worse prognostic group than the one originally assigned. Thus, in this series, more than 40 per cent of the patients were at high risk of persistent or recurrent disease after radical prostatectomy. Radiation was given after operation to 22 such high-risk patients and was well tolerated.

Ejaculation and Fertility After Extended Retroperitoneal Lymph Node Dissection for Testicular Cancer

We studied ejaculation and fertility in 55 men who had undergone suprahilar extended retroperitoneal lymphadenectomy for nonseminomatous testicular cancer between 1972 and 1980. Antegrade ejaculation had returned spontaneously in 25 patients, with sperm counts of 35 to 190 million per ml., and normal morphology and motility in 20. The other 5 men either refused to provide semen for analysis or had had vasectomies but all had fathered children postoperatively. Ten men in whom antegrade ejaculation had not returned spontaneously were treated wih sympathomimetic drugs. Antegrade ejaculation was induced in 5 patients, 1 of whom fathered a child while taking the drugs. Two other patients who had only small volumes of ejaculate also responded well to sympathomimetic drugs. A therapeutically sound retroperitoneal node dissection can be performed for testicular cancer without impairing fertility permanently in a significant number of patients.

Mode of Presentation of Invasive Bladder Cancer: Reassessment of the Problem

AbstractThe literature on bladder cancer gives the impression that most patients with invasive tumors have a history of noninvasive bladder tumors and, therefore, that methods of predicting recurrence and progression could have a significant impact on survival in this disease. We analyzed the medical histories of 166 patients with invasive bladder cancer and found that only 16 per cent had prior noninvasive bladder tumors. The depth of invasion and grade of tumor appeared to be worse in patients without prior tumors. Death of bladder cancer occurs primarily among patients who have never had a recognized early bladder tumor, a fact that must be considered when evaluating strategies for improving survival.

Dissolution of cystine calculi by irrigation with acetylcysteine through percutaneous nephrostomy

Abstract Cystine calculi in the renal pelvis of a patient with cystinuria were dissolved by irrigation with a saline solution of acetylcysteine and bicarbonate through percutaneous nephrostomy.

Spermatic Cord Block in Urologic Surgery

AbstractLocal anesthesia sufficient for vasovasostomy, hydrocelectomy, spermatocelectomy or orchiectomy for prostatic carcinoma can be obtained with 10 to 12ml. 0.5 per cent bupivacaine hydrochloride injected through the spermatic cord approximately 1cm. below and medial to the pubic tubercle. The overlying skin is infiltrated with the same anesthetic. Preoperative and intraoperative sedation rarely is needed. The post-anesthetic recovery time is short and the need for postoperative analgesia is reduced.

Extraction of Ureteral Calculi from Patients with Ileal Loops: A New Technique

A technique is described by which calculi can be removed from the distal ureters of patients with ileal conduit urinary diversions. A percutaneous nephrostomy is done and an angiogram catheter is manipulated down the ureter past the obstruction. After the angiogram catheter is retrieved from the loop with a Bumpus forceps a stone basket is attached, pulled up the ureter and opened. The stone can then be captured under fluoroscopic control and, by replacing the stone basket with a silicone splint, the ureteroileostomy also can be splinted. This may be important particularly if there is extravasation from the ureteroileostomy after stone manipulation or operation.

A Comparison of the Small-Carrion and Scott-Bradley Penile Prostheses

The Small-Carrion penile prosthesis has been implanted in 28 patients and the Scott-Bradley inflatable prosthesis has been implanted in 17. Almost all patients are satisfied with the results. There appeared to be no absolute correlation between the postoperative appearance of the penis and the sexual performance. Provided a reasonable cosmetic result is obtained the patients attitude is the most important determinant of sexual function.

Percutaneous Nephrolithotomy With Mazzariello-Caprini Forceps

Mazzariello-Caprini forceps were used percutaneously to remove a stone that was impacted distal to the ureteropelvic junction in a patient who had undergone several previous open pyelolithotomies. These forceps open by a rotational rather than a scissoring movement so the shaft size does not increase and they are well suited for operation through a narrow nephrostomy tract. The original design has been modified to allow passage over an angiographic guide wire, thereby placing the forceps precisely at the site of the stone. Also, with the angiographic guide wire to direct them the forceps can be used in a freshly established nephrostomy tract as well as in a mature tract. In our experience the Mazzariello-Caprini forceps have been most useful for nonoperative manipulation of renal and upper ureteral calculi.

Acid phosphatase for monitoring prostatic carcinoma Comparison of radioimmunoassay and enzymatic techniques

We compared a commercial radioimmunoassay kit with an enzymatic assay for prostatic acid phosphatase in monitoring the progression or remission of disease in 27 patients with prostatic cancer. In 5 of the 18 patients whose disease progressed, and in 4 of the 9 whose disease responded to treatment, the change was reflected better by the radioimmunoassay. In no case was the enzymatic assay better. Radioimmunoassay for prostatic acid phosphatase may be an effective and sensitive way to monitor the course of carcinoma of the prostate.

Testicular Cancer Markers

In perhaps no other human malignancy have the potential value and drawbacks of tumor markers become as evident as they have during the recent experience with serum alphafetoprotein (AFP) and human chorionic gonadotropin (HCG) in testicular cancer. At present, these two markers, when used together, are the best available in clinical oncology.