Ralph C. Benson

Impact of Endourology on Diagnosis and Management of Upper Urinary Tract Urothelial Cancer

The technique of transurethral ureteropyeloscopy was used in 43 patients with upper urinary tract urothelial tumors. Diagnosis was confirmed in 19 of 22 renal pelvic tumors (86 per cent) and 19 of 21 ureteral tumors (90 per cent). The major complication rate in this series is low (7 per cent) and did not appear to influence unfavorably subsequent management or outcome. A total of 21 patients underwent conservative endourological management of the upper tract tumor. The local recurrence rate was 20 per cent (1 of 8) for renal pelvic tumors and 15 per cent for distal ureteral tumors (2 of 13). The technique of ureteropyeloscopy should be added to the standard diagnostic regimen for the investigation of upper tract filling defects and conservative endourological techniques can be used safely for management of selected cases of upper tract urothelial tumor.

Perioperative and Postoperative Complications from Bilateral Pelvic Lymphadenectomy and Radical Retropubic Prostatectomy

The complications experienced by 692 consecutive patients who underwent bilateral pelvic lymphadenectomy and radical retropubic prostatectomy from 1978 through 1984 were analyzed. Four patients (0.6 per cent) died in the perioperative or early postoperative period. Pulmonary embolus developed in 19 patients (2.7 per cent) and severe to total urinary incontinence occurred in 34 (5 per cent). Our large series suggests that radical retropubic prostatectomy with staging bilateral pelvic lymphadenectomy can be performed in a safe manner with minimal postoperative morbidity.

Carcinoma of the seminal vesicle.

Strict criteria were applied to 12 cases of carcinoma of the seminal vesicle in the Mayo Clinic tumor registry. Diagnosis was carcinoma of the seminal vesicle if the neoplasm was a papillary or anaplastic carcinoma localized primarily to the seminal vesicle and no other primary tumors were demonstrated. In addition, some degree of mucin production was required, especially when prostatic involvement was present. Only 2 of our cases and 35 cases reported previously were judged acceptable or probable cases of carcinoma of the seminal vesicle. Prognosis for patients with this tumor is poor. A combination of extirpative surgery and hormonal therapy appears to provide the best opportunity for extended survival, although this remains to be proved.

Cancer-to-Cancer Metastasis

The development of another separate primary cancer in a patient with 1 malignant tumor is not uncommon but metastasis of a malignant donor tumor to a different host tumor is extremely rare. Most recipient tumors have been primary renal cell carcinomas. We report a case of metastasis of a malignant melanoma to a renal cell carcinoma.

Intravesical Thiotepa and Mitomycin C Treatment Immediately After Transurethral Resection and Later for Superficial (Stages Ta and Tis) Bladder Cancer: A Prospective, Randomized, Stratified Study with Crossover Design

In a prospective, randomized, stratified study with crossover design the effect of thiotepa was compared to that of mitomycin C when each was instilled intravesically immediately at the end of complete removal of superficial bladder cancer (stages Ta and Tis) and later on tumor recurrence. The 3-month and 1-year rates free of recurrence were 93 and 78 per cent, respectively, for thiotepa (41 patients), and 97.6 and 67.1 per cent, respectively, for mitomycin C (42 patients) (p equals 0.6). On crossover (5 patients to thiotepa and 9 to mitomycin C) at 1 year 60 per cent of the patients receiving thiotepa secondarily and 51.9 per cent of those receiving mitomycin C secondarily were free of recurrence (p equals 0.52). Therefore, both drugs are equally effective in reducing bladder tumor recurrence. Future comparative studies should continue to include thiotepa as a standard by which the efficacies of other agents are judged.

The Jonas Prosthesis—technical Considerations and Results

We analyzed 100 patients who underwent implantation of the Jonas penile prosthesis because of impotence, complications, and patient and partner satisfaction. Data were gathered by direct patient contact and mailed questionnaires, and at followup ranging from 4 to 18 months. Complications occurred in 7 patients. Of the 100 patients 90 were satisfied with the results and would choose the same operation again, although 20 claimed to have some difficulty with concealment of the penis. A total of 56 patients underwent implantation of the prosthesis under local anesthesia, which has resulted in diminished patient risk as well as reduced cost and duration of hospitalization.

Endoscopic Evaluation and Treatment of Patients with Idiopathic Gross Hematuria

We evaluated 4 patients with long-standing unilateral essential gross hematuria by newer endourological techniques. All 4 patients underwent ureterorenoscopy and 3 underwent percutaneous nephroscopy. Nephroscopy identified a bleeding site in 3 patients and ureteroscopy in 1. The bleeding sites were fulgurated and the hematuria has not recurred during followup. Percutaneous nephroscopy and/or ureterorenoscopy should be considered in selected patients with unilateral essential gross hematuria.

Complications of single and multistage operations for hypospadias: a comparative review.

From 1970 through 1975, 198 children with hypospadias were operated upon at our clinic. Three basic types of primary urethroplasty were used: 1) a modified 2-stage Cecil urethroplasty after separate straightening, 2) a modified 1-stage Denis Browne procedure after prior correction of chordee and 3) a 1-stage combined repair of hypospadias and chordee. A comparative review of early complications is presented.

Bowenoid papulosis of the penis: successful management with neodymium: YAG laser

Bowenoid papulosis of the penis is a recently described entity that clinically resembles benign verruca-like papular lesions but, histologically, it is identical to carcinoma in situ, Bowens disease or erythroplasia of Queyrat. Although a few cases of spontaneous regression of bowenoid papulosis in men have been reported, conservative therapy, consisting of topical 5-fluorouracil, electrodissection or excision, is recommended. With these treatment modalities recurrences are not uncommon. We report 2 cases of extensive bowenoid papulosis of the penis treated successfully without scarring with the neodymium-yttrium-aluminum-garnet laser.

The Nesbit procedure for Peyronie's disease.

We treated 8 patients with severe Peyronies disease with the Nesbit procedure. All patients had had partial to full erections and all had been unable to achieve vaginal penetration because of pronounced curvature of the penis. After penile straightening all patients were able to resume normal coitus. We recommend the Nesbit procedure as the first step in the surgical treatment of patients with Peyronies disease who have severe penile deformity but good erections.