Ray E. Stutzman

Ballistics and the Management of Ureteral Injuries from High Velocity Missiles

The management of 21 patients with 22 ureteral injuries from high velocity missiles is described and 6 cases are reported in detail. Ballistics should be considered in all wounds of violence. Débridement, internal stents, proximal diversion and thorough drainage are advocated.

Bilateral Fat Necrosis of the Scrotum

The typical patient with fat necrosis of the scrotum is a prepuberal heavy set male subject who has extratesticular scrotal masses, usually bilateral, with mild to moderate pain but no systemic complaints or symptons related to voiding. The masses are firm, tender and do not transmit light. With a firm diagnosis expectant treatment will allow spontaneous resolution of the lesions. If doubt exists appropriate surgical intervention is advocated. Hypothermic injury, such as swimming in frigid water, is the most probable etiologic agent.

Multiple Germ Cell Tumors: Report of 3 Cases, 1 with 3 Primary Lesions

Tumors may develop in both testes, either concomitantly or sequentially. We herein report 3 cases of bilateral testicular neoplasms. One patient had concomitant seminomas of the testes and another had sequential germ cell tumors separated by an 11-year interval. The third patient is an unusual case in that he had bilateral testicular germ cell tumors diagnosed concomitantly 8 years after irradiation of an extragonadal, histologically proved, seminoma in the mediastinum. Evidence suggests that all 3 sites, each testis and the mediastinum, were primary lesions. Standard methods of therapy should be used in the treatment of malignancies.

Avascular renal adenocarcinoma: variations and characteristics.

Six cases (men ranging in ages from thirty-seven to seventy-seven years) illustrate the varied characteristics of avascular renal adenocarcinoma. These tumors frequently stimulat benign lesions. All modalities including intravenous pyelography, nephrotomography, ultrasonography, cyst puncture with cystic fluid assessment, angiography, and operation with tissue specimens submitted for pathologic examination may be required before diagnosis is established. An orderly approach to the evaluation of lesions will allow accurate diagnosis approaching 100% with minimum morbidity. Attention to the finer details of vascular patterns on angiography has proved to be a most helpful diagnostic aid. Cyst puncture with histochemical, cytologic, and radiographic examinations appears to offer additional help in diagnosing these elusive lesions.

Complications of retroperitoneal lymphadenectomy for nonseminomatous tumors of testis

We present 4 patients with serious complications after retroperitoneal lymphadenectomy. Chylothorax developed in the first patient; hypertension, blindness, and paralysis of the lower extremities in the second; volvulus and necrosis around an adhesion in the right upper quadrant in the third; and small-bowel obstruction and radiation myelitis in the fourth patient. These complications and modes of treatment and prevention are discussed.

Anterior Bladder Tube Flap Reconstruction of the Urethrovesical Neck After Radical Retropubic Prostatectomy

Difficulty with urethrovesical neck anastomosis after radical retropubic prostatectomy led us to form an anterior bladder tube flap for anastomosis to the transected urethra in 5 selected cases. We found that combining the anterior bladder tube flap technique with radical retropubic prostatectomy facilitates the urethrovesical neck anastomosis and improves the transient postoperative incontinence sometimes encountered. Results of the 5 patients in whom this technique was used form the basis for a brief discussion of the technique.

Vasoseminal vesiculography in staging adenocarcinoma of prostate

We found vasoseminal vesiculography useful in staging adenocarcinoma of the prostate and in measurement of radiotherapy ports. In 12 patients who had radical prostatectomies, the histologic findings correlated well with the vasoseminal vesiculograms. Criteria for reading benign prostatic hyperplasia and prostatic carcinoma have been well established in the literature and are reviewed.

Renal cystography with triplecontrast material

Abstract Renal cystography with triple-contrast material (meglumine diatrizoate, air, iophendylate) was performed in 9 patients who had associated illnesses which made them high-risk surgical cases for diagnosis of renal masses. There has been no morbidity during the three year follow-up period (range five to thirty-six months, average eighteen months). The cysts retained the oily substance iophendylate (Pantopaque), and they were reduced in size.

Vasectomy with transurethral resection of prostate

A retrospective study was made of 200 patients undergoing transurethral prostatectomy. Half of these patients received bilateral vasectomies. The vasectomized patients had a 5-percent incidence of epididymitis as compared with a 2-percent incidence in the nonvasectomized patients. Vasectomy failed to provide adequate protection against postoperative epididymitis and cannot be recommended as a routine procedure with a transurethral prostatectomy.