Richard A. Watson

The Value of Computerized Tomography in Evaluation of Pelvic Lymph Nodes

AbstractTo assess the accuracy of computerized tomography in the preoperative detection of pelvic lymph node enlargement we evaluated prospectively 23 patients with potentially resectable cancer of the prostate. Subsequent staging pelvic lymphadenectomy revealed falsely negative studies in 7 patients and a falsely positive study in 1. The inaccuracy of computerized tomography mitigates against its use as a preoperative staging modality and confirms the value of pelvic lymphadenectomy as a means of detecting pelvic lymph node enlargement in patients with cancer of the prostate.

Incidental Carcinoma of the Prostate: Significance of Staging Transurethral Resection

We compared the results of staging by a second circumferential transurethral resection and/or transperineal needle biopsy in 42 patients with stage A prostatic adenocarcinoma on initial transurethral resection (defined as tumor of low grade, Gleason sum 2 to 4, and low volume, less than 5 per cent of the specimen or less than 3 foci). Transurethral resection only was done in 16 patients, transperineal needle biopsy only in 2 and both procedures in 24. In the 24 patients who underwent both procedures residual carcinoma was identified by transurethral resection in 6 and confirmed by transperineal needle biopsy in only 1. Thirty-two patients (76 per cent) had no residual carcinoma. Of the 10 patients (24 per cent) with residual carcinoma 5 underwent radical prostatectomy with pelvic lymphadenectomy, 1 had interstitial irradiation with pelvic lymphadenectomy and 1 had pelvic lymphadenectomy only. No lymphatic metastases were detected; persistent carcinoma confined to the prostate was noted in all 5 patients who had undergone radical prostatectomy and 3 of these tumors were upstaged because of higher grade and/or volume. We conclude that residual carcinoma cannot be assessed accurately with transperineal needle biopsy, whereas transurethral resection staging enabled us to define a substantial number of our patients (24 per cent) with persistent disease. Importantly, upstaging by either low volume/high grade or high volume carcinoma was identified in 3 patients at the time of radical prostatectomy. However, the true stage and prognosis of those patients with persistent low volume and low grade prostatic carcinoma remain to be determined.

A CLOSER LOOK AT SERUM PROSTATIC ACID PHOSPHATASE AS SCREENING TEST

Radioimmunoassay techniques for the detection of serum acid phosphatase are reported to provide substantial improvement in test sensitivity and test specificity. Calculation of the positive predictive value for this assay, however, does not support its use as a screening modality. Indiscriminate use of this test may have serious medical, psychological, and economic ramifications.

Triamterene stone: advantage of crystallographic analysis.

Microscopic crystallographic analysis of renal calculi provides clinically useful information concerning the pathogenesis of stone disease and is, therefore, superior to conventional chemical analysis of stones. The advantages of crystallography, performed at a centralized, experienced stone-analysis center, are highlighted by the recent discovery of triamterene deposits in kidney stones. Deposits of other medications and their metabolites have also been uncovered. Two case reports are presented, the clinical implications of these and related findings are discussed.

Biopsy cucumber unit: Improved method for preparing bladder biopsy specimens

Specially prepared segments of thinly sliced cucumber, serving as tissue mounts, facilitate the histologic processing of bladder biopsy specimens.

Surgical experience with large animals: Important adjunct to residency training in urology

Abstract The procedure-oriented protocol in an animal surgical laboratory has proved to be an extremely helpful adjunct to a urologic training program. This approach gives residents a clear and honest understanding of the important role that protocols play in mapping out sound research undertakings. These training protocols serve as important tools, both in encouraging new residents and in assisting more advanced residents. We are enthusiastic about the initial success of this program and look forward to its improved and expanded utilization.

Perivesical mass and vertical bladder caused by massive prostatic enlargement

Massive prostatic enlargment may present with the radiographic appearance of a perivesical mass and pear-shaped bladder. An explanation of this appearance, based on the compouted tomographic findings, is offered. We discuss the differential diagnosis.

Fractured catheter: Unusual complication of percutaneous nephrostomy

Abstract Temporary urinary diversion by percutaneous nephrostomy is gaining wide acceptance. The indications for this procedure are reviewed. A cracked catheter was an unusual complication after successful temporary diversion.