Richard J. Boxer

Replacement of the Ureter by Small Intestine: Clinical Application and Results of the Ileal Ureter in 89 Patients

Partial or total replacement of the ureter by small intestine was performed at the University of California/Los Angeles Hospital and affiliated hospitals 94 times in 92 patients from 1954 to 1978. Indications included recurrent calculi, ureteral stricture, fistula, congenital obstruction of the ureter and ureteral carcinoma with a solitary kidney. A special use has been for undiversion of an ileal conduit. Followup evaluation was possible in 95% of the patients and ranged from 6 months to 23 years. Thirty-six patients were followed for more than 5 years. The operation was judged successful in 81% of the cases. Serum creatinine was unchanged or decreased in 75.7% and the pyelogram was unchanged or showed decreased dilatation in 84.6% of the patients. Although reflux was seen in 40 of 55 patients who had cystograms 39 (97.5%) were considered to be treated successfully. Indications for and results of the operation are discussed. The procedure is recommended as optimal therapy for carefully selected situations when the normal urinary tract cannot be used.

Radical Prostatectomy for Carcinoma of the Prostate: 1951–1976. A Review of 329 Patients

Surgical therapy for early adenocarcinoma of the prostate has been an effective mode of cure since it was described by Young in 1905. The retropubic and perineal approaches of radical prostatectomy have been used at our hospitals for 25 years. Herein we examine 329 cases at the 2 hospitals. Although there were only 2 deaths (0.61 per cent) immediately attributable to the operation the surgical morbidity was significant. Patients of the attending staff had a 46 per cent complication rate while that of patients of the resident staff was 59 per cent. The 5 and 10-year survival rates of patients with stages A and B prostatic adenocarcinoma were 82 and 63 per cent, respectively, and the 5 and 10-year survival rates of patients who had stage C prostatic adenocarcinoma were 67 and 29 per cent, respectively. Our survival rates compare favorably to the national average survival for patients of all ages with localized or regional adenocarcinoma of the prostate. We believe that these data support the position of urologists who believe in radical surgical treatment of prostatic cancer.

Renal Carcinoma: Computer Analysis of 96 Patients Treated by Nephrectomy

We submitted to computer analysis 109 items of pathologic, clinical and survival data from 96 patients with renal carcinoma treated by nephrectomy with or without adjuvant therapy between 1956 and 1976. The combined 1, 5 and 10-year calculated survival rates for potentially curable non-metastatic renal carcinoma (stages I, II and III, provided the regional lymph nodes were not involved) were 95, 61 and 47 per cent, respectively, compared to 1, 5 and 10-year survival rates of 61, 5 and 0 per cent, respectively, for stage IV tumors. The cytoplasmic appearance (clear or granular) was not a significant microscopic feature relevant to survival of the patient but the grade of the tumor was predictive of the outcome of disease. Other features of renal carcinoma, particularly invasion of the renal vein and, to a lesser degree, perinephric fat, were not as prognostically significant in this series. In this retrospective study we further analyze the clinical, radiologic, pathologic and survival data of this group of patients.

Condylomata acuminata and squamous cell carcinoma

Until recently, condyloma acuminatum has been considered to be a benign growth with no malignant potential. The histologically similar, yet clinically different, giant condyloma acuminatum (Buschke-Lowenstein tumor) has been defined as a mass with downward growth that has no histologic malignant changes, although the clinical course may be malignant. A review of the literature yielded 65 cases of malignant degeneration of this type of tumor and supports the concept that either condyloma acuminatum or the Buschke-Lowenstein tumor may precede or be associated with squamous cell carcinoma. A patient presenting with condyloma acuminatum in whom invasive squamous carcinoma of the penis developed exemplifies the transitory character of the disease.

Non-metastatic hepatic dysfunction associated with renal carcinoma.

A retrospective computer analysis of 102 patients treated for renal tubular carcinoma revealed 7 patients who presented with non-metastatic hepatic dysfunction. Of these 7 patients 5 also had the triad of fever, weight loss and fatigue. Only 1 patient survived more than 10 years after nephrectomy. A review of the literature on non-metastatic hepatic dysfunction revealed a significant interval between onset of symptoms and detection of the underlying renal malignancy, as well as a poor over-all survival rate if the syndrome persisted after nephrectomy.

Physical and Psychological Results of Penile Prostheses: A Statistical Survey

AbstractThere have been a number of reports on the success of penile implantation for the treatment of impotence. These studies have indicated an unusually high degree of patient acceptance and satisfaction. We herein report a comprehensive social, psychological and physical assessment of the penile rod implants used for the treatment of impotence. Of all patients who responded to our questionnaire 68 per cent rated their postoperative emotional adjustment excellent or good, whereas 20 per cent considered this adjustment to be less than adequate. General activity level and participation in sports remained about the same. In addition, 74 per cent of the patients were comfortable with the way their clothes fit but 26 per cent were not, and 78 per cent were somewhat or completely satisfied, while 22 per cent were rather or completely dissatisfied with the prosthesis in general.

Telemedicine in Urology: State of the Art.

Whereas telemedicine is recognized as one of the fastest-growing components of the healthcare system, the status of telemedicine use in urology is largely unknown. In this narrative review, we detail studies that investigate the use of televisits and teleconsultations for urologic conditions. Moreover, we discuss current regulatory and reimbursement policies. Finally, we discuss the significant barriers to widespread dissemination and implementation of telemedicine and reasons why the field of urology may be positioned to become a leader in the provision of telemedicine services.

Scleroderma of lower urinary tract

Abstract A case of scleroderma involving the lower urinary tract is reported. To our knowledge, this is the first instance of a living patient with this condition.

PENILE RECONSTRUCTION IN IRRADIATED PATIENT

Reconstruction of a penis using a modified Gillies technique was performed on a forty-one-year-old man who had a total penectomy, inguinal node dissection, and 6,000 rads of cobalt-60 irradiation for carcinoma of the penis. The three different surgical techniques for reconstructing the penis are discussed in detail. It is our belief that reconstruction of a urethra and placement of a baculum in penile reconstruction after radiation therapy have more disadvantages than advantages. The literature is reviewed.

Achieving Universal Coverage Without Turning to a Single Payer: Lessons From 3 Other Countries

The most popular parts of the Affordable Care Act (ACA) are the most expensive. Universal coverage is a top priority not only for Democrats but also for President Trump. Both Republicans and Democrats want to preserve many costly coverage features of the ACA, including those that prevent insurers from precluding people with preexisting conditions and those that eliminate lifetime or annual coverage limits. The challenge is how to preserve these features and make insurance affordable.