Robert R. Bahnson

Cytological atypia in the prostate gland: frequency, distribution and possible relevance to carcinoma.

Frequency and distribution of atypical prostatic hyperplasia were assessed in 51 total prostatectomy specimens for cancer and the data were compared to similar data obtained from analysis of 51 autopsy specimens. Enlargement of columnar cell nuclei in conjunction with preservation of basal cells was chosen as the only criterion for atypia. Depending on the degree of nuclear enlargement, atypia was divided into mild and severe degrees. The evaluation of nuclear atypia was applied to areas of carcinoma as well as to atypical prostatic hyperplasia. There were 3 major findings. 1) Atypical prostatic hyperplasia was found more frequently in prostatectomy specimens (48 of 51 cases) than in autopsy specimens (14 of 37 cases after exclusion of cancer-associated cases) and the difference was significant (p less than 0.001). In addition, atypical prostatic hyperplasia found in prostatectomy specimens was more frequently of severe degree than that in the autopsy specimens (42 of 48 versus 3 of 14 cases, p less than 0.001). 2) The distribution of atypical prostatic hyperplasia and carcinoma in prostatectomy specimens was similar. 3) In a majority of prostatectomy specimens atypical prostatic hyperplasia, when found, was located at sites separate from carcinoma as well as in contiguous areas. Based on these data it is suggested that the presence of a severe degree of nuclear atypia in specimens removed for benign conditions or in prostatic needle biopsies may signify an increased incidence of coexisting carcinoma elsewhere in the prostate or of carcinoma developing in the future. Close followup of these patients may be indicated.

Effect of Local Alpha-Adrenergic Blockade on Human Penile Erection

Recent data suggest that selective local blockade of the alpha-adrenergic receptors of the sympathetic innervation within the corpora cavernosa of the penis will result in erection in normal and impotent subjects. To examine this hypothesis we studied in a randomized, double-blinded fashion 8 impotent patients and 2 normal controls. The organic nature of the impotence was documented with nocturnal penile tumescence testing, sacral latency examination, Doppler penile blood flow measurements, hormonal evaluation and psychological testing. The 2 normal controls had full erections for 5 to 7 minutes after the intracorporeal injection of 5 mg. phentolamine. All of the impotent subjects had tumescence without full erection after a similar injection. The tumescence was augmented by standing upright and diminished by assuming a supine posture, and lasted for several hours. Possible mechanisms, and diagnostic and therapeutic implications are discussed.

Fibroepithelial Polyps of the Ureter

We report a case of fibroepithelial polyps of the ureter, which are rare, benign mesodermal tumors. The advantage of ureteroscopic confirmation of this benign tumor is emphasized.

Urologic manifestations of von Recklinghausen neurofibromatosi

A sixty-seven-year-old white man was seen in February, 1981, with complaints of urinary frequency, incontinence, and gross hematuria of one-year duration. The patient had a history of von Recklinghausen neurofibromatosis since birth and had undergone multiple orthopedic procedures on his left leg for malformations secondary to his disease. Five months prior to admission, the patient had an inguinal herniorrhaphy with postoperative bladder hypotonia requiring a suprapubic catheter for two months. Physical examination was remarkable for innumerable pedunculated and subcutaneous neurofibromas covering the entire skin surface, and the previously noted left knee deformity and scarring. Intravenous pyelogram (IVP) demonstrated mild left hydroureteronephrosis. Cystoscopy revealed visual obstruction by the prostate gland, heavy trabeculation of the bladder wall, a laterally placed left ureteral orifice, and questionable left ureteral meatal stenosis, which was incised with an endoscopic scissors. A transurethral resection of 10 Gm of prostate was performed, but high post-void residual

Adjuvant radiation therapy in stages C and D1 prostatic adenocarcinoma: preliminary results.

Twenty patients with adenocarcinoma of the prostate underwent postradical prostatectomy adjuvant external beam megavoltage radiation therapy because of periprostatic disease in histologic evaluation of the resected specimen. Fourteen of these patients had pathologic Stage C and 6 pathologic Stage D1 disease. Treatment in most patients consisted of 5,000 rad delivered to the true pelvis. The five-year recurrence-free survival was 75 per cent for pathologic Stage C and 41 per cent for Stage D1 disease. The median time to first evidence of treatment failure was fifty months for D1 patients and has not been reached by the C group. Minor complications occurred in 85 per cent of patients and major complications in 5 per cent. In 1 patient with mild, postoperative stress incontinence total urinary incontinence developed after radiation therapy. These preliminary observations suggest a prolonged disease-free interval with an acceptable morbidity is obtained utilizing this regimen.

Estimation of Canine Prostatic Size by in Vivo Ultrasound and Volumetric Measurement

Two methods for estimating the weight of the canine prostate gland in vivo were investigated. Twenty-six beagle dogs underwent transrectal and transabdominal ultrasound examination of the prostate, followed by careful, standardized caliper measurement of the prostate at surgical exploration. The prostate glands were then removed and weighed, and nomograms were constructed for use in future laboratory research. The validity of these nomograms for determining prostate weight in vivo was confirmed on evaluation of 6 additional dogs.

Renal vein thrombosis following puerperal ovarian vein thrombophlebitis

A case of renal vein thrombosis following puerperal ovarian vein thrombophlebitis is reported. We review the syndrome of puerperal ovarian vein thrombophlebitis and emphasize the potential for renal vein and vena caval involvement. The utility of computed tomographic scanning for diagnostic confirmation of this postpartum complication is described.

Ultrasonography and diagnosis of pediatric genitourinary rhabdomyosarcoma

Rhabdomyosarcoma is the most common tumor of the lower genitourinary tract in children during their first two decades of life. Four patients with genitourinary rhabdomyosarcoma are presented, with ultrasonographic and radiographic findings. The utility of ultrasound in the diagnosis of this pediatric tumor is emphasized.

Epididymal metastasis from prostatic carcinoma.

A case of epididymal metastasis from carcinoma of the prostate with an unusual presentation is reported. A review of the literature disclosed only 10 reported cases of this rare finding. A mechanism for the method of metastasis in this patient is proposed.

Ureteral Infection Stones

We report a case of recurrent urinary tract infections owing to culture proved ureteral infection stones. Although ureteral catheterization studies unilaterally localized the infection to the upper urinary tract, the direct immunofluorescence antibody test indicative of upper tract infection was negative. The patient was cured of persistent urinary tract infection by antibiotics, ureterolithotomy, resection of the stenotic ureteral segment and ureteroureterostomy.