Stephen A. Kramer

Experience with Gleason’s Histopathologic Grading in Prostatic Cancer

The inaccuracy of clinical staging as a predictor of the biologic potential of prostatic cancer has prompted evaluation of additional methods of assessment. We reviewed 228 patients with prostatic adenocarcinoma who presented during a 4-year period. Of the 228 patients 144 with no detectable bony disease underwent staging pelvic lymphadenectomy with or without preliminary bilateral pedal lymphangiography. Histopathologic specimens of the primary diagnostic prostatic biopsy were classified with Gleasons grading system of tumor differentiation. Of the patients with Gleasons sum of 8, 9 or 10, 93 per cent had regional nodal metastases, regardless of preliminary clinical stage. Furthermore, no patient with Gleasons sum of 2, 3 or 4 had nodal metastatic disease. The incidences of falsely positive and falsely negative lymphangiograms were 29 and 35 per cent, respectively, reflecting the unreliability of pedal lymphangiography to predict nodal involvement accurately in patients with prostatic cancer. The Gleason system of histopathologic grading was reliable and reproducible, and afforded an accurate prediction of the surgical stage of disease.

Prognosis of patients with stage D1 prostatic adenocarcinoma.

Of 44 patients with clinically localized prostatic adenocarcinoma and regional lymphatic metastases proved by staging pelvic lymphadenectomy 11 were treated by radical prostatectomy, 20 received extended field radiation and 13 were assigned to delayed hormonal therapy. The median survival for the entire group was 39.5 months. None of the 3 treatments appeared superior in prolonging survival. Furthermore, no enhancement of disease control could be demonstrated in either treatment group. Patients with prostatic adenocarcinoma and positive nodes appear to have equivalent adverse biological potential and should be candidates for treatments designed to produce systemic effect.

Cystometric Properties of Ileum and Right Colon After Bladder Augmentation, Substitution or Replacement

Cystometric studies were performed on 38 patients who had undergone augmentation, substitution or replacement enterocystoplasty. These studies were done to determine the choice of bowel segment to augment or replace the detrusor and the shape in which the bowel segment should be reconstructed. Eleven patients underwent tubular and 10 detubularized right colon cystoplasty, while 10 underwent tubular (Camey bladder) and 7 detubularized ileocystoplasty. Compliance curves were normal in nearly all patients except those who underwent tubular ileocystoplasty. Cystoplasty contractions were more common with tubular cystoplasty. These contractions appeared at a lower bladder capacity and were higher in amplitude in tubular cystoplasty patients. Detubularizing the bowel for bladder reconstruction appears to create a better low pressure capacitor with better compliance and fewer high pressure cystoplasty contractions.

Traumatic rupture of the female urethra

The clinical course of 4 female patients with complete traumatic rupture of the urethra was evaluated in an effort to propose guide lines for the investigation and initial management of this unusual injury. Treatment modalities are determined by the level of urethral injury and the subsequent effect on continence. We recommend a retropubic approach for bladder neck injuries, a transvaginal approach for proximal urethral ruptures with reanastomosis over a stenting catheter and acceptance of a hypospadiac neomeatus for distal urethral ruptures.

Primary Non-Urachal Adenocarcinoma of the Bladder

The clinical course of 34 patients with non-urachal adenocarcinoma of the bladder was reviewed and compared to the world experience. The 5-year survivorship was 19 per cent, with only 1 patient being free of disease. Metaplasia with formation of glandular elements reflects the unstable potential of the transitional cell and may be associated with the biologic aggressiveness of the tumor.

Bilateral adrenal neuroblastoma

Bilateral adrenal neuroblastoma is extremely rare, with isolated case reports considered to represent metastatic spread rather than simultaneous occurrence. This patient was found to have synchronous, separate, and equal size neoplasms that morphologically and ultrastructurally are neuroblastoma. We believe that these findings represent the unusual occurrence of simultaneous primary adrenal neuroblastoma reflecting multicentric origin of this neoplasm.

Complications of small-carrion penile prosthesis

Seventy-six patients with impotence have undergone insertion of the Small-Carrion penile prosthesis at Duke University Medical Center. Twenty patients experienced postoperative complications. Seven of these 20 patients lost one or both prostheses either by spontaneous extrusion or surgical removal. Although success with this procedure is well documented, complications may be significant when they occur and awareness of these problems is essential for proper management. The benefits of this procedure are reviewed, and reported complications and their management are discussed.

Impact of pelvic lymphadenectomy in patients with prostatic adenocarcinoma

The clinical course of 75 males subjected to radical prostatectomy after pelvic lymphadenectomy were compared with that of 29 males receiving radical without lymphadenectomy. The adverse survival impact of positive pelvic nodes and the impact of pelvic lymphadenectomy are discussed.

Comparative morphology of primary and secondary deposits of prostatic adenocarcinoma

In 42 patients with metastatic adenocarcinoma of the prostate, histopathologic specimens of the original prostatic biopsy and lymphatic metastasis were classified using the grading system of tumor differentiation described by Gleason et al.6 The observed similarity between prostatic biopsy morphology and the morphology in the corresponding lymphatic metastasis supports the concept that the histologic growth pattern of the primary tumor is reduplicated in the metastatic lesions. The observation that a more anaplastic pattern did not appear in the metastatic deposits implies that factors other than cellular loss of differentiation are responsible for the cells ability to metastasize.

Bilateral single ureteral ectopia.

We report 11 cases of bilateral single ectopic ureter. The clinical features and surgical management are discussed. With current surgical techniques, these patients can be treated successfully.