Thomas H. Green

Urinary stress incontinence: Differential diagnosis, pathophysiology, and management

It is appropriate to introduce this review of the subject of urinary stress incontinence with a discussion of other disorders that may produce abdnormal urinary leakage,at times even stimulating true anatomic stress incontinence. It is obviously important to correctly identify patients with these other conditions and not perform surgical procedures unlikely to relieve their symptoms. Thereafter, the underlying pathophysiology of stress incontinence is considered in detail, since its fundamental understanding serves as the basis for both accurate diagnosis and proper selection and effective execution of the operations designed to correct true anatomic stress incontinence. A final section on patient management covers choice of the optimal surgical procedure for each individual patient, end results that should be achievable by proper selection and performance of the various operations, and a descriotion of some of the technical details that seem particularly helpful in carrying out the three principal types of surgical procedres currently in use.

Primary carcinoma of the vagina. An analysis of 68 cases.

Abstract Data from 68 cases of primary carcinoma of the vagina are analyzed in detail. The tumors tend to occur beyond the fifth decade of life and are primarily epidermoid carcinomas. No etiologic factor for the development of these tumors was found. The International Staging Classification was utilized and found to be useful prognostically, but prospective application should provide more accurate statistics. The problems of therapy are discussed. Individualization of cases is necessary, and effective treatment was accomplished with radical surgery. Involvement of regional lymph nodes with tumor markedly worsens the prognosis. Recurrences usually occurred in the pelvis and with one exception were not effectively treated by operation or radiation.

EVALUATION OF CURRENT MANAGEMENT OF ENDOMETRIAL CARCINOMA

A study of all patients with endometrial carcinoma who had received their primary treatment at Pondville State Cancer Hospital, during a 14-year period from 1950 through 1963, was undertaken. The primary aim was to evaluate the results of “routine” postoperative vaginal radium therapy in the prevention of vaginal recurrences as compared with preoperative intracavitary radiation. Significant data influencing the occurrence and end results after the treatment of endometrial cancer were also analyzed. Deep myometrial invasion was found to be of much greater prognostic significance as compared with uterine size. Combined surgical treatment with adjuvant radiotherapy resulted in better survival rates and a decreased incidence of vaginal metastases. No significant difference was noted in the efficacy of preoperative intracavitary irradiation as compared with postoperative vaginal application. Radical rather than simple hysterectomy alone does not reduce the incidence of subsequent vaginal recurrence.