Thomas R. Hatch

The Value of Excretory Urography in Staging Bladder Cancer

Disagreement exists about the accuracy of excretory urography in the staging of bladder cancer. During a 10-year period 38 of 524 patients with carcinoma of the bladder had ureteral obstruction on excretory urography at the time of the initial diagnosis. All 38 patients had lamina propria invasion and 35 had muscle invasion at staging transurethral resection. Of those patients 22 had exploratory laparotomies, 11 after 4,000 to 5,000 rad. Of the patients undergoing laparotomy 55 per cent had metastases. Ureteral obstruction at the time of initial diagnosis of bladder cancer usually indicates muscle invasion and/or metastases.

Time-Related Recurrence Rates in Patients with Upper Tract Transitional Cell Carcinoma

Disagreement exists about the necessity and frequency of contrast medium imaging of the upper urinary tract in patients with transitional cell carcinoma. During a 10-year period 39 patients were treated for upper urinary tract transitional cell carcinoma. There were 3 contralateral recurrences in 33 patients treated by nephroureterectomy for the initial lesion. Of 4 patients treated initially by segmental ureterectomy or partial renal pelvectomy 1 had an ipsilateral recurrence 3 years later. Two patients with bilateral upper tract transitional cell carcinoma were treated by simple nephrectomy combined with simultaneous contralateral segmental ureterectomy or renal pelvectomy. Both patients had no evidence of recurrent tumor after 4 years of followup. Of the 39 patients with upper tract transitional cell carcinoma 6 had multiple bladder tumors or carcinoma in situ documented on biopsy before the development of an upper tract tumor. The interval between the treatment for the last bladder tumor or carcinoma in situ was 1 year in 4 patients, 2 1/2 years in 1 and 5 years in 1. Of these 6 patients 2 had bilateral upper tract tumor occurring at different times. Both patients had multiple bladder tumors diagnosed between the development of each upper tract lesion. Annual contrast medium imaging of the upper urinary tract is recommended in patients who have had multiple bladder tumors and in those who have undergone treatment for upper urinary tract transitional cell carcinoma.

Renal Adenocarcinoma with Solitary Metastasis to the Contralateral Adrenal Gland: Report of 2 Cases and Review of the Literature

We report 2 rare cases of renal adenocarcinoma with solitary metastasis to the contralateral adrenal gland, 1 recognized synchronously with the primary neoplasm and 1 found 15 years after nephrectomy. The latter case represents the longest reported interval between nephrectomy and treatment of a solitary contralateral adrenal metastasis of renal adenocarcinoma. Distinction of these metastatic tumors from primary adrenocortical carcinoma was facilitated by immunohistochemical markers. Twelve other reported cases of renal adenocarcinoma with solitary contralateral adrenal metastasis support aggressive surgical management of this lesion.

Dissolution of Cystine Calculi by Pelviocaliceal Irrigation with Tromethamine-E

We report 3 cases of cystine calculi. The stones were dissolved by pelviocaliceal irrigation with tromethamine-E, performed either through a percutaneous nephrostomy tube or ureteral catheters. The 25, 27 and 37-day courses of irrigation were well tolerated by all patients. Complications included a single asymptomatic urinary tract infection that required antibiotic therapy and transient hematuria due to catheter irritation. Our experience demonstrates that cystine calculi, including staghorn, can be dissolved by tromethamine-E irrigation, thereby obviating the need for surgical intervention.

Acute lumbosacral plexopathy in diabetic women after renal transplantation

Renal transplantation is an accepted treatment for patients with end stage renal disease from insulin-dependent diabetes mellitus. Acute lumbosacral plexopathy developed following renal transplantation in 4 female patients with insulin-dependent diabetes mellitus between January 1, 1981 and June 30, 1988. In all 4 patients the internal iliac artery was used for revascularization of the renal allograft with ligation of the anterior and posterior divisions. Within 24 hours of surgery they complained of ipsilateral buttock pain, numbness in the leg and weakness below the knee. This complication has not been observed in nondiabetic patients at our institution, nor in diabetic patients when the internal iliac artery was not used. However, lumbosacral plexopathy occurred in 4 of 27 (14.8%) female patients with insulin-dependent diabetes mellitus when the internal iliac artery was used (p less than 0.001). Age, duration of insulin-dependent diabetes mellitus, hypertension, cigarette smoking history and kidney donor were not significant predictors of this complication. This unusual and newly recognized complication appears to result from ischemia of the lumbosacral plexus following ligation of the internal iliac artery in patients with severe small vessel disease.

Extragonadal germ cell tumor: the preoperative urological evaluation

Primary extragonadal germ cell tumors were diagnosed in 4 patients in whom surgical or postmortem examination of the testis failed to reveal germ cell tumor. A fifth patient underwent serial examination with testicular ultrasound without evidence of any abnormalities and he remains free of disease following chemotherapy. Based on our experience and a literature review, it is our opinion that orchiectomy is not indicated unless there is a palpable testicular abnormality, recent change in testicular size or consistency, abnormal testicular ultrasound or history of cryptorchidism, or if the primary tumor is choriocarcinoma.

Successful Term Delivery by Cesarean Section in a Patient with a Continent Ileocecal Urinary Reservoir

Childbirth in a mother with a continent urinary reservoir to our knowledge has not been previously reported. The effects of the gravid uterus on the reservoir are presented, as well as management of the pregnancy and delivery.

Intra-arterial infusion of 5-fluorouracil for recurrent adenocarcinoma of bladder

We report a case of recurrent adenocarcinoma of the bladder treated by intra-arterial infusion of 5-fluorouracil (5-FU). The use of this agent in the treatment of adenocarcinoma of the bladder is reviewed.

Klinefelter syndrome in identical twins

A rare case of Klinefelter syndrome in identical twins is reported. Salient features and clinical recognition of the syndrome are discussed.

Preservation of 32 human kidneys by simple cold storage for more than 48 hours

Transplant centers are reluctant to use kidneys stored cold for more than 48 hours. During a 6-year interval we transplanted 32 kidneys preserved by intracellular electrolyte flushing that were stored cold for 48.2 to 61.4 hours. Of the recipients 91 per cent required dialysis within 1 week after transplantation. The mean serum creatinine nadir within 1 month was 3.0 mg. per dl. and graft survival at 1 month was 81 per cent. Short-term kidney graft function was not influenced significantly by the addition of magnesium sulfate to the flush solutions or by cyclosporin immunosuppression. The 1 and 2-year actuarial kidney graft survival rates were 72 and 58 per cent, respectively. The 1 and 2-year mean serum creatinine levels were 1.9 and 1.6 mg. per dl., respectively. Kidneys can be transplanted successfully after 48 hours of simple cold storage following flushing with an ice-cold intracellular electrolyte solution.