Victor L. Carpiniello

Expansion without Significant Rigidity During Nocturnal Penile Tumescence Testing: A Potential Source of Misinterpretation

AbstractOf 134 patients who underwent nocturnal penile tumescence evaluation 23 were found to have significant penile expansion without rigidity sufficient to effect vaginal penetration. An assessment of rigidity as well as expansion is necessary for proper interpretation of the study. Although the nocturnal penile tumescence categories of normal expansion-rigidity and insignificant expansion are relatively clear-cut, and indicate psychogenic and biogenic impotence, respectively, there still exists a number of patients who are not in either of these categories and in whom further delineation is necessary.

Carcinoma of penis treated with neodymium yag laser

Sixteen men with squamous cell carcinoma of the penis were treated primarily with the Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser. Five patients had TIS, 9 had T1 tumors, and 2 had T2 carcinoma. All patients had refused traditional therapy of partial penectomy and gave informed consent as to the investigational nature of the Nd:YAG laser photoradiation therapy. Circumcisions and deep tissue biopsies were performed on all patients prior to tumoricidal neodymium photoradiation treatment. The patients were followed from twelve to thirty-six months. At follow-up, 5 patients with TIS had no evidence of recurrent cancer. Of the 9 patients with T1 squamous cell carcinoma of the penis, 6 (67%) were tumor-free at a mean follow-up of twenty-six months. The 2 men with T2 carcinoma of the penis had reduction of the tumor mass but were not cured. The obvious advantage of the Nd:YAG laser in treating carcinoma of the penis is preservation of the penis eliminating disfiguring amputation.

Renal preservation utilizing neodymium: Yag laser

Six patients with malignancies in a solitary kidney were treated with conservative renal parenchymal-sparing surgery utilizing the Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser. Three patients had transitional cell carcinoma in an upper pole calyx of a solitary kidney. The transitional cell carcinoma was treated definitively by the Nd:YAG laser through a nephroscope prior to partial nephrectomy. The 3 patients have been followed up for twenty-eight, eighteen, and six months, respectively. None of the patients has shown evidence of recurrent cancer on follow-up retrograde ureterograms or on urine cytology obtained from the renal pelves. Three patients with renal cell carcinoma in a solitary kidney had the tumor surgically excised utilizing the Nd:YAG laser in conjunction with standard surgical techniques. All the patients were elderly with compromised renal vasculature that prevented bench surgery with autotransplantation or occlusion of the renal artery. At sixteen, fourteen, and three months, respectively, there is no evidence of recurrent cancer on CAT scans obtained on these patients.

Human papillomavirus associated with bladder cancer

Recently published data have suggested a link between active human papillomavirus (HPV) infection and the development of bladder cancer. This study was undertaken to test for HPV genomic material in the tumors of patients without evidence of ongoing viral infection. Twenty-three consecutive patients with clinical evidence of intravesical neoplasia and no history of HPV infection or clinical evidence of intercurrent disease, underwent cystopanendoscopy and biopsy as part of the routine evaluation and treatment of their tumor. Routine pathologic evaluation and southern blot analysis of biopsy material were done to establish the presence or absence of HPV DNA in the bladder tumors. Twenty-one tumors were identified by routine histology: 20 were low-to-moderate grade transitional cell carcinomas; 1 was found to be squamous cell carcinoma; 1 patient had moderate dysplasia; and 1 patient had evidence of inflammation. Four of the 20 transitional cell tumors (20%) were found to contain HPV DNA. In addition, the patients with dysplasia and cystitis were also shown to have HPV genomic material in their biopsy specimens. Viral types 6/11, 16/18, and 31/33 were found. The 20 percent incidence of HPV genomic material in bladder tumors from patients without clinical evidence of viral infection is in keeping with the observations of other investigators. We present the implication of these findings within the context of our current understanding of viral oncogenesis in the urinary bladder.

Carbon dioxide laser therapy of subclinical condyloma found by magnified penile surface scanning

The etiology and treatment of condyloma caused by the human papilloma virus (HPV) and the association of HPV with cervical dysplasia and/or carcinoma is a major issue in current gynecologic literature. This study examined results of carbon dioxide (CO2) laser treatment of 127 high-risk males with biopsy-proved subclinical HPV infections found by magnified penile surface scanning (MPSS). At a mean follow-up of four months a 66 per cent recurrence rate of microscopic condyloma was encountered. A discussion of the causes of such a high recurrence rate is given, with conclusions on this and prior condyloma treatment series.

Urological Applications of Human Papillomavirus Typing Using Deoxyribonucleic Acid Probes for the Diagnosis and Treatment of Genital Condyloma

The use of deoxyribonucleic acid probes to examine the type of the human papillomavirus genome found in penile lesions is described at a technical level and in a clinical application. At least 40 different types of human papillomavirus have been identified and these types vary not only in their deoxyribonucleic acid base sequences but also in their clinical manifestations. Although deoxyribonucleic acid probes currently have a role only in a research setting, this study delineates the possible role of this technology in a clinical setting to detect subclinical intraurethral human papillomavirus. The results have widespread implications regarding the treatment of condyloma and the associated cervical dysplasia. In this series 25 grossly visible lesions were typed and 85 per cent contained human papillomavirus types 6 and 11. In contrast, microscopic lesions identified in the male partners of women with cervical dysplasia were shown to contain human papillomavirus types 16, 18 or 31 in 60 per cent of the cases. In addition, urethral brushings were obtained and were positive for human papillomavirus in 50 per cent of the cases despite normal urethroscopy. Human papillomavirus types 16, 18 or 31 accounted for 70 per cent of the positive urethral brushings.

Renal Hemangiopericytoma: Surgical, Radiological and Pathological Implications

The first case of renal hemangiopericytoma presenting radiologically as a hypovascular mass is described. Preoperative diagnostic evaluation included ultrasonography, retrograde pyeloureterography, computerized tomography and angiography. Electron microscopy is helpful to distinguish this lesion from histologically similar juxtaglomerular cell tumors. Although renal hemangiopericytoma may appear benign on pathological examination it should be treated as a low grade malignancy and followed carefully.

Advanced Peyronie’s Disease Treated With the Inflatable Penile Prosthesis

Nineteen patients with significant advanced Peyronies disease (that is severe angulation, erectile impotence and/or intractable pain) that had not responded to conservative medical therapy were treated surgically with insertion of the inflatable penile prosthesis. Of the patients 10 had correction of angulation and/or erectile impotence by instillation of the prosthesis alone and needed no additional operation, while 8 required incisions of the tunica albuginea distal to the plaques in addition to the prosthesis to correct the deformity. One patient required a monofilament knitted polypropylene velour graft to cover the defect in the tunica albuginea. Satisfactory results were obtained in 18 of 19 patients.

Omental Transposition as an Aid in Genitourinary Reconstructive Procedures

Mobilization of an intact omental pedicle graft for supportive use has been carried out in a variety of genitourinary reconstructive procedures. Mobilzation is accomplished by detachment of the omentum from the transverse colon and by separation from the greater curvature of the stomach. The right gastroepiploic artery is generally preserved as the blood supply to the omental pedicle. Further pedicle lengthening can be achieved as necessary by selective division of the omentum, based on the arterial anatomy. The rich vascular and lymphatic supply of the omentum and its attendant potential to contribute to healing, even in the presence of infection, while maintaining its suppleness and allowing epithelization to occur over its surface, makes the omental pedicle graft an extremely useful adjunct in the following difficult situations: complicated vesicovaginal, prostatorectal, and rectovaginal fistulas; reconstruction of the bladder neck and bulbo-membranous urethral areas; extensive injury to the bladder; and a variety of renal and ureteral reconstructive procedures.

Applications of Thin Needle Aspiration Biopsy in Urology

Percutaneous thin needle aspiration biopsy was done on 34 patients for better staging of malignant disease by study of opacified lymph nodes, on 12 patients to eliminate the possibility of a malignant etiology of ureteral obstruction and on 7 patients with potentially metastatic soft tissue or visceral lesions. Ideally, a positive biopsy should change subsequent patient management and may eliminate the need for an exploratory operation. A significant number of falsely negative results occur and, for this reason, a negative biopsy should not affect subsequent patient management.