William C. Maxted

Epidermoid cysts of the testis: a report of three cases and an analysis of 141 cases from the world literature.

Epidermoid cysts of the testis are rare and represent about 1% of all testicular tumors. An analysis of 141 cases reported to date in the world literature, including the cases reported here, indicates that 50% of the lesions occur in the third decade and 86% between the second and fourth decade. The most common presentations are painless enlargement of the testis (41%) for an average period of 2.25 years or incidental detection during routine physical examination (33%). Clinically, a discrete testicular nodule can be palpated in the majority of the cases (76%). Pathologic findings are those of a squamous lined cyst containing keratin with absence of appendages or other elements. It is believed that, despite the benign nature of the lesion, they should be treated by orchiectomy so that a thorough pathologic examination can be done to establish a confident diagnosis. While some controversy exists about their source of origin, all the evidence, including the age, more common occurrence among whites, and the rare reported cases arising in cryptorchid testis points to a germ cell origin for these lesions. The epidermoid cyst should thus be recognized as another subtype in the category of germ cell tumors of the testis and perhaps the ovary.

Ureteral stricture: experience with 31 cases

We reviewed the records of 31 patients treated during the last 5 years for ureteral stricture disease. The causes of stricture formation included ureteroenteral anastomoses (23 per cent), open ureterolithotomy (19 per cent), ureteroscopy (19 per cent), other urological procedures (16 per cent), general surgical and gynecological procedures (13 per cent) and miscellaneous causes (7 per cent). Of the patients 24 were managed initially with antegrade or retrograde balloon dilation or stenting and favorable outcomes were achieved in 12 (50 per cent), with a mean followup of 13 months. Of the 12 patients who failed endourological management 6 subsequently underwent open repair with a 100 per cent success rate. The remaining 7 patients underwent an open operation as the initial management and successful results were achieved in 6. The over-all rate of successful management of ureteral stricture disease using endoscopic and open surgical techniques was 77 per cent. A total of 7 patients (23 per cent) failed attempts at intervention: 5 showed evidence of decreasing renal function and 2 required nephrectomy.

A Pilot Study of Intensity Modulated Radiation Therapy with Hypofractionated Stereotactic Body Radiation Therapy (SBRT) Boost in the Treatment of Intermediate- to High-Risk Prostate Cancer

Clinical data suggest that large radiation fractions are biologically superior to smaller fraction sizes in prostate cancer radiotherapy. The CyberKnife is an appealing delivery system for hypofractionated radiosurgery due to its ability to deliver highly conformal radiation and to track and adjust for prostate motion in real-time. We report our early experience using the CyberKnife to deliver a hypofractionated stereotactic body radiation therapy (SBRT) boost to patients with intermediate- to high-risk prostate cancer. Twenty-four patients were treated with hypofractionated SBRT and supplemental external radiation therapy plus or minus androgen deprivation therapy (ADT). Patients were treated with SBRT to a dose of 19.5 Gy in 3 fractions followed by intensity modulated radiation therapy (IMRT) to a dose of 50.4 Gy in 28 fractions. Quality of life data were collected with American Urological Association (AUA) symptom score and Expanded Prostate Cancer Index Composite (EPIC) questionnaires before and after treatment. PSA responses were monitored; acute urinary and rectal toxicities were assessed using Common Toxicity Criteria (CTC) v3. All 24 patients completed the planned treatment with an average follow-up of 9.3 months. For patients who did not receive ADT, the median pre-treatment PSA was 10.6 ng/ml and decreased in all patients to a median of 1.5 ng/ml by 6 months post-treatment. Acute effects associated with treatment included Grade 2 urinary and gastrointestinal toxicity but no patient experienced acute Grade 3 or greater toxicity. AUA and EPIC scores returned to baseline by six months post-treatment. Hypofractionated SBRT combined with IMRT offers radiobiological benefits of a large fraction boost for dose escalation and is a well tolerated treatment option for men with intermediate- to high-risk prostate cancer. Early results are encouraging with biochemical response and acceptable toxicity. These data provide a basis for the design of a phase II clinical trial.

Major complications of silicone penile prosthesis: predisposing clinical situations.

Necrosis of the corpora cavernosa of the penis developed in 2 patients with diabetes mellitus complicated by significant vascular disease following insertion of a silicone penile prosthesis necessitating its removal. The surgical maneuvers thought to predispose to these complications will be considered.

Malacoplakia of the Bladder: A Case Report of Resolution with Bethanechol, Trimethoprim-Sulfamethoxazole and Ascorbic Acid

Malacoplakia is a granulomatous disease that most frequently involves the urinary tract but also may involve the genital tract, gastrointestinal tract and retroperitoneum. It is believed to be infectious in origin, secondary to a deficiency of intracellular lysosomal digestion, and heretofore considered a chronic problem. We report a case of malacoplakia of the bladder, which was treated successfully with a combination of bethanechol, trimethoprim-sulfamethoxazole and ascorbic acid.

Scrotal enlargement following inguinal herniorrhaphy: Ultrasound evaluation

Although sonography has become an established modality in the evaluation of acute and chronic scrotal abnormalities, its role in the post-herniorrhaphy patient with scrotal swelling has not yet been defined. We present 5 patients with immediate and delayed complications of herniorrhaphy in which sonography provided useful clinical information. Immediate complications included scrotal hematomas, scrotal wall and septal thickening, epididymitis, and testicular displacement. Delayed complications included an infected hydrocele demonstrating a fluid-debris level. The etiology of scrotal swelling in postherniorrhaphy patients can be determined with sonography.

Neurogenic fibrosarcoma following radiation therapy for seminoma

We report a case of radiation-induced neurogenic fibrosarcoma that developed in a patient who received radiation therapy for seminoma. The sarcoma developed within the irradiated field after a latency period of nineteen years. Although the occurrence of a secondary neoplasm is unusual, this possibility should be included in the differential diagnosis of patients who present with tumor growth after a long interval following radiation therapy.

Use of Ephedrine in Post-Lymphadenectomy Ejaculatory Failure: A Case Report

AbstractLoss of ejaculatory function following retroperitoneal lymphadenectomy is a well known phenomenon. The resulting infertility is a serious problem and, to date, no fully effective therapy has been found. We report a case of conception on 2 occasions by the same patient with the use of ephedrine.

Peliosis hepatis after long-term androgen therapy

Peliosis hepatis is a recognized, but rare, complication of androgen replacement therapy. We herein report such a complication with necropsy study of the liver so involved.

Case Report: Complete Response of Metastatic Transitional Cell Carcinoma of the Bladder with Chemotherapy Alone

Transitional cell carcinoma of the bladder has remained to date basically a surgical disease with the addition of preoperative radiation therapy to increase survival. Chemotherapy for bladder cancer is administered either in an adjuvant setting or in patients with metastatic disease, most of whom have been treated already with cystectomy and/or radiation. We report a complete response at 54 months in a patient with clinical stage D2 and pathologic stage D1 carcinoma using cisplatin, doxorubicin and cyclophosphamide. The patient was treated with urinary diversion and chemotherapy alone, and no attempt was made to remove the primary lesion.