William D. Belville

Stage A prostatic carcinoma and repeat transurethral resection: a reappraisal 5 years later.

The treatment of patients with stage A prostatic carcinoma demands precise pathological review. In an attempt to evaluate these patients thoroughly earlier reports from our institution recommended repeat transurethral biopsy. Recent studies have reaffirmed the benign nature of stage A1 disease. To examine the efficacy of this procedure a referee pathologist reviewed 8 years of experience with patients with stage A prostatic carcinoma from our institution. Clinical followup was more than 5 years in most cases. Of the 40 patients who underwent repeat transurethral biopsy the tumor in 38 remained stage A1 pathologically. While 1 patient died of the tumor the the remainder are without clinical disease. This low incidence of upstaging does not support the routine use of repeat resections.

Benign Testis Tumors

Benign testis tumors are reported to be extraordinarily rare. Recent clinical experience has shown a high prevalence (7 of 12 patients) of these tumors, which, although small, is much higher than other reports. We herein present 4 illustrative cases and a practical categorization of the varied pathologic events causing these tumors.

Inverted Papilloma of the Urinary Tract: Histogenesis, Recurrence and Associated Malignancy

We describe 5 new cases of inverted papilloma of the urinary tract. One case represents the second known recurrence of this tumor while another demonstrated areas of adjacent low grade papillary transitional cell carcinoma. Immunohistochemical studies suggest a histogenetic difference between inverted papillomas of the prostatic urethra and of the bladder.

Prostatic Abscess: Computerized Tomography Scanning as an Aid to Diagnosis and Treatment

In the antibiotic era prostatic abscesses are rare and the clinical picture often can be confusing. In 2 recent cases computerized tomography scanning not only proved the diagnosis easily but it also simplified greatly the definitive surgical procedure.

Traumatic Hematocele: Association with Rupture of the Testicle

Ten patients with hematoceles associated with blunt trauma have been seen during the last 4 years. In 80 per cent of the cases the hematocele was caused by rupture of the testicle. Prompt early exploration, adequate débridement, primary repair of the tunical laceration and Penrose drainage resulted in a salvage rate of 75 per cent.

Renal leiomyosarcoma: plea for aggressive therapy.

We report a case of renal leiomyosarcoma arising from the renal pelvis with immunohistochemical confirmation of the diagnosis. Treatment was extirpative surgery for both primary and metastatic lung lesions as well as adjunctive radiation and chemotherapy. This patient remains disease-free twelve months following treatment.

Solitary Crossed Renal Ectopia

An 18-month-old girl had crossed ectopia involving a solitary left kidney. There have been 26 cases reported previously. Several theories for this occurrence are discussed.

Seminal Vesicle Abscess: The Use of Computerized Coaxial Tomography for Diagnosis and Therapy

Seminal vesicle abscesses are extremely rare and worthy of report. Computerized tomography easily verifies the diagnosis and simplifies the treatment of transurethral incision and drainage.

Urolithiasis and Race: Another Viewpoint

We describe 193 consecutive individuals with documented urolithiasis in a military population. In contrast to other reports, the prevalence of stone disease was nearly identical in white-and black patients. This unique black population refutes the concept that urinary calculi are rare in blacks.

Determination of indwelling ureteral stent patency. Comparison of standard contrast and nuclear cystography, and lasix renography

OBJECTIVE Because of the difficulty in determining patency of Double-J ureteral catheters, a study was devised at Madigan Army Medical Center to determine the best method to demonstrate stented ureteral patency. METHODS Forty-two patients requiring Double-J ureteral stenting for various clinical reasons were the study group. Outpatients underwent contrast retrograde cystography, nuclear cystography, and diuretic renography every four to six weeks during the stent duration or just prior to stent removal if the stents were indwelling for less than four weeks. In addition, four weeks after stent removal diuretic renography alone was done to evaluate for possible delayed obstructive effect of the ureteral stenting. RESULTS A total of 53 stents and 42 patients were evaluated. Seventy-seven sets of studies were obtained. In only four instances did all three imaging methods agree on the obstruction. In the remaining 73 sets of data, at least one imaging technique indicated stented ureteral patency. The contrast retrograde cystogram was positive for reflux 52 times (71%). Nuclear cystography showed patency 54 times (74%) and an unobstructed diuretic renogram was obtained 59 times (81%). In addition, five of the six diuretic renograms accomplished with patients in the supine position only and which showed obstruction were repeated with patients in the upright position, and they showed unobstructed function. The overall sensitivity for diuretic renography was 89 percent when the diuretic renogram was done with patients in the supine and upright positions. CONCLUSIONS Diuretic renography is the most sensitive test for detecting stented ureteral patency. This test needs to be performed with patients in both the supine and upright positions.