Clinical observations on sixty-nine cases of in situ carcinoma of the urinary bladder.

In the course of screening 35,000 urological outpatients with urine cytological examinations, cytological indication of cancer was found in 106 patients in the absence of a cystoscopically visible bladder tumor. Sixty-nine of the 106 patients have biopsy-proven in situ carcinoma of the bladder, all transitional in type and anaplastic. Follow-up data on effects of therapy are available on 58 patients treated by various means, including total cystectomy, partial cystectomy, transurethral fulguration, intravesical thiotepa, and external radiation. The duration of symptoms before diagnosis was remarkably long, and the prolonged course of the in situ lesion was also noteworthy. Differences in the observed behavior of in situ bladder carcinoma may be due, in addition to differences in host resistance, to the existence of two pathogenetic forms of bladder cancer, one arising in an extensive field of abnormal epithelium and the other developing in a focal area of abnormality.

Pneumopyelography.

Poorly opacified calculi that are completely obscured by high-density contrast media can be delineated by pneumopyelography. Three examples of pneumopyelography are presented.

Postpartum onset of urinary incontinence associated with ureteral ectopia.

The onset of urinary incontinence in adult women in association with extrasphincteric ureteral ectopia is rare. Herein we report 2 cases of this unusual occurrence. The incontinence in both patients began after significant obstetric trauma. Ureteral ectopia should be included in the differential diagnosis of incontinence beginning in the immediate postpartum period.

Bolus nephrotomography in diagnosis of lesions of kidney.

Bolus nephrotomography was employed in the study of 100 patients with renal adenocarcinoma and 100 patients with renal cyst. A retrospective review of the vascular and nephrographic phases of this study was made. A diagnosis of renal adenocarcinoma could be made with confidence by bolus nephrotomography in 82 per cent of cases with the remaining cases indeterminate and requiring further investigation; the vascular phase was of greater diagnostic value than the nephrographic phase. A diagnosis of renal cyst could be made with confidence by bolus nephrotomography in 85 per cent of cases with the remaining cases indeterminate and requiring further investigation; the nephrographic phase was of greater diagnostic value than the vascular phase.

Tuberculous prostatitis.

A study of 5 patients with tuberculosis prostatitis revealed that (1) there is a greater chance of striking a noncaseating granuloma than a caseating lesion by needle biospy when both are present; (2) the absence of caseation on biopsy does not necessarily rule out tuberculosis; and (3) special stains may be negative for tuberculosis because of the small size of the tissue sample. Thus, if the clinical suspicion of tuberculous prostatitis is high and if noncaseating lesions are found, a second biopsy specimen should be taken for culture only.

[Improvement of excretory urography with the routine use of tomography (author's transl)]. / Die Verbesserung der Ausscheidungsurographie mit Hilfe der routinemässigen Anwendung der Tomographie.

The additional use of routine tomography during excretory urography in our experience has led to a significant improvement in urographic diagnosis. Tomography has provided more diagnostic studies, it also has demonstrated tumors which would have remained undetected with the use of conventional urography alone. This applies particularly to small hypernephromas of stage A, which should be considered as curable.

Renal cystic disease: radiologic appearance.

The great diversity of the various forms of renal cystic disease results in a formidable diagnostic challenge to the roentgenologist and clinician alike. Until recently, adequate diagnosis required surgical exploration or biopsy, or both, to establish benignity or to confirm the suspicion of a more esoteric form of renal cystic disease. Now, however, with refinements in excretory urography with tomography, bolus and infusion nephrotomography, selective renal arteriography, percutaneous aspiration of cysts, and sonography, the accuracy of a clinical diagnosis of cystic disease has approached that of surgical exploration and biopsy. In addition these noninvasive techniques eliminate the morbidity and mortality associated with surgical procedures.

Prostatosis, prostatitis or pelvic floor tension myalgia?

Patients with symptoms suggestive of prostatitis or prostatosis who do not have pathogenic bacteria in the prostatic secretions may, in fact, not have prostatic problems. The possibility of pelvic floor tension myalgia should be considered in these patients.

Clinical importance of microhematuria.

To evaluate the etiology of microhematuria, the cases of 200 consecutive patients with asymptomatic microhematuria who had undergone complete urologic examination and two-year follow-up were reviewed. Most patients were 50 to 59 years old. Highly significant urologic lesions were found in 20% of patients. Thirteen percent of these patients had a genitourinary malignant neoplasm. No urologic lesion could be identified in 19% of patients in this group. The results suggest that present diagnostic modalities have substantially refined and improved the urologist's diagnostic abilities. The urologic examination of patients with asymptomatic microhematuria, particularly in those older than 40 years, is justified.

Transurethral prostatic resection in patients with prosthetic cardiac valves.

Twenty-one patients with prosthetic cardiac valves successfully underwent transurethral prostatic resection at the Mayo Clinic. Temperature elevation in 4 patients was the only postoperative complication; in particular, neither congestive heart failure nor thromboembolic complications developed and there were no operative deaths. Preoperative evaluation and clinical management of potential complications are based on the recognition of the complications that are peculiar to these patients. Particularly important is the proper use of antibiotics and anticoagulants and avoidance of overloading the circulation with fluid from open prostatic venous sinuses.

Urethral calculi.

The diagnosis and management of 34 men and 13 women with urethral calculi are reviewed. A majority of patients presented with dysuria, weak stream and perineal pain. Diagnosis was made radiographically in only 42 per cent but was confirmed in all patients who underwent cystourethroscopy. All patients had lower urinary tract lesions or previous prostatic operations and 47 per cent were infected. Migrant urethral calculi were encountered 10 times more often than were native stones and a metabolic cause was found in 10 of 18 patients studied. In men penile urethral calculi were removed transurethrally and all bulbous and most posterior urethral stones were guided endoscopically into the bladder. Most of these stones were irrigated out or removed by transurethral litholapaxy; the remaining few, together with vesical calculi, required cystolithotomy. In all 13 women calculi were removed at the time of urethral diverticulectomy. A majority of 17 men (76.5 per cent) and the 4 women who were followed for an average of 5.3 years have remained free of trouble.

Prostatic adenocarcinoma of ductal origin.

Adenocarcinomas that arise from primary or secondary prostatic ducts have distinctive histopathologic features. The age of patients, symptoms, findings on digital rectal examination and determinations of serum acid and alkaline phosphatase are similar to those of patients with acinic carcinomas. Carcinomas of secondary ducts may be less responsive to endocrine manipulation and of greater malignancy than carcinomas of primary ducts. The course and survival of patients with ductal carcinomas treated conservatively are poor.

Primary transitional cell carcinoma of the prostate.

The symptoms and physical findings in patients with transitional cell carcinoma of the prostate were similar to those in patients with prostatic adenocarcinoma. Usually the neoplasm was poorly differentiated and advanced when the diagnosis was first established. Osseous metastases were commonly osteolytic. Frequently, elevations of serum alkaline or acid phosphatase levels were associated with metastasis. Tartrate-inhibited fractions of the serum acid phosphatase were not elevated. The best form of treatment is radical ablation of the prostate and radiation therapy is next best. Because these neoplasms are not hormonally dependent, hormonal manipulation is not indicated. Prognosis for patients with this malignancy is guarded.

Non-specific granulomatous prostatitis.

Between 1963 and 1972, 86 patients with non-specific granulomatous prostatitis were seen. Symptomatology was suggestive of a lower urinary tract infection in the majority of the cases. The most important feature on prostatic examination was the likelihood of confusion with prostatic carcinoma. Management by whatever means yielded uniformly good results. The natural history of this disease seems to be that of gradual resolution.