The dangerous ureter.

Seven patients with recurring transitional cell carcinoma of the urinary bladder were treated with repeated transurethral resections of these tumors and were given adjuvant intravesical chemotherapy or bacillus-Calmette Guerin (BCG) vaccine. Carcinoma either in the ureters or renal pelves subsequently developed in these patients. Unfortunately, 2 patients had inoperable tumors when the diagnosis was confirmed. When treating patients with recurring carcinoma of the urinary bladder, the possibility of upper urinary tract tumors developing must always be considered. Hence, the necessity of frequent urinary and ureteral cytology examinations proceeding to excretory urography, retrograde pyelograms, computerized tomography (CT) scans of the upper tracts, or ureteroscopy as may be necessary to locate small tumors or to diagnose carcinoma in situ.

Technetium-99m antimony sulphide colloid lymphoscintigraphy of the prostate by direct transrectal injection.

Laterality of prostatic lymphatic drainage was successfully assessed in nine patients with prostatic carcinoma after direct unilateral transrectal injections of 99Tcm-antimony sulphide colloid by Franzen needle. Pelvic lymphatic drainage was equally divided between ipsilateral, contralateral and bilateral patterns. The frequent observation of radiocolloid migration to contralateral lymph node groups in patients with prostate carcinoma, including those with primary disease localized clinically to a single lobe of the prostate, indicates the potential for contralateral pelvic lymph node metastases in this population. This finding may be important in determining the appropriate surgical staging and treatment of patients with prostate carcinoma. The clinical applicability of lymphoscintigraphy in the evaluation of metastatic spread and in lymph node biopsy planning requires further study.

The significance of asymptomatic microhematuria in women and its economic implications. A ten-year study.

A prospective study of 177 women with asymptomatic microhematuria was carried out over a ten-year period. The implications of asymptomatic microhematuria in this population indicate that endoscopic evaluation of the bladder may be unnecessary, as no vesical neoplasms were discovered. It seems that cytologic examination of the urine may be a simpler, more cost-effective method for screening the female population with microhematuria.

Analysis of papillary renal adenocarcinoma.

A retrospective review was conducted comparing the angiographic findings, tumor volumes, staging, and survival of patients with papillary renal adenocarcinoma as compared with the more common clear and granular cell renal adenocarcinoma. The data suggest that the papillary histopathologic organization confers an improved prognosis, which concurs with previous findings. We speculate on why this tumor behaves differently from clear cell carcinoma.

Radical prostatectomy or radiotherapy in carcinoma of prostate. The dilemma continues.

Evaluation of the efficacy of radical prostatectomy versus radiotherapy in carcinoma of the prostate has been compromised by the scarcity of data in comparable populations. A nationwide search was conducted to compile the available data on the use of radiotherapy in lymphadenectomy-staged patients. The assessed population consists of patients with tumor confined to the gland (Stages A2 and B), negative staging lymphadenectomy, negative bone scan, and normal serum acid phosphatase level who received external beam radiotherapy with curative intent. To provide a broad spectrum of experiences, the search included patients from a large number of institutions including Stanford University, Washington University (St. Louis), those participating in the Radiation Therapy Oncology Group, and a broad range of radiotherapy practices surveyed by the PCS (Patterns of Care Study). A total of 209 patients were identified. No selection criteria other than the aforementioned were applied. The patients were treated consecutively during the survey period. In sharp contradistinction to the reported results of the VA Uro-Oncology Group the analysis indicates a less than 10 per cent probability of progression within the first five years after completion of treatment. Nationwide, the outcome of radiotherapy-treated patients appears to be equivalent to the comparable surgically treated population.

Definitive radiotherapy in resectable (stage A2 and B) carcinoma of the prostate--results of a nationwide overview.

To evaluate the efficacy of definitive radiotherapy in a population of patients with carcinoma of the prostate who satisfy the customary selection criteria for radical prostatectomy, a nation-wide search was conducted. The assessed population consists of patients with clinical Stage A2 and B carcinoma of the prostate, negative staging lymphadenectomy, negative bone scan, and normal serum acid phosphatase. The search included patients from Stanford University, Washington University in St. Louis, those participating in the Radiation Therapy Oncology Group and a broad range of radiotherapy practices surveyed by the PCS (Patterns of Care Study). A total of 209 patients satisfying the selection criteria received definitive radiotherapy during the surveyed period. The end-point of analysis was the time to progression (distant metastases). The results of the analysis indicate a very low (less than 10%) probability of progression within the first 5 years after completion of treatment. Contrary to the recent report from the VA Uro-Oncology Group the study demonstrates a comparable outcome in radiotherapeutically and surgically treated patients.

Detection of tumor angiogenesis factor in adenocarcinoma of kidney.

Implantation of human renal adenocarcinoma in the rabbit cornea has resulted in new vascular growth from the limbus toward the tumor implant. This suggests that renal adenocarcinoma elaborates tumor angiogenesis factor (TAF) which stimulates endothelial cell growth. Such a substance could conceivably be responsible for the luxuriant vascularity of most renal adenocarcinomas. Conversely, absence or diminished secretion of TAF may be responsible for the hypovascular papillary renal adenocarcinomas and their recognized relatively benign clinical behavior.

The epithelial origin of a malignant mesodermal mixed tumor of the bladder: report of a case with long-term survival.

Malignant mesodermal mixed tumors of the bladder are complex neoplasms consisting of elements of carcinoma and differentiated sarcoma. They are rare, aggressive and usually rapidly fatal. We report on a patient who remained free of disease 7 years after resection by partial cystectomy of a malignant mesodermal mixed tumor. Only 1 other long-term survivor has been reported. Our case is of particular interest because urothelial carcinoma in situ was found in the bladder epithelium on the surface and at the periphery of the invasive tumor, strongly suggesting an epithelial origin of this and similar tumors of other organs.

Papillary adenocarcinoma of kidney. II. Radiographic and biologic characteristics.

Papillary adenocarcinoma of the kidney is an uncommon variant of renal adenocarcinomas which, on radiographic evaluation, presents characteristically as a predominantly solid, hypovascular or avascular mass. At the present time, surgery is still mandatory to distinguish this lesion from other solid renal lesions. Finally, because of its slow-growing nature, seemingly well-encapsulated appearance, and apparently more favorable biologic prognosis, these patients conceivably might be treated with less radical surgery in selected instances. As demonstrated by one of our patients (Case 1) enucleation is a reasonable alternative, particularly in patients with a solitary kidney, with compromised renal function, or in patients medically incapable of withstanding radical surgery.

Prediction of renal functional recovery after relief of upper urinary tract obstruction.

Renal cortical regions of interest were used prospectively to predict recoverability of renal function in 27 patients with unilateral or bilateral urinary tract obstruction. In these 27 patients 36 kidneys with short-term or long-term obstruction were studied. The 131iodine radiohippuran renogram curves were generated from areas of interest from the renal cortex and from the whole kidney. Curves generated during obstruction were evaluated qualitatively to determine if regional cortical renograms exhibited a more normal appearance than total kidney curves. After relief of obstruction renograms generated from the whole kidney were evaluated for evidence of renal functional recovery. Cortical curves obtained before relief obstruction were judged normal, with an abnormal whole kidney renogram in 20 of 36 kidneys. The whole kidney renogram improved after relief of obstruction in all 20 cases. Cortical curves for the remaining 16 kidneys before relief of obstruction had the same abnormal appearance as the whole kidney renogram. After relief of obstruction no evidence of kidney function improvement as measured by the renogram was evident in 14 kidneys. The over-all accuracy of this test of renal functional recoverability was 94 per cent. These data support the hypothesis that when cortical curves appear more normal than total kidney curves there is a strong likelihood of postoperative improvement in renal function when the obstruction is relieved. Abnormal cortical curves are associated with a poor prognosis for renal functional improvement.

Early definitive urologic management of patient with crush pelvic trauma and deep perineal laceration.

Crush pelvic injury with deep perineal laceration provides a unique situation for the urologist to examine directly avulsed urinary structures. Although the operative field may be fecally contaminated, and the prospect of sepsis likely, an aggressive approach of primary repair of the urinary tract may avoid future complexities in reconstruction. A multidsciplinary approach is a prerequisite to deciding on proper therapeutic modalities.

Papillary adenocarcinoma of kidney: a new perspective.

A retrospective review of cases of renal adenocarcinoma during a five-year period revealed 6 cases with a papillary histologic organization. Closer examination indicates that papillary adenocarcinoma of the kidney is a slow-growing neoplasm with a clinical prognosis that appears to be considerably better than in other types of cellular organization.

Adult Wilms tumor treated with radiotherapy and chemotherapy: a case report.

A 24-year-old man underwent a left radical nephrectomy for a mass that was found to be a Wilms tumor. The postoperative course, consisting of combined radiotherapy and chemotherapy, is discussed and the recent literature is reviewed.

[Prolactin secreting adenomas: surgical treatment and results. 120 female cases, 30 males cases (author's transl)]. / Adénomes à prolactine: résultats du traitement chirurgical. 120 cas féminins, 30 cas masculins.

Twenty one per cent of the female cases concerned microadenomas discovered because of amenorrhea with or without galactorrhea. Sixty two per cent of these cases were cured by surgery alone, against 40% of the other types of prolactin (Prl) -- secreting tumors with extra-sellar extensions which were not cured. With men, no microadenomas was discovered (although one case demonstrated their possible existence) and in the most frequent cases, tumors exhibited extra-sellar extensions sometimes very large (giant tumors). In these cases, tumoral symptoms were cured by surgery while only 5 out of 30 men recovered a normal plasma Prl. level (30 ng/ml). In all cases the prognosis was established taking into account the volume and invasive characters (at the surgical and histopathological level) of the tumors. The different therapeutical approaches of these tumors (i.e. medical treatment by CB 154, surgery of Rxtherapy) were evaluated. Anyway the necessity of an earlier diagnosis is pointed out allowing the possibility of a selective adenomectomy by a microsurgical approach.