Recurrences in surgical stage I nonseminomatous germ cell tumors of the testis.

A retrospective analysis of patients with surgical stage I nonseminomatous germ cell tumors of the testis was done in an attempt to define the pathogenesis of treatment failure. Of 138 patients 126 (91 per cent) remain free of disease, with a median followup of 5 or more years, and 12 (9 per cent) suffered relapse an average of 9 months after orchiectomy and retroperitoneal lymph node dissection. The majority of recurrences were in the lungs. Of 12 patients who had recurrence 6 were salvaged and are alive without evidence of disease 3 or more years after the second complete remission. A history of scrotal surgery or scrotal violation, the extent of the primary tumor and the presence of sarcomatous elements in the primary were not statistically significant risk factors in this study. A higher recurrence rate with embryonal carcinoma than with teratocarcinoma was not statistically significant.

Selected experience with surgery and combination chemotherapy in the treatment of nonseminomatous testis tumors.

We treated 208 patients with newly diagnosed nonseminomatous germ cell tumors of the testis between January 1975 and March 1978. Patients with stages I and II disease underwent retroperitoneal lymph node dissection, and the majority of patients with stage II neoplasm received adjuvant chemotherapy afterwards. Patients with stage III and palpable stage II neoplasm had initial chemotherapy with or without subsequent surgery. The over-all cure rates were 96 per cent (76 of 79) for patients with stage A, 94 per cent (31 of 33) with stage IIA, 83 per cent (35 of 42) with stage IIB and 35 per cent (15 of 43) with stage III disease. The stage of disease at the time of diagnosis, local extent of the primary tumor, nodal category in stages I and II cancer, and chemotherapy were factors influencing relapse rate and over-all survival.

Autopsy findings in 154 patients with germ cell tumors of the testis.

Autopsy findings are reviewed in 154 patients treated for germ cell tumors of the testis. Of the patients with apparently pure seminoma, 44% had autopsy evidence of nonseminomatous metastases. For all tumor types, the most common sites of distant metastasis were lung (89%), liver (73%), brain (31%), and bone (30%). There was a high incidence of brain metastases in choriocarcinoma and of bone metastases in seminoma. Brain, liver, and bone metastases were late occurrences in the course of the disease and were almost always associated with involvement of other sites. Recurrences in the retroperitoneal area after lymph node dissection occurred mainly in those who had had retroperitoneal lymph node metastases. No difference in site or frequency of metastases was apparent in autopsied patients treated before or after introduction of platinum containing regimens. Respiratory failure, secondary to lung metastases, was the most common cause of death. Of the autopsied patients, 6% died of iatrogenic causes.

The curability if invasive bladder cancer treated by radical cystectomy.

174 patients with transitional cell carcinoma of the urinary bladder were treated by radical cystoprostatectomy, with or without adjunctive radiation therapy, and followed for at least 5 years or until death. Survivorship relates to both grade and stage of disease at the time of treatment. Adjunctive radiotherapy improved survival in patients with extensive bladder wall and extravesical involvement in this series. Best results were achieved in patients with a low pathologic stage of disease, poorest results--predictably--with high stage, high grade tumors.

Bilateral nephrectomy by the posterior approach.

The experience with 94 patients undergoing bilateral nephrectomy suggests that the posterior retroperitoneal approach has lower morbidity and mortality than transabdominal procedures. In addition, the lack of transgression of the peritoneal cavity facilitates the possible use of chronic peritoneal dialysis in the future management of these patients. The circumstances in which bilateral nephrectomy is indicated are reviewed.

Simultaneous open prostatectomy and inguinal herniorrhaphy.

We report our results in 18 patients who had simultaneous open prostatectomy and inguinal herniorrhaphy between 1969 and 1976, and present our criteria for patient selection, operative technic, and postoperative results. The incidence of postoperative wound infection and recurrent hernia was 5.6% and 0 respectively, which compares favorably to results of herniorrhaphy and prostatectomy performed separately. The historic development of this procedure and the results of previously reported series are reviewed.

Traumatic rupture of the female urethra.

The clinical course of 4 female patients with complete traumatic rupture of the urethra was evaluated in an effort to propose guide lines for the investigation and initial management of this unusual injury. Treatment modalities are determined by the level of urethral injury and the subsequent effect on continence. We recommend a retropubic approach for bladder neck injuries, a transvaginal approach for proximal urethral ruptures with reanastomosis over a stenting catheter and acceptance of a hypospadiac neomeatus for distal urethral ruptures.

Siblings with prune belly syndrome and associated pulmonic stenosis, mental retardation, and deafness.

This is the fifth family in the literature with siblings having the prune belly syndrome. It is the first with associated pulmonary stenosis, mental retardation, and hearing deficit. A genetic factor is suggested as the primary cause of the syndrome.

Retrocaval ureter in Turner syndrome.

Turner syndrome is commonly associated with urinary tract anomalies. A second case is reported of its unusual association with retrocaval ureter and massive hydronephrosis.

Complications of Small-Carrion penile prosthesis.

Seventy-six patients with impotence have undergone insertion of the Small-Carrion penile prosthesis at Duke University Medical Center. Twenty patients experienced postoperative complications. Seven of these 20 patients lost one or both prostheses either by spontaneous extrusion or surgical removal. Although success with this procedure is well documented, complications may be significant when they occur and awareness of these problems is essential for proper management. The benefits of this procedure are reviewed, and reported complications and their management are discussed.

Adenoid cystic carcinoma of the prostate: report of a case.

Adenoid cystic carcinoma of the prostate is a rare but distinctive variant of prostatic adenocarcinoma. A case report is presented and the pathology, differential diagnosis and treatment modalities are discussed.