Iodine 125 seed implants for prostatic carcinoma. Five- and ten-year follow-up.

Between 1975 and 1985 132 patients underwent bilateral pelvic lymphadenectomy and insertion of Iodine 125 seeds for biopsy-proved localized carcinoma of the prostate. Surgical stages were A2 9 percent, B 64 percent, C 9 percent, and D1 18 percent. Operative mortality was zero. Short and long-term complications were less than 33 percent. Ten-year survival rates of evaluable patients for surgical Stages A2, B1, B2, and C1 were 75 percent, 70 percent, 48 percent, and 44 percent, respectively. For these patients, ten-year disease-free rates for Stages A2, B1, B2, and C1 were 67 percent, 36 percent, 60 percent, and 25 percent, respectively. Interstitial radiotherapy may play a role in the treatment of nonsurgical candidates with low volume and well- to moderately-differentiated adenocarcinoma of the prostate.

Ileal loop to iliac artery fistula: a report of 2 cases.

We report 2 cases of a fistula between the iliac artery and an ileal urinary conduit. Both patients had a small bleeding episode before the major hemorrhage. Gaining control of the bleeding can be a challenge because of the many adhesions. Control of the iliac artery proximal and distal to the loop in a longitudinal direction aids in exposure.

Five-year survival following excision of renal cell carcinoma extending into inferior vena cava.

Fifteen consecutive patients having radical nephrectomy and excision of tumor extension from the inferior vena cava for pathologic Stage 3A renal cell carcinoma were followed up for a minimum of five years. Survival was compared with patients having radical nephrectomy for Stage 2 or Stage 3 renal cell carcinoma in the same time interval. Five-year survival in the Stage 3A group (47%) was similar to that for patients with Stage 2 tumors (54%) and significantly better than Stage 3 patients with positive lymph nodes at surgery (12%). Renal cell carcinoma with venous extension has a reasonable prognosis after surgical excision and warrants an aggressive surgical approach.

Scrotal incarceration of the ureter with crossed renal ectopia: case report and literature review.

To our knowledge only 18 cases of ureteral herniation into the groin have been reported in the literature. We encountered a patient with crossed renal ectopia and ureteral incarceration into a right indirect inguinal hernia. Based on analysis of the presentation and management of our patient combined with a review of the literature we conclude that patients with urinary symptoms and a groin hernia should undergo preoperative urological evaluation, all hernias containing a ureter should be repaired and ureteral resection rarely is necessary during the hernia repair.

Unusual site for an unusual disease. Malacoplakia of the prostate.

Malacoplakia is an unusual granulomatous disease that most frequently affects the urinary tract, but also may affect other organ systems. Only about 200 cases have been reported in the literature (11), and only 11 have involved the prostate (1-10). We report the twelfth case of malacoplakia of the prostate.

Kinetics of drug release from polylactic acid-hydrocortisone microcapsules.

Polylactic acid microcapsules of similar particle size distribution containing various drug loadings of hydrocortisone were prepared. The microcapsules, which contained randomly dispensed drug particles, showed a dissolution pattern which consists of a fast first-stage and a slow second-stage drug release. Our studies showed that the kinetics of drug release from the microcapsules can be adequately described by a spherical matrix model based on a flux mechanism involving the diffusion of dissolved drug at the penetrating front of the dissolution medium. Drug loading played an important role in the control of drug release rate. An empirical relationship between drug loading and drug diffusibility through the polymeric matrix was developed and showed that the rate of drug release increased exponentially with the increase in drug loading. The microcapsules were further shown to exhibit increased rate of drug release in dissolution medium containing either cetylpyridium chloride or aerosol OT. The effect of the surfactants was attributed to surface tension lowering and improved wetting of the microcapsule particles.

Preparation and in vitro evaluation of polylactic acid-mitomycin C microcapsules.

An emulsion method was developed for the incorporation of water-soluble mitomycin C into polylactic acid biodegradable microcapsules. With an average particle size of about 95 microns, microcapsules with a desired loading of from 3.65 to 13.80 per cent were prepared. These microcapsules, which contained both crystalline and finely dispersed drug particles, showed a dose-dependent drug release pattern with microcapsules of higher drug loading having a faster release rate than those of lower drug loading. Effective sterilization of the microcapsules for parenteral use was achieved by 60Co gamma-ray irradiation, which did not affect the microcapsule structure, release rate or drug stability. Mitomycin C showed dose-dependent antiproliferative activity against the growth of the K562 human erythroleukaemia cells. The microencapsulated dosage form of mitomycin C was found to enhance the drug's activity through sustained drug release. In experiments where drug concentrations in the cell medium were reduced according to the drug's biological half-life, the microcapsule systems showed a distinct advantage over the non-capsulated dose for the kinetic inhibition of K562 cell growth.

Postradiation biopsy and histological effects in early-stage prostatic cancer treated with 125iodine implants.

One hundred twenty patients with adenocarcinoma of the prostate were treated with 125I irradiation to the prostate and pelvic lymphadenectomy. Clinical stages were A-2 (13 pts), B-1 (34 pts), B-2 (49 pts), and C-1 (24 pts). The tumors were well differentiated in 44%, moderately differentiated in 39% and poorly differentiated in 17%. Nineteen of 22 patients with positive lymph nodes had either moderately or poorly differentiated tumors. A total radiation dosage between 15,000 and 24,000 rads per year were given to all patients. Seventy-six patients had been rebiopsied at 1 year, and 26 were positive for malignancy (34%). Thirty-eight patients had rebiopsy at 2 years, and 16 were positive (42%). Forty-four percent of the postradiation biopsies were of a different histologic grade from the primary lesion. Radiation injury was identified in 95% of the posttreatment biopsies and were moderate or severe in 71%. One hundred one patients are living from 1 to 9 years. Eight patients have died of metastatic carcinoma, and 11 have died of cardiovascular problems.

Effect of preoperative channel transurethral prostatectomy on complications of 125iodine implantation in carcinoma of prostate.

Patients receiving 125Iodine implantation and pelvic lymphadenectomy for clinically localized prostatic carcinoma were divided into two groups, with one group receiving a preoperative channel transurethral prostatectomy. The groups were matched according to clinical stage and histologic grade. Complications were classified as operative, short-term, and long-term. Although preoperative channel transurethral prostatectomy was associated with a greater incidence of surgical procedures after implantation, the overall complication rate did not differ between the two groups. The overall mortality rate and the incidence of progression of Stage C tumors did not differ between the two groups.

In vitro growth of renal cell carcinoma after preoperative renal infarction.

Renal cell carcinoma tissue was cultured from 2 patients who underwent embolization of the tumor before surgery and from 2 patients who did not have the tumor embolized. A combination of small Gelfoam particles and polyvinyl alcohol foam particles (250-590 mu diameter) was used to devascularize maximally the tumors that were embolized. The tumor cells from all 4 patients grew in short-term tissue cultures and demonstrated histology and growth properties characteristic of tumor cells. Successful embolization of renal cell carcinomas may not completely infarct the primary tumor, and local tumor growth may continue.

Percutaneous nephrostomy under guidance of ultrasonography and fluoroscopy using a pigtail catheter.

Percutaneous nephrostomy using a pigtail catheter was performed in 37 patients under the guidance of ultrasonography and fluoroscopy. The only failure in 60 attempts was due to a subcapsular haematoma. The catheter appears to be well tolerated and is large enough for good drainage. Ultrasonography has proved to be a valuable part of this technique and has made antegrade pyelography easy.

Facilitation of difficult percutaneous ureteral stent insertion.

Attempts to convert percutaneous nephrostomies into internal ureteral stents were done by antegrade techniques in 26 patients in whom a retrograde approach for stent placement previously had been unsuccessful. There appeared to be complete obstruction of the ureter on antegrade urography in 8 patients but the area of the obstruction was traversed and a ureteral stent was inserted. Dilation of malignant or benign ureteral strictures followed by ureteral stent placement was done in 15 patients. The major difficulties in antegrade ureteral stent placement were marked ureteral tortuosity and ureteral kinking. The tortuosity was managed by insertion of a pigtail catheter in these instances. The pigtail catheter was wedged in the region of the kink and passed through the area of difficulty by manipulation of the catheter and guide wire under fluoroscopy. Another problem encountered was coiling and kinking of the catheter in a dilated renal pelvis. This problem was resolved by the transparenchymal approach for percutaneous nephrostomy and application of torque guide wires and stiffer torque control catheters. We herein demonstrate that apparent complete obstruction of the ureter on pyelography does not preclude consideration of ureteral stent insertion and that an antegrade approach often is successful when a ureteral stent cannot be placed by a retrograde technique.

Percutaneous nephrostomy and antegrade ureteral stent insertion.

Sixty consecutive percutaneous nephrostomies were attempted in 37 patients with a 97-per cent success rate. The patients ranged in age from three to seventy-three years. Twenty-eight attempted nephrostomies were bilateral and 32 unilateral. When possible, the percutaneous nephrostomies were converted into internal ureteral stents by antegrade techniques. In each case of apparent complete ureteral obstruction, the area was successfully negotiated, and an indwelling ureteral stent was placed. In 2 patients, combined antegrade and retrograde techniques were required for successful internal stent placement. There was one failure because of a subcapsular hematoma resulting from multiple punctures with an 18-gauge needle. One major complication occurred when a segmental branch of the renal artery was injured by the nephrostomy catheter.

Clinical results of early stage prostatic cancer treated by pelvic lymphadenectomy and 125iodine implants.

Eighty patients with clinically early stage adenocarcinoma of the prostate were treated with pelvic lymphadenectomy and interstitial implantation of 125iodine seeds. A new applicator that permits greater accuracy in spacing the seeds has been developed. Postoperative complications were minimal, with urinary irritability being the most common. Multiple transrectal needle biopsies were performed 12 and 18 months after treatment in 46 patients. The prostatic biopsies were negative for carcinoma in 61 per cent and positive in 39 per cent of the patients. Long-term followup is needed to correlate post-treatment biopsies with survival and to determine if patients with positive biopsies should receive further treatment.

Anatrophic nephrolithotomy: preservation of renal function demonstrated by differential quantitative radionuclide renal scans.

Differential quantitative radionuclide renal scans have been used to confirm that early removal of staghorn calculi by anatrophic nephrolithotomy preserves renal parenchyma without significant renal damage by the surgical procedure. The 99mtechnetium diethylenetriaminepentaacetic acid scan was useful in predicting recovery of function in the involved kidney, while the 131iodine orthoiodohippurate scan provided a quantitative evaluation of the effect of the surgical procedure on individual kidney function. All of 13 consecutive patients evaluated by 131iodine orthoiodohippurate renal scans had stable or improved effective renal plasma flow to the involved kidney and an unchanged or improved total excretory index 6 months after nephrolithotomy.