Role of computed tomography in the evaluation and management of carcinoma of the prostate.

Between January 1978 to March 1980, 25 patients with biopsy-proven prostate carcinoma were evaluated by computerized tomography (CT). CT differed from clinical stage in 7 of 25 patients (28%). In 6 of the 7 patients, change in stage resulted because of demonstration of extracapsular extension and/or pelvic lymph node involvement. Twelve of the 25 patients (48%) underwent surgery with histological confirmation of CT findings. Ct identified nodal involvement accurately in 10 of 12 patients (83%). We recommend use of CT for initial staging, treatment planning and assessment of response in the management of prostate cancer.

Current applications of immunoscintigraphy in prostate cancer.

While adenocarcinoma of the prostate has always been one of the top three lethal malignant diseases in adult men, the ever-increasing size of the older male population due to prolonged life expectancy has added to the importance of this condition. It is estimated that over 133,000 new cases of prostatic cancer will be diagnosed this year and some 34,000 men will die from the disease. Thus, the importance of early detection and accurate staging has become more critical, particularly since safe and effective treatments are available. There is still considerable debate as to the most effective means of detection and routine screening procedures for prostatic cancer in men over the age of 50 yr. Digital rectal examination, prostatic-specific antigen determinations and rectal ultrasonography are the most successful and cost-effective screening procedures available. Regardless of the technique used, simple, accurate and reproducible staging is essential. Total surgical removal of the prostate, whether by radical retropubic or perineal approach, along with a lymph node dissection, is a potentially curative procedure. This is true provided the clinical staging is accurate and no undetected metastatic lesions are present. It is in this latter area that current technology is lacking. Routine technetium bone scans are not specific for prostatic cancer. Similarly, abdominal/pelvic computed tomography studies fail to detect lesions in localized prostatic cancer. A tumor-specific scan that detect not only bony lesions but also soft-tissue lesions would be optimal. Some believe that monoclonal antibodies directed at tumor-specific antigens afford this opportunity. We report on the Phase 1 clinical study results using an indium-labeled conjugate of the 7E11-C5.3 murine monoclonal antibody in patients with prostate cancer.

Scintiphotography in diagnosis of urinary fistula after renal transplantation.

Scintiphotographic studies in six patients with ureteral fistula following renal transplantation are presented. Images were obtained using 99m-Tc-Sn-DTPA or 131-I-orthoiodohippurate. Urinary leakage was accurately detected in each case but the pattern of extravasation is highly variable. When carefully performed, radionuclide scintiphotography is a safe and effective method for detecting urinary leakage after renal transplantation.

Pheochromocytoma of the urinary bladder: a broad clinical spectrum.

A case of pheochromocytoma of the urinary bladder is reported, and 35 perviously reported cases are analyzed. This interesting entity can present with symptoms of catecholamine excess and severe hypertensive spells (often micturition-induced) or as asymptomatic hematuria without hypertension. The present case represents the severest end of the clinical spectrum, with advancing acute retinopathy and visual loss, very high blood pressure and greatly increased catecholamine excretion. Several special precautions were utilized during diagnostic studies and surgery. On the whole, prognosis is excellent in nonmalignant cases properly handled, and the location of the tumor provides opportunity for early case finding and complete cure.

Monoclonal antibodies in ovarian and prostate cancer.

Radioimmunoscintigraphy (RIS)--using radiolabeled monoclonal antibodies (MoAbs) to image disease--is a growing subspecialty of nuclear medicine. RIS of the reproductive tracts of men and women has shown encouraging results in imaging both primary lesions and metastases of these cancers. Ovarian cancer is the most fatal gynecologic cancer in the United States, and prostate cancer is the most prevalent form of cancer in men. Several MoAbs against reproductive tumor antigens were used with limited success in clinical trials before 1989. Most recently, MoAbs CYT-103 (satumomab pendetide) and OV-TL 3 have shown promise as safe, sensitive imaging tools for ovarian cancer. Although to date more agents have been used to image ovarian carcinoma than prostate cancer, research has been restimulated in prostate carcinoma imaging because of development of a promising MoAb conjugate, CYT-356. Radionuclide indium-111 appears to be the most promising radiolabeled to date for ovarian and prostate carcinoma RIS performed in the United States. In future clinical trials, consideration of safety issues and a standardization of methods among institutions using RIS are needed before the use of MoAb technology in cancer imaging will become routine. Comparative studies with more traditional methods like computed tomography are needed, as well as more trials comparing radioimmunoscintigraphic findings with pathological evidence.

Genital outflow tract obstruction in an adolescent with cloacal exstrophy.

The combination of congenital anomalies in patients with cloacal exstrophy presents a difficult management problem. Experience with these problems is limited because of the infrequent occurrence of the disorder and because few patients survive to adulthood. The present paper describes a 14-year-old female who presented with hyperchloremic metabolic acidosis, secondary to retained urine in a redundant ileal conduit, and symptoms of müllerian outflow tract obstruction. The literature is reviewed on genetic females with cloacal exstrophy, revealing a high incidence of müllerian fusion defects. Data are presented showing that women with cloacal exstrophy have a high potential incidence of genital outflow tract obstruction. These patients must be followed closely during adolescence so that diagnosis and treatment may be initiated early.

Ureteral rejection in isolated allograft ureter.

Ureteral rejection has been studied in the dog utilizing the isolated transplanted ureter technique. While on adequate immunosuppressive therapy, the allograft ureter remains functionally and histologically normal. When the drugs are discontinued, progressive destructive changes occur within the ureteral wall. As the muscle wall is destroyed the rejection process becomes irreversible. This process helps explain some of the findings seen during clinical renal transplantation.

Testicular scanning: evaluating the acute scrotum in the clinical setting.

In a retrospective study of patients with acute scrotal pain presenting to the hospitals of Southern Illinois University School of Medicine from January 1982 until September 1987, determination was made of the appropriate use of testicular scan for definitive diagnosis. Though the testicular scan is a highly sensitive and specific examination in the identification of testicular torsion, we believe its routine use in clinical practice is limited. Appropriate utilization of the examination requires its use in high-risk groups with equivocal physical findings or in patients with unusual presentations of age, anatomy, or neurologic deficit. The scan if used for routine screening of the acute scrotum would result in needless delays and unjustifiable expense when it is mandatory that the treatment be immediate surgical exploration.

Endobronchial metastasis from prostatic cancer in patient with renal cell carcinoma.

A patient was seen with a right upper lobe endobronchial mass initially thought to be brochogenic carcinoma. There was a history of prostatic carcinoma, and subsequent investigation demonstrated a hypernephroma. Thoracotomy and special studies proved the endobronchial metastasis to be prostatic in origin, a rare cause of endobronchial metastasis.

Paraganglioma of urinary bladder wall.

A classic case of pheochromocytoma of the urinary bladder is presented. The history of headaches and palpitations during micturition is the result of sudden release of catecholamines into the general circulation. The diagnosis using selective arteriography as well as the medical and surgical management are described.

Spontaneous vesicoileal fistula two years post ureteroileoneocystostomy undiversion.

The complication of spontaneous vesicoileal fistula formation in an eleven-year-old male two years after ureteroileoneocystostomy undiversion is presented.

Simplified experimental ureteroneocystostomy.

Improvement in renal transplantation has been the result of increased clinical experience and laboratory investigation. One of the causes of transplant failure is urinary leakage and slough at the ureteroneocystostomy site. A simplified extravesical ureteral implantation technique is described. This method has been used in more than 200 canine renal transplants producing consistently good results.

Analysis of hypospadias and fistula repair.

A total of 83 children underwent hypospadias repair from 1977 to 1991. The method of repair was based on individual patient pathology. Meatal advancement and glanuloplasty repair (MAGPI) was the most common operation performed (n = 37) followed by flip flap (n = 19), free tube graft (n = 11), and vascularized tube graft (n = 16). Fistula formation was the most common complication, with an overall incidence of 16 per cent. Fifty-four per cent of fistulas occurred following free tube graft urethroplasties, and 25 per cent of fistulas were noted following vascularized tube graft procedures. After 1986 the fistula rate decreased to 11 per cent in vascularized tube grafts, indicating a learning curve for this procedure. Seventy per cent of all fistulas required uncomplicated surgical repair, and 30 per cent closed spontaneously. We present our experience involving hypospadias repair, fistula formation, and management with an emphasis on penile hypospadias.

Dilation of the urethra in males.

Treatment of male urethral strictures can be safely performed in the office. Urinary tract infections should be treated with appropriate antibiotics prior to urethral dilation. Complications from urethral instrumentation, such as bleeding and perforation, can be minimized by careful selection of instruments and gentleness on the part of the physician. If frequent dilations are necessary or the instrumentation is poorly tolerated by the patient, definitive surgical repair of the stricture should be considered.

Success and patient satisfaction following the Stamey procedure for stress urinary incontinence.

A long-term followup survey to determine patient satisfaction following Stamey endoscopic vesicourethral suspension was obtained by means of a mail-in questionnaire. A total of 284 charts was reviewed and surveys were mailed, 17 of which were returned for lack of a forwarding address. A total of 192 replies was received for a 72% response rate. Overall improvement was found to be 82%, with approximately half of these patients found to be totally dry. When asked if they would be willing to go through the experience again 65% said they would. Criteria for the success or failure of the procedure were determined, weighing the degree of dryness against the previously mentioned question. With these criteria there was an overall success rate of 73%. Pulmonary disease, body weight greater than 86 kg., prior Marshall-Marchetti-Krantz procedure and concomitant abdominal hysterectomy lowered the success rate. Prior hysterectomy and concomitant vaginal hysterectomy had no influence on the success rate.