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.

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.

Operative and nonoperative hypertension. Recent advances in treatment.

In the past five years there have been significant advances in the diagnosis and treatment of operative and nonoperative forms of hypertension. Several areas of specific interest to urologists will be discussed.

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.

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.

Adenocarcinoma of kidney implicated by urinary cytologic study.

Adenocarcinoma of the kidney in children and adolescents is believed to be a rare disease. Although only 57 cases 1,2 have been described in the world literature, many others, no doubt, have occurred and have not been reported. Herein reported is an unusual case of a very small neoplasm in which urinary cytologic study aided in the diagnosis.

Nonduplication of upper urinary tract associated with horseshoe kidney and bilateral ureteral ectopia.

A three-month-old white baby girl was found to have marked hydroureteronephrosis associated with ectopic, nonduplicated ureters and horseshoe kidney. Her clinical and radiographic course are discussed.

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.

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.

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.

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.

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.

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.