Evolved improvements in placement of the silicone gel prosthesis for post-prostatectomy incontinence.

During the last 2 1/2 years we have used the silicone gel prosthesis for 8 consecutive patients who were incontinent after prostatectomy. Although the prosthesis had to be replaced in 1 instance a satisfactory result has been obtained by each patient. We believe that with minimal patient selection successful results can be achieved in a large majority of such patients by implementing the evolved improvements in prosthesis placement: 1) use 4 serrated knee staples or George Washington modification to improve fixation, 2) release the urethral bulb from the central perineal tendon for better compression and 3) place the prosthesis higher on the ischiopubic rami. Avoidance of urethral erosion is the single most important aspect of the procedure and intraoperative urethral pressure profile may be helpful in this regard. Guidelines regarding the procedure, prosthesis injection and patient management are discussed briefly.

Large lymphoceles resulting from retroperitoneal lymphadenectomy.

We report 2 case of large lymphoceles resulting from retroperitoneal lymphadenectomy. The literature is reviewed briefly and management alternatives are discussed. In 1 case disastrous complications ensued during expectant management, which could have been prevented by earlier surgical intervention. Early definitive surgical management for these large lymphoceles using external drainage is recommended.

Colon conduit in pediatric renal transplantation.

During the last 2 years we have used contralateral colon conduit diversion alternatives. Our review of the literature revealed that of 36 patients with renal transplants into intestinal conduits 19 (52.8 per cent) survived with a functional transplant. Of these patients 17 were children including 12 (70.6 per cent) who have functional grafts. In 1 of our patients a large submucosal hematoma developed along the ureteral tunnel, which resolved with expectant management. These preliminary data for this high risk group of pediatric transplant patients requiring intestinal diversion are encouraging.

Ureteral and renal vein perforation with placement into the renal vein as a complication of the pigtail ureteral stent.

A 43-year-old woman with recurrent colon carcinoma presented with bilateral pelvioureteral obstruction. After a 6F ureteral catheter had been in place for 4 days the left ureter was perforated near the ureteropelvic junction, while an attempt was made to insert a 7F Cook indwelling pigtail ureteral stent. The errant stent was allowed to remain in its extraureteral locale until urinary drainage was established. To our surprise the stent had been placed into the renal vein, after exiting the ureter 2 cm. inferiorly. There was excellent tamponade. When the large stent was removed severe bleeding ensued that was controlled by ligatures. Methods to prevent perforation are discussed. Should perforation of these stents occur in the proximal ureter or renal pelvis it would seem judicious to leave these in place rather than perform any further endoscopic manipulation before surgical inspection.

Ureteropelvic fibrosis in renal transplants: radiographic manifestations.

An uncommon cause of late ureteric obstruction in renal transplants is fibrosis involving the allograft pelvis and ureter. Three new cases are reported, emphasizing a characteristic radiographic appearance of marked generalized narrowing of the renal pelvis and ureter with concomitant dilatation and hydronephrosis of the calyceal system. This unique pattern of obstruction is the result of infiltration of the transplant ureter and pelvis by fibrous tissue. Although the exact stimulus that incites this intense fibrotic scarring is unknown, ischemia, rejection episodes, and infection have been implicated. When properly diagnosed, conservative urologic management, with ureteral stenting and dilatation, is usually adequate to maintain transplant function.

Dramatic palliation for painful, fixed bladder squamous cell carcinoma with 5-fluorouracil infusion.

A case of an exquisitely painful squamous cell carcinoma of the bladder is reported. The pain progressed and rectal obstruction developed during palliative radiotherapy. With less than 7 days of infusion chemotherapy the patient became totally free of pain, with subjective and objective relief of the rectal obstruction (avoiding colostomy).

Computed tomography and transabdominal ultrasound in the evaluation of the prostate.

The prostates of eight patients scheduled to undergo prostatectomies were studied prospectively by transabdominal gray scale ultrasound and computed tomography. Computed tomography gave excellent visualization of prostate morphology and pelvic anatomic relationships. Ultrasound provided more histopathologic information in the cases of carcinoma and prostatitis. Additionally, its capacity to distinguish surgical capsule from adenoma, in benign prostatic hypertrophy, made it more useful for volume determinations.