Combined cholecystectomy and radical genitourinary cancer surgery.

We have routinely performed simultaneous cholecystectomy in patients with cholelithiasis undergoing selected radical genitourinary cancer surgery. A total of 31 patients have undergone cholecystectomy at the time of radical nephrectomy (25), radical cystectomy (5), and radical prostatectomy (1). Operative time was increased twenty-five to forty-five minutes. There was no significant increase in blood loss, postoperative total bilirubin, or number of complications. No complications were directly attributable to the cholecystectomy except for 1 patient who had prolonged drainage from a closed suction drain in the gallbladder fossa. We conclude that concomitant cholecystectomy at the time of radical genitourinary cancer surgery does not significantly increase morbidity and recommend that it be performed in the presence of cholelithiasis.

Management of preexisting inflatable penile prosthesis during radical retropubic prostatectomy.

A potentially difficult technical situation exists when a man with a functioning inflatable penile prosthesis elects radical prostatectomy as treatment for localized prostate cancer. Between February 1988 and June 1991 we encountered 8 men with a preexisting inflatable penile prosthesis who subsequently underwent radical retropubic prostatectomy. In 2 patients the reservoir portion of the prosthesis was in the perivesical space such that radical prostatectomy could be performed without difficulty. However, in 6 patients removal of the reservoir was necessary to complete the prostatectomy. In 3 of these 6 patients the reservoir was replaced at 3 to 6 months after radical prostatectomy and all 3 systems function well. The remaining 3 patients have not yet elected replacement of the reservoir. Only 1 patient had an infection and a complication attributable to the prosthesis. We believe that a preexisting inflatable penile prosthesis should not preclude successful radical retropubic prostatectomy, although temporary removal of the reservoir may be required.

Pentobarbital-anesthesia decreases fructose 2,6-bisphosphate levels in rat liver.

Fructose 2,6-bisphosphate levels were assayed in freeze-clamped livers of anesthesized rats. All doses of pentobarbital that were effective in anesthesizing the rats caused a significant decrease in fructose 2,6-bisphosphate levels. Injection of pentobarbital also resulted in decreased 6-phosphofructo 2-kinase activity and increased fructose 2,6-bisphosphatase activity measured in dialyzed (NH4)2SO4-treated liver extracts but with no change in pyruvate kinase activity. It was concluded that the anesthesia-induced decrease in fructose 2,6-bisphosphate levels results at least in part from increased phosphorylation of 6-phosphofructo 2-kinase/fructose 2,6-bisphosphatase.