Carcinoma of prostate in men aged fifty and under: therapeutic options.

We made a retrospective study of 20 men, aged fifty or under, with adenocarcinoma of the prostate to evaluate presenting symptoms, stage, grade, and therapeutic results. Sixty-five percent were found to have extracapsular spread of disease (Stage C or D). The therapy used was one or a combination of three types: radical prostatectomy, radiation therapy, and hormonal manipulation. Five of 6 patients with Stage B disease and 3 of 6 patients with Stage C disease were treated with radiation therapy. The other Stages B and C patients underwent radical prostatectomy. In all 5 of Stage B patients receiving radiation, therapy failed; the mean time to tumor recurrence was 3.2 years. Two of 3 patients with Stage C disease died of metastatic disease within three years of receiving radiation. The 4 patients (Stages B and C) who underwent radical prostatectomy are free of disease. There was a statistically higher failure rate among the radiation therapy patients with Stages B and C disease than among the surgical patients (X2 = 8.4, p less than 0.1).

Renal cell carcinoma vs. renal oncocytoma. Report of a case with overlap features and review of the literature.

Although the salient features of renal oncocytomas and renal cell carcinomas have been discussed in the recent literature, renal masses with features of both entities will present diagnostic difficulty, especially when the cells are diffusely eosinophilic on microscopic examination. A case of a firm, tan, rounded mass replacing the lower pole of the kidney is discussed. The final diagnosis of renal cell carcinoma, granular cell type, was made after multiple sections of the tumor were examined, and after electron microscopy was performed. A thorough search by light microscopy should be made for clear cell foci, necrosis, mitotic activity, and vascular or capsular invasion, features generally accepted as pathognomonic for renal cell carcinoma. Cellular and especially nuclear pleomorphism is typically focal or mild in renal oncocytomas. True oncocytic tumors will be packed with mitochondria on electron microscopy; however, granular renal cell carcinomas will contain mitochondria as well as other cellular organelles, lipid, and glycogen. Electron microscopy should be performed on tumors suspected of being oncocytomas because eosinophilia on hematoxylin and eosin stain, as demonstrated by this case, is not a predictable measure of mitochondria content. Immunoperoxidase staining for vimentin in oncocytomas has recently been shown to be negative, and may offer a method of ruling out oncocytoma in vimentin-positive tumors, pending further studies.

Chromosomal analysis as prognostic tool in transitional cell carcinoma: preliminary report.

Twelve patients with transitional cell carcinomas were studied for chromosomal abnormalities correlated with cystoscopic and histologic findings. The tumors with abnormal chromosome "markers" or numbers (aneuploidy or polyploidy) appeared to be more aggressive or recurred more frequently than those with normal chromosome patterns.

Home monitoring of penile tumescence for erectile dysfunction. Initial experience.

A technique using nocturnal penile tumescence monitoring has been developed to gather objective data on an outpatient basis. Patients have readily accepted the procedure and have easily learned to operate the monitor. Data from this group of controls and subjects are consistent with previously published reports by others. Suggestions are made from possible further refinements in technique.

Post-biopsy intrarenal arteriovenous fistula.

We present 5 cases of intrarenal arteriovenous fistulas after renal biopsy. Of these cases 3 followed percutaneous needle biopsy and 2 occurred after open renal biopsy. A nephrectomy was necessary in 1 patient to control the severe hypertension secondary to a hydronephrotic kidney and 1 patient required a partial nephrectomy to control marked hematuria.

Open renal biopsy technique: results in 202 patients.

Two hundred five cases of open renal biopsy using a muscle-splitting technique have been performed over the past seven years. Eighty-seven per cent were done under local anesthesia. Tissue for routine histology, immunofluorescence staining and electromicroscopy were obtained in all cases. Morbidity was low, and there were no deaths attributed to the procedure.

Extensive renal involvement by renal cell carcinoma.

Experience with the management of 3 cases of bilateral adenocarcinoma and 1 case of unilateral carcinoma in the solitary kidney is presented. Two patients died of metastases six and thirteen months postoperatively, while one is alive with metastases at fourteen months and another is alive without metastases at four months. The literature is reviewed, and the various treatments are discussed.

Effects of phenoxybenzamine hydrochloride on canine lower urinary tract: clinical implications.

The results of our study show that phenoxybenzamine hydrochloride, a potent long-acting alpha-adrenergic blocker, has clearly demonstrable effects on urethral function. In a dose of 0.5 mg. per kilogram of body weight it caused a significant lowering of the resting urethral pressure, a decrease in the arterial pressure, and no change in the intravesical pressure. Higher doses caused similar but more pronounced and prolonged effects. The combined use of phenoxybenzamine and bethanechol increased the intravesical pressure and decreased the urethral pressure. It appears that the predominant mechanism of urethral resistance is alpha-adrenergic activity in smooth muscle. A review of the medical literature, our experimental studies, and limited clinical application lead uo to conclude that phenoxybenzamine could be useful in treating neurogenic vesical dysfunction of various types, urethral syndrome, urgency incontinence, functional outlet obstruction with or without vesicoureteral reflux, drug-related obstructive urinary symptoms, partial prostatic obstruction, and ureteral colic. The combination of phenoxybenzamine and bethanechol could be used in managing patients with atony of the bladder of neuropathic or myopathic origin.

Imipramine hydrochloride: pharmacodynamic effects on lower urinary tract of female dogs.

Our study of the pharmacodynamics of imipramine hydrochloride of the female canine lower urinary tract indicates the primary mode of action to be the stimulation of alpha adrenergic neuroreceptors in the bladder neck and urethra. This stimulation results in increased resting urethral pressure, adequate sphincter closure, possibly an increase in the bladder capacity and efficient urinary control. Imipramine had no anticholinergic effect on the bladder and the urethra. It also appears unlikely that in enuretic patients imipramine acts by central augmentation of the adrenergic system. No change was noticed in the intravesical or arterial pressures.

Bacteriuria in the catheterized patient. Cystitis or pyelonephritis?

Seventy-two patients with indwelling urethral catheters had urine specimens cultured to detect bacteriuria. Bacterial sediments were examined to find the source of the bacteria, with use of an antibody immunofluorescence (IF) technique. Antibody coating demonstrated by fluorescence was considered evidence for pyelonephritis. In cystitis, the bacteria did not fluoresce. Repeat culture and immunofluorescence studies were done 3 to 18 week later. One third of the patients had a urinary infection. Two (13%) of the patients catheterized for one day and 17 (55%) catheterized four or more days had appreciable bacteriuria. One patient catheterized less than three days had positive IF, while 5 patients (16%) catheterized four or more days had positive IF. Only two of the ten patients observed, with an initial infection, had sterile urine on follow-up culture. On follow-up study, of the four patients with bacteriuria of renal origin, one showed a sterile urine, two had cystitis, and one still had pyelonephritis.