Obstructive urinary retention in a young female: case report.

The authors report a case of acute urinary retention in a young female patient with a large uterine leiomyoma. Urinary symptoms resolved completely after surgery.

Laparoscopic nephrolithotomy: the value of intracorporeal sonography and color Doppler.

Laparoscopic nephrolithotomy was used as an alternative to open surgery in a patient who had failed extracorporeal shock-wave lithotripsy and whose anteriorly located stone-bearing calix precluded percutaneous extraction. Endocavitary ultrasonography and color Doppler render the procedure safe and effective; localization of the stone, selection of an optimal nephrotomy site away from large vessels and where cortical thickness is minimal, and control of fragment clearance are greatly facilitated.

[Local recurrence following radical nephrectomy for renal adenocarcinoma]. / Récidive locale après néphrectomie radicale pour adénocarcinome rénal.

PRESENTATION: If the rate of tumoral relapse after partial nephrectomy for hypernephroma is 8-10%, this element is rarely reported in the literature after radical nephrectomy. PATIENTS AND METHODS: 159 patients (pts) have undergone radical nephrectomy for kidney adenocarcinoma. Mean age is 61.3 years (26-85 years). The mean duration of follow-up is 50.8 months (12-183 months). The patients were regularly followed by abdominal CT scan at 6 months and than yearly by CT scan and chest X-ray. CONCLUSION: Considering the poor incidence of local relapse (1.3%) after nephrectomy and in a period where economical aspect weigh on our practice, a new policy of post-operative follow-up should be carried.

Leydig cell tumor: estradiol level at different locations.

The authors report on estradiol levels at different locations in a patient with a Leydig cell tumor. The highest value was found in the testicular vein. The estradiol level was, however, ten times higher in the peritesticular vaginal fluid than in the peripheral veins.

Undetectable prostate-specific antigen in aging men.

Undetectable prostate-specific antigen was found in three aging men despite the absence of any prostatic surgery or exogenous hormonal deprivation. Clinical and elementary hormonal workup revealed the presence of secondary hypogonadism. This finding confirms the hormonal dependency of this prostatic marker and may, in some cases, explain the discrepancy between prostatic volume and the value of serum prostate-specific antigen.

[Urinary continence after radical prostatectomy: importance of the vesico-urethral anastomosis. Objective evaluation]. / Continence urinaire après prostatectomie radicale: importance de l'anastomose vésico-urétrale. Evaluation objective.

Urinary continence after radical prostatectomy is frequently evaluated subjectively. The authors describe their technique of vesicourethral anastomosis and report their method of objective evaluation of postoperative urinary continence. At the 6th postoperative week, 15% of patients presented with severe incontinence. This percentage fell to 3.3% by the 16th postoperative week.

Pathologic response and long term results of preoperative M-VAC regimen in regionally advanced transitional cell carcinoma of the bladder.

Patients with tumor extending through the bladder wall with invasion of adjacent structures or lymph node metastases are seldom cured by radical surgery. Preoperative chemotherapy was given to 17 patients with T3-T4, N0, N+ tumor to assess operability and long-term survival. Tumor downstaging (T0, Ta, T1, CIS, N0) occurred in 4 (80%) of the 5 T3 patients, and in 3 (25%) of the 12 patients with T4 tumors. All patients have been followed until death or for a minimum of 42 months (mean: 56 months, range 42 to 78 months). Surgery was possible in all patients. Long-term survival is realized in only 30%, suggesting that this approach did not alter the ultimate course of the natural history of the disease. Although local recurrence did not occur, 70% of the patients with downstaged cancers developed distant metastases.

Ischemia of neobladder. Clinical manifestations and management.

Substitution enterocystoplasty is becoming more common in a selected group of patients. Acute or chronic ischemia is an exceptional event. We describe the clinical manifestations and management of chronic ischemia of a neobladder that occurred weeks after a successful initial operation. The possible mechanisms responsible for this complication are reviewed.

Do seminal or prostatic secretions play a role in local recurrence after radical prostatectomy for localized prostate cancer?

Neoplastic cellular contamination of the surgical bed may be responsible for late local failure after radical prostatectomy. Cytology analysis of the seminal and prostatic fluid collected intraoperatively was undertaken in 30 patients. Neoplastic cells were found in 2 patients both with seminal vesicle involvement. Although it is difficult to admit that tumor spillage during surgery would be a major cause of local recurrence, the presence of tumor cells in the ejaculate may be diagnostic of seminal vesicle invasion. All patients with pathologic stage T2 had a negative cytologic finding.

Controversies in ilioinguinal lymphadenectomy for cancer of the penis.

One of the most important aspects in oncology is the definition of clinically relevant subgroups of patients whose disease wil have different behavior to enable decision making about therapeutic methods. The appropriate management of regional adenopathy in patients with penile cancer has generated a number of controversies. Generally, clinical determination of the extent of local disease is difficult. About 50% of patients with node enlargement have no tumor on histologic examination, and 20% of patients with clinically negative nodes have micrometastases. Lymph node biopsies, including sentinel node biopsy, are of limited staging value. Patients with lesions that do not invade the corpora and who have no palpable nodes should be followed carefully at 2- to 3-month intervals after excision of the primary tumor. Those with persistent adenopathy should undergo superficial lymph node dissection first, and if positive nodes are found, bilateral deep node dissection should be performed. Bilateral inguinal and pelvic lymphadenectomy is recommended for patients with lesions invading the corpora with clinically negative or positive nodes because of the high incidence of lymph node metastases in such cases (Table 1). When adenopathy persists after excision of the primary tumor, we advocate first a limited pelvic dissection. If the pelvic nodes are negative or not extensively involved, bilateral groin dissection should be performed, preferably in two stages. Percutaneous fine-needle aspiration of palpable or nonpalpable nodes can be helpful in preoperative staging in patients with penile cancer. Potential areas of study include identification of better risk factors and improvement of preoperative staging methods. This goal is hampered by the fact that penile cancer is a rare finding.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of local recurrence after radical prostatectomy by prostate specific antigen and transrectal ultrasound.

Twenty patients with detectable levels of prostate specific antigen (PSA) after radical prostatectomy with no identifiable distant metastases were evaluated for local recurrence by digital rectal examination and transrectal ultrasound combined with biopsies. Of the patients 9 (45%) were found to have histological evidence of local recurrence at the initial assessment. All 4 patients with an abnormal digital rectal examination had recurrent disease. Transrectal ultrasound displayed abnormalities in 12 of the 20 patients, 7 of whom had positive biopsies. Random biopsies of the vesicourethral junction were performed in 8 patients who had negative ultrasound findings and an unremarkable digital rectal examination, of whom 2 had histological documentation of local recurrence. Complications occurred in 1 patient (5%) who presented with clot retention. We conclude that PSA is an excellent tool for identification of recurrent disease after radical prostatectomy, and transrectal ultrasound guided biopsy is a useful diagnostic approach in patients suspected of local failure, especially when the digital rectal examination is unremarkable.

Renal cell carcinoma: basic biology and current approaches to therapy.

Renal cell carcinoma (RCC) represents an unusual solid tumor for which no treatment other than surgical therapy has been effective. The remarkable heterogenous behavior of this tumor and the documented rare spontaneous regressions suggest an unusual sensitivity to host immunologic control. In recent years, exciting developments in molecular genetics, growth factors, modulators of invasion of metastases, and cytokine-lymphocyte interactions have produced new hypotheses and a wealth of information regarding the origin, behavior, and control of RCC. Interest in the immunotherapy of metastatic RCC has recently increased with the demonstrated reproducible tumor responses obtained with recombinant human interferon-alpha or interleukin-2. Durable clinical remissions in some patients with advanced RCC can now be achieved by using cytokine therapy alone or in combination with activated killer cells. This article reviews the current understanding of the basic biology of RCC, surgical approaches to localized RCC, and biologic therapy for advanced disease.