Indwelling ureteral stents as definitive therapy for distal ureteral calculi.

Distal ureteral calculi are a common urological problem often requiring surgical and anesthetic intervention. In a health care system with limited resources this intervention can lead to the expenditure of significant monies. Ureteral stents are often used to stabilize symptomatic patients preoperatively. Since stent placement causes passive ureteral dilation, we hypothesized that temporary placement of a ureteral catheter would facilitate spontaneous calculus passage. We prospectively studied 27 patients who presented with distal ureteral calculi less than 10 mm. large and met criteria established for surgical intervention. Self-retaining Double-J stents were placed in 10 male and 7 female patients, and left for 2 weeks using only topical anesthesia during the procedures. In the majority of the patients (83%) the calculi passed spontaneously after stent removal, obviating surgical or anesthetic intervention.

Proliferative activity as an adjunct in the diagnosis of prostatic adenocarcinoma.

Sixty-nine men underwent transrectal ultrasound-directed biopsy of the prostate. One biopsy core from each side of each gland was sent for DNA flow cytometric testing (138 total specimens). Results were correlated with findings from standard hematoxylin and eosin staining of other cores. Twelve patients (17.4%) had biopsies with histopathologic evidence of prostatic carcinoma. Of 57 patients (82.6%) with benign biopsies, two had stage A prostate adenocarcinoma noted on subsequent transurethral resection. Proliferative activity was calculated from DNA histograms by adding the percentage of nuclei in the proliferative (S and G2/M) phases of the cell-division cycle. Mean proliferative activity for the malignant group (19.08) was significantly higher (p < 0.001) than that of the benign group (13.43). Inflammation was associated with elevated proliferative activity scores among benign glands. Proliferative activity is an objective, easily obtainable indicator of the biological activity of a population of cells which, when elevated, may suggest a need for repeat biopsy in patients with otherwise normal prostate biopsies. Flow cytometry may have value as a complement to standard histologic analysis of transrectal core biopsies in the diagnosis of prostate cancer.

Extragonadal yolk sac tumor in a superior scrotal mass.

We report a case of an extragonadal yolk sac tumor in a superior scrotal mass. Testicular ultrasonography was normal preoperatively and after chemotherapy. Serum alpha-fetoprotein was initially increased to 344.55 ng./ml. (normal 0 to 15) but it returned to normal after surgery and chemotherapy.

An evaluation of serial digital rectal examinations in screening for prostate cancer.

The purpose of this review is to test the hypothesis that serial digital rectal examinations of the prostate lead to detection of prostate cancer at an earlier and more curable stage. The clinic records of 4,843 patients between 40 and 79 years old seen at the Brooke Army Medical Center prostate cancer screening clinic between January 1979 and September 1985 were reviewed. Of the patients with palpable nodules 122 were found on biopsy to have adenocarcinoma of the prostate. We compared the clinical and, when possible, pathological stage of disease diagnosed at the initial clinical visit to those from patients who had prior normal digital rectal examinations at the screening clinic and who were followed at our clinic. There was a numerically striking difference in the percentage of patients in each group with clinical as well as pathological stage B cancer. Due to the small number of patients in each group these differences were not statistically significant.