Transurethral laser prostatectomy: a comparison of contact tip mode and lateral firing free beam mode.

Transurethral laser prostatectomy was performed on 66 patients for the management of bladder outlet obstruction secondary to prostatic hyperplasia. All of the patients were treated on an outpatient basis primarily using IV sedation or spinal anesthesia. Selection consisted of patients with obstructive voiding symptoms who would be considered candidates for transurethral resection of the prostate (TURP). Thirty procedures were performed with the contact tip laser probe, with successful results noted in 24 cases (80%). Thirty-one of the 36 patients who underwent laser prostatectomy using the lateral firing free beam probe experienced a significant improvement in their obstructive voiding symptoms, for a success rate of 86%. Transurethral laser prostatectomy using the contact tip laser system or the lateral firing free beam mode appears to be an acceptable alternative to TURP in individuals with obstructive voiding symptoms.

Transurethral laser resection of the prostate.

Transurethral laser resection of the prostate was performed on 25 patients for the management of bladder outlet obstruction secondary to prostatic hyperplasia. All of the patients in our series were treated on an outpatient basis and the majority of these under IV sedation. Patient selection was limited to older, high-risk patients who were poor surgical candidates for transurethral resection of the prostate or suprapubic prostatectomy because of underlying medical problems. Successful results were noted in 20 of the 25 cases (80%). Five procedures were unsuccessful because the patients were unable to spontaneously void after laser resection. Transurethral laser resection of the prostate utilizing the contact laser system is an acceptable alternative to transurethral resection of the prostate in advanced age, high-risk patients with small gland volumes.

Balloon dilation of prostatic urethra.

Retrograde balloon catheter dilation of the prostatic urethra was performed for the management of bladder outlet obstruction secondary to prostatic hyperplasia. Of the 55 patients in our series, 43 were treated entirely as outpatients and 12 were inpatients for unrelated conditions. The patient selection was limited to older, high-risk patients who were poor surgical candidates for transurethral resection of the prostate or suprapubic prostatectomy because of underlying medical problems. Twenty-two of these patients had Foley catheters for relief of their outflow obstructions. The procedures were performed under local anesthesia or intravenous sedation. Successful results were noted in 46 of 55 patients with relief of symptoms for up to twenty-six months. In 9 cases the procedures were unsuccessful and transurethral resection of the prostate was required.

Balloon dilatation of urethral strictures.

Balloon dilatation of the urethra in 9 male patients with either post-inflammatory or post-traumatic strictures was successfully performed. This procedure is primarily indicated in those patients with unsatisfactory results using conventional dilatation with metal sounds. A flexible endoscope was used for guide wire passage and fluoroscopic guidance for positioning the balloon and assuring complete dilatation of the urethral strictures or vesical neck contracture. In this manner, dilatation to 36 F can be performed in a relatively atraumatic manner with minimal discomfort.

Balloon dilation of the ureter: a means to facilitate passage of ureteral and renal calculi.

Dilation of the ureter with a balloon catheter, 20 cm. long and 6 mm. in diameter, passed over a guide wire introduced into the ureter in a retrograde or antegrade fashion has been followed by prompt painless passage of calculi as large as 6 mm. in diameter in 3 patients. Limited radiographic evaluation has revealed no significant sequelae. Our limited experience indicates that it is a safe and expedient method to facilitate passage of ureteral and renal calculi.

Pneumocalyx following percutaneous nephrostolithotomy.

We present an interesting and unusual case of persistent gas within the renal collecting system occurring two days after percutaneous nephrostolithotomy.

Forceps extraction of ureteral stones.

Ureteroscopy and pyeloscopy in association with ultrasonic lithotripsy for extraction of ureteral stones has, in most instances, eliminated the need for open surgical intervention. Four ureteral stones were successfully extracted by the technique described using flexible cup biopsy forceps introduced through a Teflon sheath. This method was used when basket extraction, ureteroscopy, and other forms of endoscopic stone manipulation were unsuccessful. Two ureteral stones were removed by the transurethral route, and two were removed through a percutaneous nephrostomy tract. There has been little morbidity with this procedure, and patients have returned to normal activity within several days of hospital discharge.

Renal angiomyolipoma: definitive diagnosis by ultrasonography and computerized tomography.

The advent of the newer imaging modalities of ultrasonography and computerized tomography allows a definitive preoperative diagnosis of renal angiomyolipoma. Our case illustrates the management dilemma of a patient with gross hematuria and a solid mass in a solitary kidney. The characteristic appearance of an angiomyolipoma by various imaging modalities allowed simple excision of the mass, sparing the kidney.

Incidental sonographic detection of renal cell carcinoma.

Renal cell carcinoma is not an uncommon finding in our population. Since the symptoms of renal cell carcinoma may mimic those of other abdominal disease, we strongly advocate ultrasonic evaluation of the entire abdomen when screening patients with pain. Whether our three patients' symptoms were due to gallbladder disease or the incidentally detected renal cell carcinoma is relatively inconsequential, as long as detection of the potentially life-threatening lesion is achieved.

Palatal metastases in renal cell carcinoma.

Renal cell carcinoma may metastasize early in its course and sometimes before the primary lesion becomes apparent. Two cases of renal cell carcinoma with the initial manifestation of metastases to the roof of the mouth are presented. The mode of metastases to the palate is discussed.

Pulmonary embolus presenting as initial manifestation of renal cell carcinoma.

Pulmonary emboli from renal cell carcinoma may be more common than previously suspected. A case is reported of renal cell carcinoma presenting with a massive pulmonary embolus. Pulmonary embolectomy followed by radical nephrectomy with venocavotomy and tumor thrombectomy was successfully performed.

A case of a giant pheochromocytoma.

A case of a large pheochromocytoma weighing 1,150 gm. is reported. The surgical approach to this massive tumor is discussed. Early recognition of the various clinical and metabolic manifestations of the tumor are important objectives in the cure of this potentially lethal neoplasm.

Pulmonary embolus presenting as the initial manifestation of renal cell carcinoma.

Recent literature suggests that pulmonary embolus secondary to renal cell carcinoma may by more common than previously suspected. Renal tumors are known for their ability to metastasize early, often before the primary lesion is apparent. A patient with renal cell carcinoma and having massive pulmonary tumor embolus is presented. Attention was called to the occult tumor by the identification of clear cell carcinoma in the pulmonary embolic material. Pulmonary embolectomy and surgical extirpation of the primary tumor resulted in long-term survival.

Complications of renal cyst exploration versus renal mass aspiration.

This report presents a comparison of the complications of surgical exploration with unroofing and renal cyst puncture. Two hundred fifty-five patients were operated on, with a mortality rate of 1 per cent and a morbidity rate of 28 per cent. The complications in 63 patients examined by mass aspiration included a morbidity rate of 6.4 per cent and no mortality. The possibilities of over-looking carcinomas through cyst aspiration are weighed against the demonstrated morbidity of surgical exploration and found to be much less significant. The authors recommend that an asymptomatic renal mass that radiographically appears to be a cyst and is unaccompanied by urine changes or clinical stigmata of renal neoplasia be treated by cyst aspiration and not subjected to surgical exploration.