Case against routine 2-stage cystectomy for carcinoma of the bladder.

A total of 25 patients with carcinoma of the bladder was subjected to urinary diversion, staged irradiation and total cystectomy. Of these 25 patients 1 died after cystectomy, for a mortality rate of 4 per cent. Complications occurred in 60 per cent of the patients. The projected 5-year survival rate is 49 per cent. We conclude that this protocol offers no advantages over radiation followed by cystectomy and diversion, and we believe that the procedure is unwarranted except in individualized instances.

Giant urethral diverticulum after free full thickness skin graft urethroplasty.

A case of a giant urethral diverticulum, developing as a complication of a free skin graft urethroplasty 2 years previously, is reported. The incidence of diverticulum formation in reported series of free skin graft urethroplasty is small. The degree of dilatation present in this case has not been reported in the recent literature and its management is discussed.

Proliferative glomerulonephritis associated with reflex nephropathy.

A case of unilateral reflux nephropathy treated by initial ureteral reimplantation and subsequent nephrectomy is reported. Pathologic examination of the resected kidney showed unsuspected proliferative glomerulonephritis. The relationship of chronic atrophic pyelonephritis, as seen in reflux nephropathy, and glomerulonephritis is discussed to emphasize that reflux nephropathy does not exclude the presence of other renal disease that may complicate the long-term care of the patient.

Tandem transureteroureterostomy.

A case of bilateral hydronephrosis after transureteroureterostomy is reported. Management of such complications may be difficult and should include innovative ureteral salvage based upon fundamental principles of ureteral surgery.

Postdiversion precystectomy irradiation for cancer of the bladder.

This is the first report of a 4-year prospective trial of integrated irradiation and cystectomy in the management of advanced bladder carcinoma. Patients are treated sequentially with staging laparotomy and urinary diversion, highdose preoperative irradiation (5,000 rad/30 treatments/42 days), and total cystectomy. Twenty-eight consecutive patients have been entered into the study; all had Grade III or IV tumor or clinical evidence of invasion (Jewett Stage B1-D1). Local control has been achieved in 21 of 22 patients, and the 4-year actuarial survival is 54%. The initial staging procedure not only defines inoperable patients, but also allows completion of urinary diversion prior to small bowel irradiation with fewer anastomotic problems. Acute and chronic complications have been minimal, and there have been no treatment-related deaths.

Atypical carcinoma of kidney: possibly originating from collecting duct epithelium.

An atypical carcinoma of the kidney with cellular elements of renal cell and transitional cell carcinoma is presented. The unusual histologic features suggest a lesion originating from the collecting duc t epithelium. Evaluation of atypical renal carcinoma as to origin is advocated.

A comparison of serum immunoglobulins from patients with non-neoplastic prostates and prostatic carcinoma.

The major immunoglobulin classes were surveyed among 23 patients with carcinoma of the prostate, 14 patients with clinically manifest benign prostatic hyperplasia and 23 healthy, elderly men without evidence of prostatic disease to determine if differences in immunoglobulin levels existed. Levels of IgG,IgA and IgM were determined by single radial immunodiffusion. Serum IgM levels were depressed in patients with all stages of carcinoma of the prostate as compared to levels in controls. These depressions were significant statistically for the tumor group considered as a whole and for patients with stages A and B tumors; the depression of IgM levels in patients with stages C and D tumors bordered on statistical significance. Serum IgG levels were depressed significantly in patients with stages A and B carcinoma of the prostate as compared to controls. Levels in patients with stages C and D lesions exceeded control levels but the difference was not statistically significant. Serum IgA levels in patients with stages A and B tumors were comparable to control levels but levels in patients with stages C and D lesions were significantly higher than controls.

Herpesvirus type2: study of semen in male subjects with recurrent infections.

Semen from 30 healthy male subjects with recurrent infections with herpesvirus type 2 was obtained when subjects were free of lesions and surveyed by tissue culture for an infectious virus in an attempt to elucidate the transmission of this disease. Inclusion bodies compatible with herpesvirus were found in tissue cultures of semen from 2 participants but an infectious virus could not be cultured directly from any sample. The data suggest that herpevirus type 2 is not ubiquitous in semen of male subjects with recurrent genital infections. The possible role of seminal inhibitors and a defective virus in causing the observed results is discussed, as are the current theories of herpesvirus type 2 transmission.

Urologic implications of von Hippel-Lindau syndrome.

A patient with von Hippel-Lindau syndrome is presented. Bilateral simultaneous radical nephrectomy was performed for bilateral renal cell carcinoma without evidence of metastasis. The literature is reviewed and the urologic implications of this syndrome are emphasized.

En bloc transpubic urethrectomy in conjunction with radical cystectomy for bladder carcinoma in males.

A technique for en bloc transpubic urethrectomy and radical cystectomy in the male is described and compared with commonly employed means of urethrectomy. Although this technique has been performed in a limited number of cases, this report is warranted because of the following advantages: en bloc resection is achieved at one operation without compromised positioning or need to reposition; the risk of transecting tumor in the urethra or leaving tumor behind in the urethra is avoided; the contamination inherent with a perineal incision and the resulting increase in morbidity are avoided, yet the mobilization of the urethra and prostate is comparable to that achieved transperineally; the exposure with this technique equals or excels that achieved by other approaches; although thirty minutes are required to perform pubectomy and urethrectomy, this is comparable to the time required to expose and close the perineum; and usually time is saved because of the improved exposure.

Renins and prostaglandins in segmental renal artery aneurysm associated with accelerated hypertension.

A patient with hypertension of sudden onset and with segmental renal ischemia due to an aneurysm in a renal artery branch underwent a nephrectomy which apparently cured his arterial hypertension. The nephrectomy specimen was studied to determine the activity of the juxtaglomerular cells and the concentration of prostaglandins in both ischemic and normal renal tissue. As compared with the normal tissue, the ischemic cortex had an increased number of heavily granulated juxtaglomerular cells. Interstitial fibrosis in the ischemic segment was associated with considerably lower tissue concentration of both prostaglandins A2 and E2 when compared with surrounding normal medulla. These findings appear to correlate well with present theories that consider renal ischemia to be associated with decreased production or response of prostaglandins that normally would counteract the effects of angiotensin.

Renin-dependent renovascular hypertension in infant with abdominal aortic atresia.

A newborn infant was seen with severe and progressive arterial hypertension, congenital atresia of the abdominal aorta, and a renal venous renin activity ratio greater that 1:1.5 (1:3.1). Preoperative studies indicated that the renin-angiotensin axis was responsible for the production and maintenance of the severe hypertensive process. Right nephrectomy cured the arterial hypertension both above and below the area of coarctation. The possible roles of the pathogenic mechanism are discussed.

Herpesvirus type 2: isolation from seminal vesicle and testes.

Reproductive tissues from 10 recent male cadavers were examined. Herpesvirus type 2 was isolated from testes, seminal vesicle, or both in 4 cases. This is the first report of the isolation of herpesvirus type 2 from human seminal vesicular tissue. The data support previous evidence that herpesvirus type 2 can be isolated from the reproductive tissues of males without active or prior infection and suggest that these tissues may serve as a reservoir for transmission of this virus. The study also documents, for the first time, the ability to culture herpesvirus type 2 in organ explants from cadaveric reproductive tissues with the subsequent release of infectious virus.

Primary signet ring cell carcinoma of bladder exemplifying vesical epithelial multipotentiality.

The eighth reported case of primary signet ring cell carcinoma of the urinary bladder is described clinically and pathologically. It is unusual because of complete replacement of the transitional epithelium by squamous and glandular metaplasia. The latter was particularly striking, demonstrating "normal" colonic mucosa, cystitis glandularis, well-differentiated adenocarcinoma, poorly differentiated adenocarcinoma, and the rare signet ring cell carcinoma variant. The possible origin of such changes is discussed.