Extracorporeal shockwave lithotripsy for kidney stone on surgical clip.

We report the successful use of extracorporeal shockwave lithotripsy for the destruction of a renal stone that had formed around a surgical clip. The SWL led to passage of both the stone and the clip.

Report of a multicenter clinical evaluation of the Dura-II penile prosthesis.

PURPOSE: Information was collected during the first 2 years of an ongoing, prospective, multi-institutional evaluation of the Dura-II penile prosthesis. Evaluation included data on clinical outcomes and a patient satisfaction survey, and will continue for 5 years after implantation for each patient. MATERIALS AND METHODS: To date 196 patients have been evaluated. Surgical data, adverse events and information from satisfaction surveys are reported. RESULTS: At a followup of 13.4 +/- 8.4 months postoperatively, adverse events occurred in 8.2% of the patients, resulting in reoperation in 5.1%. There have been no mechanical failures. Overall satisfaction rates were 85% at 3 months, 83% at 1 year and 91% at 2 years after implantation, and levels of sexual functioning were correspondingly high. A majority of patients assigned high scores to rigidity, concealability, ability to have intercourse and erection size, although satisfaction with erection size ranked lower than the other measures. CONCLUSIONS: The Dura-II penile prosthesis provides a satisfactory result and has an acceptable level of complications associated with its use. Further followup will assess temporal changes in satisfaction rates and sexual functioning for these patients.

Conservative management of rectocutaneous fistula following radical perineal prostatectomy.

Inadvertent rectal injury during radical perineal prostatectomy may sometimes lead to the development of a rectocutaneous fistula. This has traditionally been managed with diverting colostomy until closure of the fistula is assured. We report 3 cases of rectocutaneous fistula following radical perineal prostatectomy, which were managed in a more conservative fashion. This included appropriate wound care, antibiotics, bowel rest, parenteral hyperalimentation, and, in the presence of a concomitant urine leak in 1 case, optimal urinary diversion and bed rest. All fistulas healed without incident.

Renal cell carcinoma arising from the free wall of a renal cyst.

We report an unusual case of a 1 cm papillary renal cell carcinoma arising from the outer surface of the free wall of a radiographically simple renal cyst. Most malignancies arising from the wall of a renal cyst are present along the inner surface, usually adjacent to underlying renal parenchyma. While this is a rare occurrence, it does reinforce the need to explore even small solid renal masses.

Rectal injuries during radical perineal prostatectomy.

OBJECTIVES: To review a contemporary series of rectal injuries occurring during radical perineal prostatectomy. METHODS: Of 81 patients who underwent radical perineal prostatectomy, 9 (11%) sustained a full-thickness laceration of the anterior rectal wall. All 9 patients had a preoperative bowel preparation, although only 1 received a complete oral lavage regimen. All received prophylactic perioperative intravenous antibiotics. None had undergone prior surgery to the rectum or perineum or received prior pelvic radiation therapy. RESULTS: In most cases injury occurred during division of the rectourethralis muscle, but in at least two instances the injury appeared to be the result of undue posterior retraction along the rectal wall. All injuries were recognized at the time of surgery and repaired primarily. No patient had associated postoperative complications. CONCLUSIONS: Rectal injury occurs with significantly greater frequency with radical perineal prostatectomy than with the retropubic approach. However, if the rectum is adequately prepared, the injury promptly recognized and repaired, and postoperative care appropriate, the great majority of cases will not lead to attendant morbidity.

Transcatheter embolization of large idiopathic renal arteriovenous fistula.

Renal arteriovenous fistulas are unusual lesions with a variety of clinical manifestations. Congenital and acquired forms have been treated successfully with transcatheter embolization for 2 decades. In the case of large aneurysmal lesions the risk of inadvertent pulmonary embolism has traditionally precluded this approach and necessitated open surgery. However, with refinements in angiographic equipment and technique, such an approach is now feasible and desirable.

Laparoscopic management of incidentally noted omphalomesenteric duct remnant.

An adolescent undergoing laparoscopic varicocele ligation was incidentally found to have a persistent omphalomesenteric duct remnant. The fibrous band coursing between the umbilicus and terminal ileum was resected laparoscopically without difficulty. Remnants of the type presented herein should be removed to prevent subsequent complications.

The long-term risk of development of prostate cancer in patients with benign prostatic hyperplasia: correlation with stage A1 disease.

Although historical data generally attest to a relatively benign course for stage A1 prostate cancer, at least some recent studies suggest that with prolonged followup patients have a significant risk of disease progression. This study was done with the hypothesis that such disease progression is a function of patient age and close, prolonged followup, and not the mere presence of stage A1 disease. A total of 304 patients who underwent transurethral resection of the prostate for histologically confirmed benign prostatic hyperplasia was reviewed, with a minimum followup of 8 years. Of 269 patients with full followup data 187 (70%) are alive without prostate cancer and 61 (23%) died without development of the disease. A total of 21 patients (7.8%) had clinically apparent prostate cancer at a mean of 7.0 years following transurethral resection, of whom 3 (14%) died of prostate cancer and 1 died of other causes. These data suggest that the risk of progression and death from prostate cancer may not be significantly greater in patients with stage A1 disease than in those reported to have benign disease at transurethral prostatectomy.

Functional characteristics of enterocystoplasty after interruption of the mesenteric blood supply.

Previous studies have suggested that small (5 to 7 cm.) enteral patches used for bladder augmentation could remain viable following ligation of the mesenteric vascular pedicle. We performed subtotal cystectomy and ileocystoplasty in 5 female mongrel dogs using a 25 cm. segment of detubularized ileum. Functional bladder capacity, compliance and size of the bowel segment were measured 4 months later, and the mesenteric blood supply was interrupted. Immediately after pedicle ligation all patches appeared dusky and had diminished or absent Doppler pulsations with poor fluorescein uptake. However, all animals had an uneventful postoperative course without any signs of urine leak or peritonitis. Urodynamic studies were performed 2 months later and the animals were re-explored with removal of the augmented bladder for histological examination. All of the bowel segments were viable on exploration at that time but a decrease in patch size was noted ranging from 9 to 63%. Functional bladder capacity was also decreased in 4 animals. Although the integrity of augmentation was maintained in all animals, changes in bladder capacity and size of the enteral segment occurred in the majority after interruption of the mesenteric blood supply. These changes could possibly negate the clinical benefits that had been achieved by the bladder augmentation. This finding would suggest the need to consider revision of the enterocystoplasty in the event of inadvertent ligation of the vascular pedicle.