Determination of indwelling ureteral stent patency: comparison of standard contrast and nuclear cystography, and lasix renography.

OBJECTIVE: Because of the difficulty in determining patency of Double-J ureteral catheters, a study was devised at Madigan Army Medical Center to determine the best method to demonstrate stented ureteral patency. METHODS: Forty-two patients requiring Double-J ureteral stenting for various clinical reasons were the study group. Outpatients underwent contrast retrograde cystography, nuclear cystography, and diuretic renography every four to six weeks during the stent duration or just prior to stent removal if the stents were indwelling for less than four weeks. In addition, four weeks after stent removal diuretic renography alone was done to evaluate for possible delayed obstructive effect of the ureteral stenting. RESULTS: A total of 53 stents and 42 patients were evaluated. Seventy-seven sets of studies were obtained. In only four instances did all three imaging methods agree on the obstruction. In the remaining 73 sets of data, at least one imaging technique indicated stented ureteral patency. The contrast retrograde cystogram was positive for reflux 52 times (71%). Nuclear cystography showed patency 54 times (74%) and an unobstructed diuretic renogram was obtained 59 times (81%). In addition, five of the six diuretic renograms accomplished with patients in the supine position only and which showed obstruction were repeated with patients in the upright position, and they showed unobstructed function. The overall sensitivity for diuretic renography was 89 percent when the diuretic renogram was done with patients in the supine and upright positions. CONCLUSIONS: Diuretic renography is the most sensitive test for detecting stented ureteral patency. This test needs to be performed with patients in both the supine and upright positions.

Prostate-specific antigen and digital rectal examination in long-term follow-up of stage A1 prostatic carcinoma.

Twenty-six individuals with Stage A1 carcinoma of the prostate (less than or equal to 5%, Gleason score less than or equal to 4) diagnosed from 1969 to 1980 were evaluated with digital rectal examination (DRE) and prostate-specific antigen (PSA). This unique cohort, sixty-one to eight-two years of age (median 72 years), had a mean interval from diagnosis of thirteen years (median 12.5 years). Abnormal findings on DRE were found in 6 individuals, whereas only one elevated PSA was detected. Ninety-six percent of the PSA levels were less than 3.0 ng/mL and nearly 60 percent of the group had 1.0 ng/mL or less. These levels compare favorably with healthy control subjects under forty years of age and with the limited data available for PSA in healthy men over seventy years of age (87% and 26%, respectively). While biopsy showed persistent or recurrent carcinoma in 2 of 5 individuals, further evaluation disclosed only localized disease. Though the PSA provided little additional information to DRE in the individual patient, it appears from an overview of this group that a low level of PSA in Stage A1 prostatic carcinoma may be associated with long-term survival.

Digitally-directed transrectal biopsy using Biopty gun versus transrectal needle aspiration: comparison of diagnostic yield and comfort.

A technique for digitally-directed core biopsy using the Biopty device and prospective comparison of accuracy and comfort, using this technique simultaneously with transrectal needle aspiration, are presented. To better estimate the true prevalence of carcinoma in the study population, a repeat combined procedure was performed on all subjects who did not have carcinoma confirmed on the initial core biopsies. All procedures were done by one investigator and all pathology reviewed by one senior pathologist. A total of 180 combined procedures were performed on 100 consecutive patients with palpably abnormal prostates; 30 carcinomas were detected. Digitally-directed Biopty biopsy yielded a sensitivity rate of 87 percent compared with 57 percent for needle aspiration (p less than 0.05). Using a numerical comfort scale, the Biopty device was also rated less painful than needle aspiration (p = 0.0001). The morbidity of the combined procedure was minimal, with a minor complication rate of 2.2 percent. No infections occurred.

Congenital prepubic sinus.

We report the fourth case of a congenital prepubic sinus extending from the anterior bladder wall through rectus fascia to overlying skin. Intermittent erythema and discharge prompted exploration and excision. This lesion may represent a mild forme fruste of the midline closure defects.

Eosinophilic ureteritis associated with eosinophilic cholangitis: a case report.

Eosinophilic infiltrate of the urinary tract is rare. We report on a patient with eosinophilic cholangitis who later had eosinophilic ureteritis. This case emphasizes the potential serious nature of eosinophilic ureteritis, which often presents with complete ureteral obstruction. The literature pertaining to eosinophilic ureteritis and eosinophilic biliary disease is reviewed.

Use of resectoscope for colon cancer.

Urologic endoscopic resectoscopes greatly simplify electrofulguration and resection of rectal tumors. The most important advantage is the enhanced visibility that allows determination of the depth of resection and good hemostasis. The indications for this procedure are otherwise-poor surgical candidates, palliation, excision of locally aggressive tumors such as villous adenomas, and bowel diversion prior to definitive therapy. Bleeding, peritoneal perforation requiring colostomy, and postoperative infection have all been reported, but the complication rate appears to be acceptable. Further clinical studies are necessary to determine if, indeed, this can be considered a curative procedure. Finally, because the practicing urologist is intimately aware of the technical aspects of the urologic resectoscope, he will probably be called on to perform, and should be aware of, this procedure.

Elective cholecystectomy during major urological surgery.

A total of 6 patients underwent a major urological operation with simultaneous elective cholecystectomy for cholelithiasis. All patients did well with no morbidity or increased hospital stay attributable to the biliary operation. Numerous articles in the vascular, general and gynecological surgery literature advocate concomitant cholecystectomy when gallstones are present. The complications of nonoperated biliary calculous disease, including postoperative cholecystitis, are well known. A concomitant operation could reduce over-all risks and costs to the patient and health care system.

Postoperative intussusception in children.

Intussusception in the postoperative period is an unusual yet potentially fatal surgical complication. We present 3 illustrative cases and contrast postoperative intussusception with the more common classic childhood intussusception. Physician awareness of this condition is critical for early recognition and treatment.

Seminal vesicle abscess: the use of computerized coaxial tomography for diagnosis and therapy.

Seminal vesicle abscesses are extremely rare and worthy of report. Computerized tomography easily verifies the diagnosis and simplifies the treatment of transurethral incision and drainage.

Traumatic hematocele: association with rupture of the testicle.

Ten patients with hematoceles associated with blunt trauma have been seen during the last 4 years. In 80 per cent of the cases the hematocele was caused by rupture of the testicle. Prompt early exploration, adequate débridement, primary repair of the tunical laceration and Penrose drainage resulted in a salvage rate of 75 per cent.

Prostatic abscess: computerized tomography scanning as an aid to diagnosis and treatment.

In the antibiotic era prostatic abscesses are rare and the clinical picture often can be confusing. In 2 recent cases computerized tomography scanning not only proved the diagnosis easily but it also simplified greatly the definitive surgical procedure.

Solitary crossed renal ectopia.

An 18-month-old girl had crossed ectopia involving a solitary left kidney. There have been 26 cases reported previously. Several theories for this occurrence are discussed.

Bilateral synchronous germ cell tumors.

We present cases 38 and 39 of primary bilateral synchronous germ cell tumors of the testes and review the literature. Seminoma (42 of 68 cases) is the most common cell type reported, and bilateral seminoma is the most common cell type combination (19 of 34 cases). The incidence of cryptorchidism is not increased in patients with bilateral synchronous germ cell tumors. A tendency towards occurrence in older patients is noted. The stage of disease at presentation appears to be no worse than that for unilateral disease.

Spermatic cord block and manual reduction: primary treatment for spermatic cord torsion.

A total of 16 consecutive cases of acute torsion of the spermatic cord less than 24 hours in duration are presented. All patients were diagnosed and treated initially by spermatic cord blockade and attempted manual detorsion. Of the 16 patients 15 underwent successful detorsion under local anesthesia. All patients underwent subsequent bilateral orchiopexy. Testicular salvage was 93 per cent in those patients who underwent successful detorsion by manipulation.

External beam radiotherapy for adenocarcinoma of the prostate: a clinical followup.

Post-irradiation biopsies were done on 68 patients who had received curative external beam radiation therapy for adenocarcinoma of the prostate. These patients were evaluated to determine subsequent rates of disease progression and patients survival. Mean followup was 5 years. Results revealed that 1) residual tumor present 12 months after therapy does not disappear, 2) advance in tumor grade occurred in 19 of 39 patients (49 per cent) with positive biopsies after therapy, 3) patients who had positive biopsies after therapy had a greater chance for disease progression (11 of 39 cases or 28 per cent) than patients with negative biopsies (4 of 29 cases or 14 per cent) and 4) hormonal therapy started when a positive biopsy was obtained appears to delay onset of disese progression.

A closer look at serum prostatic acid phosphatase as screening test.

Radioimmunoassay techniques for the detection of serum acid phosphatase are reported to provide substantial improvement in test sensitivity and test specificity. Calculation of the positive predictive value for this assay, however, does not support its use as a screening modality. Indiscriminate use of this test may have serious medical, psychological, and economic ramifications.

The ultrastructural changes of prostate adenocarcinoma following external beam radiation therapy.

Ultrastructural studies were done to determine the effects of radiation therapy on prostatic adenocarcinoma. Twenty patients were included in the study: 6 with benign hyperplasia, 4 with untreated adenocarcinoma and 10 with adenocarcinoma who had received radiation therapy. Benign and malignant ultrastructural characteristics were established. On the basis of these characteristics 6 of the 10 radiated prostates were believed to have tumor cells present after therapy. Of the remaining 4 patients 3 had ultrastructural changes suggesting radiation effects and a possibly altered malignant potential.