Analysis of imaging modalities, staging systems, and prognostic indicators for renal cell carcinoma.

A retrospective analysis of 314 patients with renal cell carcinoma was done focusing mainly on imaging modalities and prognostic significance of tumor stage using both the Robson and TNM systems. Computerized tomography (CT) scan proved to be the most effective modality for staging. Overall staging accuracy was 62 and 68 percent for TNM and Robson staging, respectively, and understaging was more frequent than overstaging. The actuarial five-year survival using the Robson system was 73 percent for Stage A, 68 percent Stage B, 51 percent Stage C, and 20 percent Stage D. The main limitation of the Robson system is the heterogeneity of the Stage C group which includes patients with renal vein and those with nodal involvement with a significant difference in survival. The survival by the TNM system showed no difference in those with T1, T2, T3a and T3b disease but a significant difference in those with T3c or T4a. One hundred sixteen patients (37%) presented with metastatic disease with a median survival of seventeen months (range 2-204) for those with solitary metastasis and six months (range 1-132) for those with multiple metastases (the difference was not statistically significant). Except for anecdotal cases, nephrectomy with or without treatment of the metastases did not seem to affect survival significantly. The presence of spindle cell, alone or in association with clear or granular cell, affected the prognosis adversely. Thirty-one patients had their tumors identified incidentally. Their stage at diagnosis was earlier than the symptomatic group (Stage T1-T2: 77% vs 34%), and there was a significant difference in the disease-free survival at fifty-four months between the two groups (79% vs 57%, respectively).

Conservative management of renal lacerations in blunt trauma.

Controversy in the treatment of blunt renal trauma is largely focused on immediate surgery versus conservative management for parenchymal lacerations. A retrospective analysis of 133 cases of blunt renal trauma at the Victoria General Hospital in Halifax over a 10-year period revealed 26 cases of renal laceration. The conservative approach to radiologic diagnosis and treatment options is discussed. Our experience confirms a low rate of both nephrectomy and secondary complications using conservative management.

Rectal obstruction by prostatic carcinoma: diagnosis by computerized tomography scan.

We report 3 cases of rectal obstruction from locally invasive prostatic carcinoma. The importance and difficulty of differentiating primary prostatic cancer from rectal cancer in this circumstance are stressed, and the usefulness of computerized tomography is discussed.

Carcinoma of the penis: an 11-year review.

Management of primary carcinoma of the penis in 37 men by local excision or radiotherapy was associated with a high risk of recurrence. The authors in this review recommend partial penectomy as the minimum surgical procedure for the primary lesion. Clinical assessment of the inguinal lymph nodes was often inaccurate and the value of early sentinel node biopsy is discussed. All patients who underwent ilioinguinal node dissection had complications and only one of six men with histologic stage III disease was cured. The overall 2-year survival rate was 51%.

Acute renal failure secondary to bilateral ureteric obstruction: review of 50 cases.

The records of 50 patients with acute renal failure secondary to bilateral ureteric obstruction were reviewed. An underlying malignant disorder was the cause of the obstruction in 38 of the patients and had not previously been diagnosed in almost half of them. Carcinomas of the cervix and prostate were the most frequent malignant disorders, and aggressive management resulted in good survival rates. Similarly, the outcome for patients with benign bilateral ureteric obstruction, usually caused by retroperitoneal fibrosis, was good with proper management.