Thermocoagulation effect of diode laser radiation in the human prostate: acute and chronic study.

OBJECTIVES: To evaluate the safety and efficacy of low-power slow-heating diode laser-induced photocoagulation of prostatic tissue for treatment of benign prostatic hyperplasia, we conducted a series of acute and chronic studies using a diode laser (810 nm) to irradiate human prostate. METHODS: The study included 6 patients undergoing radical prostatectomy because of malignancy. Laser radiation to the prostate was given transurethrally, in a noncontact mode, at the time of the procedure in 2 patients (acute group): 10 W for 300 seconds on the right side of the prostate and 15 W for 180 seconds on the left. In the remaining 4 patients (chronic group), laser radiation was given at 1, 7, 10, and 12 weeks prior to the prostatectomy. RESULTS: In the acute group the average depth of coagulation was 8.5 and 9.0 mm for the laser regimens of 15 W for 180 seconds and the 10 W for 300 seconds, respectively. In the chronic group, the average depth of coagulation was 8.9 mm for both laser regimens studied. In the acute group, there was an ill-defined hemorrhagic ring at the periphery of the lesion. At 1 week, an intact necrotic coagulum was present. At 7 weeks, some of the coagulated tissue had already sloughed off. Longer follow-up at 10 and 12 weeks demonstrated formation of a well-defined cavity with mostly re-epithelialized surface. CONCLUSIONS: Our findings suggest that noncontact diode laser (810 nm) irradiation can induce in the human prostate significant coagulation necrosis followed by sloughing of tissue and cavitation of the prostatic urethra.

Bilateral ilioinguinal lymph node dissection in the management of cancer of the penis.

Twenty-nine patients with squamous cell carcinoma of the penis underwent bilateral ilioinguinal groin dissection 6 weeks after removal of the primary penile lesion. Eighty percent of the patients were alive and without evidence of disease at 5 years when the dissected lymph nodes were negative. When positive nodes were found, 62.5% of the patients were alive and without evidence of disease at 5 years: two of these patients had one iliac deep node positive each. The mortality rate at 5 years because of progression of disease was 6.6% when the dissected lymph nodes were negative, as compared to 37.5% when the dissected lymph nodes were positive.

Transrectal ultrasound of the prostate.

One hundred and twenty-one transrectal ultrasound examinations of the prostate were performed between August and October of 1987. Indications included screening in 41 patients, evaluation of bladder outlet obstruction in 63 patients, evaluation of palpable nodules in 6 patients, and evaluation after transurethral resection of the prostate in 11 patients. A total of five patients were discovered to have prostate cancer after biopsy of a hypoechoic lesion in a normal feeling prostate by digital rectal examination. One patient was from the screening group, two patients with bladder outlet obstruction and two patients from the postransurethral resection group. All six patients with palpable nodules were diagnosed as having a cancer: Stage B2 on the rectal examination and two of the six patients were upstaged to Stage C by ultrasound criteria. In our hands transrectal ultrasound of the prostate is a valuable adjunct in the urological armamentarium with clear application in the diagnosis and staging of prostate cancer.

Transabdominal radical nephrectomy in ninety-one consecutive patients with Wilms' tumor.

Ninety-one children that were subjected to transabdominal radical nephrectomy are reviewed. The patients' ages ranged from 20 days to 10 years. Forty cases had a right side tumor and 44 a left side tumor; bilateral tumor incidence was 7.70% (7 cases). The tumor weight incidence was 75% for greater than or equal to 500 g and 37.5% for greater than or equal to 1,000 g. Incidence of local extension of the disease was 21.98%. Intraoperative complications were 12 ruptures of the kidney capsule, 1 laceration of the cecum, 1 opening of the pleura, 1 section of the superior mesenteric artery, and 1 section of the right common iliac artery. The mortality rate in unilateral surgery, because of intraoperative massive hemorrhage, was 3/83 (3.61%). One patient with bilateral tumor died because of acute renal insufficiency and sepsis. One patient with caval thrombus which extended up to the right atrium died because of intraoperative massive pulmonary embolism.

Management of yolk sac carcinoma of the testis clinical stage I: lymphadenectomy vs. no lymphadenectomy.

Thirty seven patients with Stage I yolk sac tumor of the testis were registered at the Instituto Nacional de Enfermedades Neoplasicas (I.N.E.N.), Lima-Peru from 1962 through 1980. Eighteen patients underwent retroperitoneal Lymph node dissection. The age incidence was 5 to 29 months except for two patients 50 and 84 months of age each. Bilateral retroperitoneal lymph node dissection was performed in seventeen patients; unilateral dissection was performed in one patient. In two patients both had one positive node at lymphadenectomy (2/18: 11%). Eleven patients (61.11%) are alive and with no evidence of disease in between 7 to 26 years post lymphadenectomy. Seven patients (38.89%) died: 4/18 (22.22%) because of progression of the disease and three patients because of no neoplastic cause. Nineteen patients did not have retroperitoneal lymph node dissection: seven patients (36.84%) are alive with no evidence of disease and 12 patients (63.16%) died: 8/19 (42.10%) because of progression of the disease and 4/19 (21%) with no neoplastic disease. In conclusion, patients with localized disease (Clinical Stage I) benefit from retroperitoneal lymph node dissection when compared to a similar group of patients not submitted to lymphadenectomy.