Transactions of the American Association of Genito-Urinary Surgeons最新文献

Identification of specific 17-beta-estradiol, 5-alpha-dihydrotestosterone and progesterone binding proteins in 10 patients with metastatic adenocarcinoma of the prostate is presented. A synthetic androgen radioligand (R1881) and a synthetic progesterone (R5020) were used. In all but 1 patient receptor protein assays were done before hormonal manipulation. Based on the preliminary findings it seems probable that prostatic carcinoma might be categorized for endocrine therapy similar to the method used for carcinoma of the breast.

Experience with suprapubic closure of vesicovaginal fistulas in 42 patients considered candidates for this procedure is reviewed. Five patients required a second operation for cure and the reasons for failure are discussed. Wide exposure with tension-free closure of well vascularized flaps and the judicious interposition of pedicled omentum have produced the most encouraging results. The litigious nature of this distressing condition is lessened when primary closure is successful and supravesical diversion by ileal or colonic conduits can be avoided.

Renal autotransplantation as an alternative to ileal interposition has been done successfully in patients with repetitive episodes of renal colic. Urinary tract continuity has been re-established by anastomosis of a Boari tube directly to the renal pelvis. This has resulted in easy egress of recurrent calculi without pain. Furthermore, the musculature of the Boari tube seems to be adequate for prevention of vesicorenal reflux. The procedure has been devoid of electrolyte and mucous urinary retention problems associated with ileal interposition and it is advocated as an alternative in the management of such patients when medical therapy fails.

Schistosomiasis is a chronic granulomatous disease endemic in the Middle East and Africa, which undermines the function of the genitourinary tract to a serious degree. It is amenable to medical treatment in the early stages but therapy usually is negated by frequent reinfestations. Patients who have complications in the chronic stage of the disease require the level of judicious handling that always taxes the ingenuity and skill of the urologic surgeon.

To evaluate the incidence and significance of an enlarged prostatic utricle in hypospadiac patients without underlying intersex 44 patients with the meatus located in the perineum, penoscrotal junction or proximal two-thirds of the penis were evaluated with cystourethroscopy immediately before the operation. There was an abnormally enlarged utricle in 57% of the perineal, 10% of the penoscrotal and none of penile hypospadiacs, for an over-all incidence of 14%. Concurrent analysis of a series of phenotypic male patients with hypospadias and intersex revealed a high incidence of enlarged utricle or the presence of a vagina masculinus. Utricular enlargement in itself does not indicate intersexuality but careful cystoscopic examination of its vault needs to be undertaken, searching for a cervix. An enlarged utricle can be a manifestation of delayed müllerian duct regression or decreased androgenic stimulation of the urogenital sinus.

Cis-diamminedichloroplatinum II currently is the most effective chemotherapeutic agent in advanced bladder cancer. However, most of the objective responses are partial and/or of limited duration (average 6 months). In an effort to identify a more effective compound with less toxicity platinum analogues have been synthesized. Since results in the carcinogen-induced murine bladder cancer model have correlated with activity of drugs in man this model was used to evaluate 4 of these analogues. Although not as effective as the parent compound, cis-diamminedichloroplatinum, they exhibited significant antitumor activity in the poorly differentiated transplanted tumor. However, they were not able to reduce the incidence or size of primary tumors. Another approach to enhance tumor cell kill is combination chemotherapy. The addition of cyclophosphamide or cyclophosphamide and doxorubicin hydrochloride to cis-diamminedichloroplatinum produced a greater tumor inhibition than cis-diamminedichloroplatinum alone in experiments with the transplanted and the primary tumor models. It is hoped that these studies will continue to provide background information for the design of disease oriented phase I and II clinical trials.

Comparisons of the bone marrow and serum acid phosphatase values obtained by counterimmunoelectrophoresis and the Roy biochemical test were made in 72 patients with and in 13 patients without prostatic cancer. The counter-immunoelectrophoresis test, when positive at more than 1 international unit per liter, showed only 4.4% falsely positive results. The Roy biochemical test, which uses sodium thymolphthalein monophosphate as the substrate, had 65% falsely positive bone marrow acid phosphatase levels. Conflicting reports regarding the value of bone marrow acid phosphatase determinations in patients with prostatic cancer result from the use of non-specific substrates in biochemical methods for measurement and from the trauma incidental to bone marrow aspiration, which releases many non-prostatic acid phosphatase enzymes. The use of immunoassay such as counter-immunoelectrophoresis minimizes this source of error.

Plasma catecholamines have been used for diagnosis and computerized tomography scanning for localization in 21 patients with proved pheochromocytoma. Blood catecholamines were obtained in 20 of the patients and were elevated significantly in every instance. Successful localization of the tumor was accomplished by excretory urography in only 47% of the cases, by selective angiography in 85% and by abdominal computerized tomography scanning in 88%. In 7 patients preoperative identification and localization of the tumor were determined correctly by computerized tomography scanning alone. Data in our series suggest that the diagnosis and localization of pheochromocytoma can be accomplished usually by a simple blood test and body scan. More elaborate and sometimes hazardous studies should be necessary only in exceptional cases, usually with tumors less than 3 cm. in diameter.

The difficult problem of a vesicovaginal fistula originally was cured surgically by Sims in 1849. During the last 25 years at UCLA and affiliated hospitals 68 patients have been treated by urologic surgeons for fistulas between the vagina and the urinary tract: 21 ureterovaginal and 47 vesicovaginal and urethrovaginal fistulas. The ureterovaginal fistulas often were complex and patients presented the most challenging diagnostic problem. However, they usually were repaired successfully by simple ureteroneocystostomy. Vesicovaginal and urethrovaginal fistulas were repaired transvaginally in 24 cases, with 70% success at the first attempt and 92% success with 2 attempts. Transabdominal or combined approaches were less successful. Only 58% of the cases were closed at first attempt. The transvaginal approach required less operating time, and resulted in less blood loss and shorter hospital stays than the transabdominal approach and will be described in detail.