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

THE INCIDENCE OF SEXUAL IMPOTENCE IN 20 MEN WHO HAVE RECEIVED AT LEAST 2 KIDNEY TRANSPLANTS WAS 65 PER CENT COMPARED TO 10 PER CENT AFTER THE FIRST TRANSPLANT. The impotence was transient (2 to 4 months) in both affected men after the first transplant but permanent (2 to 10 years) in 6 men after the second operation. We attribute this increased percentage of impotance to the second end-to-end arterial anastomosis that requires division of the internal iliac arteries. We suggest that the second transplant be placed end-to-side into the common iliac artery.

Since first described in 1975, non-operative external manipulation of small intrarenal calculi has been done on 30 individuals. This procedure has facilitated stone passage successfully in 80 per cent of the cases and, thus far, has been free of significant complication. Fluoroscopic control and materials available in most radiology departments allow for intrarenal manipulation to dislodge small calculi in virtually any calix, permitting spontaneous and usually asymptomatic passage. The procedure and subsequent management are described in detail.

Estramustine has been shown previously to be an effective drug in the treatment of metastatic prostatic cancer, demonstrating significant objective and subjective responses in long-term non-randomized trials and in other randomized trials. In this study prednimustine alone has shown a minimal over-all objective response rate of 12.9 percent of the cases, although with marked subjective improvement of pain relief and patient performance status. The combination of prednimustine with estramustine did not result in improvement of objective or subjective response parameters. The effects in terms of responses or in terms of toxicity for either agent were not additive when they were given in combination. Cross-over for those patients whose disease progressed on prednimustine therapy to estramustine had some benefit in over-all survival. Prednimustine alone or in combination with estramustine may be used safely and could improve markedly the quality of life for irradiated patients with advanced prostatic cancer who failed on hormonal treatment and have too poor a bone marrow reserve to be treated by other currently available myelosuppressive agents.

Minipigs (20 to 25 kg.) were subjected to bilateral renal artery occlusion for 60 minutes. Renal blood flow was reduced to 65 per cent and glomerular filtration rate to 40 per cent of normal in control animals. Administration of adenosine triphosphate with magnesium chloride intravenously immediately after the period of ischemia resulted in restoration of renal blood flow to normal and glomerular filtration rate to 74 per cent of normal 24 hours later. Bilateral renal artery occulsion for 90 minutes resulted in a more severe impairment of renal function, which was not improved by the administration of adenosine triphosphate with magnesium chloride. Adenosine triphosphate with magnesium chloride may exert its effect by improving renal blood flow through inhibition of post-ischemic intrarenal vasoconstriction or possible by enhancing restoration of intracellular adenine nucleotides. The exact mechanism remains unclear.

There were 30 patients with solitary kidneys containing staghorn claculi who have been subjected to nephrolithotomy with extensive plastic revision of strictured calices using local renal hypothermia. These patients have been followed for 8 months to 16 years and all have had a recent in-hospital evaluation of renal function and recurrent stone formation. No surgical mortality occurred (death within 3 months of operation). Seven patients have died postoperatively, only 1 of whom had associated progressive deterioration of renal function as a contributory cause of death. It is concluded that surgical removal of calculi from a solitary kidney is a relatively safe procedure that results in significant improvement in the patient's well being. The degree of improvement is of such a nature that it may be equated to "cure of the disease" in 63 per cent of the patients.

The binding of 3H-R 1881 to cytosol prepared from benign and malignant prostatic neoplasms has been investigated. We have demonstrated that high affinity binding of 3H-R 1881 is present in cytosol preparations of benign prostatic hyperplasia, in specimens of prostatic cancer obtained from patients prior to hormonal therapy and in carcinoma of the prostate metastatic to lymph nodes. In addition, high affinity binding was present in all specimens of prostatic cancer from patients who had objective evidence of progressive metastatic disease after an initial response to hormonal therapy. Until greater numbers of patients have been studied the significance of these findings can only be speculative. Because the binding of 3H-R 1881 may measure androgen and progesterone receptors future investigations must include careful steroid specificity studies. Finally, because steroidal hormones exert their major influence within the nucleus of target tissues the measurement of nuclear receptor content may provide a more accurate means to predict the hormonal responsiveness of prostatic cancer.

Between 1950 and 1974, 35 men and 10 women underwent partial cystectomy for transitional cell carcinoma of the bladder. Indications, contraindications and the principles of technique for partial cystectomy as therapy for transitional cell tumors of the bladder are discussed. All patients were evaluated postoperatively, with cystoscopic examination every 3 months for 1 year, every 6 months for 3 years and then at yearly intervals if no tumors had been detected. None of the patients received preoperative irradiation. Eight ureters were re-implanted and 6 prostate glands were enucleated at the time of partial cystectomy. There was 1 death in the immediate postoperative period. Complications developed in 12 patients, in 3 of whom they were considered major. When recurrences were noted appropriate therapy was performed as indicated. Irradiation was the most commonly used method to treat distant metastases. The over-all 5-year survival rate is 57.7 per cent (26 patients). Thirty-four patients were followed for 10 years. The survival rate for this group of patients was 32.4 per cent (11 patients). The results of this study correlate well with other published reports.