Biomedical subjects
Publications and source records attributed to C J Godec.
The eleventh case of malignant Sertoli cell tumor of the testicle is described. The tumor displayed malignant character with local invasion into the epididymis. Retroperitoneal lymph node dissection revealed a malignant deposit around the left renal artery.
Despite existing information that most impotent patients have normal serum testosterone, testosterone is still used frequently in the treatment of impotence. In 11 patients who underwent penile implantation, we measured the presence of testosterone receptors in the corpora cavernosa. An average value of 1.82 fmol/mg of protein cytosol was found in this group of patients. This value is too low to obtain any significant improvement in erectile function following testosterone application. Testosterone hypogonadism will likely remain the only indication in which testosterone application might improve organically triggered impotence.
We report on a patient with xanthogranulomatous pyelonephritis, in situ transitional cell carcinoma, and focal prosoplasia revealing abrupt conversion of transitional epithelium to moderately well-differentiated adenocarcinoma. The etiology and pathogenesis of mucinous adenocarcinoma in the renal pelvis very likely involves the prosoplastic transition of pre-existing transitional carcinoma to adenocarcinoma. The urologist should be aware of the increased possibility of this tumor developing in a patient with longstanding infection, and frozen section should be performed more often because the gross structure of the tumor frequently appears normal. This permits the urologist to change his surgical strategy if frozen section is positive for tumor.
Vibratory stimuli were used for diagnostic evaluation of 130 impotent patients. The stimuli were applied to the glans penis, and erectile response was measured and displayed on a recorder. The erectile response to vibration was compared with nocturnal penile tumescence (NPT) monitoring and to artificially produced full erection. At the present time vibratory stimuli do not represent an alternative diagnostic method to NPT. However, the two methods are complementary. Erectile activity during vibration was detected in 43 of 130 patients. For these 43 patients further evaluation with NPT monitoring would not be necessary. Because vibration evaluation is performed as an outpatient procedure, it can contribute to a significant cost reduction in the evaluation of impotent patients.
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Female patients need more privacy for micturition and are, therefore, more prone to suppress the normal micturition reflex. Due to postponed micturition, their bladders are usually full and during stress conditions urinary incontinence does occur. In 20 patients who had functional stress incontinence, the urologic and urodynamic evaluation was performed. When no major structural deformities were found, the timed voiding was taught to the patients. In 79 per cent of patients the urinary incontinence was cured by timed voiding only. Some of the patients who had positive urinary cultures became sterile following the new voiding patterns. The possible neurophysiologic mechanisms of timed voiding are discussed.
In a group of 13 patients who underwent penile surgery, a small amount of cavernosal tissue was removed and examined for content of cholinergic receptors. Three patients did not display any amount of cholinergic receptors. Values in the other 10 patients ranged from 34 to 136 femtomols. In another group of 61 impotent patients with some degree of preserved erectile capacity, cholinergic stimulation was administered to the patients and the response monitored. Preliminary data displayed improved erectile capacity in 41 per cent. Further studies are needed to identify impotent patients who might respond favorably to cholinergic stimulation.
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Acute urinary retention in middle-aged females is an infrequent occurrence; therefore, when such a patient presents to the urologist, an aggressive diagnostic evaluation is warranted. Carcinoma of the urethra might be the underlying pathologic process causing urinary retention. Herein, we present 2 cases of acute urinary retention triggered by adenocarcinoma of the urethra. In 1 patient the diagnosis was delayed due to severe superimposed infection which responded poorly to medication. Anterior exenteration and radiotherapy were used in the management of both patients.
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A case of bilateral, synchronous ureteral tumors and a tumor in the left renal pelvis is presented. Conservative surgical treatment involved local resection of both ureteral tumors and partial nephrectomy of the left kidney. Multiple urothelial tumors subsequently developed in the bladder which were resected. The patient has had good kidney function and no evidence of disease.
Nonoperative (catheter) management was used in 18 patients with extraperitoneal rupture of the bladder with limited extravasation of dye found by retrograde cystogram. Complications occurred in 4 of the 18 patients. A review of the literature shows a 20 to 25-per cent complication rate with nonoperative management of bladder rupture. However, with a small extraperitoneal rupture with limited extravasation, especially in a female, the nonoperative (catheter) management will give a satisfactory result.
A new method of treatment of urinary incontinence is described. A tape recorder with two outlets generates musical stimuli. One outlet brings direct unconverted musical stimuli to the patient's ear, the other outlet conveys the musical stimuli to a converter where the musical pulses are converted into electrical stimuli which are then applied to the patient's anus. At first stimultaneous application of stimuli into the ear and anus is performed and anal pressure response recorded. After conditioning takes place, music is applied to the patient's ear, stimulation to the anus is disconnected, and only anal pressure response is recorded. The patients are conditioned enough to generate good and response to aural stimulation only.
Massive hematuria, which is most frequently caused by radiation for pelvic malignancies, after treatment with cyclophosphamide or secondary to aggressive anticoagulation, represents a vexing problem for the practicing urologist. The existence of numerous therapeutic approaches results from the lack of an effective therapeutic modality. Lately, formalin seems to offer a new hope for the treatment of intractable hematuria. Analysis of published results after treatment with formalin revealed generally excellent results regarding control of hematuria. Nevertheless, the complication rate of formalin application is surprisingly high, including vesicoureteral reflux and hydroureteronephrosis as local reactions and systemically tubular necrosis with anuria. Our series of patients is presented with a detailed description of a patient who was afflicted with a vesicovaginal fistula following formalin instillation. Formalin can serve as excellent therapy for massive hematuria. If attention is paid to the concentration and to the technical details of its instillation the noxious side effects can be minimized or prevented in the majority of cases.
Surgical exploration of a testicular mass should follow the basic principles of cancer surgery, including an inguinal approach, occlusion of the spermatic vessels, opening of the tunica vaginalis, and careful exploration of the testicle, epididymis, paratesticular structures, and spermatic cord. In a very few patients, when intratesticular lesion is small and moveable and can be seen through the tunica albuginea, and if there is a long history of scrotal mass, then the tunica albuginea should be opened and intratesticular exploration performed. The opening of the tunica albuginea should be opened and intratesticular exploration performed. The opening of the tunica albuginea does not violate the principles of cancer surgery, and for a few selected cases can prevent unnecessary orchiectomy. The incision of the tunica albuginea should no longer represent a surgical taboo to the urologist. Six cases of rare, benign intratesticular tumors are presented along with a rare indication for intratesticular exploration and testicle-preserving surgery.
The treatment of recurrent renal calculi in patients after ureteroileal urinary diversion is difficult, especially when urinary stones are formed in the presence of urinary tract infection. In many cases, these patients already have undergone multiple renal operations and more surgery could pose difficult technical problems. We report on a patient with a high urinary diversion in whom bilateral staghorn renal calculi developed, and then were endoscopically removed. The conversion of ureteroileocutaneous diversion to a high pyeloileocutaneous diversion is recommended in selected cases as alternate treatment for patients with recurrent stone formation.
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We report a case of stage D, poorly differentiated invasive squamous cancer of the bladder. Following transurethral resection of the tumor (170 gm.) and urinary diversion, the patient received 6,500 rad external radiation. After completion of radiation the bladder was converted from an inoperable (fixed to the pelvis) to an operable (mobile) condition. A cystectomy was performed and the patient was without evidence of disease 4 years later. The controversies of the therapeutic approach to squamous cancer of the bladder are discussed.