Biomedical subjects
Publications and source records attributed to H A Fuselier.
For the surgical treatment of priapism we have created a percutaneous fistula between the glans penis and the corpus cavernosum with good results. This is our preferred method of management for all patients except those undergoing sickle cell crisis.
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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 13 patients, 3 of which 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% (26 patients). Thirty-four patients were followed for 10 years. The survival rate for this group of patients was 32.4% (11 patients). The results of this study correlate well with other published reports.
Adenocarcinoma of the bladder is an uncommon malignancy comprising less than 2% of all bladder tumors. Eleven cases of adenocarcinoma of the bladder were seen from 1947 to 1977 at the Ochsner Medical Institutions. Six of the tumors were urachal in origin, and five involved the base and lateral walls of the bladder. Six patients were treated with total cystectomy, four with segmental cystectomy, and one with radiation therapy only. The average survival time for the patients with urachal adenocarcinoma was 2.8 years and for those with vesical adenocarcinoma, 2.4 years. Although segmental cystectomy is recommended by some, the authors recommend radical cystectomy for all patients with adenocarcinoma of the bladder.
Giant hydronephrosis is the term designating the presence of more than 1,000 ml. of fluid in the collecting system. Of 4 cases of congenital hydronephrosis found over a three-year period at the Ochsner Medical Institutions, 2 were associated with unsuspected carcinomas. Hydronephrosis may first be detected as a mass palpable in the abdomen and displacing the intestines on gastrointestinal films. Excretory urography, retrograde pyelography, and angiography confirm the diagnosis. The treatment of choice is nephrectomy.
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.
Nephrogenic adenoma of the bladder, which has been associated with either a chronic infection or severe trauma to the bladder, occurred in a six-year-old girl apparently secondary to urologic surgery. It was also a possible cause of enuresis.
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A 24-year-old man had a cyst of the seminal vesicle and ipsilateral renal agenesis with an ectopic ureter. Nineteen other patients with similar anomalies are reviewed. The usual age at the onset of symptoms is between 20 and 28 years, during the time of maximal reproductive activity. Usually, diagnosis is established by history, the finding of a mass in the area of the seminal vesicle and an excretory urogram. Treatment consists of excision, aspiration or transurethral unroofing of the cyst.
The free, full thickness skin graft urethroplasty, which has been used successfully for 20 years, was first adopted for anterior urethral strictures at our hospital in 1969. Presently, 66 cases of urethral stricture have been treated, 5 of them for posterior urethral strictures. The free, full thickness tube graft technique is discussed and 3 cases are reported. Of the 66 cases 54 (84 per cent) had good results. When indicated this procedure is advocated with considerable enthusiasm.
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A patient with a most unusual neoplasm of the bladder, a paraganglioma, is presented herein. A combination of episodes of hypertension during or immediately after micturition associated with hematuria is almost pathognomonic of this condition. The patient presented with hematuria only. Less than 7 per cent of all reported cases have a malignant course. The proper treatment appears to be partial cystectomy with wide margins of the affected area, being prepared for wide fluctuations in blood pressure in those patients who have elevated catecholamine levels preoperatively.
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