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Biomedical subjects

H M Spence

Publications and source records attributed to H M Spence.

At least 19 recordsLinked to original sources
PubMed1990

Current status of tumor of the bowel following ureterosigmoidostomy: a review.

In the final analysis the major question that arises is whether urinary diversion to the intact colon should be performed at all for benign conditions in which a relatively long life expectancy may be anticipated. In answer to this question we believe that if exstrophy is the problem early primary closure with the staged reconstruction should be attempted first. If such efforts are marred by persistent incontinence management with an artificial urinary sphincter should be considered. In individuals with multiple bladder dehiscences after attempts at primary bladder closure, or in an individual with persistent incontinence despite multiple procedures surgical alternates should include diversion by a bowel conduit, continent urinary diversion, a variant of the ureterosigmoidostomy or standard ureterosigmoidostomy. Indeed, despite the appropriate concern regarding the development of tumor in ureterosigmoidostomy, this diversion may still have a major role in the educational process of urology throughout the next decade. Specifically, we must apply the knowledge gained from our clinical and laboratory investigations of ureterosigmoid diversion to the current more popular means of diversion. Of particular concern are the clinical findings of adenocarcinoma in enteric augmentations. This discovery must serve as a warning for the possibility of urocolonic tumors developing within alternative continent urinary diversions within the next 20 to 30 years. Certainly, at least annual evaluations of any diversions are mandatory until we can define accurately the morbidity and mortality arising from our interventional management.

Adenocarcinoma↗
PubMed1988

Progression of leukoplakia of the bladder to squamous cell carcinoma 19 years after complete urinary diversion.

We report a rare case of squamous cell carcinoma developing in a defunctionalized bladder with known leukoplakia 19 years after urinary diversion. We conclude from this case that once the initial metaplasia of the transitional epithelium of the urinary tract to leukoplakia has occurred chronic irritation by (infected) urine is not required to cause further progression to squamous cell carcinoma. Therefore, we recommend prophylactic cystectomy if palliative urinary diversion for relief of symptoms is considered in patients with leukoplakia of the bladder.

Carcinoma, Squamous Cell↗
PubMed1984

The life and death of Captain Charles Martell and kidney stone disease.

Hyperparathyroidism was unknown in this country until the diagnosis was first made by Eugene F. DuBois in 1926. The patient was Captain Charles Martell, a mariner who had become disabled by demineralization of the skeleton during many years. Finally, a parathyroid adenoma was removed at the seventh operation in 1932. Urinary calculi were a major part of the long illness and their complications caused death. Charles Martell contributed significantly to our knowledge of calcium metabolism in general and kidney stone disease in particular.

History, 19th Century↗
PubMed1979

Tumour of the colon as a late complication of ureterosigmoidostomy for exstrophy of the bladder.

Two cases of cancer of the colon have occurred recently in our series of 38 patients with exstrophy of the bladder treated by ureterosigmoidostomy. Twenty-six and 14 years elapsed between the original operation and the diagnosis of malignancy. Since 1929 the literature contains reports of 55 patients who have developed bowel neoplasms as a late complication of this form of diversion. The operation was performed for exstrophy in 35 of these, in whom the resulting tumour at the anastomotic site was malignant in 28 and benign in 7 patients. The shortest interval between ureterosigmoidostomy and recognition of the growth was 10 years with a mean latent period of 25 years. The aetiology remains uncertain but it is clear that long-term survivors after ureterosigmoidostomy should have diagnostic large bowel studies included in the follow-up.

Adult↗
PubMed1975

Exstrophy of the bladder. I. Long-term results in a series of 37 cases treated by ureterosigmoidostomy.

Of the 37 patients with exstrophy of the bladder in whom ureterosigmoidostomy was selected as the mainstay of treatment 4 died of causes related to the procedure. Faulty judgment and poor followup accounted for these deaths, which might well be preventable today. In 18 survivors, or approximately half of the entire series, the operation has held up well for many years, with no further surgical procedure being required for complications. In 12 patients, or approximately a third of the group, remedial operations for complications attributable to the ureterosigmoidostomy have been required but it was elected to retain this form of diversion. The long-term end result in these patients also remains acceptable. Combining these 2 groups 30 of 37 patients with ureterosigmoidostomy may be considered to have been eventually successful. However, in 7 of 37 patients the method was a frank failure, in that 4 patients died and 3 required substitution of another form of diversion. While all forms of treatment of exstrophy of the bladder leave much to be desired, results obtainable in today's setting lead us to recommend ureterosigmoidostomy as first choice in the management of this disorder. This recommendation is accompanied by the admonition that systematic followup is imperative so that if things do go badly from the clinical, laboratory or urographic viewpoint corrective measures can be done before renal deterioration occurs. The measures required may range from simple correction of electrolytes to conversion to an ileal loop.

Adolescent↗