Although primary prostatic carcinoma is very common, prostatic metastasis is unusual. We describe a unique example of prostatic metastasis from noncontiguous colon cancer, after presumed curative resection of the primary tumor. Potential mechanisms of metastasis are examined in the context of clinical and histopathologic evidence. A possible role is proposed for early transrectal ultrasound examination in diagnosis of patients with unexplained urologic symptoms after resection of colorectal cancer.

Adenocarcinoma↗

PubMed1993

Cancer trends unique to Georgia.

Using information from 1980 through 1991 Cancer Statistics, published by the American Cancer Society, we assigned a rank order of new cancer cases for Georgia and eight other states. Female breast, colon and rectum, lung, oral, uterus, prostate, pancreas, and leukemia are the site-specific cancers that were considered. There was an increasing trend in Georgia for colon and rectal cancer and breast cancer during this study period. This increased trend for colorectal and breast cancer in Georgia was not apparent in the other index states. Possible influences of population, physician practices, and socioeconomic factors are considered. The results of this project indicate that further study is needed to evaluate this trend, possibly by examination of regional differences within the state of Georgia, especially with regard to environmental factors.

Breast Neoplasms↗

PubMed1992

Sutureless laparoscopic rectopexy for procidentia. Technique and implications.

Procedures for treating rectal prolapse may constitute some of the best applications for colorectal laparoscopic techniques. Although the condition is benign, rectal prolapse is often debilitating and frequently progressive in terms of functional limitations. Moreover, many patients are elderly, medically unfit, or both. A technique that afforded relief of prolapse and of incontinence by laparoscopic rectal sacropexy, performed without sutures, using a newly designed laparoscopic sacral tacker and laparoscopic staples, is described. Indications, contraindications, technical details, and surgical implications are discussed. Laparoscopic pelvic suspension procedures are presented as realistic and appropriate objectives for colon and rectal surgeons.

Colorectal Surgery↗

PubMed1991

Sleeve advancement anorectoplasty for complicated anorectal/vaginal fistula.

Transanal flap-advancement procedures for complicated anorectal or rectovaginal fistula may include vertically incised flaps, horizontal flaps, and tubal flaps. Anatomic and pathologic considerations affecting choice of the three major techniques are examined in the context of their historical development over the last century. Application of the tubal (or sleeve) advancement principle is described in a woman whose combined rectovaginal and cryptogenic fistulas encompassed more than one-third of her anal circumference, necessitating surgical modifications beyond those afforded by previously documented techniques. Obliteration of disease and preservation of sphincteric competence were the achieved objectives of the procedure. Rationale for the procedure and technical details of the sleeve advancement anorectoplasty are described, mindful of the surgical antecedents of this therapeutic option.

Adult↗

PubMed1990

Delorme's transrectal excision for internal rectal prolapse. Patient selection, technique, and three-year follow-up.

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term "placebo" effect attends many therapies, this report describes results of transrectal excision only after a three-year postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.

Adult↗

PubMed1990

Streamlining the management of defecation disorders.

Obstinate constipation is a frequent but elusive gastrointestinal symptom. Increased understanding of defecation physiology and recent availability of simple, ready-to-use tools have increased specificity of both diagnosis and treatment. This patient series includes over 700 severely constipated patients with over 70 percent overall therapeutic success. Cinedefecography, pelvic floor electromyography, and determination of rectoanal inhibitory reflex were performed with simple and readily available equipment to document outlet anatomy and dynamics. Colonic transit time was examined in patients whose defecography and electromyography results were nondiagnostic and/or whose response to medical management was suboptimal, using a commercially available marker capsule, followed by abdominal x-rays. Retention of markers throughout the colon suggested colonic hypomotility or "inertia"; rectosigmoid retention confirmed functional outlet obstruction. With careful history, physical examination, and exclusion of organic causes, orderly application of readily available techniques can afford rapid, objective, and anatomically specific evidence upon which treatment of disordered defecation may be based.

Cineradiography↗

PubMed1990

Markers, motility, and mental illness.

Explore the source record for details and available documents.

Constipation↗

PubMed1989

Understanding the dysfunctional bowel. An expanding role for the colon and rectal surgeon.

Explore the source record for details and available documents.

Colonic Diseases, Functional↗

PubMed1987

Rectal reservoir reduction procedures for internal rectal prolapse.

Forty-four patients presenting with painful outlet constipation had internal rectal intussusception documented by cinedefecography. Rectal reservoir reduction by multiple elastic ligation or staple excision of redundant mucosa effectively improved bowel function and outlet symptoms in the majority of patients. Rectal reduction procedures were performed under intravenous sedation with antibiotic coverage, no postoperative sepsis, and a single case of significant postoperative bleeding. Associated abnormalities on defecography were unaffected.

Adult↗

PubMed1985

Anatomic specificity in the diagnosis and treatment of internal rectal prolapse.

Distal bowel evacuation was studied by cinedefecography in 85 women with obstinate constipation, tenesmus, and incomplete evacuation in whom a diagnosis of internal rectal intussusception was clinically suspect. Sixty-five patients showed radiographic evidence of intussusception--mostly of the distal rectum, without rectosacral separation. Patients with distal intussusception who did not respond to nonoperative measures were treated by Delorme's transrectal excision with excellent results. Internal rectal intussusception is a real and demonstrable entity which may be symptomatically disabling and whose documentation may be integral to effective and anatomically specific treatment. The syndromes of perineal descent, solitary rectal ulcer, levator syndrome and so-called recurrent hemorrhoids may be diagnostic intermediaries in the evolution of internal rectal intussusception.

Adult↗