Biomedical subjects
Publications and source records attributed to J R Beahrs.
Opening the bladder allows for excellent exposure and more accurate placement of sutures for correction of stress urinary incontinence. The results of our first 100 cases with a minimum 3-year followup are presented. Because of the high success rate with minimal morbidity or complications we recommend this procedure as the operation of choice for surgical correction of stress urinary incontinence.
We studied 425 patients who had undergone radical cystectomy for transitional cell cancer of the bladder and were followed for 5 years or more, or until death. Upper urinary tract urothelial cancer developed in 14 patients (3.3 per cent), 3 of whom had bilateral disease: 2 synchronous and 1 asynchronous. The interval between cystectomy and emergence of the upper tract tumor ranged from 8 to 100 months (mean 40 months). There was a declining incidence of upper tract cancer relative to cystectomy P stage for carcinoma in situ (9.1 per cent), papillary stages O and A (3.6 per cent), stages B1, C and D1 (2.6 per cent) and no residual cancer (0 per cent). Of the 14 patients 8 (57 per cent) had features of multifocal carcinoma in situ in the cystectomy specimens. In 4 of the 14 patients (29 per cent) ipsilateral disease developed when the distal ureteral margins were involved with cancer at cystectomy. Only 3 of the 14 patients (21.4 per cent), all with stage I disease, were alive at the time of this report.
Radical cystectomy and urinary diversion were performed on 349 patients with transitional cell cancer of the bladder. Followup for 4 to 13 years revealed that 91 and 83 per cent of the patients were free of urethral recurrence 5 and 10 years after cystectomy, respectively. Statistical elimination of urethral recurrences did not improve the over-all survival rate significantly. It appears that supplementation of cystectomy with simultaneous urethrectomy may not be justified if the urethra is not involved by the cancer.
An unexplained abdominal mass discovered on CT examinations of a postsplenectomy patient may represent a hypertrophied residual accessory spleen. Six such patients were found to have left upper quadrant masses on CT examinations that were subsequently proved to be enlarged accessory spleens. The CT appearance is that of discrete, solitary, rounded masses of uniform soft-tissue density in the left upper quadrant. Diameters of the masses were 3.5-5.0 cm. The splenic nature of such a mass can be confirmed by appropriate radionuclide imaging.
The possibility of urinary tract injury should always be considered in the course of anterior resection or combined abdominoperineal resection of the lower colon and rectum. Controlled studies of ureteral and other injuries and fistulas cannot be made; but fortunately, unanticipated damage to the lower urinary tract does not occur often. The surgeon operating in the pelvis should be aware of the problems rarely encountered and should be capable of their management. If a urologic surgeon is available, consultation often is desirable. Prompt intraoperative recognition is most important so remedial procedures can be carried out immediately. Delay in recognition and treatment jeopardizes the patient's course and the function of the urinary tract. Postoperative urinary tract infections should be diagnosed early so prompt treatment can be instituted.