[Surgical treatment of recurrent urethral neoplasms after cystectomy for bladder carcinoma].
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The multicentric potential of urothelial malignancy is well recognized, and the occurrence of urethral neoplasm after cystectomy is attributed to this characteristic of urothelial tumors. Eight instances of tumors in the glandular urethral remnant after subtotal urethrectomy illustrate the necessity of excising the fossa navicularis and urethral meatus when performing urethrectomy.
Transitional cell carcinoma of the urethra in men after radical cystectomy for bladder carcinoma have an incidence which varies from 4 to 18%. The Authors present their experience of 6 cases (6/196; 3.06%) analysing the characteristics of the urethral neoplasm and confirming the systematic cystourethrectomy when there is a urethra prostatic and bladder neck infiltration or when there is a urethral ca in situ. It also underlines the role of the clinical, radiological, cytological and urethro-endoscopical follow-up in patients who have undergone a cystoprostatovesciculectomy.
A nippled ureteroileal anastomosis was performed in 37 patients. Follow-up examination showed reflux to be absent in most patients. Ureteroileal stenosis developed in 1 patient, and this was the only patient in the series who had a clinical attack of pyelonephritis.
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Endoscopy in the detection of urinary tract cancer is one of the primary tools of the urologist. It is used in the localization of bleeding sites, the systematic follow-up in detecting recurrent malignancies, the pathologic staging of carcinoma of the bladder through transurethral biopsy, and the identification and biopsy of primary transitional cell carcinoma of the prostate. It is also a prime tool in the diagnosis of ureteral and pelvic tumors through retrograde pyelography, brush biopsy, and urine collection for cytology. Nephroscopy is now also possible for the obscure lesions difficult to diagnose otherwise. Urethroscopy is also important in detecting malignant changes. The various sites for urologic cancer, their incidence, and the role of endoscopy in relation to other means of diagnosis and management are discussed.
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Total eradication of intraurethral condyloma acuminatum was accomplished in 10 of 11 patients by intraurethral administration of 5 percent 5 fluorouracil cream.
Sarcoidosis of the urethra was found during endometrial curettage in a thirty-nine-year-old woman with a history of menometrorrhagia and decreased urine stream. Sarcoidosis is known to occur in many parts of the body, but an extensive search of the literature has failed to reveal any previous report of urethral involvement.
Leiomyomas may originate from any anatomic location of smooth muscle in the genitourinary system but are uncommon neoplasms. Five unusual cases of leiomyomas arising from the renal pelvis, bladder, spermatic cord, and glans penis are presented. The leiomyoma arising from the glans penis in a three-year-old boy is the first case of a leiomyoma in that location noted in the literature. A review of leiomyomas from each genitourinary structure of origin is presented.
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Solitary fibrous polyps are in uncommon but important cause of obstructive uropathy, infection and hematuria in boys. The clinical presentation and management in 5 boys are discussed and the literature is reviewed. Emphasis is placed on the pitfalls in diagnosis and recent endoscopic techniques of treatment.
Most investigators agree that a urethral stricture is a predisposing cause of primary carcinoma of the urethra. The etiology of the carcinoma is probably chronic irritation. The role of squamous metaplasia in the etiology is discussed briefly. A case of primary squamous cell carcinoma of the urethra occurring 4 years after a first stage urethroplasty is reported and 2 cases from the literature are described. The suggested origins of urethral malignancy after urethroplasty are 1) unrecognized malignancy at operation, 2) premalignant mucosal changes that progress postoperatively, 3) recurrence of stricture with continued irritation leading to malignant metaplasia and 4) malignant change in the urethroplasty skin flaps. Although rare, primary male urethral carcinoma is a deadly disease. The hope for early diagnosis is a high index of suspicion during urethroplasty and in subsequent followup studies. The patient presented herein also exhibited pseudohyperparathyroidism as a result of the malignancy.
We herein report a case of primary malignant melanoma of the female urethra, summarize the histopathology, review the available literature and discuss the treatment. Although a definitive regimen for the treatment of this virulent malignancy has not been established a 10-year-survival has been obtained by surgical extirpation preceded by preoperative radiotherapy.