The clinical course of 4 female patients with complete traumatic rupture of the urethra was evaluated in an effort to propose guide lines for the investigation and initial management of this unusual injury. Treatment modalities are determined by the level of urethral injury and the subsequent effect on continence. We recommend a retropubic approach for bladder neck injuries, a transvaginal approach for proximal urethral ruptures with reanastomosis over a stenting catheter and acceptance of a hypospadiac neomeatus for distal urethral ruptures.
The clinical course of 34 patients with non-urachal adenocarcinoma of the bladder was reviewed and compared to the world experience. The 5-year survivorship was 19 per cent, with only 1 patient being free of disease. Metaplasia with formation of glandular elements reflects the unstable potential of the transitional cell and may be associated with the biologic aggressiveness of the tumor.
A retrospective analysis of patients with surgical stage I nonseminomatous germ cell tumors of the testis was done in an attempt to define the pathogenesis of treatment failure. Of 138 patients 126 (91 per cent) remain free of disease, with a median followup of 5 or more years, and 12 (9 per cent) suffered relapse an average of 9 months after orchiectomy and retroperitoneal lymph node dissection. The majority of recurrences were in the lungs. Of 12 patients who had recurrence 6 were salvaged and are alive without evidence of disease 3 or more years after the second complete remission. A history of scrotal surgery or scrotal violation, the extent of the primary tumor and the presence of sarcomatous elements in the primary were not statistically significant risk factors in this study. A higher recurrence rate with embryonal carcinoma than with teratocarcinoma was not statistically significant.
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