Epididymal abnormalities in undescended testes are probably more common than suggested in the literature but only sporadic reports are found on this subject. For many years discussions have centered around the ideal age to operate on patients with undescended testes and consequently increase chances for future fertility. We analyzed 66 patients (82 testes) treated for undescended testis in our department, with special distinction between ectopia and cryptorchidism. Abnormalities ranged from simple epididymal elongation to more complex forms, such as complete disruption between the testis and epididymis. Among 49 ectopic testes the epididymides of 19 (38.8%) displayed more severe abnormalities in addition to elongation, while 16 (32.6%) showed only an elongated epididymis and 14 (28.6%) were normal. Among the 33 cryptorchid testes 29 (87.9%) showed the more complex anomalies and elongation, 3 (9.1%) were normal and only 1 (3%) was elongated. Our results demonstrate a much higher incidence of complex epididymal abnormalities in cryptorchidism (p less than 0.001). Elongated epididymis may present problems for sperm maturation and transportation, although with no other associated abnormality most can be regarded as patent. In our theory cases of elongation plus other major abnormalities probably are associated with severe impairment in sperm maturation and hindered transportation, with the future intrascrotal or extrascrotal position of the testis or early surgical repair being of little importance in terms of fertility.
We reviewed the surgical specimen from 142 men undergoing radical prostatectomy for prostate cancer detected because of an elevation in serum prostate specific antigen alone. No patient had a palpable abnormality suggestive of cancer. One patient had no identifiable tumor in the radical prostatectomy specimen, 8 (6%) had only a few high power microscopic fields showing cancer, 40 (28%) had an estimated tumor volume of less than 1 cc and 93 (65%) had a tumor volume of greater than 1 cc. Surgical margins were positive in 37 patients (26%) and negative in 105 (73%). Most patients with cancer detected because of modest elevation in prostate specific antigen, even without palpable abnormalities, have a clinically significant tumor volume and are good candidates for radical prostatectomy.
Variceal bleeding from an ileal conduit stoma is an uncommon complication of portal venous hypertension. We report on a 59-year-old man who experienced frequent and severe bleeding episodes from the parastomal skin and mucosa of an ileal conduit requiring multiple blood transfusions. A mesenteric angiogram showed portal hypertension and large varices around the ileal conduit. Resolution of the dilated cutaneous veins occurred after a portosystemic shunt and he has had no further bleeding episodes. Recognition of this unusual complication of ileostomy formation is important for urological surgeons who may encounter patients with liver disease requiring urinary diversion.
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