The first case of xanthogranulomatous pyelonephritis associated with renal carcinoma is reported. Differentiation of the 2 entities clinically may be difficult and, since treatment regimens recommended in the past have included partial nephrectomy in cases of limited xanthogranulomatous pyelonephritis, one must hereafter be aware of such a combination when considering such a therapeutic modality.
We present 2 cases of carcinosarcoma of the bladder. These tumors are considered as true admixtures of epithelial and mesenchymal neoplastic cells rather than 2 separate neoplasms that touch or marginally invade each other. Although the etiology of this tumor is unclear it tends to be aggressive and probably requires an early radical operation with adjuvant radiotherapy and chemotherapy.
We herein review 45 patients with carcinoma of the bladder treated by segmental resection from 1955 to 1976. Survival rates were similar to those reported in other series and compared favorably to those found with total cystectomy. Patients with high grade (III and IV) stage A tumors experienced a 100% recurrence rate and only 40% survived more than 5 years, whereas patients with low grade (I and II) stage A tumors had a 28% recurrence rate and 86% lived 5 years or more. Therefore, it is postulated that patients with high grade lesions, even though stage A, undergo more aggressive therapy. It also was found that extensive segmental resection, even though necessitating ureteroneocystostomy, resulted in a favorable 5-year survival rate.
Spermatocytic seminoma is noted generally for its relative infrequency of regional or distant metastases. A case of metastatic spermatocytic seminoma is reported in which there was radiographic evidence of tumor recurrence within an irradiated area. The need for aggressive initial management and careful followup of patients with this entity is emphasized.
Current treatment of prostate cancer is highly controversial, however accurate assessment of pelvic lymph node status is important to determine early in the course of therapy if adjuvant hormonal ablation is necessary. Indications for laparoscopic assessment of pelvic lymph nodes are now better defined and the technique requires a high degree of technical skill and expertise. A series of 50 patients who underwent laparoscopic pelvic lymphadenectomy is presented. A greater than 40% chance of node positivity was found in a group of patients who had either a clinical stage B2, C, DO, or a prostate-specific antigen level greater than 40 ng/dl, or a total Gleason score of 7, 8, 9, or 10. Laparoscopic pelvic lymphadenectomy remains the current method to accurately stage lymph node involvement in prostate carcinoma.
Since endourologic procedures were first introduced at the Atlanta Stone Center in 1982, electrohydraulic lithotripsy (EHL) has been utilized to fracture 62 ureteral calculi via antegrade (percutaneous) or retrograde (ureteroscopic) techniques. Using a 5F or a 3F probe, success was achieved in 60 cases (97%). Intravenous urlograms were performed in 60 patients after treatment, and only one revealed mild hydronephrosis. Six perforations of the ureter and two ureteral stone extrusions were managed conservatively with good results. Recently, having incorporated the pulsed dye laser as an alternative modality to manage ureteral calculi, 22 patients with ureteral stones have been treated at the Center via either an antegrade or a retrograde approach. Twenty stones (91%) were considered successfully fractured. Intravenous urlograms were performed in only two patients, and both were normal. There were no perforations directly attributed to the laser probe. The two failures were calcium oxalate monohydrate stones. In summary, both modalities proved safe and efficacious. There is a significant cost difference favoring EHL; however, at this time, the laser probe offers the advantages of more flexibility and a smaller diameter.
Ureteral diverticulosis is a rare condition found mostly in men more than 50 years old and generally requires retrograde pyelography for diagnosis. Urinary obstruction and infection are often associated. No significant morbidity occurs but the analogy of hematuria from ureteral diverticulosis to bleeding from colonic diverticulosis is present.
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