Biomedical subjects
Publications and source records attributed to R J Correa.
It is not uncommon for urologists to be involved in the care of patients with either adult polycystic kidney disease or horseshoe kidney. Personal clinical experience indicates that it is most unusual to have these 2 congenital disorders simultaneously in the same patient. The first known report of such a situation describing removal of a kidney so involved in preparation of renal transplantation is presented.
Many renal lesions that were once treated by nephrectomy now lend themselves to surgical correction. The value of in situ hypothermia and ischemia produced by occlusion of the renal artery is detailed. This technique has proved to be a simple, safe and effective surgical approach to the management of most difficult renal lesions.
A new indwelling ureteral stent to provide long-term ureteral drainage is described. This radiopaque stent is manufactured of non-reactive, non-collapsible tubing and is designed to resist downward expulsion and upward migration. Internal stent diversion offers advantages in managing patients whose ureters are obstructed by malignancy. 1) Endoscopic placement of the ureteral stent is associated with less morbidity and mortality than supravesical diversion. 2) Unilateral obstruction can be corrected at the time of diagnosis, thus ensuring that later supravesical diversion will not be necessary. 3) If time proves that the urinary diversion is no longer desirable in terms of quality of life, the stent can be removed.
Radiation therapy will result in tumor disappearance in a select number of patients. However, it does not prevent local recurrence and, therefore, the patient continues at risk. Tumor recurrence was noted in more than half the patients in our series and more than 50 per cent of these patients experienced multiple recurrences. A functional bladder was maintained in nearly 60 per cent of the patients. Survival in 11 patients in category 1 with radiation therapy and subsequent non-ablative extirpative surgical procedures in 8 patients was equivalent to series treated by preoperative irradiation and cystectomy. In contrast the 14 patients in category 2 had a survival rate that was appreciably lower than that obtained with preoperative irradiation followed by cystectomy. There was a significantly increased morbidity associated with an open operation in the treatment of recurrence in the irradiated patient. We would advocate preoperative irradiation followed by cystectomy in the patients with high grade and high stage disease. The value of single versus adjuvant forms of therapy for patients with diffuse, rapidly recurring low grade and low stage disease would be determined best by a randomized prospective study. Evidence from this series suggests that irradiation improved over-all survival in this category.
A new method of percutaneous nephrostomy using techniques to place a No. 12 French balloon catheter in the renal collecting system is described. Case reports demonstrate tumor palliation and temporary drainage to improve the very ill prior to definitive surgery. A translumbar aortogram catheter is placed lateral to paraspinous muscles and Dotter vascular dilators are used to allow insertion of the large balloon catheter.
A study was made of 35 patients with tumors of the renal pelvis. Tumors were indipendently graded and staged by a newly proposed method. The method of staging correlated well with grading of renal pelvic tumors and bore a direct relationship with prognosis. The high incidence of associated urothelial tumors, especially on the involved side, mandated radical nephroureterectomy including a bladder cuff as the treatment of choice.
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