[Use of lasers in endoscopic surgery in the practice of urology].
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Cystectomy remains one of the standard treatments for women with locally advanced (stage C) urethral cancer, or stage A or B lesions that have failed radiation therapy. Often, the urethral neoplasm does not invade the bladder. We treated 5 women with stage C urethral cancer by wide local excision with or without concomitant radiation therapy, while preserving the bladder. Local control was achieved in all patients with followup ranging from 4 to 75 months (median 42). We believe that bladder sparing treatment strategies should be considered for selected stage C tumors when the bladder is not invaded by the neoplasm.
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.
Approximately 15-25% of malignant non-Hodgkin's lymphomas (NHLs) are primarily extranodal and only 2.7% of these are located in the genitourinary tract. Only a few particular cases of primary manifestation of NHL in the urethra have been described, most of them in female patients, whereas a secondary involvement occurs more frequently. In the present case a high-grade malignant NHL of the B-cell type was located in the urethra of a 29-year-old male patient. No other manifestations of NHL could be found. After surgical removal of the urethral neoplasm the patient was treated with combined chemotherapy (6 cycles of the CHOP scheme). Thereafter, reconstruction of the urethra by the island flap method of Duckett was carried out. Two years after diagnosis the patient is alive and in complete remission with good functional and cosmetic results of surgery and a normal sexual life.
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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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The authors report their early experience with ND-YAG laser in 55 patients treated for superficial bladder or urethral tumors and for urethral stenosis. The advantage of the technique (local anesthesia, shorter hospitalization) and the disadvantages (cost, duration, unsatisfactory results in urethral stenoses) are discussed.
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Nine cases of urinary incontinence in dogs were evaluated by various diagnostic methods, including the urethral pressure profile (UPP). The UPP was derived from a need to study th dynamics of the urethra in patients with urinary tract obstruction or incompetence of the urethral sphincteric mechanism and was obtained in dogs with similar problems. The method involved slowly withdrawing a fluid-filled catheter through the urethra while a chart recorder graphed the pressure changes within the urethral lumen. The graphs obtained from clinical cases were compared with normal values established for the UPP in dogs. The UPP proved to be a simple and reliable means by which to determine intraurethral events and aided in establishing the cause of urinary incontinence in several dogs. The profile provided a graphic description of intraurethral resistance in each case and was valuable in localizing areas of increased urethral resistance or obstructions and decreased urethral resistance or incompetence. Frequently, specific therapy for the urinary incontinence was instituted on the basis of the UPP.
Permanent cystostomy catheters were placed in 7 dogs to relieve urine outflow obstruction from presumed transitional cell carcinoma of the bladder trigone and urethra. The catheters were easily managed at home by the owners. Complications were minimal. The most frequent complication was urinary tract infection. Two owners complained of difficulty in draining the bladder 1 week before euthanasia of their dogs. The primary reason for euthanasia of all dogs was progression of the tumor. Survival times of these dogs were similar to those previously reported for dogs with transitional cell carcinoma involving the bladder and urethra, irrespective of treatment. Placement of a permanent cystostomy catheter should be considered in dogs with transitional cell carcinoma associated with urine outflow obstruction when, owing to the dog's condition or the owner's preference, radical surgery or other treatment is not an option.
A urethral filling defect in the proximal portion of the pelvic urethra, suggestive of a mass, was detected by positive-contrast retrograde urethrography in 2 dogs with prostatic disease and Sertoli cell neoplasms. Extension of prostatic neoplasia into the urethra or primary urethral neoplasia were considered as explanations for the radiographic finding of an intraluminal filling defect in the pelvic urethra. Masses were visualized and biopsied during prostatic surgery. Masses were nonneoplastic and represented enlargement of the colliculus seminalis.
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