Faculty Bibliography

We report the case of a 77-year-old white woman who presented with a left breast mass, lethargy, and weight loss. Pelvic computed tomographic scan revealed a 9.5-cm mass in the right kidney. Surgical pathology demonstrated a diffuse large B-cell lymphoma of the subcutaneous tissue of the breast and renal cell carcinoma with concurrent extensive intravascular lymphomatosis. Systemic dissemination of malignant lymphoma to a concurrent visceral primary neoplasm is rare. To the best of our knowledge, this is the first case illustrating a renal cell carcinoma collision with intravascular lymphomatosis

Three patients presenting with infertility were found to have low volume azoospermia. All 3 were taking sympatholytic medications; 2 were taking antipsychotics and 1 was taking an alpha-blocker. Low volume azoospermia may result from the use of sympatholytic medications, which cause aperistalsis of the adrenergically innervated vas deferens and seminal vesicles. Two patients had normal spermatogenesis on biopsy and were unobstructed on vasography. In 1 patient, biopsy and vasography were avoided. Pseudoephedrine, a sympathomimetic agent, was given to all 3 patients, resulting in marked improvement in semen analysis parameters. A trial of pseudoephedrine can obviate the need for biopsy and vasography in such patients.

PURPOSE: We evaluated outcomes in 20 patients 1 to 21 years old who underwent vaginal construction between 1980 and 1996. MATERIALS AND METHODS: A total of 21 vaginal constructions was performed in 20 children using ileum in 13, sigmoid colon in 6, bladder mucosa from a diverticulum in 1 and scrotal skin in 1. The diagnoses included the Mayer-Rokitansky syndrome in 6 cases, micropenis in 5, cloacal exstrophy in 3, penile agenesis in 3, and testicular feminization, classic bladder exstrophy and true hermaphroditism in 1 each. RESULTS: Patients treated with intestinal vaginoplasty had excellent cosmetic results without excessive mucous production or the need for routine dilation. The bladder mucosa vagina achieved good results with periodic dilation. Loss of depth developed in the scrotal skin vagina and it was converted to an ileal vagina. Stenosis at the mucocutaneous junction in 1 patient with a sigmoid and 1 with an ileal vagina was treated with Y-V plasty. CONCLUSIONS: Vaginal construction may be performed using isolated bowel segments with excellent results and minimal morbidity. We have found ileum to be the segment of choice in younger patients, while sigmoid colon is preferred for vaginal construction in adolescents. Vaginal construction with isolated bowel segments provides a cosmetic, self-lubricating neovagina with low rates of failure and revision, and without the need for routine dilation.

PURPOSE/OBJECTIVE:We evaluated patients who received multiple UroLume Wallstents during the North American UroLume trial for the treatment of recurrent bulbar urethral strictures. MATERIALS AND METHODS/METHODS:A total of 41 patients received multiple UroLume stents. The clinical histories and therapeutic outcomes of these patients were reviewed. RESULTS:Of the patients 23% required placement of multiple urethral stents. Stents placed at the initial procedure were required for strictures longer than 2.5 cm. and for multiple, separate strictures. Indications for secondary insertion included recurrent stricture adjacent to the stent, hyperplastic tissue growth within the stent and gaps between previously adjacent stents. The repeat treatment rate was 43.9% versus 14.3% for the study group overall. Urine flow rates and symptom scores in the multiple stent group showed improvement similar to that of the study group overall. CONCLUSIONS:Patients who required multiple stents had greater rates of repeat treatment but similarly improved urine flows and symptom scores, which were maintained at 2 years.

PURPOSE: We report long-term results in 11 patients born with bladder exstrophy who underwent lower urinary tract reconstruction using a ceco-appendiceal unit. MATERIALS AND METHODS: Four boys and 2 girls underwent lower urinary tract reconstruction using an unaltered ceco-appendiceal unit. In 2 boys and 1 girl the bladder was replaced with a reservoir of terminal ileum, cecum and ascending colon, and the appendix was used as an orthotopic neourethra. In another 2 boys and 1 girl the bladder was augmented, while the appendix was used to create a stoma to the umbilicus. In 5 patients in whom the ceco-appendiceal junction was incompetent the cecum was plicated over the base of the appendix to reinforce the sphincteric mechanism. Four patients underwent augmentation with the appendix brought out as an umbilical stoma, and in 1 the bladder was replaced and the appendix was used as a neourethra. RESULTS: Six patients in whom the ceco-appendiceal junction was unaltered and 5 in whom it was plicated remain continent 5 to 11 and 2 to 7 years postoperatively, respectively. In the initial patient urinary incontinence developed due to high intraluminal pressure, which resolved after detubularization of the urinary reservoir. Another patient underwent revision of the abdominal stoma. CONCLUSIONS: The ceco-appendiceal unit may be used for continent lower urinary tract reconstruction. Ceco-appendiceal junction competence can be tested intraoperatively and the sphincteric mechanism may be reinforced as necessary. The appendix may be ectopically or orthotopically placed and used for intermittent catheterization.