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Objectives. We undertook this study to establish criteria for adrenalectomy in patients with renal cell carcinoma.Methods. We retrospectively reviewed the records of 162 patients undergoing radical nephrectomy from 1979 to 1993 at University Hospitals of Cleveland. Simultaneous ipsilateral adrenalectomy was performed in 57 patients (35%).Results. Three of these 57 patients (5.3%) had ipsilateral...
Objectives. to reassess positive rate of sextant biopsy according to gland size.Methods. We evaluated 1974 consecutive men with systematic sextant biopsy, among whom we examined biopsy yield according to gland-volume intervals to 10 cc.Results. Decreasing yield of sextant biopsy is strongly associated with increasing gland volume (P <0.001). Highest biopsy rate (39.6%) was recorded among men...
Congenital cysts of the seminal vesicles with ipsilateral renal aplasia or dysplasia are rare but have been well described in the literature. We report the first case where anal tenesmus was the only presenting symptom. Another unique feature was the combination of this anomaly with a duplication of the inferior vena cava.
Extra-adrenal myelolipomas are rare, benign tumors composed of hematopoietic and adipose elements. Although these tumors can cause local symptoms or hemorrhage, they are generally asymptomatic. However, when discovered intraoperatively, they pose a diagnostic dilemma to the urologic surgeon. We present a case of perirenal extra-adrenal myelolipoma discovered intraoperatively in a patient with von...
Objectives. Women undergoing four-corner bladder neck suspension were evaluated for subjective and objective results of the procedure. Patients were evaluated for continence, prolapse, and symptomatic status postoperatively.Methods. Forty-seven women underwent four-corner bladder neck suspension for moderate cystocele with (44) or without (3) stress urinary incontinence. Mean and median follow-up...
Objectives. There are a variety of open surgical and endoscopic approaches to the treatment of traumatic urethral injuries. The objective of our study was to evaluate the efficacy of early fluoroscopic realignment of the urethra following traumatic injury.Methods. Seven patients with urethral rupture injuries (two anterior and five posterior urethral injuries) were treated. Follow-up ranged from...
Objectives. Renal cell carcinoma extends into the inferior vena cava (IVC) in 4% to 10% of patients. The purpose of this study was to evaluate the diagnostic accuracy of preoperative transesophageal echocardiography (TEE) in determining the presence and level of IVC involvement in such cases.Methods. From June 1992 to December 1995, 13 patients with suspected IVC tumor thrombi were studied with...
An elderly man presented with urinary outflow obstruction and a smooth mass arising from the bulbar urethra. Biopsy revealed large cell lymphoma, B cell subtype. A literature review revealed no previous cases of undisseminated lymphoma arising within the male urethra. The obstructing mass and symptoms resolved with multiagent chemotherapy.
Objectives. To evaluate the cost-effectiveness of assisted reproduction using in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) as a primary treatment for varicocele-associated infertility.Methods. Analysis of cost per delivery using published and contemporary results for treatment with ICSI in the United States for male factor infertility was compared with cost per delivery...
Gardner's syndrome (GS) is complicated by abdominal desmoid tumors in approximately 8% of cases. We describe two cases of ureteral obstruction and fistulization due to rapidly enlarging desmoid tumors. Initial management consisted of placement of ureteral stents to provide urine drainage from the kidney as well as from the collection in the cavities within the desmoid tumors.
Objectives. The effect of intranasal gonadotropin-releasing hormone (GnRH) and intramuscular human chorionic gonadotropin (hCG) in the treatment of cryptorchidism was investigated in 48 prepubertal boys.Methods. Forty-eight prepubertal boys with 70 undescended testes were enrolled into a prospective study between November 1989 and November 1991. GnRH was applied as nasal spray at a dose of 1.2 mg/day...
Personal computers may be used to create, store, and deliver graphical presentations. With computer-generated combinations of the five media (text, images, sound, video, and animation)--that is, multimedia presentations--the effectiveness of message delivery can be greatly increased. The basic tools are (1) a personal computer; (2) presentation software; and (3) a projector to enlarge the monitor...
Objectives. Tumor biomarkers to detect prostate cancer earlier may reduce prostate cancer deaths. Transforming growth factor-beta1 and -beta2 (TGF-beta1 and -beta2) become overexpressed in prostate cancer and might be useful tumor markers of prostate cancer.Methods. Plasma and urinary TGF-beta1 and plasma TGF-beta2 levels were studied preoperatively in 74 consecutive patients who had prostate cancer...
Horseshoe kidney and retrocaval ureter are two uncommon congenital anomalies of the genitourinary system that have rarely been reported to occur in the same patient. In each case previously reported, the isthmus of the horseshoe was positioned posterior to the inferior vena cava and anterior to the aorta. In no case was the diagnosis of both anomalies made preoperatively. We report a case of simultaneous...
Objectives. The increasing interest in exploring the use of intermittent androgen deprivation in prostate cancer has prompted a retrospective review of patients who elected to stop treatment.Methods. Case records were reviewed.Results. Twenty patients after 3 to 48 months (median 12) of endocrine therapy elected to stop therapy. Thirteen subsequently relapsed after a median observation of 9 months...
Objectives. Hitherto, patients with testicular dysfunction and azoospermia had to resort to adoption, donor sperm insemination, or child-free living. The realization that a proportion of such men harbor spermatozoa in their testicular parenchyma, combined with the ability of intracytoplasmic sperm injection (ICSI) to effect pregnancy with single sperm, has prompted male infertility clinicians to explore...
Objectives. To evaluate changes in the smooth muscle and connective tissue development in the obstructed and normal fetal bladder.Methods. The smooth muscle and connective tissue composition of 19 fetal urinary bladders, including those of 9 fetuses with anatomic obstruction and 10 controls free of urologic disease, were analyzed by light microscopy and computer-assisted color image analysis.Results...
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