0022-53471951153 1-000 1$03.00/0 THE JOURNAL OF UROLOGY Copyright 0 1995 by AMERICAN UROLOCICAL ASSNIATION, INC.

Vol. 153, 1, January 1995 Printed in U.S.A.

This Month in Urology

CONSERVATIVE APPROACH TO BILATERAL TESTICULAR TUMORS Six patients with bilateral testes tumors (3 simultaneous and 3 sequential) underwent organ sparing surgery.

The tumors were 6 to 30 mm. in diameter and none involved the rete testis. Associated carcinoma in situ was treated by radiation. Mean followup of 43 months, as reported by Heidenreich et a1 (page 10) from Germany, revealed no recurrences.

RETROPERITONEAL LYMPHADENEXTOMY IN CLINICAL STAGE B TESTIS CANCER Donohue et a1 (page 85) from Indiana report on a large experience with retroperitoneal lymphadenectomy for

clinical stage B testis cancer. Of the patients 23% had pathological stage A disease and 65% with stage B cancer were cured by retroperitoneal lymph node dissection alone. This cure rate is equivalent to that achieved by primary chemotherapy alone. In the post-cisplatin era (1979 to 1989) none of 59 pathological stage B cancer patients receiving adjuvant chemotherapy had relapse. Of the 49 patients with pathological stage B disease who did not undergo adjuvant chemotherapy 37% had relapse and 2 died.

COMPARISON OF LASER VERSUS TRAN- RESECTION OF THE PROSTATE In a prospective study Kabalin et al (page 94) from Stanford compared 13 patients undergoing laser prosta-

tectomy to 12 undergoing electrocautery resection. Symptom scores, residual urine volumes and peak urine flow rates were equivalent through 18 months.

RECURRENT STONE FORMATION FOLLOWING EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

Medical management in stone-free patients caused a decrease in stone formation from 0.67 to 0.00 calculi per patient per year, compared to a decrease of 2.47 to 0.00 calculi per patient per year in the group with residual fragments as reported by Fine et a1 (page 27) from Dallas. Medical management, decreased stone formation and presence of residual fragments placed patients a t higher risk for recurrent stone formation or growth.

URINARY RISK FACTORS FOR UROLITHIASIS IN URINARY INTESTINAL DIVERSION

Terai et a1 (page 37) from Kyoto, Japan found that a continent urinary reservoir causes a long-term increase in urinary calcium, phosphate and magnesium. The degree of metabolic alterations is greater with a continent reservoir than with an ileal conduit.

I " G URETERAL STENTS AS THERAPY FOR DISTAL URETERAL CALCULI A total of 17 patients with distal ureteral calculi less than 1 cm. large received an indwelling ureteral stent.

Leventhal et al (page 34) from Honolulu found that 83% of the patients passed the calculi spontaneously after stent removal.

BACILLUS CALMETTE-GUERIN TREATMENT OF SUPERFICIAL TRANSITIONAL CELL CARCINOMA AND CARCINOMA IN SITU OF PROSTATIC URETHRA

Of 17 patients with superficial transitional cell carcinoma and carcinoma in situ 12 (70%) responded to bacillus Calmette-Guerin therapy as reported by Schellhammer et al (page 53) from Norfolk.

OUTCOME OF SALVAGE RADICAL PROSTATECTOMY Rogers et al (page 104) from Houston report the results of 40 patients who underwent salvage radical prostatectomy

for local recurrences aRer radiation therapy. Rectal injury occurred in 15% of the patients and urinary incontinence was noted in 58%. At 5 years the actuarial nonprogression rate measured by prostate specific antigen was 55%. The best results were obtained in the group with a prostate specisc antigen level of less than 10 ngJml.

BOOK REVIEW Rajfer from California reviews the book entitled Management of Impotence and Infertility by Whitehead and

Nagler (page 293).

Jay Y. Gillenwater Editor

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