Abstract

An estimated 750,000 to 1,000,000 vasectomies are done per year in the United States. For a variety of reasons, many of these patients may eventually present for vasectomy reversal.2 Here at the Kaiser- Permanente Los Angeles Medical Center, we have developed a modified one-layer, nonstented, microsurgical vasovasostomy which we have been using routinely for vasectomy reversals since 1984. The technique is easy to learn and can be employed with a high degree of success.

Abstract

Benign prostatic hyperplasia (BPH) is a nonmalignant enlargement of the prostate uncommon before the age of 40 but occurring in most men as they age. The symptoms of BPH are generally attributed to bladder outlet obstruction from the enlarging prostate gland. However, not all men with enlarged prostates are symptomatic, and similar voiding symptoms can occur from other causes in the absence of BPH. Symptomatic BPH is a major health problem and a major expense to the healthcare system. Transurethral resection of the prostate (TURP) has been the treatment of choice for over 50 years, and until recently, approximately 400,000 TURPs have been performed annually in the United States at an estimated cost of $4 billion to $5 billion per year.1 TURP is an effective treatment for relief of prostatic obstruction and has generally been referred to as the “gold standard.”

Abstract

Prostate cancer is the most frequently diagnosed neoplasm in men in the United States and the second leading cause of cancer deaths.1 Traditionally, advanced prostate cancer was used in reference to patients with bony metastases. Changes in the management and detection of adenocarcinoma of the prostate have altered the very definition of what we consider “advanced disease.” Over 50% of patients newly diagnosed with adenocarcinoma of the prostate present with locally advanced or metastatic lesions. This corresponds to stages T3, N+, or M+.2 Sixty-eight percent of patients with advanced adenocarcinoma of the prostate will respond to androgen withdrawal. This may come in the form of either orchiectomy, estrogen administration, or luteinizing hormone–releasing hormone (LHRH) agonist administration. Unfortunately, one-half of patients with metastatic adenocarcinoma of the prostate will live less than two years.3 The mean survival of patients presenting with metastatic disease is 1.8 years.4 Once patients relapse from hormonal control of advanced prostatic carcinoma, few will respond to cytotoxic chemotherapy. Since the introduction of hormonal therapy by Huggins and Hodges in 1941, multiple forms of androgen manipulation have been proposed.5 The concept of advanced prostatic carcinoma needs to include not only those patients with Stage D-2 (M+), but also those with D0, D1 (N+), C (T-3), a rising prostate-specific antigen (PSA) after radical prostatectomy, and initial high Gleason grade (9 to 10). These patients are all at significant risk of progression and potential death due to prostate cancer.

Abstract

Malignant epithelial tumors of the urinary bladder are the fourth most common cancer among men, excluding squamous cell cancer of the skin, and are diagnosed in over 50,000 patients each year. Although the ratio is decreasing somewhat, bladder cancer is three times as common in males than in females and is responsible for over 10,000 deaths annually. White males may have an increased risk compared to Afro-American males though this appears to be true for superficial disease only. Well-documented risk factors for the disease include cigarette smoking, chemical carcinogens, schistosomiasis and chronic urinary tract infections, and a wide variety of occupations concentrated in the chemical, dye, rubber, and textile industries. Occupational exposure appears to be a contributory factor for the disease in nearly 25% of the male population in the United States with bladder carcinoma.

Abstract

Augmentation cystoplasty is the treatment of choice for the hyperreflexic, poorly compliant bladder unresponsive to medical treatment. While the etiology for such bladders is multiple, the clinical manifestations are few and include urinary incontinence, urinary tract infections, and upper tract deterioration. When such bladders are accompanied by hydroureteronephrosis with or without reflux, the dilated ureter and pelvis may be used to augment the bladder. Ureterocystoplasty is rapidly gaining acceptance among pediatric urologic surgeons. Dilated ureter is clearly the best tissue available for augmentation. It is lined with transitional cell epithelium, and the muscular backing provides the necessary properties for a compliant reservoir. The lack of mucous production and absorptive or secretory properties of urothelium prevents some of the most common problems encountered with other forms of augmentation cystoplasty (e.g., metabolic abnormalities, mucous production, lithiasis, and recurrent infections). The use of urothelium also eliminates the long-term concern of malignant degeneration of bowel used in augmentation.