LETTERS TO THE EDITOR
TESTIS TUMOR AND UNILATERAL CRYPTORCHIDISM
To the Editor: The article, “Early Orchiopexy and Testis Tumors,” by J. M. DeCenzo, M.D., and G. W. Leadbetter, M.D., published in the March issue of UROLOGY (vol. 5, page 365), does emphasize the principle that orchiopexy at an early age does not protect against the subsequent development of a malignant tumor in that testis. However, it is the development of tumor in the descended testicle in patients with unilateral cryptorchidism that fascinates me. For example, one Johnson et al. * report that: “Approximately out of five testicular tumors reported in patients with a history of (unilateral) cryptorchidism have developed in the contralateral scrotal testis.” I believe that explaining this occurrence has more significant implications about the development of tumors in cryptorchid testes than even the patient reported, that is, “Does the individual have defective testes (with malignant potential) to start with?” Glenn C. Szalay, M.D. South California Permanente Medical Group 1059 West Pacific Coast Highway Harbor City, California 99710 *Johnson, D. E., et al.: Cryptorchidism and testicular tumorigenesis, Surgery 63: 919 (1968).
DISSEMINATED COAGULATION
INTRAVASCULAR
To the Editor: I would like to reply to the comments of Michael L. Pergament, M.D.; William R. Swaim, M.D. ; and Clyde E. Blackard, M.D.; (UROLOGY, vol. 6, page 266) regarding my article, “Hematologic Problems in Urology: Basic Mechanisms and Clinical Approach” (vol. 5, page 589). The treatment of DIC is far from incisive and straight-forward. As mentioned in my article, treatment of DIC “. . . is based on the use of an
UROLOGY
I
SEPTEMBER
1975 / VOLUME
VI, NUMBER 3
antithrombin agent and on the elimination, ifpossible, of the source of the thromboplastic infusion.” If acute DIC occurs as the result of surgery, such as prostatectomy, then there is no way to “control the underlying disease,” which is the entry of thromboplastic agents into the circulation during the operative procedure. As noted in the article, large-dose hormonal therapy may not reverse the clotting abnormalities noted in some prostatic cancer patients with DIC. Therefore, although treatment of the underlying disease process is desirable, it may not be sufficient in the common circumstances mentioned, wherein DIC is noted by the urologist. References are given in the article, which would challenge the use of replacement therapy, for example, platelet concentrates, fresh whole blood, and others, without proper heparin therapy, since such replacement agents could be consumed in the process of DIC in a manner similar to the consumption of intrinsic blood factors. The article emphasized the importance of basic hematologic knowledge to the urologist in approaching the diagnosis and treatment of the various clotting abnormalities. I believe most urologists are not qualified to treat systemic hematologic abnormalities without the help of an expert hematologist. I conclude from my review variaof the literature that there is considerable tion among hematologists regarding the treatment of DIC. I have presented what I believe is the consensus. Edward S. Rader, M.D. 911 South Brentwood Boulevard St. Louis, Missouri 63105
BUSCHKE-LOWENSTEIN
TUMOR
To the Editor: Since I recently presented a report on the conservative management of Buschke-Lowenstein tumor at the Kimbrough
397
TESTIS TUMOR AND UNILATERAL CRYPTORCHIDISM
To the Editor: The article, “Early Orchiopexy and Testis Tumors,” by J. M. DeCenzo, M.D., and G. W. Leadbetter, M.D., published in the March issue of UROLOGY (vol. 5, page 365), does emphasize the principle that orchiopexy at an early age does not protect against the subsequent development of a malignant tumor in that testis. However, it is the development of tumor in the descended testicle in patients with unilateral cryptorchidism that fascinates me. For example, one Johnson et al. * report that: “Approximately out of five testicular tumors reported in patients with a history of (unilateral) cryptorchidism have developed in the contralateral scrotal testis.” I believe that explaining this occurrence has more significant implications about the development of tumors in cryptorchid testes than even the patient reported, that is, “Does the individual have defective testes (with malignant potential) to start with?” Glenn C. Szalay, M.D. South California Permanente Medical Group 1059 West Pacific Coast Highway Harbor City, California 99710 *Johnson, D. E., et al.: Cryptorchidism and testicular tumorigenesis, Surgery 63: 919 (1968).
DISSEMINATED COAGULATION
INTRAVASCULAR
To the Editor: I would like to reply to the comments of Michael L. Pergament, M.D.; William R. Swaim, M.D. ; and Clyde E. Blackard, M.D.; (UROLOGY, vol. 6, page 266) regarding my article, “Hematologic Problems in Urology: Basic Mechanisms and Clinical Approach” (vol. 5, page 589). The treatment of DIC is far from incisive and straight-forward. As mentioned in my article, treatment of DIC “. . . is based on the use of an
UROLOGY
I
SEPTEMBER
1975 / VOLUME
VI, NUMBER 3
antithrombin agent and on the elimination, ifpossible, of the source of the thromboplastic infusion.” If acute DIC occurs as the result of surgery, such as prostatectomy, then there is no way to “control the underlying disease,” which is the entry of thromboplastic agents into the circulation during the operative procedure. As noted in the article, large-dose hormonal therapy may not reverse the clotting abnormalities noted in some prostatic cancer patients with DIC. Therefore, although treatment of the underlying disease process is desirable, it may not be sufficient in the common circumstances mentioned, wherein DIC is noted by the urologist. References are given in the article, which would challenge the use of replacement therapy, for example, platelet concentrates, fresh whole blood, and others, without proper heparin therapy, since such replacement agents could be consumed in the process of DIC in a manner similar to the consumption of intrinsic blood factors. The article emphasized the importance of basic hematologic knowledge to the urologist in approaching the diagnosis and treatment of the various clotting abnormalities. I believe most urologists are not qualified to treat systemic hematologic abnormalities without the help of an expert hematologist. I conclude from my review variaof the literature that there is considerable tion among hematologists regarding the treatment of DIC. I have presented what I believe is the consensus. Edward S. Rader, M.D. 911 South Brentwood Boulevard St. Louis, Missouri 63105
BUSCHKE-LOWENSTEIN
TUMOR
To the Editor: Since I recently presented a report on the conservative management of Buschke-Lowenstein tumor at the Kimbrough
397
