Vol. 121, June

0022-5347 /79/1216-0838$02.00/0

Printed in U .SA.

THE JOURNAL OF UROLOGY

Copyright© 1979 by The Williams & Wilkins Co.

Letters to the Editor RE: EXPERIENCE WITH NEW DOUBLE J URETERAL CATHETER STENT

Roy P. Finney

J. Urol., 120: 678-681, 1978 To the Editor. In the year since this paper was submitted enthusiasm for the use of this stent has not diminished. A word of caution should be noted. It is essential that during an open operation a stent of sufficient length be used and that the distal end of the stent be passed into the bladder for at least 4 cm. to allow the retaining hook to form. If the stent is passed into the bladder for a shorter distance the hook will not form and the stent may migrate outside of the bladder. The safest procedure is to pass a whistle-tip ureteral catheter down the ureter, while aspirating with a syringe. As the tip of the catheter enters the bladder urine will appear in the syringe. This distance is noted and used as a guide when the stent itself is passed. An additional 4 cm. is passed to be certain that the distal hook has formed. Aspiration of the stent with a blunt tipped needle or angiocath through an appropriate side hole confirms that the stent itself has reached the bladder. We have yet to have a stent that had been properly placed migrate in either direction. Respectfully, Roy P. Finney Division of Urology University of South Florida Tampa, Florida 33612 SQUAMOUS CELL CARCINOMA OF THE BLADDER

To the Editor. Rous recently reported on 17 cases of squamous cell carcinoma seen during a 20-year-period. 1 He indicated that this lesion is uncommon in patients in the United States and that the average age of patients is 58 years. Squamous cell carcinoma of the bladder is the most frequent type of bladder cancer seen in patients in the Middle East. It is related directly to the incidence of bilharziasis and is most prevalent in Egypt, Iraq and Yemen. The average age of patients is 25 to 35 years but it can occur in teenagers in areas of heavy infestation with bilharziasis. The usual number of cases in any one series in this locale would be in the hundreds for any 10-year period. Rous has reached the same conclusion that we have long believed and that is that total cystectomy is the proper and almost only

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modality of treatment that will provide a favorable prognosis. Positive pelvic lymph nodes usually are found and commonly are removed simultaneously. However, in most cases these nodes are found microscopically to be the seat of a hyperplastic fibrotic reaction to the infestation rather than epithelial metastases. The fibrosis that is inherent in cases ofbilharzial vesical lesions positively delays lymphatic spread until late in the stages of the disease. Respectfully, Hessein A. Amin Urology 336 Marzook Pearl Building Salmiya, Kuwait 1. Rous, S. N.: Squamous cell carcinoma of the bladder. J. Urol., 120: 561, 1978. IDIOPATHIC PRIAPISM IN THE NEWBORN J. Leal, D. Walker and E. A. Egan

J. Urol., 120: 376, 1978 To the Editor. It was with great interest that I read this article on idiopathic priapism, inasmuch as I had had a similar patient approximately 6 months earlier. The newborn was sent to me on the third day of life because of persistent erection. Circumcision had been performed when he was 1 day old. I observed the patient in the neonatal unit for approximately 6 hours and the erection persisted. I had him scheduled for creation of a glandular-cavernosum shunt' but just before he was to be taken to the operating room one of our urology residents examined him for the first time. To our surprise there no longer was an erection. The operation was canceled and I observed the. newborn for a further 24 hours. During this period labile erections were noted. The most minimal stimulation, such as movement of sheets, would stimulate an erection but, at this time, a flaccid state was nearly always achieved shortly thereafter. It is gratifying to see that others have had a similar experience. In the future I would certainly be prepared to observe a patient with a similar problem for a longer period before intervening surgically. Respectfully, Stephen R. Shapiro Pediatric Urology Sacramento, California 95819 1. Winters, C. C.: Priapism. Urol. Surv., 28: 163, 1978.

Squamous cell carcinoma of the bladder.

Vol. 121, June 0022-5347 /79/1216-0838$02.00/0 Printed in U .SA. THE JOURNAL OF UROLOGY Copyright© 1979 by The Williams & Wilkins Co. Letters to...
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