Randall G. Rowland

Cecoileal reservoirs were created in 29 patients. Tunneled ureteral implantations along the tenia of the cecum provided the antireflux mechanism. Plication or tapering of the terminal ileal segment along with the ileocecal valve provided the continence mechanism. The tubular configuration of the cecum was disrupted with either an ileal or sigmoid patch, or it was re-configured in a Heineke-Mikulicz type of closure to avoid bolus (unit) contractions. Short-term followup examination with excretory urography showed no upper tract obstruction. X-rays of the pouch showed no reflux and interviews revealed satisfactory continence in 93 per cent of the patients.

The feasibility of sparing postganglionic fibers of lumbar sympathetic nerves during the course of retroperitoneal lymphadenectomy has been investigated at our university medical center beginning in 1978. We selected 75 patients for nerve-sparing retroperitoneal lymphadenectomy in an effort to preserve ejaculatory function postoperatively. This cohort of patients was selected on the basis of clinical stage. Of the 75 patients 73 had clinical stage I disease. However, 14 of these 73 patients had pathological stage II cancer. No patient was treated with adjuvant chemotherapy after nerve-sparing retroperitoneal lymphadenectomy. Of these 14 patients with pathological stage II disease 4 had relapse: 1 with proved retroperitoneal recurrence, and 3 with serological elevations of tumor markers and questionable clinical findings as to anatomical site of relapse. All 4 patients are free of disease after chemotherapy and/or surgical (1) rescue. There were no local recurrences in the 61 patients with negative nodes. All 75 patients ejaculate and had no evidence of disease more than 2 years after nerve-sparing retroperitoneal lymphadenectomy. It is clear that nerve-sparing retroperitoneal lymphadenectomy is a feasible technique. As noted, it can even be applied to selected patients with low volume positive nodes, yet maintaining relapse and survival figures that are acceptable. Ejaculation is reliably preserved when this nerve-sparing technique is applied accurately in retroperitoneal lymphadenectomy.

PURPOSE: The American Urological Association convened the Bladder Cancer Clinical Guidelines Panel to analyze the literature regarding available methods of treating nonmuscle invasive bladder cancer, and to make practice policy recommendations based primarily on treatment outcomes data. MATERIALS AND METHODS: The panel searched the MEDLINE database for all articles related to nonmuscle invasive bladder cancer published from 1966 to January 1998. Outcomes data were extracted from articles accepted after panel review and meta-analyzed to produce comparative probability estimates for alternative treatments. RESULTS: All of the intravesical agents (thiotepa, bacillus Calmette-Guerin, mitomycin C and doxorubicin) when used as adjuvant therapy after transurethral resection resulted in a lower probability of recurrence compared to resection alone. However, there is no evidence that intravesical therapy affects long-term progression. CONCLUSIONS: For patients with no prior intravesical therapy adjuvant intravesical chemotherapy or immunotherapy is a treatment option after endoscopic removal of low grade Ta bladder cancers. Intravesical instillation of bacillus Calmette-Guerin or mitomycin C is recommended for carcinoma in situ, and after endoscopic removal of T1 and high grade Ta tumors.

No AccessJournal of UrologyClinical Urology: Original Article1 Mar 1995Original Articles: Testis Cancer: Complications of Post-Chemotherapy Retroperitoneal Lymph Node Dissection J. Baniel, R.S. Foster, R.G. Rowland, R. Bihrle, and J.P. Donohue J. BanielJ. Baniel , R.S. FosterR.S. Foster , R.G. RowlandR.G. Rowland , R. BihrleR. Bihrle , and J.P. DonohueJ.P. Donohue View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)67616-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail The surgical morbidity rate of 603 patients who underwent lymphadenectomy after primary chemotherapy for clinical stages II and III testis cancer from 1982 to 1992 was reviewed. There were 144 complications in 125 patients (20.7%). The majority of patients (93%) had a tumor volume of greater than 5 cm. Five patients died 3 to 47 days postoperatively, for an operative mortality rate of 0.8%. Pulmonary complications were the most frequent cause of severe morbidity: 6 patients had the adult respiratory distress syndrome and 5 needed prolonged ventilation. The underlying cause was a combination of bleomycin induced pulmonary toxicity, and large volume retroperitoneal and pulmonary disease resected in these patients. Limiting inspired oxygen concentration and perioperative volume replacement are imperative to minimize bleomycin related pulmonary morbidity. Additional procedures, such as nephrectomy and colectomy, did not add to the morbidity rate. Among patients undergoing concomitant venacavectomy there was a higher occurrence of postoperative chylous ascites. Most of the other complications (gastrointestinal, lymphatic, neurological and renal) were temporary and treated conservatively. Perioperative management of the post-chemotherapy testis cancer patient is different from that of the patient undergoing primary retroperitoneal lymphadenectomy. The latter operation is usually performed in physically fit patients and the surgical template of dissection is of a smaller scale. Thus, the complications in this group are minor and without mortality. Specific technical considerations and difficulties are common to post-chemotherapy patients. Factors, such as large volume of disease, post-chemotherapy desmoplastic reaction and extensive retroperitoneal dissection, make these patients more prone to have complications. Decreased pulmonary, renal and nutritional reserves add to the surgical morbidity. Knowledge of possible pitfalls and their causes can avoid unnecessary operative complications. References 1 : Thoracoabdominal approach for retroperitoneal gland dissection: its application to testis tumors. Surg., Gynec. & Obst.1950; 90: 486. Google Scholar 2 : Retroperitoneal lymphadenectomy: the anterior approach including bilateral suprarenal-hilar dissection. Urol. Clin. N. Amer.1977; 4: 509. 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Crossref, Medline, Google Scholar From the Department of Urology, Indiana University Medical Center, Indianapolis, Indiana© 1995 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byKern S, Cary C, Kaimakliotis H, Pedrosa J, Masterson T, Bihrle R, Foster R and Kesler K (2020) Surgical Management of Retrocrural Disease in Germ Cell Tumors: Outcomes and Evolution of PracticeJournal of Urology, VOL. 205, NO. 3, (812-819), Online publication date: 1-Mar-2021.Pedrosa J, Masterson T, Rice K, Bihrle R, Beck S and Foster R (2014) Reoperative Retroperitoneal Lymph Node Dissection for Metastatic Germ Cell Tumors: Analysis of Local Recurrence and Predictors of SurvivalJournal of Urology, VOL. 191, NO. 6, (1777-1782), Online publication date: 1-Jun-2014.Evans J, Spiess P, Kamat A, Wood C, Hernandez M, Pettaway C, Dinney C and Pisters L (2018) Chylous Ascites After Post-Chemotherapy Retroperitoneal Lymph Node Dissection: Review of the M. D. Anderson ExperienceJournal of Urology, VOL. 176, NO. 4, (1463-1467), Online publication date: 1-Oct-2006.Pinthus J, Bogaards A, Weersink R, Wilson B and Trachtenberg J (2018) Photodynamic Therapy for Urological Malignancies: Past to Current ApproachesJournal of Urology, VOL. 175, NO. 4, (1201-1207), Online publication date: 1-Apr-2006.MOSHARAFA A, FOSTER R, KOCH M, BIHRLE R and DONOHUE J (2018) Complications of Post-Chemotherapy Retroperitoneal Lymph Node Dissection for Testis CancerJournal of Urology, VOL. 171, NO. 5, (1839-1841), Online publication date: 1-May-2004.ALBERS P, WEISSBACH L, KREGE S, KLIESCH S, HARTMANN M, HEIDENREICH A, WALZ P, KUCZYK M and FIMMERS R (2018) Prediction of Necrosis After Chemotherapy of Advanced Germ Cell Tumors: Results of a Prospective Multicenter Trial of the German Testicular Cancer Study GroupJournal of Urology, VOL. 171, NO. 5, (1835-1838), Online publication date: 1-May-2004.SEXTON W, WOOD C, KIM R and PISTERS L (2018) Repeat Retroperitoneal Lymph Node Dissection for Metastatic Testis CancerJournal of Urology, VOL. 169, NO. 4, (1353-1356), Online publication date: 1-Apr-2003.Chang S, Smith J, Girasole C, Baumgartner R, Roth B and Cookson M (2018) Beneficial Impact of a Clinical Care Pathway in Patients with Testicular Cancer Undergoing Retroperitoneal Lymph Node DissectionJournal of Urology, VOL. 168, NO. 1, (87-92), Online publication date: 1-Jul-2002.BECK S, FOSTER R, BIHRLE R, KOCH M, WAHLE G and DONOHUE J (2018) AORTIC REPLACEMENT DURING POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTIONJournal of Urology, VOL. 165, NO. 5, (1517-1520), Online publication date: 1-May-2001.KAPOOR A, ZIPPE C and GILL I (2018) EMERGENCY AORTORENAL REVASCULARIZATION DURING SALVAGE RETROPERITONEAL LYMPH NODE DISSECTIONJournal of Urology, VOL. 162, NO. 4, (1377-1378), Online publication date: 1-Oct-1999.DONAT S and LEVY D (2018) BLEOMYCIN ASSOCIATED PULMONARY TOXICITY: IS PERIOPERATIVE OXYGEN RESTRICTION NECESSARY?Journal of Urology, VOL. 160, NO. 4, (1347-1352), Online publication date: 1-Oct-1998.TOGNINI P, FOSTER R, McGRAW P, HEILMAN D, BIHRLE R, ROWLAND R, WAHLE G, EINHORN L and DONOHUE J (2018) COMBINED POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION AND RESECTION OF CHEST TUMOR UNDER THE SAME ANESTHETIC IS APPROPRIATE BASED ON MORBIDITY AND TUMOR PATHOLOGYJournal of Urology, VOL. 159, NO. 6, (1833-1835), Online publication date: 1-Jun-1998.NASH P, LEIBOVITCH I, FOSTER R, BIHRLE R, ROWLAND R and DONOHUE J (2018) EN BLOC NEPHRECTOMY IN PATIENTS UNDERGOING POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION FOR NONSEMINOMATOUS TESTIS CANCER: INDICATIONS, IMPLICATIONS AND OUTCOMESJournal of Urology, VOL. 159, NO. 3, (707-710), Online publication date: 1-Mar-1998.Spitz A, Wilson T, Kawachi M, Ahlering T and Skinner D (2018) VENA CAVAL RESECTION FOR BULKY METASTATIC GERM CELL TUMORS: AN 18-YEAR EXPERIENCEJournal of Urology, VOL. 158, NO. 5, (1813-1818), Online publication date: 1-Nov-1997.Van Basten J, Jonker-Pool G, Van Driel M, Sleijfer D, Droste J, Van De Wiel H, Koops H, Molenaar W and Hoekstra H (2018) SEXUAL FUNCTIONING AFTER MULTIMODALITY TREATMENT FOR DISSEMINATED NONSEMINOMATOUS TESTICULAR GERM CELL TUMORJournal of Urology, VOL. 158, NO. 4, (1411-1416), Online publication date: 1-Oct-1997.Leibovitch I, Nash P, Little S, Foster R and Donohue J (2018) Spinal Cord Ischemia After Post-Chemotherapy Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell CancerJournal of Urology, VOL. 155, NO. 3, (947-951), Online publication date: 1-Mar-1996.Swanson D (2018) Editorial: Low Stage Testis Cancer is Still Potentially LethalJournal of Urology, VOL. 154, NO. 4, (1376-1377), Online publication date: 1-Oct-1995.Baniel J, Leibovitch I, Foster R, Rowland R, Bihrle R and Donohue J (2018) Hyperamylasemia After Post-Chemotherapy Retroperitoneal Lymph Node Dissection for Testis CancerJournal of Urology, VOL. 154, NO. 4, (1373-1375), Online publication date: 1-Oct-1995. Volume 153Issue 3SMarch 1995Page: 976-980 Advertisement Copyright & Permissions© 1995 by American Urological Association, Inc.MetricsAuthor Information J. Baniel More articles by this author R.S. Foster More articles by this author R.G. Rowland More articles by this author R. Bihrle More articles by this author J.P. Donohue More articles by this author Expand All Advertisement PDF downloadLoading ...

No AccessJournal of UrologyCLINICAL UROLOGY: Special Communications1 Nov 1999BLADDER CANCER CLINICAL GUIDELINES PANEL SUMMARY REPORT ON THE MANAGEMENT OF NONMUSCLE INVASIVE BLADDER CANCER (STAGES Ta, T1 AND TIS) JOSEPH A. SMITH, RICHARD F. LABASKY, ABRAHAM T.K. COCKETT, JOHN A. FRACCHIA, JAMES E. MONTIE, and RANDALL G. ROWLAND JOSEPH A. SMITHJOSEPH A. SMITH , RICHARD F. LABASKYRICHARD F. LABASKY , ABRAHAM T.K. COCKETTABRAHAM T.K. COCKETT , JOHN A. FRACCHIAJOHN A. FRACCHIA , JAMES E. MONTIEJAMES E. MONTIE , and RANDALL G. ROWLANDRANDALL G. ROWLAND View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)68208-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The American Urological Association convened the Bladder Cancer Clinical Guidelines Panel to analyze the literature regarding available methods of treating nonmuscle invasive bladder cancer, and to make practice policy recommendations based primarily on treatment outcomes data. Materials and Methods: The panel searched the MEDLINE database for all articles related to nonmuscle invasive bladder cancer published from 1966 to January 1998. Outcomes data were extracted from articles accepted after panel review and meta-analyzed to produce comparative probability estimates for alternative treatments. Results: All of the intravesical agents (thiotepa, bacillus Calmette-Guerin, mitomycin C and doxorubicin) when used as adjuvant therapy after transurethral resection resulted in a lower probability of recurrence compared to resection alone. However, there is no evidence that intravesical therapy affects long-term progression. Conclusions: For patients with no prior intravesical therapy adjuvant intravesical chemotherapy or immunotherapy is a treatment option after endoscopic removal of low grade Ta bladder cancers. Intravesical instillation of bacillus Calmette-Guerin or mitomycin C is recommended for carcinoma in situ, and after endoscopic removal of T1 and high grade Ta tumors. References 1 Smith, J. A., Labasky, R. F., Cockett, A. T. K., Fracchia, J. A., Montie, J. E. and Rowland, R. G.: Bladder Cancer Clinical Guidelines Panel: Report on the Management of Non-Muscle-Invasive Bladder Cancer (Stages Ta, T1 and Tis). Baltimore: American Urological Association, Inc., 1999. 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Google Scholar © 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byBarlow L, McKiernan J and Benson M (2018) Long-Term Survival Outcomes with Intravesical Docetaxel for Recurrent Nonmuscle Invasive Bladder Cancer After Previous Bacillus Calmette-Guérin TherapyJournal of Urology, VOL. 189, NO. 3, (834-839), Online publication date: 1-Mar-2013.Lu Z, Yeh T, Wang J, Chen L, Lyness G, Xin Y, Wientjes M, Bergdall V, Couto G, Alvarez-Berger F, Kosarek C and Au J (2018) Paclitaxel Gelatin Nanoparticles for Intravesical Bladder Cancer TherapyJournal of Urology, VOL. 185, NO. 4, (1478-1483), Online publication date: 1-Apr-2011.Pruthi R, Baldwin N, Bhalani V and Wallen E (2018) Conservative Management of Low Risk Superficial Bladder TumorsJournal of Urology, VOL. 179, NO. 1, (87-90), Online publication date: 1-Jan-2008.Huang G, Hamilton A, Lo M, Stein J and Penson D (2018) Predictors of Intravesical Therapy for Nonmuscle Invasive Bladder Cancer: Results From the Surveillance, Epidemiology and End Results Program 2003 Patterns of Care ProjectJournal of Urology, VOL. 180, NO. 2, (520-524), Online publication date: 1-Aug-2008.Hall M, Chang S, Dalbagni G, Pruthi R, Seigne J, Skinner E, Wolf J and Schellhammer P (2018) Guideline for the Management of Nonmuscle Invasive Bladder Cancer (Stages Ta, T1, and Tis): 2007 UpdateJournal of Urology, VOL. 178, NO. 6, (2314-2330), Online publication date: 1-Dec-2007.Abaza R, Keck R and Selman S (2018) Intraperitoneal Chemotherapy for the Prevention of Transitional Cell Carcinoma ImplantationJournal of Urology, VOL. 175, NO. 6, (2317-2322), Online publication date: 1-Jun-2006.MULLERAD M, BOCHNER B, ADUSUMILLI P, BHARGAVA A, KIKUCHI E, HUI-NI C, KATTAN M, CHOU T and FONG Y (2018) HERPES SIMPLEX VIRUS BASED GENE THERAPY ENHANCES THE EFFICACY OF MITOMYCIN C FOR THE TREATMENT OF HUMAN BLADDER TRANSITIONAL CELL CARCINOMAJournal of Urology, VOL. 174, NO. 2, (741-746), Online publication date: 1-Aug-2005.MARIAPPAN P and SMITH G (2018) A SURVEILLANCE SCHEDULE FOR G1Ta BLADDER CANCER ALLOWING EFFICIENT USE OF CHECK CYSTOSCOPY AND SAFE DISCHARGE AT 5 YEARS BASED ON A 25-YEAR PROSPECTIVE DATABASEJournal of Urology, VOL. 173, NO. 4, (1108-1111), Online publication date: 1-Apr-2005.KIPP B, KARNES R, BRANKLEY S, HARWOOD A, PANKRATZ V, SEBO T, BLUTE M, LIEBER M, ZINCKE H and HALLING K (2018) MONITORING INTRAVESICAL THERAPY FOR SUPERFICIAL BLADDER CANCER USING FLUORESCENCE IN SITU HYBRIDIZATIONJournal of Urology, VOL. 173, NO. 2, (401-404), Online publication date: 1-Feb-2005.MARTÍNEZ-PIÑEIRO J, MARTÍNEZ-PIÑEIRO L, SOLSONA E, RODRÍGUEZ R, FERNÁNDEZ GÓMEZ J, MARTÍN M, MOLINA J, COLLADO A, FLORES N, ISORNA S, PERTUSA C, RABADÁN M, ASTOBIETA A, CAMACHO J, ARRIBAS S and MADERO R (2018) HAS A 3-FOLD DECREASED DOSE OF BACILLUS CALMETTE-GUERIN THE SAME EFFICACY AGAINST RECURRENCES AND PROGRESSION OF T1G3 AND TIS BLADDER TUMORS THAN THE STANDARD DOSE? 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Volume 162Issue 5November 1999Page: 1697-1701 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.Keywordsbladder neoplasmsimmunotherapychemotherapy, adjuvantendoscopycarcinoma, transitional cellMetricsAuthor Information JOSEPH A. SMITH More articles by this author RICHARD F. LABASKY More articles by this author ABRAHAM T.K. COCKETT More articles by this author JOHN A. FRACCHIA More articles by this author JAMES E. MONTIE More articles by this author RANDALL G. ROWLAND More articles by this author Expand All Advertisement PDF downloadLoading ...