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Complications of electrohydraulic lithotresis
LETTERS TO THE EDITOR _____ _____ BLADDER CANCER CYCLOPHOSPHAMIDE
AFTER THERAPY
To the Editor: Dr. Charles Durkee and Dr. Ralph Benson’s report, “Bladder Cancer Following Administration of Cyclophosphamide,” published in the August issue (vol. 16, pages 145-147, 1980) of UROLOGY, as well as all of the cases of the apparent oncogenic effect of this drug previously reported, deal with middle-aged to elderly patients, many of whom had antecedent hemorrhagic cystitis. As this report demonstrates, neither age nor lack of hemorrhagic cystitis is a bar to oncogenesis. A sixteen-year-old white male was seen in 1976 initially with gross hematuria of a single day’s duration. Eight months earlier he had noted gross hematuria on a single occasion, with no urinary tract symptoms in the intervening period. At the age of three years he had been diagnosed as having a lymphoma involving cervical lymph nodes and, after a course of radiotherapy, had been treated with cyclophosphamide. Despite lack of any evidence of recurrent neoplasm, he had been continued for the entire thirteen-year period on maintenance cyclophosphamide therapy, in recent years 25 mg. daily for five days of each week. Except for the 2 episodes of gross hematuria there had been no urinary tract symptoms. Cystoscopic examination showed a 1.5-cm. papillary neoplasm which was treated by transurethral resection. Histopathologic examination showed Grade 1, Stage A transitional cell carcinoma. Multiple follow-up cystoscopic evaluations over the past four years have shown no recurrent tumor. Repeated urine cytologic evaluations are, however, persistently reported to show “atypical epithelial cells consistent with cyclophosphamide effect.” For this reason continued frequent endoscopic surveillance is planned. Michel A. Glucksman, M.D. Brunswick, Georgia 31520
COMPLICATIONS OF ELECTROHYDRAULIC
tresis,” by William Pelander, M.D., and Joel Kaufman, M.D., published in the August issue (vol. 16, pages 155-159, 1980) of UROLOGY. As the manufacturer of the SD-l stone disintegrator, we have made a conscientious effort to provide high-quality devices that have successfully undergone rigorous laboratory and clinical investigations. We have marketed the SD-1 for urinary bladder calculi fragmentation since 1973. Because of the success with no complications, we have sponsored research into the areas of ureteral, kidney, and common duct stones - also with no complications. The SD-l has received approval by the FDA, UL, and CSA for safety and efficacy. To the best of our knowledge and belief no other such device has been approved by any of these organizations. According to our records, the SD-1 has been utilized successfully in at least 2,000 cases of urinary bladder calculi fragmentation. In no case has the patient suffered trauma due solely to its use. And in no case has an SD-1 electrode tip separated in the bladder during normal use. This can be verified by a review of the literature. In the aforementioned article, only 1 case out of 10 utilized the SD-l. The reader of this article is led to believe that the SD-1 electrodes are unsafe because of tip separation. The SD-1 was utilized in Case 7, and the electrode tip did not separate. This was confirmed by Dr. Fauver who uses the SD-1 at Fitzsimmons and reports no complications. Granted, the calcium phosphate stone did not fragment electrohydrauhcally, but it could not be fragmented mechanically either. In the past we have reported that certain stones are just too hard for electrohydraulic fragmentation, but we have experienced an over-all success rate of approximately 90 per cent. It is unfortunate that the authors chose to classify the SD-1 along with the EHL-2 without due regard for the record of the SD-l. The complications reported were experienced with the EHL-2. We willingly invite inquiries concerning the SD-1 and our research protocol. Also a complete list of users will be furnished gladly on request.
LITHOTRESIS
William Shene, Vice President Northgate Research Corporation Plattsburgh, New York 12901
To the Editor: I was extremely article,
UROLOGY
“Complications
/
NOVEMBER
distressed to read the of Electrohydraulic Litho-
1980
/
VOLUME
XVI,
NUMBER
5
553
AFTER THERAPY
To the Editor: Dr. Charles Durkee and Dr. Ralph Benson’s report, “Bladder Cancer Following Administration of Cyclophosphamide,” published in the August issue (vol. 16, pages 145-147, 1980) of UROLOGY, as well as all of the cases of the apparent oncogenic effect of this drug previously reported, deal with middle-aged to elderly patients, many of whom had antecedent hemorrhagic cystitis. As this report demonstrates, neither age nor lack of hemorrhagic cystitis is a bar to oncogenesis. A sixteen-year-old white male was seen in 1976 initially with gross hematuria of a single day’s duration. Eight months earlier he had noted gross hematuria on a single occasion, with no urinary tract symptoms in the intervening period. At the age of three years he had been diagnosed as having a lymphoma involving cervical lymph nodes and, after a course of radiotherapy, had been treated with cyclophosphamide. Despite lack of any evidence of recurrent neoplasm, he had been continued for the entire thirteen-year period on maintenance cyclophosphamide therapy, in recent years 25 mg. daily for five days of each week. Except for the 2 episodes of gross hematuria there had been no urinary tract symptoms. Cystoscopic examination showed a 1.5-cm. papillary neoplasm which was treated by transurethral resection. Histopathologic examination showed Grade 1, Stage A transitional cell carcinoma. Multiple follow-up cystoscopic evaluations over the past four years have shown no recurrent tumor. Repeated urine cytologic evaluations are, however, persistently reported to show “atypical epithelial cells consistent with cyclophosphamide effect.” For this reason continued frequent endoscopic surveillance is planned. Michel A. Glucksman, M.D. Brunswick, Georgia 31520
COMPLICATIONS OF ELECTROHYDRAULIC
tresis,” by William Pelander, M.D., and Joel Kaufman, M.D., published in the August issue (vol. 16, pages 155-159, 1980) of UROLOGY. As the manufacturer of the SD-l stone disintegrator, we have made a conscientious effort to provide high-quality devices that have successfully undergone rigorous laboratory and clinical investigations. We have marketed the SD-1 for urinary bladder calculi fragmentation since 1973. Because of the success with no complications, we have sponsored research into the areas of ureteral, kidney, and common duct stones - also with no complications. The SD-l has received approval by the FDA, UL, and CSA for safety and efficacy. To the best of our knowledge and belief no other such device has been approved by any of these organizations. According to our records, the SD-1 has been utilized successfully in at least 2,000 cases of urinary bladder calculi fragmentation. In no case has the patient suffered trauma due solely to its use. And in no case has an SD-1 electrode tip separated in the bladder during normal use. This can be verified by a review of the literature. In the aforementioned article, only 1 case out of 10 utilized the SD-l. The reader of this article is led to believe that the SD-1 electrodes are unsafe because of tip separation. The SD-1 was utilized in Case 7, and the electrode tip did not separate. This was confirmed by Dr. Fauver who uses the SD-1 at Fitzsimmons and reports no complications. Granted, the calcium phosphate stone did not fragment electrohydrauhcally, but it could not be fragmented mechanically either. In the past we have reported that certain stones are just too hard for electrohydraulic fragmentation, but we have experienced an over-all success rate of approximately 90 per cent. It is unfortunate that the authors chose to classify the SD-1 along with the EHL-2 without due regard for the record of the SD-l. The complications reported were experienced with the EHL-2. We willingly invite inquiries concerning the SD-1 and our research protocol. Also a complete list of users will be furnished gladly on request.
LITHOTRESIS
William Shene, Vice President Northgate Research Corporation Plattsburgh, New York 12901
To the Editor: I was extremely article,
UROLOGY
“Complications
/
NOVEMBER
distressed to read the of Electrohydraulic Litho-
1980
/
VOLUME
XVI,
NUMBER
5
553