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Re: Urological Complications in 1,000 Renal Transplant Recipients
Vol. 154.537638, August 1995 Printed in U S A .
Letters to the Editor RE: UROLOGICAL COMPLICATIONS IN 1,000 RENAL, TRANSPLANT RECIPIENTS
thors is unnecessary and transurethral resection is adequate treatment for this tumor unless it is not feasible. However, patients must be followed as for a malignant tumor of the bladder in view of the D. A. Shoskes. D. Hanbury, D. Cranston and P. J . Morris diagnostic pitfalls and lack of sufficient long-term data. J. Urol., 153: 18-21, 1995 The danger in diagnosing this disease based on a small biopsy specimen cannot be overemphasized. Superficial changes resembling To the Editor. We read this article with great interest and would pseudosarcoma may coexist with underlying transitional cell carcilike to congratulate the authors on their excellent results with such noma and, therefore, an adequate biopsy specimen is mandatory.' In a large series on renal transplantation. However, we would take our patient the findings on urine cytology were mistaken for well issue with the statement that in oliguric and anuric patients trans- differentiated transitional cell carcinoma. urethral resection of the prostate should be performed before The terminology used for this entity has generated considerable transplantation as the approach of choice. We believe from our ex- controversy.*.3 The term inflammatory pseudotumor is certainly perience and from the l i t e r a t ~ r e l -that ~ transurethral resection of more elegant and easier to pronounce, although it shares the imperthe prostate and internal optical urethrotomy in the anuric patient fections that pseudosarcomatous myofibroblastic proliferation carare inadvisable before reestablishment of urine flow because a dense, ries. The review would have been more useful had details of the long stricture will always invariably develop. It would be urological histological differences from sarcoma been presented. practice in general to wait until after transplantation to treat these Respectfully, problems if necessary. S. Sinha Respectfully, Lkpartmnt of Urology Wahid A. Baluch and David P. Hickey Sanjay Gandhi Postgradccate Institute Department of Urology and Transplantation of Medical Sciences Beaumont Hospital Raebareli Road Dublin 9 L~~kn~~olu-226014 Ireland India 1. Reinberg, Y., Bumgardner. G. L. and Aliabadi, H.: Urological 1. Jones, E. C., Clement, P. B. and Young, R. H.: Inflammatory aspects of renal transplantation. J. Urol., 143: 1087, 1990. pseudotumor of the urinary bladder. A clinicopathologic, im2. Shenask J H 11. Renal transplantation in patients with uromunohistochemical,ultrastructural and flow eytometric study lo 'c atnom&ties. J. Urol., 116: 490, 1976. of 13 cases. Amer. J. Surg. Path., 1% 264, 1993. 3. SheEon, C. A., Martin, L. W. and Churchill, B. M.: Surgical 2. Ro, J. Y., El-Nagger, A. K, Amin, M. B. and Ayala, k G.: Ingersgectives in yediatric renal transplantation. In: Adult and flammatory pseudotumor of the urinary bladder. Letter to the Edited b J Y. Gillenwater, J. T. ae iatnc Uro o Editor. h e r . J. Surg. Path., 1% 1193, 1993. Gra hack. S. S. %wards and W: Duckett. Chicago: Year 3. Jones, E. C. and Young, R. H.: Inflammatory pseudotumar of the Boo{ Medical Publishers. vol. 2, chapt. 62, pp. 2056-2095, urinary bladder. Amer. J. Surg.Path., 1% 1193, 1993.
j.
1987.
4. Freier, D. T., Konnak, J. W., Niederhuber, J. E. and Turcotte, J. G.: Renal transplantation. In: Urology. Edited by A. R. Kendall and L. Karafin. Philadelphia: Harper & Row Publishers, vol. 2, chapt. 27, pp. 1-37, 1984.
Reply by Authors. Although accepted in September 1993, our review was submitted on March 5 and that certainly explains our involuntary omission of the study by Jones et al (reference 1 in Letter). Fortunately, S i a adds more information to our review and we thank him for his interest in the article. We agree that the rarity of this entity demands further clarification. However, our observation that pseudosarcomatous myofibroblastic proliferation tends to appear in children or young adults still remains valid. On one hand consultation files may reveal a strong bias in patient age distribution. Even though 6 of 13 patients reported on by Jones et al were less than 30 years old (mean age in that series is 35.4), we certainly can consider that a young adult population. Besides, iftheir patients and the aforementioned patient of Sinha are included in our review, 37% present within the first 2 decades of life and 20% present in the first decade. With regard to terminology, we still consider pseudosarcomatous myofibroblastic proliferation to be the most accurate. Medical terminology should never be a question of elegance or easy pronunciation.
Reply 6y Authors. We are grateful for the comments of Baluch and Hickey about our paper, and the point that they make is valid, especially in anuric patients. However in patients who are still producing reasonable amounts of urine we have successfully performed transurethral resection of the prostate without the problems that they mention.
RE: PSEUDOSARCOMATOUS MYOFIBROBLASTIC PROLIFERATION OF THE BLADDER REPORT OF 2 CASES AND LITERATURE REVIEW
J. C. Angulo, J . I. Lopez and N. Flows J. U r ~ l . 151: , 1008-1012,1994 To the Editor. The review on this rarely diagnosed condition made interesting reading. However, some aspects need further clarification. The largest series of 13 caees by Jones et al was not mentioned despite having been published 6 months before acceptance of the review.' Certain conclusions drawn by the authors must be judged in light of this article. Only 1 of the 13 patients presented in the first 2 decades of life and none was younger than 5 years. Therefore, the contention (based on 35 cases) that 50% of the patients present within the first 2 decades and 20% a t less than age 5 years must be revised. The condition OCCUI'B a t virtually all ages with no age predilection. Of 13 patients 8 underwent transurethral resection and none had evidence of diseaee at an average followup of 32 months (range 13 to 64).One of our patients, a 43-year-old diabetic man, was disease-free at 6 months after transurethral resection. We believe that open surgery (partial cystectomy) as recommended by the au-
RE: SALVAGE RADICAL PROSTATECTOMY: OUTCOME MEASURED BY SERUM PROSTATE SPECIFIC ANTIGEN LEVELS E. Rogers, M . Ohori, V. S. Kassabian, T.M. Wheeler and P. T. Scardino
J. Urol., 16% 104,1995
To the Editor. The authors describe their experience with salvage radical prostatectomy in 40 patients who had recurrent prostate cancer after radiation therapy. Many patients had surgical complications but their survival was excellent. The best results were obtained in the 18 patients whose disease w a s confined to the prostate gland (stage pT1,2) or the tissue immediately around the gland (stage pT3a.b). AAer 5 years the cancer had not progressed in 82% of
537
Letters to the Editor RE: UROLOGICAL COMPLICATIONS IN 1,000 RENAL, TRANSPLANT RECIPIENTS
thors is unnecessary and transurethral resection is adequate treatment for this tumor unless it is not feasible. However, patients must be followed as for a malignant tumor of the bladder in view of the D. A. Shoskes. D. Hanbury, D. Cranston and P. J . Morris diagnostic pitfalls and lack of sufficient long-term data. J. Urol., 153: 18-21, 1995 The danger in diagnosing this disease based on a small biopsy specimen cannot be overemphasized. Superficial changes resembling To the Editor. We read this article with great interest and would pseudosarcoma may coexist with underlying transitional cell carcilike to congratulate the authors on their excellent results with such noma and, therefore, an adequate biopsy specimen is mandatory.' In a large series on renal transplantation. However, we would take our patient the findings on urine cytology were mistaken for well issue with the statement that in oliguric and anuric patients trans- differentiated transitional cell carcinoma. urethral resection of the prostate should be performed before The terminology used for this entity has generated considerable transplantation as the approach of choice. We believe from our ex- controversy.*.3 The term inflammatory pseudotumor is certainly perience and from the l i t e r a t ~ r e l -that ~ transurethral resection of more elegant and easier to pronounce, although it shares the imperthe prostate and internal optical urethrotomy in the anuric patient fections that pseudosarcomatous myofibroblastic proliferation carare inadvisable before reestablishment of urine flow because a dense, ries. The review would have been more useful had details of the long stricture will always invariably develop. It would be urological histological differences from sarcoma been presented. practice in general to wait until after transplantation to treat these Respectfully, problems if necessary. S. Sinha Respectfully, Lkpartmnt of Urology Wahid A. Baluch and David P. Hickey Sanjay Gandhi Postgradccate Institute Department of Urology and Transplantation of Medical Sciences Beaumont Hospital Raebareli Road Dublin 9 L~~kn~~olu-226014 Ireland India 1. Reinberg, Y., Bumgardner. G. L. and Aliabadi, H.: Urological 1. Jones, E. C., Clement, P. B. and Young, R. H.: Inflammatory aspects of renal transplantation. J. Urol., 143: 1087, 1990. pseudotumor of the urinary bladder. A clinicopathologic, im2. Shenask J H 11. Renal transplantation in patients with uromunohistochemical,ultrastructural and flow eytometric study lo 'c atnom&ties. J. Urol., 116: 490, 1976. of 13 cases. Amer. J. Surg. Path., 1% 264, 1993. 3. SheEon, C. A., Martin, L. W. and Churchill, B. M.: Surgical 2. Ro, J. Y., El-Nagger, A. K, Amin, M. B. and Ayala, k G.: Ingersgectives in yediatric renal transplantation. In: Adult and flammatory pseudotumor of the urinary bladder. Letter to the Edited b J Y. Gillenwater, J. T. ae iatnc Uro o Editor. h e r . J. Surg. Path., 1% 1193, 1993. Gra hack. S. S. %wards and W: Duckett. Chicago: Year 3. Jones, E. C. and Young, R. H.: Inflammatory pseudotumar of the Boo{ Medical Publishers. vol. 2, chapt. 62, pp. 2056-2095, urinary bladder. Amer. J. Surg.Path., 1% 1193, 1993.
j.
1987.
4. Freier, D. T., Konnak, J. W., Niederhuber, J. E. and Turcotte, J. G.: Renal transplantation. In: Urology. Edited by A. R. Kendall and L. Karafin. Philadelphia: Harper & Row Publishers, vol. 2, chapt. 27, pp. 1-37, 1984.
Reply by Authors. Although accepted in September 1993, our review was submitted on March 5 and that certainly explains our involuntary omission of the study by Jones et al (reference 1 in Letter). Fortunately, S i a adds more information to our review and we thank him for his interest in the article. We agree that the rarity of this entity demands further clarification. However, our observation that pseudosarcomatous myofibroblastic proliferation tends to appear in children or young adults still remains valid. On one hand consultation files may reveal a strong bias in patient age distribution. Even though 6 of 13 patients reported on by Jones et al were less than 30 years old (mean age in that series is 35.4), we certainly can consider that a young adult population. Besides, iftheir patients and the aforementioned patient of Sinha are included in our review, 37% present within the first 2 decades of life and 20% present in the first decade. With regard to terminology, we still consider pseudosarcomatous myofibroblastic proliferation to be the most accurate. Medical terminology should never be a question of elegance or easy pronunciation.
Reply 6y Authors. We are grateful for the comments of Baluch and Hickey about our paper, and the point that they make is valid, especially in anuric patients. However in patients who are still producing reasonable amounts of urine we have successfully performed transurethral resection of the prostate without the problems that they mention.
RE: PSEUDOSARCOMATOUS MYOFIBROBLASTIC PROLIFERATION OF THE BLADDER REPORT OF 2 CASES AND LITERATURE REVIEW
J. C. Angulo, J . I. Lopez and N. Flows J. U r ~ l . 151: , 1008-1012,1994 To the Editor. The review on this rarely diagnosed condition made interesting reading. However, some aspects need further clarification. The largest series of 13 caees by Jones et al was not mentioned despite having been published 6 months before acceptance of the review.' Certain conclusions drawn by the authors must be judged in light of this article. Only 1 of the 13 patients presented in the first 2 decades of life and none was younger than 5 years. Therefore, the contention (based on 35 cases) that 50% of the patients present within the first 2 decades and 20% a t less than age 5 years must be revised. The condition OCCUI'B a t virtually all ages with no age predilection. Of 13 patients 8 underwent transurethral resection and none had evidence of diseaee at an average followup of 32 months (range 13 to 64).One of our patients, a 43-year-old diabetic man, was disease-free at 6 months after transurethral resection. We believe that open surgery (partial cystectomy) as recommended by the au-
RE: SALVAGE RADICAL PROSTATECTOMY: OUTCOME MEASURED BY SERUM PROSTATE SPECIFIC ANTIGEN LEVELS E. Rogers, M . Ohori, V. S. Kassabian, T.M. Wheeler and P. T. Scardino
J. Urol., 16% 104,1995
To the Editor. The authors describe their experience with salvage radical prostatectomy in 40 patients who had recurrent prostate cancer after radiation therapy. Many patients had surgical complications but their survival was excellent. The best results were obtained in the 18 patients whose disease w a s confined to the prostate gland (stage pT1,2) or the tissue immediately around the gland (stage pT3a.b). AAer 5 years the cancer had not progressed in 82% of
537