Use of double-urinary diversion stents in intestinal urinary diversion

cancer, one cannot be obsessed with serum levels alone. For example, the responses to flutamide (SCH-13521) are equivalent to DES6.’ although serum testosterone levels remain in the normal range.6 In Stage C disease the VACURG study revealed fewer cancer-related deaths with either 1 mg or 5 mg DES compared to placebo or 0.2 mg DES daily.3 This favorable response was achieved in spite of the failure to measure serum testosterone levels during therapy. As everyone should be aware by now, patients initially randomized to the placebo arm, received hormonal treatment when deterioration became evident. Thus DES was compared to delayed endocrine treatment. I believe that the beneficial effects of DES would have been more evident had either 1 mg or 5 mg DES been compared to no treatment. The rationale for early versus delayed treatment is detailed in the review article.* It may be small comfort to Dr. Chodak for me to acknowledge that the last word on the subject has not been written. One should remember that the article under discussion is a review of published work. Therefore we must all share the credit or discredit for the results of the intensive investigations by our peers.

USE OF DOUBLE-J URINARY DIVERSION STENTS IN INTESTINAL URINARY DIVERSION To the Editor: With regard to the article, “Use of Single-J Urinary Diversion Stents in Intestinal Urinary Diversion,” by M. Jarowenko and A. Bennett, published in the October issue (vol. 22, pages 369-370), of UROLOGY we suggest an alternative. We agree with the use of J urinary diversion stents in intestinal urinary diversion, but the single-J stent has the disadvantage of other stents, that its end is out of the body, thus increasing the risk of infection. Over the past two-and-one-half years we have used the double-J urinary diversion stent in intestinal urinary diversion. We perform an end-to-end ureteroileal anastomosis using a modified Wallace technique. The anastomosis is performed over 2 double-J stents with the lower end placed in the ileal loop (Fig. 1). The stents are removed endoscopically

1349 Camino Del Mar Del Mar, California 92014 References 1. Huggins C, and Hodges CV: Studies on prostatic cancer, I. the effect of castration, of estrogen and androgen injection on serum phosphatases in metastatic carcinoma of the prostate, Cancer Res 1: 293 (1941). 2. Blackard CE: The Veterans Administration Cooperative Urological Research Group’s studies of carcinoma of the prostate: a review, Cancer Chemother Rep 59: 225 (1975). 3. Byar DP: The Veterans Administration Cooperative Urological Research Group’s studies of cancer of the prostate, Cancer 32: 1126 (1973). 4. Robinson MRG, and Thomas BS: Effect of hormonal therapy on plasma testosterone levels in prostatic carcinoma, Br Med J 4: 391 (1971). 5. Shearer RJ, Hendry WF, Sommerville IF, and Fergusson JD: Plasma testosterone: an accurate monitor of hormone treatment in prostatic cancer, Br J Urol 45: 668 (1973). 6. Prout GR Ir. et al: Prostatic cancer and SCH-13521:II. histological altera;ons and the pituitary gonadal axis, J Urol 113: 834 (1975). 7. Jacob0 E, et al: Comparison of flutamide (SCH-13521) and diethylstilbestrol in untreated advanced prostatic cancer, Urology 8: 231 (1976). 8. Pollen JJ: Endocrine treatment of prostatic cancer, Urology 21: 555 (1983).

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FIGURE 1. Double-] urinary diversion stent as intestinal urinary diversion.

very easily nine to twelve days postoperatively. In 18 anastomoses performed, using this technique, the results were excellent. We believe that internal stenting in intestinal urinary diversion is a good technique which prevents ureteroileal anastomotic fistulas. There is no risk of postoperative infection, and the postoperative care of the patient is easier. Certainly, the internal stenting can be used in any variation of ureteroileal anastomosis. Angelos J. Cranidis, M.D. Constantin A. Dimopoulos, M.D. University of Athens, Greece

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