Advanced cancer of the vulva treated by vulvectomy and proctectomy. Case report.

In 5 selected patients with squamous cell carcinoma of the vulva invading the anus, a vulvectomy in combination with proctectomy and in three cases bilateral groin dissection en bloc, was performed. All five patients had microscopically well differentiated tumors and no one showed evidence of distant metastases. All five patients are now alive and well with a mean observation time of 8 years.

Hypospadias. A review of 299 cases operated 1957-69.

A review of 299 unselected primary cases of hypospadias of all types treated during the period 1957 to 1969 is presented. The same indications for operation and the same surgical principles were applied in all cases. The surgical treatment was performed in two stages: meatotomy or meatotomy combined with straightening in the first stage and urethral construction according to Denis Browne's method in the second stage.

Microscopic studies of curvature-causing structures in hypospadias.

Microscopical studies were performed in a consecutive series of 20 hypospadiacs (3 crypto-hypospadias; 9 glandular; 7 penile; and 1 perineal) with curvature, 3 of whom also exhibited torsion. Specimens for the investigation were dissected free at the first operation and it was found that the binding tissues on the ventral side of the penis reached about half of the circumference of the penile shaft, stretching longitudinally from the coronal sulcus, passing the original meatus and extending proximally on the shaft. The specimens from the 17 hypospadias with curvature only exhibited a symmetric pattern in the tissue plate, while in 3 hypospadias with curvature and torsion an asymmetry was found, with longer lateral tissue plates in the contralateral direction to the torsion.

Morphology of hypospadias.

Morphological investigation was performed in a clinical series for prospective study comprising 220 unselected cases of hypospadias. The patients were followed up postoperatively for 8 to 12 years. The investigation comprised the external and internal genitals, including anomalies of the testes and disturbances in gonad differentiation, and simultaneous malformations in the upper urinary tract and extraurogenital malformations.

Micturition studies in hypospadiacs.

Micturition studies were performed pre-, inter- and postoperatively in a consecutive series comprising 148 unselected hypospadiacs, both short-term results (on average 1 3/12 years after the last operation) and long-term results (on average 6 3/12 years after the last operation) being recorded. The clinical material was subdivided into 6 age-groups and the results were compared with a control material comprising 176 males. Supernormal flow values were recorded preoperatively in 38% of hypospadiacs, normal values in 49% and subnormal in 13%.

On aetiological factors in hypospadias.

An analysis of genetic and non-genetic factors which might be of importance for the aetiology of hypospadias was performed in a clinical and in a registered material comprising altogether 893 hypospadiacs. Of 213 index patients in the clinical material, the probable aetiology was known in 11: in 3 patients chromosomal aberrations, in 2 well-defined syndromes with a known genetic background, in one maternal diabetes, in 2 maternal rubella, and 2 of the hypospadiacs were born after the mothers' use of anticonvulsant drugs and one after the mother's use of thalidomide. Other hypospadiacs were identified in 28 of the families of the remaining 202 index patients.

The development of puberty, the sexual début and sexual function in hypospadiacs.

The development of puberty, the sexual debut and the sexual function were investigated in a longitudinal study of an unselected material of 220 primary cases of hypospadiacs, treated during the period 1965 to 1969 and followed-up during the period 1965 to 1974. The development of puberty in hypospadiacs strongly resembled that in a normal male population. Out of 121 hypospadiacs between 13 and 30 years of age 66 had had sexual intercourse.

The incidence of hypospadias in Sweden.

In a study of the incidence of hypospadias the source material consisted of cases of hypospadias continuously reported to two central registers during the years 1965 to 1968. The material was then extended by the addition of hypospadiacs aged 5 to 9 years and admitted to departments of plastic and pediatric surgery, and in a few cases to departments of urology or surgery, who were not reported to either of the registers. During the years 1965 to 1968, 666 live male infants with hypospadias were identified among a total of 480 607 live births of both sexes in Sweden.