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Over a 28-year period, 46 patients with previously treated carcinoma of the cervix developed bilateral ureteral obstruction that was treated with palliative urinary diversion. All but 3 patients had elevated blood urea nitrogen (BUN) levels, and 19 had received no prior treatment. Forty-one percent (19/46) lived 6 months or more and spent 86% of their remaining life out of the hospital. Various factors potentially affecting survival are examined, and guidelines for patient selection are offered.

Adenocarcinoma of the endometrium with intrauterine pregnancy is extremely rare. This report presents the finding of an adenoacanthoma of the endometrium discovered during therapeutic abortion and compares it with 6 other cases previously published. Four of the 7 tumors were adenocanthomas, a neoplasm that accounts for 20-30% of endometrial adenocarcinoma in the general population. Follow-up on 4 of the 6 previously reported patients indicates that 3 are well more than 5 years after diagnosis. The 1 patient who died of disease had an adenoacanthoma and was the only patient with extensive myometrial invasion at hysterectomy. The patient described in the present report is well 2 1/2 years after hysterectomy.

A recent reassessment of the combined experience in treating vulvar cancer at the Pondville State Cancer Hospital and the Massachusetts General Hospital has been undertaken, covering the 25 years that have elapsed since an earlier comprehensive review was carried out. A few differences in some of the clinical features of the disease and the manner in which it presents itself today were observed. Basic principles of management that had emerged at the time of the earlier report have remained fundamentally the same. However, as the result of a recent trend toward earlier diagnosis that permits prompt treatment of smaller lesions with a lower potential for having had lymphatic spread at the time they are dealt with, there is now room for a somewhat greater degree of careful individualization of the basic surgical approach. This philosophy has been reflected in certain modifications of the overall plan of management as well as in improvements in the technical aspects of diagnosis and therapy that have reduced complications and increased salvage.

It is appropriate to introduce this review of the subject of urinary stress incontinence with a discussion of other disorders that may produce abdnormal urinary leakage,at times even stimulating true anatomic stress incontinence. It is obviously important to correctly identify patients with these other conditions and not perform surgical procedures unlikely to relieve their symptoms. Thereafter, the underlying pathophysiology of stress incontinence is considered in detail, since its fundamental understanding serves as the basis for both accurate diagnosis and proper selection and effective execution of the operations designed to correct true anatomic stress incontinence. A final section on patient management covers choice of the optimal surgical procedure for each individual patient, end results that should be achievable by proper selection and performance of the various operations, and a descriotion of some of the technical details that seem particularly helpful in carrying out the three principal types of surgical procedres currently in use.