A S Cass

Hennepin County Medical Center, Minneapolis, Minnesota, United States

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Publications (89)231.48 Total impact

  • A S Cass, M Luxenberg
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    ABSTRACT: We reviewed 91 testicular injuries in 86 patients (5 bilateral) as a result of blunt trauma in 72 patients and gunshot wounds in 14 patients. In 90 percent of the patients the injury was solitary. With blunt trauma initially conservative management led to the loss of the entire testis in 21 percent in comparison with only 6 percent of those explored promptly. The recent use of testicular ultrasonography has not differentiated intratesticular hematoma from rupture in the majority of cases of blunt trauma. Bilateral testicular injury occurred in 1 of 72 patients (1.4%) with blunt trauma versus 4 of 14 (29%) with penetrating trauma and affected the fertility in 3 of 4 patients on follow-up.
    Urology 07/1991; 37(6):528-30. · 2.42 Impact Factor
  • A S Cass, M Luxenberg
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    ABSTRACT: We found simultaneous upper and lower urinary tract injury to be rare, being present in 10 of 2,310 patients (0.4%). Multiple associated injuries were present in all patients (average 4.4 per patient). In 3 patients both upper and lower urinary tract injuries were minor, and 1 patient died of associated injuries. In 4 patients one of the urinary injuries was significant and the other minor, and 2 of these patients died. In 3 patients both urinary injuries were significant, and all 3 died of associated injuries. A comprehensive urologic evaluation was required in all 10 patients because of their severe associated multiple injuries.
    Urology 10/1990; 36(3):226-7. · 2.42 Impact Factor
  • A S Cass, Michael Luxenberg
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    ABSTRACT: The accuracy of computed tomography (CT) in the diagnosis of renal artery injury has not been resolved. Since 1982, 428 patients with renal trauma have been evaluated at our institutions, 35 of whom were suspected of having a severe renal injury by clinical examination and initial urography and were managed by repeated clinical observation and CT scans. Seven of these patients had main or branch renal artery injuries, all of which were diagnosed with CT by the absence of opacification or lack of enhancement of the kidney or a renal segment and confirmed by arteriography, surgery, or follow-up radiologic studies. In our experience, CT was accurate in the diagnosis of renal artery injury.
    Urology 12/1989; 34(5):249-51. · 2.42 Impact Factor
  • A S Cass, M Luxenberg
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    ABSTRACT: If there was a correlation between the type of renal laceration and its healing, and if radiologic evaluation on admission could accurately diagnose the type of renal laceration present, then surgical intervention could be reserved for those renal lacerations that will not heal satisfactorily by themselves. We reviewed the outcome of initially conservative or immediate operative treatment of renal laceration in 122 patients. Thirty-six patients were managed initially without operation. All fifteen cortical lacerations and all five deep lacerations that created only a small parenchymal defect healed themselves, with 4 of the 16 patients available for follow-up having hypertension. In contrast, six deep lacerations that caused large parenchymal defects, six disrupted poles or segments, and four split kidneys did not have satisfactory healing with conservative management, necessitating delayed renal surgery, or causing hypertension or both. Because computed tomography on admission can accurately diagnose the site and extent of a renal laceration, it should be possible to decide early which patients truly will benefit from conservative management.
    Urology 06/1989; 33(5):367-70. · 2.42 Impact Factor
  • A S Cass, M Luxenberg
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    ABSTRACT: We reviewed 105 cases of extraperitoneal bladder rupture admitted to our hospitals from 1959 to 1985. Primary suturing of the rupture was performed in 65 patients, and catheter drainage alone without suturing of the rupture was performed in 34. The incidence of blunt trauma causing the rupture of gross hematuria on admission, and of associated injuries was similar in both groups. There was a higher incidence of women older than sixty years in the group managed by catheter drainage alone, and a higher incidence of laparotomy for associated intra-abdominal injuries and a higher mortality rate in the group treated by primary suturing. There were three early complications in the group treated by suturing (hematuria with clot retention 2, sepsis contributing to death 1) and four early complications in the conservatively treated group (hematuria with clot retention 1, pseudodiverticulum with bone spike in its floor 1, persistent urinary fistula 1, and sepsis contributing to death 1). There were two late complications in 42 patients followed in the group treated by suturing (urethral stricture 1, frequency and dysuria 1), and three late complications in 14 patients followed in the conservatively treated group (hyperreflexic bladder 2, urethral stricture and vesical calculi 1). Catheter drainage alone for extraperitoneal rupture from external trauma was simple, quick to perform, and appealing in the multiple-injured patient. Although the early and late complication rates were higher in the conservatively managed group, there was no statistically significant difference from the group treated by primary suturing.
    Urology 04/1989; 33(3):179-83. · 2.42 Impact Factor
  • R Gary, A S Cass, G Koos
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    ABSTRACT: Retrograde or antegrade transurethral incision of urethral strictures that have formed after complete rupture of the membranous urethra has been advocated to restore urethral continuity. With this technique we encountered vascular complications in 2 patients, which consisted of opening of a patent vessel entrapped in the fibrous tissue of the stricture. The opened vein in 1 patient healed without bleeding. The opened artery in the other patient did not heal with catheter drainage and pressure dressings, resulting in recurrent severe hemorrhage that necessitated stage 1 urethroplasty with ligation of the artery. The entrapment of a patent vessel in fibrous scar tissue resulting from complete urethral rupture is believed to be responsible for these complications.
    The Journal of Urology 01/1989; 140(6):1539-40. · 3.75 Impact Factor
  • R Gary, A S Cass, C F Johnson
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    ABSTRACT: Computed tomography (CT) permitted preoperative diagnosis of traumatic rupture of a congenital hydronephrotic renal pelvis. In cases in which renal pelvic rupture is suspected CT may obviate traditional cystoscopy and retrograde pyelography.
    Urology 08/1988; 32(1):65-6. · 2.42 Impact Factor
  • A S Cass, M Luxenberg
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    ABSTRACT: The use of ultrasound for evaluation of blunt testicular injury with hematocele allows contusion to be differentiated from rupture, and some authors advocate reserving surgical management for rupture. Our experience with the conservative management of 20 men with testicular contusion and hematocele was not encouraging. Of the patients 8 (40 per cent) required delayed exploration that involved orchiectomy in 3 (15 per cent) because of unresorbed hematoma or infection despite antibiotic use. In contrast, early surgical exploration in 19 patients reduced the morbidity and duration of disability, and resulted in an orchiectomy rate of 0.
    The Journal of Urology 05/1988; 139(4):746-7. · 3.75 Impact Factor
  • A S Cass, M Luxenberg
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    ABSTRACT: We reviewed 164 cases of bladder rupture from external trauma. Of these patients 145 (88 per cent) suffered blunt trauma, and 59 (35.5 per cent) suffered intraperitoneal, 93 (57.5 per cent) extraperitoneal and 12 (7 per cent) both types of rupture. Bladder rupture owing to blunt trauma was caused by a compression (burst) type of injury in all patients with intraperitoneal rupture and in 24 per cent of those with extraperitoneal rupture. In the remaining instances of extraperitoneal rupture pelvic bone fragments corresponded to the site of the injury. Although surgical repair has been the traditional method of management of all bladder ruptures, nonoperative (catheter) management of extraperitoneal rupture was successful in most cases.
    The Journal of Urology 11/1987; 138(4):743-5. · 3.75 Impact Factor
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    ABSTRACT: It was recently reported that renal loss by partial or total nephrectomy for renal trauma increases the rates of acute renal failure and death in the multiply-injured patient. Because our preference has been for immediate surgical intervention in such patients, a retrospective review was performed to ascertain the effect of partial or total nephrectomy. Eighty-eight patients met the criteria of multiple injuries including severe renal injuries (laceration, rupture, or pedicle injury) and availability of renal function data. Partial or total nephrectomy had been performed in 50 patients, renorrhaphy in 23, and 15 were managed without renal operation. In patients with renal lacerations, the numbers of associated injuries (including intra-abdominal injuries) were similar to those managed conservatively or by operation, and the rates of acute renal failure and mortality were the same with conservative management, renorrhaphy, or nephrectomy. Patients with renal pedicle injuries who had a nephrectomy did have a higher rate of acute renal failure than those managed conservatively (75% vs 0%; p less than 0.05), but they also had more associated injuries (2.8 vs. 1.6/patient; p less than 0.04) and they were older. These two factors, rather than the nephrectomy, probably accounted for the greater rates of acute renal failure and death.
    Urology 10/1987; 30(3):213-5. · 2.42 Impact Factor
  • A S Cass, M Luxenberg
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    ABSTRACT: We reviewed the records of 27 patients with main renal artery injury admitted to our hospitals from 1959 through June 1986. Before 1969, 7 patients were hospitalized of whom 4 had nonsurgical management with total loss of function of the affected kidney, 2 had immediate nephrectomy and 1 died before treatment. Despite the nonfunctioning kidney no hypertension developed in 3 of the 4 patients followed for an average of 72 months. After 1969 when immediate radiological assessment and surgical management of main renal artery injuries were instituted 20 patients were hospitalized. Of 4 patients treated nonoperatively loss of function of the affected kidney resulted and hypertension occurred in 1, necessitating delayed nephrectomy, after an average followup of 3.5 months. Immediate nephrectomy was performed in 10 patients and vascular repair in 3. In both survivors who underwent vascular repair followup at 24 and 36 months, respectively, showed no hypertension but loss of approximately half of the function of the affected kidney. The other 3 patients died before treatment. Aggressive management reduced markedly the time from injury to diagnosis from a median of 48 hours before 1969 to 5 hours after 1969 but only a small number of patients were suitable for vascular repair, and this procedure did not restore complete function to the kidney.
    The Journal of Urology 09/1987; 138(2):266-8. · 3.75 Impact Factor
  • A S Cass, M Luxenberg
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    ABSTRACT: Traumatic thrombosis of a segmental renal artery branch is being diagnosed with increased frequency because of the more frequent evaluation of renal injury by isotope renography, arteriography or computerized tomography, leading to questions about appropriate management. The medical records of 9 documented cases of segmental thrombosis were reviewed. No specific diagnostic features were found on clinical examination or an initial excretory urogram. All 9 patients had associated injuries (an average of 2.0 per patient) and 2 died of these injuries. One patient had immediate surgical repair of a thrombosed posterior branch of the renal artery whereas the other 8 had nonoperative management. No hypertension was found on followup of the 5 available patients, and hypertension occurred in only 10 of 170 reported cases (6 per cent) of traumatic thrombosis or operative ligation of segmental branches. Traumatic thrombosis of a segmental renal artery branch initially should be managed nonoperatively.
    The Journal of Urology 07/1987; 137(6):1115-6. · 3.75 Impact Factor
  • A S Cass, J Vieira
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    ABSTRACT: Excretory urography (IVP) is the primary diagnostic tool for renal injury but has been indeterminate in diagnosing severe renal injuries in most cases. Computed tomography (CT) provides precise anatomic detail of renal injuries. The IVP and CT findings were compared in 22 patients with suspected severe renal injuries suggested by clinical examination and initial screening IVP. CT provided determinate diagnoses in all the cases of severe renal injury, while the IVP diagnoses were indeterminate in 82 per cent of these cases. Although clarification is needed on the accuracy of CT in diagnosing renal vascular injury, the CT diagnoses were accurate in all other types of severe renal injury (as well as minor renal injuries).
    Urology 06/1987; 29(5):484-7. · 2.42 Impact Factor
  • H Aliabadi, A S Cass
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    ABSTRACT: A case of a nontraumatic scrotal hematoma thought to result from a ruptured varicocele is reported. It is postulated that a high venous pressure generated during a Valsalva maneuver while defecating may have precipitated the variceal hemorrhage.
    Urology 05/1987; 29(4):421-2. · 2.42 Impact Factor
  • H Aliabadi, A S Cass, P Gleich
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    ABSTRACT: A benign prostatic utricular papilloma was found in a twenty-seven-year-old man complaining of urethral bleeding and intermittent hematuria after sexual intercourse. Local endoscopic resection was performed. Since the natural history of this lesion is not known, follow-up cystourethroscopy will be performed.
    Urology 04/1987; 29(3):317-8. · 2.42 Impact Factor
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    ABSTRACT: The priority for treatment of a urologic injury in multiple injured patients from external trauma should be determined by the frequency of death from the urologic injury. The medical records of 2,058 patients with urologic injury from external trauma including 214 deaths were reviewed. Four deaths were attributed mainly to the urologic injury; one early in the postinjury period from continued severe hemorrhage from a ruptured kidney managed conservatively and three 6 to 8 weeks after injury from sepsis with a pelvic abscess from a ruptured urethra or bladder. The remaining 210 deaths were attributed to the associated injuries and occurred in the more severely injured older patients compared to the survivors. Death in multiple injured patients was rarely due to the urologic injury.
    The Journal of trauma 04/1987; 27(3):319-21. · 2.35 Impact Factor
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    ABSTRACT: In the management of renal lacerations most attention has centered on surgical or non-surgical treatment and little attention has been given to the long-term results. We have evaluated the medical records and radiographs of 70 patients with blunt renal lacerations; 30 had initial non-surgical management and 40 had initial surgical management. Patients with initial non-surgical management were followed up for an average of 40.4 months. Normal blood pressure and/or radiological evaluation of the kidney were noted in 22% of those who had non-surgical management (hypertension in 55%) and in 75% of those who had delayed renal surgery (hypertension in 29%). Patients with immediate surgical management were followed up for an average of 49.6 months and normal blood pressure and/or radiological evaluation of the kidney were present in 83% (no hypertension). On long-term follow-up, patients with non-surgical management had a much higher rate of hypertension and/or abnormal radiological evaluation of the kidney than those with immediate surgical management.
    British Journal of Urology 02/1987; 59(1):17-20.
  • A S Cass, C S Smith, P Gleich
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    ABSTRACT: When a calculus is present in the upper urinary tract during pregnancy, the upper tract dilatation seen on radiography and ultrasonography can be due to the calculus or to the pregnancy. This makes the decision on management difficult unless there are associated clinical findings of pain or sepsis. The records of 24 pregnant patients with proved urinary calculi were reviewed. The stone passed spontaneously in 18 patients, and procedures to remove the stone were required in 6 for pain and/or sepsis. With an upper urinary tract calculus and dilatation during pregnancy the deciding factors for intervention were the clinical findings of pain and/or sepsis and not the dilatation alone.
    Urology 12/1986; 28(5):370-2. · 2.42 Impact Factor
  • A S Cass, B A Bloom, M Luxenberg
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    ABSTRACT: During the last 25 years more myelomeningocele patients have survived to adulthood and there is increasing interest in their sexual function. Little has been written on this subject. Of 108 patients 16 or more years old with myelomeningocele 47 were interviewed regarding sexual function. Of the 35 female patients 24 were sexually active and 12 of the 17 having actual sexual intercourse had become pregnant. Of the latter 12 patients 10 had ileal conduit urinary diversions, and neither they nor their children experienced any major complications from pregnancy and delivery. Among the 12 male patients 10 were sexually active, with erection and ejaculation present in 9. Six male patients were having sexual intercourse and 1 had become a father. Most of our adults with myelomeningocele had satisfactory sexual function.
    The Journal of Urology 09/1986; 136(2):425-6. · 3.75 Impact Factor
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    ABSTRACT: The evaluation of patients with blunt renal trauma has become controversial. We tested the hypothesis that renal contusion can be diagnosed clinically and that these patients do not require radiographic evaluation. To evaluate the association of microhematuria without shock and with renal contusion, we reviewed the medical records of 831 patients with hematuria following blunt renal trauma. Microscopic hematuria without shock was noted in 160 of 241 patients without and 334 of 590 with associated injuries. Of the former 160 patients 159 had renal contusion and 1 had a renal laceration, while of the latter 334 patients 329 had renal contusion, 3 had renal laceration, 1 had renal rupture and 1 had a pedicle injury. Most patients with microscopic hematuria and no shock after blunt renal trauma had a renal contusion, especially those with no associated injury. All of the patients with renal contusions experienced no complications from nonoperative management. However, avoiding a radiographic evaluation in patients with blunt renal trauma plus microhematuria and no shock would miss a few cases of severe renal injury.
    The Journal of Urology 09/1986; 136(2):370-1. · 3.75 Impact Factor

Publication Stats

828 Citations
231.48 Total Impact Points

Institutions

  • 1978–1991
    • Hennepin County Medical Center
      Minneapolis, Minnesota, United States
  • 1976–1989
    • St. Joseph's Hospital, St. Paul, Minnesota
      Minneapolis, Minnesota, United States
  • 1978–1985
    • Gillette Children's Specialty Healthcare
      Saint Paul, Minnesota, United States