Vesicouterine fistula: a rare complication of cesarean section.

A vesicouterine fistula complicating a cesarean section is the least common of the urogenital fistulas. In this study, two patients are presented who developed this complication. The first patient was treated nonoperatively, with resolution of the problem. The second patient was treated surgically after failure of conservative management. The clinical features, etiologic factors, diagnostic procedures, and treatment modalities are discussed in relation to these cases and others reported in the literature.

Reappraisal of the value of testicular biopsy in the investigation of infertility.

One hundred and forty-two biopsies were reviewed to reappraise the value and indications for testicular biopsy in the investigation of infertility. These biopsies were categorized within the following morphologic patterns: normal, hypospermatogenesis, maturation arrest, Sertoli cell-only syndrome, and Klinefelter's syndrome. The morphology of the biopsies was correlated with the available sperm count, and the contribution of the biopsy to the patient's treatment was assessed. Testicular biopsy has proved most useful in azoospermia for the identification of obstruction. In oligospermia, biopsy appears to be of little use.

Heterogeneity of reproductive tract abnormalities in men with absence of the vas deferens: role of cystic fibrosis transmembrane conductance regulator gene mutations.

OBJECTIVE: To determine if the types of reproductive tract abnormalities linked to absence of the vas deferens varies with the cystic fibrosis transmembrane conductance regulator (CFTR) genotype. DESIGN: Prospective data gathering. SETTING: University infertility clinic. PATIENT(S): Forty-six infertile men with absence of the scrotal vas deferens and no signs of cystic fibrosis. INTERVENTION(S): All had blood taken for CFTR gene analysis, 33 had scrotal ultrasounds, and 25 had transrectal ultrasounds. MAIN OUTCOME MEASURE(S): The frequency of testicular, seminal vesicle, and ampullae of the vas deferens malformations was compared between subgroups of men with two, one, or no CFTR gene mutations. RESULT(S): None (0 of 21) of the men with at least one CFTR gene mutations had normal ampullae of the vas or seminal vesicles bilaterally. Two (50%) of 4 men with no CFTR gene mutations had normal ampullae of the vas deferens bilaterally, and 50% had normal bilateral seminal vesicles (statistically significantly different). There was no correlation between testicular malformations and CFTR genotype. CONCLUSION(S): This study indicates that the severity of the malformations in the testis is unrelated to the CFTR genotype, whereas the frequency and severity of wolffian duct malformations are related directly to the CFTR genotype.

Patent urachus and infected urachal cyst in an adult: a case report.

Urachal abnormalities are usually diagnosed early in life, so the finding of a patent urachus associated with an infected urachal cyst in a 21-year-old man as reported by the author is rare and of interest. The condition was managed by excision of the urachus, the cyst, the umbilicus and dome of the bladder, which is the preferred treatment. The author reviews other urachal anomalies and the complications arising from them.

Renal artery embolism: diagnosis and treatment.

A 59-year-old woman presented with flank pain, atrial fibrillation and a nonfunctioning left kidney. A diagnosis of renal artery embolism was made and she was treated successfully by embolectomy. A review of the literature reaffirms the role of embolectomy, even in cases with delayed diagnosis.

Laser lithotripsy in the treatment of ureteral calculi.

We examined the effectiveness of laser lithotripsy with a flash-lamp-pumped tunable dye laser in the treatment of ureteral calculi that were too large for direct extraction and that could not be treated with or had not responded to extracorporeal shock-wave lithotripsy (ESWL) or forms of ureteroscopic lithotripsy other than laser lithotripsy. In 20 (74%) of the 27 patients the laser alone successfully fragmented the calculi into pieces small enough to pass spontaneously or to be easily extracted with a basket. In five (19%) laser lithotripsy was partially successful: another procedure (ESWL in three and fragment extraction with a basket in two) was needed. In two patients (7%) the stones could not be fragmented with the laser, and either ESWL or percutaneous antegrade extraction was performed. At follow-up 3 months after treatment there was no sign of stone fragments in 26 (96%) of the patients. We believe that laser lithotripsy is a safe and effective method of ureteral stone fragmentation.

Epidermoid cysts of the testicle.

We report 4 cases of intratesticular cystic lesions. Three patients had epidermoid cysts and 1 had cystic mature teratoma initially diagnosed as an epidermoid cyst. In all cases an inguinal approach to testicular exploration was used.

Adverse effects on vasoepididymostomy outcomes for men with concomitant abnormalities in the prostate and seminal vesicle.

PURPOSE: Following microsurgical vasoepididymostomy as many as 85% of men have sperm in the ejaculate, yet only 30 to 50% will spontaneously father children. We examined the possibility that there may be concomitant abnormalities in the prostate and seminal vesicle, which may be associated with low pregnancy rates. MATERIALS AND METHODS: Transrectal ultrasound was performed in azoospermic men with suspected epididymal obstruction, excluding those who had undergone vasectomy, to identify abnormalities of the seminal vesicles and ejaculatory ducts. Microsurgical vasoepididymostomy was attempted in all men. RESULTS: Transrectal ultrasound revealed ejaculatory duct dilatation in 13 of 40 men (33%), although only 3 had accompanying seminal vesicle dilatation. Two men had atrophic seminal vesicles with normal ejaculatory ducts. At surgery 8 of 40 patients (20%) were deemed to have irreparable conditions. For the 27 men followed at least 6 months postoperatively patency and pregnancy rates were 75 and 22%, respectively. Mean sperm counts plus or minus standard deviation were significantly higher in men without compared to those with seminal vesicle or ejaculatory duct abnormalities (43 +/- 68 versus 5.7 +/- 6.9 x 10(6) sperm per ml., respectively), and so was the percentage of motile sperm (30 +/- 16% versus 1.2 +/- 2.2%, respectively). Pregnancy rates were also higher in men without (6 of 19, 32%) than with (0 of 8, 0%) seminal vesicle or ejaculatory duct abnormalities. CONCLUSIONS: Transrectal ultrasound detected abnormalities of the seminal vesicles and ejaculatory ducts are common in men with suspected epididymal obstruction. These abnormalities are associated with a poor outcome for vasoepididymostomy. We recommend that all men with suspected epididymal obstruction undergo transrectal ultrasound before any attempted reconstruction.

Intraoperative ultrasound in the conservative resection of testicular neoplasms.

In a series of approximately 400 patients investigated for oligospermia 4 had small testicular tumors demonstrated by high resolution real-time ultrasound. The lesions ranged in size from 3 to 6 mm., were clinically impalpable and were demonstrated on repeated sonograms. Exploration was done in all 4 patients with the aid of intraoperative high resolution ultrasound. This procedure allowed for conservative resection of the tumor with preservation of the testicle. The pathological diagnosis in all cases was benign Leydig cell tumor.

Endometriosis: an unusual cause of ureteral obstruction.

Endometriosis is a common disorder, affecting women in the child-bearing years. While urologic involvement is rare, the bladder is more often affected than the ureter. The authors describe the case of a 30-year-old woman who had unilateral ureteral obstruction secondary to an isolated periureteral retroperitoneal area of endometriosis. The theories of histogenesis are discussed. Current treatment consists of surgery or hormonal manipulation or a combination of the two.

Spontaneous hypoglycemia associated with hemangiopericytoma of the kidney.

We report the third case of renal hemangiopericytoma associated with spontaneous hypoglycemia. The clinical and pathological features suggest that excessive glucose storage by the tumor is an important factor in the pathogenesis of the hypoglycemia. Other possible mechanisms producing hypoglycemia associated with mesenchymal tumors are reviewed.

Bilateral multilocular renal cysts.

Multilocular renal cystic disease is a rare, benign condition thought to occur unilaterally. We report a case of asynchronous, bilateral multilocular renal cystic disease, which suggests that unilaterality is not essential for diagnosis of this lesion.