Skene's duct cyst in a newborn: case report and review of the literature.

The diagnosis of a rare Skene's duct cyst in a newborn was made based on its location in relation to the urethra and the demonstration of transitional epithelium in the cyst wall. A through urologic evaluation was required to differentiate it from an ectopic ureterocele, urethrocele, urethral diverticula, and benign or malignant urethral and paraurethral tumors. Other uncommon vaginal cysts may be of müllerian duct origin and lined with stratified squamous epithelium or from persistent mesonephric (Gartner's) ducts and lined with columnar epithelium. Many cysts drain spontaneously but if treatment is indicated, marsupialization or simple transvaginal excision usually is adequate.

Intraoperative compression cystourethrograms: a measure of adequate resection of posterior urethral valves.

The technique of intraoperative compression cystourethrograms is described. This procedure has proved to be a safe, reliable objective means of determining adequate destruction of the valvular tissue is complete, the characteristic dilatation of the posterior urethra seen on preoperative cystourethrograms immediately disappears.

Long-term followup of anterior urethral transposition in female patients with neurogenic bladder.

Between 1961 and 1976, 13 carefully selected female patients with neurogenic bladders and incontinence refractory to other conservative therapy (9 patients) or deteriorating upper urinary tracts (4 patients) underwent anterior urethral transposition. Followup averaging 6 years revealed minimal stomal problems and excellent preservation of renal function. The surgical technique with modifications is presented.

Cardiac rhythm in men during cystoscopy.

Cardiac rhythm was monitored prospectively in 69 men during 191 cystoscopies. Ectopic beats from ventricular and supraventricular foci occurred in a significantly greater proportion of procedures in men with (76 per cent) compared to men without (16 per cent) heart disease. Other arrhythmias occurred to a lesser extent but there was no significant difference between men with and without heart disease. Plasma lidocaine was detected in significant amounts following intraurethral injection used for local anesthesia. Comparison of the types of arrhythmias that occurred during cytoscopy and the type of anesthetic used showed that significantly fewer ventricular ectopic beats occurred with general (8 per cent) or epidural anesthesia (13.8 per cent) as opposed to local lidocaine anesthesia (48.7 percent). Among the 3 anesthetic groups there was no difference with respect to frequency of supraventricular ectopic beats. No permanent cardiovascular complications occurred although several potentially serious dysrhythmias were seen.

Effect of intrarenal angiotensin II blockade on renal function in conscious dogs.

The effects of intrarenal infusion of 1-sar-8-ala angiotension II (P 113) and a converting enzyme inhibitor, SQ 20881, at doses that did not affect systemic blood pressure (2.0 mug/kg per min) were studied in conscious, uninephrectomized dogs. In dogs receiving approximately equal to 5 mEq/day of sodium, intrarenal infusion of P 113 increased renal blood flow (RBF) from 219.8 +/- 32.3 to 282.7 +/- 20.0 ml/min (P less than 0.004), and with intrarenal SQ 20881 infusion from 215.3 +/- 14.2 to 278.0 +/- 22.2 ml/min (p less than 0.005). In sodium-restricted dogs (approximately equal to 5 mEq/day), glomerular filtration rate (GFR) also increased with intrarenal P 113 infusion from 57.9 +/- 5.7 to 66.3 +/- 6.6 ml/min (P less than 0.05), and with SQ 20881 infusion from 43.1 +/- 2.1 to 55.7 +/- 4.5 ml/min (P less than 0.01). Dogs on approximately equal to 5 mEq/day of sodium showed significant increases in plasma renin activity (PRA) with intrarenal infusion of the peptides, unmasking a negative feedback inhibition of renin release by angiotensin II. No increases in RBF, GFR, or PRA were seen with infusion without inhibitors, or in dogs give P 113 or SQ 20881 while on approximately equal to 80 mEq/day of sodium. In addition, angiotensin II inhibition increased sodium excretion during sodium restriction. These findings suggest that intrarenal angiotensin II is intimately involved in renal responses to sodium restriction which result in conservation of sodium and water.

Intrarenal renin-angiotensin-sodium interdependent mechanism controlling postclamp renal artery pressure and renin release in the conscious dog with chronic one-kidney Goldblatt hypertension.

We studied postclamp renal artery pressure and renin release in eight conscious dogs with one-kidney Goldblatt hypertension. On normal sodium intake, intrarenal blockade of angiotensin II with Sar1-Ala8-angiotension II (P-113, saralasin acetate) markedly decreased postclamp renal artery pressure and increased renin release during the first 5 days after renal artery constriction. We found that 10-14 days after renal artery constriction, the maintenance of postclamp renal artery pressure and negative feedback on renin release became markedly less dependent on angiotensin II, as shown by almost no change in postclamp renal pressure or renin release with intrarenal blockade of angiotensin II. At this stage of our study the dogs were given a sodium diet of less than 5 mEq/day and we found that within 5-10 days intrarenal blockade of angiotensin II once again markedly decreased postclamp renal artery pressure and increased renin release. These observations support the concept of an angiotensin II-sodium interdependent negative feedback mechanism for renin release.