Permanent open shunt as a reason for impotence or reduced potency after surgical treatment of priapism in 26 patients.

A permanent open shunt as a cause of impotence or impaired potency after a shunt operation for priapism is an unusual situation. In this series we studied the persistence of an open shunt in 26 patients who had developed impotence or impaired potency after operative treatment for priapism. All patients had been examined by cavernosography on the suspicion of an open shunt, giving a positive finding in five of 26 cases, in all of which impotence was cured by closure of the shunt. In five patients without a permanent open shunt potency returned to normal only after 6-12 months.

Surgical treatment of ureteric obstruction in idiopathic retroperitoneal fibrosis.

Thirteen patients who received surgical treatment for histologically proven retroperitoneal fibrosis were reviewed retrospectively. All patients had idiopathic disease, bilateral in 11 patients. Elevated ESR occurred in 12 patients and in eight patients the hemoglobin value was decreased preoperatively. Intravenous urography on admission was normal in six kidneys, excretion was delayed in four kidneys and another four upper urinary tracts were dilated. No excretion was seen in four kidneys and eight kidneys were not examined urographically because of uremia. Ureteric obstruction was treated surgically by ureterolysis alone in two ureters, by ureterolysis and lateral displacement in eight ureters, by ureterolysis and intraperitonealization in 12 ureters and by ureterolysis and omental wrapping in two ureters. After primary surgery one nephrectomy was performed because of a nonfunctioning kidney. Postoperatively 19 kidneys are functioning well, in three the function is poor and there is no function in three kidneys. According to our experience the cornerstone of the surgical treatment is complete and extensive ureterolysis and permanent displacement of the ureter from the area of fibrosis.

Bladder outlet surgery in men with spinal cord injury.

The effect of bladder outlet surgery on voiding ability, changes in the upper urinary tract and urinary infections was studied in 51 men with spinal cord injury. In 24 patients reoperation was required after varying periods of time to achieve satisfactory bladder voiding. Eight of the 22 men who had undergone external sphincterotomy had constant dribbling of urine postoperatively. Dilation of the upper urinary tract was completely reversed or reduced in 13 of 18 patients following the primary operation on the bladder outlet. Vesico-ureteric reflux was found in 6 of the 8 men in whom deterioration of the upper urinary tract persisted after the initial operation or appeared during the follow-up years. Bacteriuria usually persisted, despite bladder outlet surgery, but febrile attacks of urinary tract infection ceased or became less frequent in 15 of the 22 patients who had experienced such episodes preoperatively.

The occurrence of vasculitis in perianeurysmal fibrosis.

The histological findings of retroperitoneal fibrosis in 17 operated patients are described. Of these patients 6 showed a simultaneous aneurysm of the abdominal aorta verified either by computerized tomography, ultrasound, arteriography or during an operation. Of the patients 14 were operated on primarily because of ureteral obstruction, 2 because of aortic aneurysm and 1 because of rupture of the abdominal aorta. Advanced fibrosis with varying amounts of inflammation was detected in all 17 patients. The same histological pattern was present in patients with aneurysm of the abdominal aorta and in those without aneurysm. Accompanying vasculitis with destruction of the vascular wall was noted in 8 patients, including 6 with an abdominal aortic aneurysm. In 3 patients who underwent aneurysm resection as well as in 1 patient with aortic rupture the process extended into the aortic wall. The only patient with vasculitis and no aortic process suffers from severe rheumatoid arthritis. On the basis of the different histological findings we suggest that retroperitoneal fibrosis with vasculitis and aneurysm may represent a distinct pathological entity.

Priapism, its incidence and seasonal distribution in Finland.

Priapism is regarded as an uncommon disease in white populations, although no previous research has been done into its incidence in a certain geographical area. All cases of priapism in Finland during the years 1975-90 are reviewed here. Its incidence varied from 0.34 to 0.52/100,000 males per year, being very stable during the whole period of 16 years, when cases due to intracorporeal injections for treatment of impotence are excluded. Typical patients were 40-50 years old, and the incidence was higher in the eastern part of the country. Most cases of priapism were seen during the lighter half of the year, between March and August (65%). The use of intracorporeally injected vasoactive drugs for impotence increased the incidence more than two-fold.

Diagnosis and treatment of patients with renal trauma.

In this selective study, 59% of the patients had a renal injury (laceration, rupture or pedicle injury). A normal IVU excluded significant renal injury after blunt trauma. Renal angiography was more accurate than ultrasonography or computed tomography in determining the extent of the injury. A retroperitoneal haematoma found during laparotomy should be explored if significant renal trauma cannot be excluded. Renal salvage after rupture or pedicle injury should be attempted in stable patients.

Preservation of potency after treatment for priapism.

Impotence is the most serious complication of priapism. In order to study its incidence and risk factors, the final outcomes of 124 cases of priapism in previously potent patients were analyzed and correlated with the duration of symptoms, age of the patients, aetiology and modality of treatment. Thirty-nine per cent of the patients became impotent. The duration of symptoms before treatment correlated markedly with the risk of impotence, in that 92% of those whose priapism had lasted less than 24 h remained potent but only 22% of those for whom it had lasted longer than 7 days. The younger the patients the better the prognosis, so that 88% of those younger than 30 years preserved their potency but only 40% of those older than 50 years. The prognosis was poorest when heparin therapy or a combination of alcohol drinking and psychopharmaceuticals was the aetiological factor behind priapism. Only 31% of patients preserved their potency after conservative treatment for priapism, whereas 69% of those treated with small glandocorporeal shunts did so. Priapism is an emergency state, in which immediate procedures are necessary to ensure detumescence as soon as possible. If puncture with lavation and intracorporeal injection of alpha-sympathomimetics does not restore detumescence, small glandocorporeal shunts should be performed.

Role of magnetic resonance imaging in blunt renal parenchymal trauma.

The accuracy of magnetic resonance imaging (MRI) in the evaluation of blunt renal parenchymal trauma was compared with that of contrast-enhanced computed tomography (CT) and ultrasonography (US) in a prospective study of 12 patients. CT was superior to other methods in identifying and characterising the renal parenchymal lesion, and both CT and US exceeded low field MRI in recognising a perirenal fluid collection. The role of high field MRI in the evaluation of blunt renal trauma requires further study.

Diagnostic difficulties in oncocyte-containing renal carcinoma.

Two cases of renal tumor presenting diagnostic difficulties are reported. In one case, fine-needle aspiration biopsy from a large neoplasm yielded only oncocytes, but histologic examination showed also islets of renal cell carcinoma. The tumor caused pain, and computed tomography demonstrated inhomogeneity of its inner composition. In the second case there was a silent, small neoplasm, and both cytologic and histologic specimens showed a mosaic pattern of renal cell carcinoma and oncocytes. The diagnostic difficulties are discussed on the basis of these two cases and reports in the literature.