Left hydronephrosis caused by Crohn disease successfully treated conservatively.

We report the case of a 35-year-old man who presented with fever, diarrhea, and a left abdominal mass. Diagnostic studies confirmed Crohn disease and revealed an abdominal mass obstructing the left ureter with hydroureter and hydronephrosis. The patient was successfully treated conservatively, with corticosteroids and mesalamine, A review of the literature indicates a predominance of right ureteral involvement in Crohn disease, associated with a high incidence of ileocecal disease. Most of these patients were treated surgically, with resection of ileocecal lesion and/or ureterolysis. Ureteral obstruction as a complication of Crohn disease is discussed, with emphasis on conservative treatment.

[Disintegration of urinary stones].

Since January 1988 we performed 520 extracorporeal lithotripsy procedures for urinary stones with the EDAP LT-01 device. The calculi were localized by ultrasonography and the destructive energy was piezoelectrically generated. Treatment was on an ambulatory basis, without local, regional or general anesthesia. In less than 10% of the patients oral analgetics were given prior to, or during the procedure. Ages ranged from 3-79 years and the mean duration of treatment was 45 minutes. Of the first 210 patients, 148 (70.6%) were free of stones after 3 months, in 28 (13.3%) there was only partial success, and in 34 (16.1%) the treatment failed. It must be emphasized that some have not as yet been followed for as long as 3 months. Hematuria of a few hours duration, and renal colic amenable to oral treatment in 25% of the cases, were the only complications. 4 patients were hospitalized for renal colic, but more because of mental unrest than medical necessity.

A müllerian prostatic cyst protruding into the base of the urinary bladder.

The unique appearance of a midline prostatic cyst is reported. The cyst presented as a round-shaped filling defect at the base of the urinary bladder during an intravenous pyelography study. Transabdominal sonography showed the mass to be a midline prostatic cyst. The sonographic features of the mass and its location are the hallmark of a müllerian duct prostatic cyst. Midline prostatic cysts are discussed and the features differentiating müllerian duct cysts from utricle cysts are emphasized.

Effect of distilled water and bacillus Calmette-Guérin on exfoliated bladder tumor cells.

The effect of distilled water on exfoliated tumor cells from transitional bladder carcinoma was compared to the effect of bacillus Calmette-Guérin (BCG; a nonspecific immunotherapeutic agent) dissolved in either saline or distilled water. The experiment was controlled by comparison to the effect of saline on tumor cells under the same conditions. Distilled water proved as effective as BCG in distilled water (p less than 0.001) and much more destructive than BCG in saline within the 2-hour time limit of the experiment (p less than 0.001).

Metastatic malignant melanoma of the kidney. Case report and review of the literature.

A rare case of malignant melanoma metastasizing to the kidney is described. Five other cases were found in the English literature, this being the sixth. A review of the subject is brought up.

An operation for incisional lumbar hernia.

To date, no standard technique for incisional lumbar hernia repair can be recommended since it depends on the size of the defect in the transversalis fascia. A new technique for this purpose, by using plication of the normal fascia, is described.

Lymphangioma of bladder.

We report the first case of a lymphangioma arising from the wall of the bladder, protruding into the lumen on 1 side and invading the peritoneal cavity on the other side. The presenting sign was painless macroscopic hematuria that had occurred initially 2 months before hospitalization. Treatment consisted of partial cystectomy. A review of the literature failed to reveal a report of an identical case.

Prostatic gland damage: a possible complication of bladder neck Y-V-plasty.

A case of primary ejaculatory failure due to prostatic damage in a 23-year-old patient is presented. This occurred secondary to Y-V operation of the bladder neck which was performed 19 years earlier. To our knowledge, this complication has not been described previously.

Urethro-thigh fistula. Report of 2 cases.

Two rare cases of urethro-thigh fistula are described. Both of them occurred following pelvic trauma. We suggest that trauma, hematoma and infection, suppuration, are the etiology for the development of fistula from a torn urethra to the thigh. A review of the English literature failed to reveal other cases of such an unusual complication.

Pitfalls in the treatment of urological injuries.

'Pitfall' is a trap made by digging a hole in the ground and concealing its opening, and any danger or difficulty that is not easily anticipated or avoided. It is our intention in this article to point out the traps, dangers and difficulties involved in our treatment of three urological injuries. It is clear that the pitfalls are due to the inexact interpretation of parameters used.

Lich-Gregoir anti-reflux operation: a surgical experience and 5-20 years of follow-up in 149 ureters.

The surgical management of vesicoureteral reflux and the choice between the many good procedures available continue to be debated by urologists. The goal of each procedure is to achieve as normal a function of the urinary system as possible, to eliminate urinary tract infections, and thus to prevent further kidney damage. We present our experience in 149 antireflux repair operations with a technique first described by Lich and Gregoir in 1961. The follow-up in this study is 5-20 years, throughout which recurrent infections, reflux and other operative complications have carefully been considered. The success rate of this operation was 92.5%, with an additional 3.75% success in repair operations. Discussion and evaluation of other repair methods are reviewed but, in our opinion the Lich-Gregoir technique, because of its simplicity, should be the method of choice and should be used more by urologists.

Primary giant calculus in urethral diverticulum.

Urethral stone is a rare clinical entity and usually encountered in men with urethral stricture or diverticulum. They are exceedingly rare in females secondary to the low incidence of vesical calculi and short urethra. We report a very rare case of a primary giant calculus in a urethral diverticulum of a female.