Sacral agenesis: why is it so frequently misdiagnosed?

Thirty-four patients with sacral agenesis were seen from 1954 to 1983, cases of meningomyelocele excluded. Five recognizable and consistent patterns of bone malformation were identified. Urodynamic examinations were done in 10 of the 34 patients. Their evaluation and response to treatment are analyzed; we tried to determine and establish the possible causes for its late diagnosis and consequences regarding the upper urinary tract.

Cavernospongiosum shunt in management of priapism: is it a reliable method?

The efficiency of cavernospongiosum shunt in the management of priapism was evaluated in 10 patients. Technical details such as the "Z" perineal incision and the opening followed by closure of the contralateral corpus cavernosum, at the time of corpora evacuation, can improve the local exposure and permits a more complete drainage of the corpus cavernosum, but did not improve our results when they were compared with other techniques for treatment of priapism. Penile flaccidity and preservation of sexual potency occurred in 6 (60%) and 5 (50%) patients, respectively, and no surgical complications were observed. Immediate penile flaccidity and regaining of physiologic erection were, however, not complete even in the successfully treated patients. The cavernospongiosum shunt does not seem to represent the definitive form of treating priapism. New knowledge about mechanisms involved in priapism has to be obtained, in order to improve the approach and the prognosis of this disabling condition.

Pelvic neurilemmoma.

A rare case of benign pelvic neurilemmoma with bladder infiltration and ureteral obstruction is presented. This neurally originated tumor may occur anywhere in the body, but involvement of the urinary tract is rare. Management depends upon location and other clinical findings, and in this case, since complete removal was impossible, urinary derivation was employed as a palliative treatment.

Vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum for advanced germ cell testis tumors: Brazilian experience.

Disseminated germ cell testicular cancer proved to be highly sensitive to platinum-containing chemotherapy regimens. We present data concerning the treatment of advanced seminoma and nonseminomatous tumors in a developing country. We treated 30 patients with advanced germ cell testis tumors with 3 or 4 cycles of vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum. Surgical resection of residual masses was done 30 days after completion of chemotherapy in 18 patients. The histology of the primary tumor was seminoma in 13 patients and nonseminomatous tumors in 17. Toxicity was mild and no treatment-related deaths occurred. All 13 patients (100 per cent) with seminoma and 12 of 17 patients (71 per cent) with nonseminomatous tumors had a complete response to chemotherapy, and 1 of 17 patients was free of disease after a debulking operation and additional chemotherapy. A total of 3 patients with seminoma and 2 with nonseminomatous tumors had recurrences 5 to 8 months after an initial complete response and received additional chemotherapy (VP-16 regimen) with or without radiotherapy. Complete clinical response was achieved in 4 of 5 patients. Median followup was 24 months (range 8 to 38 months) in the 13 patients with seminoma and 28 months (range 9 to 58 months) in those with nonseminomatous tumors, and 13 (100 per cent) and 12 (71 per cent), respectively, are alive without evidence of disease. These data suggest that the protocol of vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum is highly effective and minimally toxic in the treatment of disseminated germ cell testicular cancer, inducing an 83 per cent long-lasting clinical remission. Seminomas seem to be equally or even more sensitive than nonseminomatous tumors to this platinum-containing chemotherapy regimen. Recurrence after initial complete response can be treated successfully with regimens containing VP-16.

Modified meatal advancement and glanuloplasty repair of distal hypospadias.

Meatal advancement with glanuloplasty is indicated in cases of distal hypospadias. The principles of this operation are safe. Incorporation of urethroplasty with meatal advancement and glanuloplasty enables treatment of the more severe cases of distal hypospadias. We have used this modified operative technique in 10 boys with only 1 complication, which probably was related to the wrong choice of urinary diversion.

[Chronic cystitis in a child (author's transl)]. / Cystite chronique chez un enfant.

The authors report an unusual case of pseudo-tumoral cystitis in a young boy also suffering on the same side from a purulent arthritis of the hip with an abscess pointing towards the pelvis and treated by iliac drainage. In contrast to other published cases, it was neither a cystic cystitis nor a glandular cystitis, but a chronic bullous cystitis without any specificity. Prolonged antibiotic treatment achieved the desired aim at the same time as all symptoms and signs of the arthritis of the hip disappeared.

Renal autotransplantation in the treatment of hypertensive disease associated with unilateral renal artery stenosis.

Renal autotransplantation was performed on 15 subjects with renovascular hypertensive disease owing to unilateral renal artery stenosis. Kidney survival was achieved in 14 cases. Followup for a minimum of 6 months showed 50 per cent of the patients to be cured, 28 per cent improved and 22 per cent unchanged according to the criteria described herein. There was an 85 per cent cure rate among a subgroup of patients less than 35 years old, with less than 20 months of hypertension and non-atherosclerotic lesions. Plasma renin assay was not found to be a good prognostic indicator as reported previously. In our hands the method showed only a 70 per cent correlation with the final results. Non-atherosclerotic lesions had a better prognosis.

Steroid therapy in idiopathic retroperitoneal fibrosis: report of two successful cases.

We report 2 patients in whom regression of ureteral obstruction due to recurrent idiopathic retroperitoneal fibrosis was obtained with steroids. Steroids are a valid alternative to surgery in the initial treatment of biopsy-proven benign (idiopathic) retroperitoneal fibrosis.

Varicocele: the value of reflux in the spermatic vein.

Three groups of patients were studied: varicocele with altered spermogram (24 patients), varicocele with normal spermogram (12 patients), and 12 normal individuals. All underwent selective spermatic venography by the Seldinger technique. No statistically significant differences were found as to the presence of spermatic vein reflux in three groups, nor between varicocele patients and controls. It was concluded that reflux per se cannot explain the alterations of spermatogenesis, nor does it have prognostic value in varicocele.

[Female urethral leiomyoma (author's transl)]. / Léiomyome de l'urèthre féminin.

Literature registers 18 cases of female urethral leiomyoma. Three new cases of such pathology are herein described, with symptoms generally recorded in the literature : obstruction. The three patients were successfully treated by transvaginal resection of the tumor. Diagnosis and treatment are simple, while follow up and prognosis are good, according to our cases and those previously described.

Varicocele: relation between anoxia and hypospermatogenesis.

Three groups of patients were analysed: varicocele patients with abnormal seminal fluid (17 cases), variococele and normal sperm (seven cases) and normal males (17 cases). Blood gas was secured in the internal spermatic vein, perpheric vein and femural artery, in an attempt to evaluate the possibility of altered gas content as a cause of spermatogenic depression. No statistical differences were found when we compared the three groups. We concluded that anoxia was not the cause of hypospermatogenesis in varicocele patients.

[Traumatic urethral stenosis in children]. / Estenosis traumáticas de uretra en niños.

A study is made of 20 children suffering from postraumatic, urethral stenosis and they compare the different techniques used in repairing it. Different methods have been proposed but all produce poor results and doubts always arise in a specific case. The stenoses presented in our study occurred at different levels; four in the bulbar urethra and 16 in the membranous urethra. The patients have been divided into four groups, according to the surgical technique applied. The results have been assessed according to the functioning, radiological aspect and the absence or presence of urinary infection. With reference to the functional aspect, 89.5% presented good results, which is greater than those registered in adults. The explanation may lie in the better, local conditions at the time of surgery and the fact that none of these stenoses were of inflammatory origin.

Blood loss during and following transurethral resection.

Blood loss measurement in transurethral prostatic surgery (TUR) has been studied with the following objectives: (1) to measure the total lost volume (during surgery and 48 hours postoperatively); (2) to compare surgical bleeding and coagulogram alterations in benign prostatic hypertrophy (BPH) and prostatic carcinoma (CaP); (3) to establish the relationship between blood loss, duration of the procedure, and amount of resected tissue. The method of Jansen was used to measure blood loss, and the "coagulogram" included the following parameters: hematrocrit; prothrombin, recalcification, thrombin, and partial thromboplastin times; fibrinogen; platelets and fibrin split products. The study is based on TUR performed on 75 patients from whom a mean weight of 25.68 grams was resected resulting in a mean total bleeding volume of 305 ml. Blood loss over 400 ml was associated with surgical durations of 60 minutes or with resection of over 40 grams of tissue. There was a slight tendency for fibrinolysis in prostatic cancer, which could explain the relatively higher amount of blood loss observed in these cases.

Congenital cyst of the seminal vesicle.

A case of congenital cyst of the seminal vesicle in association with an ectopic ureter is presented. The clinical, diagnostic and therapeutic aspects are discussed with special emphasis on the role played by ultrasound and computerized tomography in the evaluation of pelvic pain and painful ejaculation.

[Vesicostomy: a temporary urinary diversion in childhood]. / La vésicostomie: dérivation urinaire temporaire dans l'enfance.

The authors report on 21 pediatric cases of tubeless cystostomies (19 males and 2 females). 15 cases of posterior urethral valves (septic condition and very narrow urethra). 3 primitive vesico-renal refluxes (small bladder, severe impairment of renal function and extensive dilatation of the upper urinary tract). 2 prune-belly syndromes. 1 neurogenic bladder. (Impracticable intermittent catheterization). 19 of the 21 cases showed dramatic improvement (narrowing of the upper urinary tract, disappearance of infection and resumption of staturo-ponderal thrive). Only 1 child with valves had to be put on cutaneous ureterostomy. The improvement in the upper urinary tract, as seen on the IVP, is very rapid in valve cases without reflux. The improvement is visible earlier on isotopic renal scans than on IVP. 11 children suffered acute pyelonephritis during vesicostomy. There were no cases of cutaneous peristomal modification. Simultaneous closure of the derivation and surgery of the primitive disease were performed in 10 cases after a 1-3 year period of vesicostomy. Vesicostomy will succeed in those babies who have shown clinical and biological improvement after a short period of trans-urethral or suprapubic catheterization. The suprapubic endoscopis treatment of the valves becomes possible through the vesicostomy hole excluding urethral trauma.