The use of standard imaging techniques and their diagnostic value in the workup of renal colic in the setting of intractable flank pain.

OBJECTIVES: This study reviews the rate at which diagnostic imaging techniques are used in patients with intractable flank pain attributed to renal colic who are admitted to the hospital through the emergency room and determines the diagnostic values of plain film of the abdomen {kidney, ureter, bladder [KUB]} and of ultrasonography (US) of the urinary tract, using intravenous urography (IVU) as the gold standard for establishing the presence of a calculus. METHODS: We reviewed the medical records of 288 patients who were admitted to our medical center over a period of 5 consecutive years for intractable flank pain, the admission and working diagnosis in all cases being that of renal colic, and we retrieved all data pertaining to their diagnostic evaluation. RESULTS: A total of 265 patients (92%) were subjected to KUB, 158 (55%) to IVU, and 135 (45%) to US of the renal-urinary tract. Two diagnostic imaging techniques were used in the same patient in the following combinations: KUB and IVU in 146 patients (51%), KUB and US in 110 (38%), and IVU and US in 60 (21%). Three imaging techniques (IVU, KUB, and US) were utilized in 54 patients (19%). The sensitivity and specificity of KUB alone were 95% and 65%, respectively, and the positive and negative predictive values were 82% and 88%. The sensitivity of US alone was 93%, its specificity 83%, the positive predictive value 93%, and the negative predictive value 83%. The sensitivity of combined KUB and US (requiring both tests to be positive for diagnosing the presence of a calculus) was 89%, the specificity 100%, the positive predictive value 100%, and the negative predictive value 81%. CONCLUSIONS: Our data indicate that combining US with KUB provides the best diagnostic algorithm that approaches the yield of IVU in excluding the presence of a calculus in the renal-urinary tract in patients who present with intractable flank pain.

[Traumatic fracture of the corpus cavernosum with urethral rupture].

Traumatic fracture of the corpus cavernosum with urethral rupture occurs rarely, mostly during intercourse. About 200 cases have been published. Some reports favor conservative treatment, but lately it has been shown that this results in longer hospitalization and to late complications in 29%. Cavernography should be used in the equivocal cases without hematuria or signs of fracture. We present a case of fracture of the corpus cavernosum and tear in the urethra. Treatment consisted of surgical repair of the tunica albuginea and stenting of the urethra. Long term results were excellent.

Protease and plasminogen activator activity in human bladder carcinoma.

The ability of human bladder tissue extracts to cleave 14C-labelled globin in the absence and in the presence of plasminogen was assayed to quantify non-specific protease and plasminogen activator (PA) activity, respectively. In normal human bladder tissue the non-specific protease activity was approximately 2-fold higher than in tissue samples obtained from transitional cell carcinoma of the bladder (TCC). In contrast, PA activity was almost 4-fold higher in TCC than in normal transition cell epithelium. Acid-treated urine from 19 patients with TCC of the bladder exhibited significantly higher levels of plasminogen activator activity than similarly treated urine from controls. These results indicate that malignant transformation of the bladder epithelial tissue results in elevated levels of PA in the tissue and in urine. Further studies are needed to assess the potential of PA determination in the management of bladder cancer patients.

Incidence and pattern of bladder tumor recurrence following combined suprapubic prostatectomy and excision of a bladder tumor.

We studied retrospectively 36 patients who had undergone combined suprapubic transvesical prostatectomy for benign prostatic hypertrophy (BPH) and excision of a simultaneous bladder tumor. The follow-up period ranged from 1 to 7 years (average 3 years) and included periodic cystoscopy and voided urine cytology. Thirteen recurrences out of 60 (21.7%) occurred at the bladder neck, in 8 out of 23 patients (34.8%) with recurrent tumors. We relate the high recurrence rate located at the bladder neck to the concurrent prostatectomy. We conclude that combined surgery for BPH and bladder tumor is not recommended since it predisposes the bladder neck to tumor implantation at surgery.

Modification of the penile block.

Penile block is a recommended technique for circumcision in adults. The classic technique for performing this block fails to produce satisfactory analgesia in many cases, and pain sensation in the region of the prepuce persists. We propose a modified technique of penile block with the addition of infiltration of local anesthetic along the raphe of the penis up to the prepuce. In 30 patients (group 1), circumcision was performed with the classic technique of penile block, and in 100 patients (group 2) the modified technique was used. The frequency and intensity of pain during the operation were significantly higher in group 1, whereas patients in group 2 were practically pain-free. The discomfort experienced during performance of the block and in the postoperative period was equal in the two groups. We recommend this modified technique of penile block for circumcision in adults.