Descending urethral ultrasound of the native and reconstructed urethra in patients with hypospadias.

A retrospective study, over a 7 year period, examining the use of descending urethral ultrasound in corrected and uncorrected hypospadias was performed. 15 examinations were performed on 14 patients; 12 patients had undergone previous surgery for hypospadias, ranging from urethral reconstruction to stricture dilatation. Eight strictures, four irregular urethras, two normal post-operative urethras and one urethral valve were demonstrated. All the clinically significant abnormalities (those which impaired the flow of urine) demonstrated by ultrasound were confirmed with subsequent urethroscopy or contrast urethrography. This small series illustrates the application of descending urethral ultrasound in patients with hypospadias who are difficult to examine with more conventional radiographic techniques.

An unusual case of renal cell carcinoma with two rare metastases.

It is well known that renal cell carcinoma metastasizes to unusual sites. We report a case in which two rare sites of metastasis, the maxilla and contralateral ureter, appeared in a single patient.

Rectal obstruction secondary to carcinoma of the prostate treated by transanal resection of the prostate.

Rectal obstruction caused by carcinoma of the prostate is uncommon. If the disease does not respond to either hormonal treatment or radiotherapy, the only surgical means of relieving the obstruction has been the formation of a colostomy. We present an alternative treatment, since many of these patients are elderly with a short life expectancy and they may have difficulty coping with a stoma. Seven transanal endoscopic resections of the prostate (TARP) have been performed on 5 patients. The procedure is not without complications, but it does offer simple surgical palliation of the rectal obstruction and obviates the need for a colostomy.

Identifiable factors in post-prostatectomy haemorrhage: the role of aspirin.

Post-operative haemorrhagic complications following the ingestion of aspirin have been reported after several types of surgery, most notably coronary artery bypass surgery. In this study, aspirin ingestion also appeared to be a significant aetiological factor in post-prostatectomy haemorrhage. This is explained in terms of its inhibitory effect on platelet aggregation. A history of aspirin ingestion should be carefully sought and its haemorrhagic implications considered prior to prostatectomy.

Upper urinary tract compliance: its importance in obstructive hydronephrosis.

Improvements in diagnostic modalities over the last 15 years have meant that obstruction can now be diagnosed accurately in dilated upper tracts. However, it is no longer sufficient to diagnose obstruction in a hydronephrotic kidney; it is necessary to determine the likelihood of functional deterioration in that kidney by measuring its elastic distensibility (compliance). 111 pressure flow studies have been reviewed in an attempt to measure the compliance of each upper tract under study and to assess its clinical implications. Good compliance was seen in 64 dynamically unobstructed renal units as well as in 16 obstructed systems. These 16 obstructed systems with good compliance had less significant degrees of obstruction than a group of 31 obstructed systems with poor compliance. Obstruction with good compliance was associated with preservation of renal function as measured by diuresis renography whilst impaired function was seen in systems with obstruction and poor compliance. Systems with good compliance and obstruction may not necessarily need surgery to relieve obstruction but instead could be managed by avoiding a high fluid intake which is liable to produce a pressure rise in the kidney. Poor compliance or functional deterioration are indications for immediate relief of the obstruction.