Pyeloplastic surgery in the presence of suppurative pyelonephritis.

Six out of 135 pyeloplastic operations were performed in the presence of an acute infection. In spite of the inflammatory process the postoperative course was uneventful and the late results were also satisfactory. With the exception of one case, the operation was invariably of the Anderson-Hynes type, with splinting of the ureter and nephrostomy. The anastomosis was prepared with interrupted cat-gut stitches. Three cases are reported in some detail.

Lymphadenectomy in Urology.

Surgical radicality in tumours of the urinary tract with lymphonodular deposits requires extirpation of the adjacent and regional lymphadenoid tissues, in particular of the lymph nodes. The theoretical and practical aspects of lymphadenectomy in testicular and renal tumours are discussed, and the technical problems are outlined. The importance of early diagnosis and the benefits of surgery of adequate radicality involving lymphadenectomy are emphasized.

Problems of the indications of radiotherapy in renal tumours after radical nephrectomy.

The complex therapy of renal tumours is discussed. While pointing to the advances in this field over the last decade, the fact is emphasized that it is primarily in the radicality of the operations were progress has been achieved. Radiotherapy is viewed with a critical eye. Its hazards are illustrated by observations of four lethal cases consecutive to complications of postoperative irradiations, which had been administered without any need when malignant changes were no longer present.

Early and late complications of uretero-enteric anastomosis.

The authors report on early and late complications of uretero-enteric anastomosis. The results of pre- and postoperative US evaluations in 67 patients with urinary diversion using isolated bowel segment are reviewed. Ultrasonography (US) is the first method of choice in recognizing postoperative complications. Authors observed 5 early and 5 late complications directly related to the uretero-enteric anastomosis operation. Possible treatment modalities and the role of US guided nephrostomy are discussed.

[Surgical management of masculine trassexualism]. / Transsexualismus masculinus mütéte.

The authors report on the first Hungarian case of sex-transforming operation. They present details of the social history and management of their case leading up the decision for surgery. Preoperative assessment and medication, operation technique and postoperative care are also described in detail. The case report highlights the difficult ethical and legal issues which have to be considered when such surgery is requested. Following a series of in-depth psychological, gynaecological, urological and forensic consultations that had been carried out in order to be convinced about the patients's determination for undergoing sex-transforming operation, the authors were granted legal and professional license by the Hungarian Medical Research Council to carry out the procedure. Two years after the operation, the patient commented on her full satisfaction with the care he had received.

[Ultrasonic examination of the penis]. / A hímvesszö ultrahangvizsgálata.

Authors describe their experiences with penile ultrasonography. US was very useful in diagnostics of urethral strictures, urethral stones, Peyronie's plaques and for control of corpora cavernosa during papaverine induced erection. Application of ultrasonography for such purposes is very rare as yet, and the international literature referring to this is not very numerous either. According to authors' knowledge, this is the first paper in Hungarian dealing with this topic.

[In utero creation of a reno-amniotic shunt for the preservation of a hydronephrotic fetal kidney]. / Hydronephrotikus magzati vese megmentése in utero renoamnialis shunt alkalmazásával.

The authors wish to discuss the successful decompression treatment of a serious, fast progressing one-sided hydronephrotic fetal kidney (that also caused deformation of abdominal and thoracic organs) in a 29th week pregnancy. Under the guidance of ultrasonography they created a permanent link between the amniotic cavity in the uterus and the pelvis of the kidney. As a final solution a pyelo-ureteral anastomosis operation was performed on the newborn that was delivered on the 37th gestational week. The baby is 11 months old at the moment and both of her two kidneys are functioning perfectly.

[Bladder repair using an ileocecal segment]. / Hólyagpótlás kirekesztett coecum-ileumból.

Subtotal cystectomy and bladder replacement from shorted-out ileocecal segment as well as uretero-ileostomy was carried out in a 25-year-old woman because of a contracted urinary bladder, consequence of a developmental disorder, i.e. colonic-type mucous membrane of the bladder. The patient is continent passes urine every 3-4 hours without residuum.

[Combined therapy of malignant testicular tumors]. / A rosszindulatú heredaganatok komplex kezelése.

The 5-year survival of patients with malignant testicular tumors rose during the past 25 years from 10-25% depending on stage to 55-100% after radical castration performed from high inguinal opening, retroperitoneal lymphadenectomy, ultra-tension irradiation and adjuvant chemotherapy. It is stressed that patients diagnosed at stage T1-2, N0-2, M0 may even recover perfectly upon complex therapy. Three to five-year long or even longer survival may be reached with 50% of the patients at the stage T1-3, N1-3, M1. Patients at stage T4, N3-4, M1 die because of the recurrence of the tumor and/or the complication of the adjuvant treatment within 1-3 years and even the interdisciplinary work which is very effective in other stages fails to change this at the present time.

Suprapubic transvesical puncture and sclerotization of a müllerian duct cyst under US guidance.

Abdominal, ultrasonography (US) performed on a middle-aged patient who presented with partial urinary retention, long lasting lower back pain, and abdominal pain revealed a cyst in the midline of the prostate. The cyst, which protruded into the bladder, was punctured under US guidance transvesically and sclerotized with 1% Aethoxysklerol. Following this procedure, the patient became steadily free of his complaints and is voiding without retention.

[Vesico-ureteral reflux in childhood]. / Vesikoureteraler Reflux im Kindesalter.

After having reviewed the anatomy and physiology of vesicoureteral reflux, the authors claim that in the case of appropriate indication and technique of the operation good results can be expected of plastic surgery. They stress that the indications of the operations for obstructed reflux have considerably narrowed. Conservative treatment beside long-term disinfection of the urine and removal of the focus results in the majority of cases--mainly when the patients are small children--, in the abolishment of vesico-ureteral reflux. In about 50% of the discovered refluxes surgical intervention is necessary, but also in these cases the administration of antibiotics is indispensable.