Continent urinary diversion using an ileal servomechanism sphincter.

A continent, catheterizable, physiologically responsive urinary sphincter servomechanism can be created from a short segment of ileum for use in a continent urinary diversion. Because it is easily constructed and provides dynamic continence control, this new sphincter appears to have applications in reconstructive urologic surgery.

Computed tomography of primary transitional cell carcinoma of upper urinary tracts.

Preoperative computed tomography (CT) was utilized to evaluate 20 patients with primary transitional cell carcinoma of the upper urinary tracts. Of the 20 patients, 18 (90%) had CT visualization of the tumor as either a discrete mass or local ureteral and/or renal pelvic wall thickening; 2 (10%) had false-negative examinations. Seven of the 20 patients (35%) had CT evidence of tumor extension demonstrated by frank tumor invasion beyond the urothelium or by perirenal pelvic and/or periureteral fat streaks. Of the 4 patients with fat streaks, 2 (50%) had superficial tumors (T(A)T2), 1 had a T1 (25%) tumor, and 1 had a T3 (25%) tumor. All 3 patients with CT findings of direct extension of tumor through the wall of the ureter or renal pelvis had T3 tumors. Among the 13 with localized noninvasive tumor on CT, 5 (38%) had superficial tumors (TA, TIS, T1), 5 (38%) had T2 tumors, and 3 (21%) had T3 tumors. Of the 5 patients with enlarged regional lymph nodes (greater than or equal to 1.5 cm) on CT, 2 had tumor confirmed histologically, 2 had subsequent negative CT-guided biopsies, and 1 had a negative lymphadenectomy. Distant metastasis was discovered in 1 patient. The data suggest that when CT demonstrates direct tumor extension through the renal pelvic or ureteral wall, it is a sensitive indicator of high-stage disease. However, in the absence of this finding, CT is of limited value in staging patients with primary transitional cell carcinoma of the pyeloureteral system.

Clinical and urodynamic features of a new intestinal urinary sphincter for continent urinary diversion.

We describe a new sphincter mechanism and its clinical application in 11 patients requiring continent diversion. The sphincter, composed of 2 short segments of ileum, is urodynamically responsive and actually increases its resistance to leakage when reservoir pressure or volume increases. Because of this dynamic continence control and its ease of construction, it appears to be a useful addition to the reconstructive urological armamentarium.

ESWL treatment of urinary calculi.

A total of 711 patients with symptomatic upper and lower urinary tract calculi underwent extracorporeal shock-wave lithotripsy (ESWL) at the Ohio Kidney Stone Center during the first six months. At follow-up 84 percent of the first 180 patients are stone-free. Retreatment was required for 2.8 percent of the patients with residual stone material. Thirty-seven percent of the treatments required cystoscopy with ureteral stent placement for manipulation of stones or delineation of distal ureteral anatomy to facilitate ESWL. Complications were minimal at less than 3 percent.

Rectal perforation as a complication of urethral instrumentation: 2 case reports.

A review of the complications of urethral instrumentation performed at our institution during the last 15 years revealed 2 cases of urethrorectal perforation. These patients were managed with loop colostomy and suprapubic cystostomy diversion with excellent healing and no evidence of fistula formation at 24-month followup. This rare complication is described and the principles of diagnosis, prevention and prompt aggressive management are emphasized.

Ureteric obstruction secondary to endometriosis. Report of three cases with a review of the literature.

Three cases of endometriosis are presented. In one patient bilateral obstruction was noted; in a second patient bilaterally enlarged kidneys with unilateral obstruction were found and in the third patient only unilateral obstruction was defined. Intrinsic ureteric obstruction and bilateral obstruction, both rare findings, are described in this report. The diagnosis, evaluation and management of these patients are discussed.

Penile necrosis secondary to an indwelling Foley catheter.

Penile necrosis is a rare entity but it may be brought about more readily if certain risk factors are present. Such factors are discussed in this paper and the reader is forewarned about this problem.

Extracorporeal shock wave lithotripsy (ESWL).

There hundred sixteen patients with symptomatic upper and lower urinary tract calculi underwent extracorporeal shock wave lithotripsy (ESWL) at the Ohio Kidney Stone Center during the first three months. Ninety-seven percent of the stones were treated with one ESWL session. Twenty-four percent of the treatments required cystoscopy with ureteral stent placement for manipulation of stones to facilitate ESWL. Complications were minimal, less than three percent.

Dissemination of carcinoma: unusual complication of percutaneous nephrostomy.

Percutaneous nephrostomy is a safe and highly effective means of urinary diversion. We report a case of unusual complications: severe peritonitis and massive intraperitoneal dissemination of carcinoma.

Complete ureteral triplication with ectopia.

A case of complete ureteral triplication is reported and a brief review of the literature is presented.

Mitomycin-C induced improvement in superficial bladder tumors: a morphologic and immunohistochemical evaluation.

Twenty bladder biopsies from ten patients with superficial transitional cell carcinoma were obtained prior to and following therapy with intravesical mitomycin-C. Each biopsy was evaluated histologically and immunohistochemically for A, B, H blood group antigen (BGA) expression. A, B and H blood group antigens were identified using monoclonal anti-A, B and H antibody and were localized with the avidin-biotin-peroxidase complex (ABC) technique. Particular attention was directed toward flat urothelial lesions and the urothelium adjacent to papillary tumors. Routine histologic evaluation showed improvement in post-therapy biopsies compared to corresponding pre-therapy biopsies in 7/10 cases but was equivocal in 3/10 cases. Immunohistochemical evaluation, however, showed improvement in all 10 cases, as judged by increased urothelial BGA expression. This increase in urothelial BGA expression after intravesical mitomycin-C therapy suggests a therapy induced improvement in dysplastic urothelium which was not uniformly evident on routine histologic examination.

Pelvic lipomatosis: 9-year followup in a woman.

Pelvic lipomatosis is uncommon in female subjects. The symptoms and signs are vague in all patients but radiologic studies, especially pelvic computerized tomography, should provide data for the diagnosis and obviate operative intervention. All patients should have careful followup to rule out obstructive uropathy.

Carcinoma in a colon conduit urinary diversion.

In recent years urinary diversion by means of the colon conduit has gained popularity because of the failure to exhibit reflux and the lower incidence of stomal stenosis. However, colon conduit diversion may be associated with adenocarcinoma, as is ureterosigmoidostomy. We report the first occurrence of adenocarcinoma in a colon conduit and, perhaps more important, in a colon conduit in which there had never been a fecal stream.

Results in children managed by cutaneous ureterostomy.

A review of 59 children with severe hydronephrosis managed by cutaneous ureterostomy reveals that the procedure is safe, quick, and effective in draining the kidney. Although chronic bacteriuria is common, pyelonephritis is rare. The major drawback of this technique for temporary urinary diversion in children is that the subsequent urinary reconstruction is formidable and more difficult than primary repair. The complications of urinary diversion using this technique are low, however, and it may remain the safest form of diversion available for long-term use in children with dilated ureters.

Significance of impaired penile tumescence and associated polysomnographic abnormalities in the impotent patient.

Of 15 consecutive patients with secondary impotence 7 (46 per cent) had varied degrees of abnormal nocturnal penile tumescence and 1 or more of the following sleep-associated events: frequent apnea and hypoventilation, myoclonus and a slow but remarkably stable heart rate even during episodes of respiratory impairment. All nocturnal penile tumescence measurements, except circumference change at the glans, were significantly lower than in patients with psychogenic impotence or normal subjects. These findings, not described previously, suggest probable central nervous system etiology of organic impotence in some patients. Skilled nocturnal penile tumescence assessment in conjunction with a comprehensive polysomnographic study is an essential diagnostic procedure in the evaluation of the impotent patient.