Chromosomal anomaly and malformation syndrome with abdominal polyorchidism.

We describe a neonate who presented with multiple severe malformations including polyorchidism. To our knowledge this is the second case reported with ipsilateral testes located intra-abdominally. Chromosomal studies in cases of polyorchidism have been reported previously only once and the patient exhibited a normal karyotype. Our patient had a chromosome 21 long arm deletion. Interestingly, a trisomy 21 patient has been reported with agonadism. We suggest that genes on chromosome 21 may have some role in gonadal development.

Surgical management of long urethral strictures.

A total of 25 patients with a long urethral stricture involving the bulbomembranoprostatic urethra underwent excision of the afflicted region via the perineal approach with end-to-end anastomosis. Liberation of the distal urethra provided sufficient length for anastomosis without tension of the healthy urethra. Satisfactory results were obtained in 23 of the 25 patients without any functional disturbance of sphincter control.

Sports hematuria.

Strenuous exercise makes extraordinary demands. The transition from rest to intensive physical activity can cause pathological changes in various organs, particularly in the urinary tract. Hematuria (microscopic or macroscopic) is one of the abnormalities commonly found after sports activity. This phenomenon can occur in noncontact sports (such as rowing, running and swimming) as well as in contact sports (boxing, football and so forth). The pathophysiology can be either traumatic or nontraumatic. Renal trauma and/or bladder injury due to repeated impact of the posterior bladder wall against the bladder base can cause vascular lesions and consequently hematuria. There are 2 mechanisms of nontraumatic injury. 1) Vasoconstriction of the splanchnic and renal vessels occurs during exercise in order that blood can be redistributed to the contracting skeletal muscles, thus causing hypoxic damage to the nephron. This results in increased glomerular permeability which would favor increased excretion of erythrocytes and protein into the urine. 2) A relatively more marked constriction of the efferent glomerular arterioli results in an increased filtration pressure, which favors increased excretion of protein and red blood cells into the urine. It must be noted that sports hematuria differs from other conditions that may cause reddish discoloration of the urine due to physical exercise, such as march hemoglobinuria and exercise myoglobinuria. In the latter 2 abnormalities there is excretion of hemoglobin and myoglobin molecules in the urine and not whole blood or intact red blood cells. Sports hematuria usually has a benign self-limited course. However, coexisting urinary tract pathological conditions should be excluded carefully.

Combined retropubic prostatectomy and preperitoneal inguinal herniorrhaphy.

Inguinal hernia and an enlarged prostate causing urinary obstruction are 2 disorders with a higher frequency among elderly patients. The anatomical proximity of an inguinal hernia to the enlarged prostate raises the possibility of joint, concurrent surgical treatment of both disorders. We report on the successful preperitoneal repair via a Pfannenstiel incision of 131 inguinal hernias in 97 patients who had undergone retropubic prostatectomy owing to benign enlargement of the prostate. Followup averaged 7 years and included 91 patients with 122 direct and indirect, unilateral or bilateral hernias. Summation of our results shows a low recurrence rate (4.9 per cent) and no complications in the wake of the combined operation. In our opinion prostatectomy combined concurrently with inguinal hernia repair via a preperitoneal retropubic approach should be applied routinely in urological practice.

Liver granulomas: a possible paraneoplastic manifestation of hypernephroma.

A patient with hypernephroma presented with signs of liver dysfunction. Liver biopsy disclosed the presence of granulomas. Extensive search for a known cause of hepatic granulomas was negative. The presence of granulomas in lymph nodes draining the neoplasm, the improvement of liver dysfunction after nephrectomy, and its aggravation preceding overt metastatic manifestation support the existence of a cause and effect relationship between the renal cell carcinoma and the liver granulomatous disease.

Evoked response studies in detrusor hyperreflexia due to infravesical obstruction in neurological patients.

Urodynamic evaluation was performed on 80 patients with urological disorders identified as benign prostatic hypertrophy whose main complaints ranged from irritation to urine loss owing to urgency. Detrusor hyperreflexia was detected in 40 patients, of whom 24 were operated on either by the transurethral or the retropubic approach. At repeat urodynamic evaluation about 1 year postoperatively function had returned to normal in 14 patients and the hyperreflexia persisted in 10. The preoperative evoked response in these latter 10 patients was less than 60 msec. It is possible that apart from the diagnosis of detrusor hyperreflexia by cystometric examination in patients with benign prostatic hypertrophy an abbreviated evoked response could indicate deterioration in neural function with or without an accompanying neurological disease. If this is the cause of detrusor hyperreflexia then prostatectomy will not ameliorate the condition but can only subject the patient to the risk of urine loss.

Hypercalcemia associated with transitional cell carcinoma without bone metastases: description of two cases.

Two cases of hypercalcemia associated with transitional cell carcinoma and negative bone scan are described. In both cases hypercalcemia appeared while there was evidence of tumor spread. Although hypercalcemia was controlled, both patients died shortly thereafter. Hypercalcemia rarely occurs in transitional cell carcinoma and its appearance may suggest spreading of the tumor and poor prognosis.

Megacalycosis.

Megacalycosis is a primary disease of the renal calyx which is diagnosed usually because of its complications, such as calculi or infections in the urinary tract. In the absence of complications, the disease is discovered accidentally in the course of urologic examination undertaken for a different reason. The present article reports 4 cases of megacalycosis: one with histologic confirmation in addition to radiologic diagnostic criteria and 3 with diagnosis based on radiologic findings alone. Alertness to the possible existence of megacalycosis in patients suffering from infections and calculi in the urinary tract contributes to and facilitates choice of appropriate treatment.

[Diagnosis and surgical treatment of female urinary stress incontinence]. / Diagnostic et traitement chirurgical de l'incontinence urinaire d'effort chez la femme.

A total of 100 female patients with putative urinary stress incontinence (USI) were surveyed by us. Of these, 27 patients with genuine USI underwent urologic, uroradiologic and urodynamic evaluations before and after their corrective surgery by the technique of Burch. The results of the surgery were assessed clinically and subjectively and compared to the data obtained from postoperative urodynamic analysis. The operation affected significantly the urethral closure pressure and the posterior angle between the urethra and the base of the bladder, bringing about marked clinical improvement in most of the patients. Thus 89.5% of operated patients were cured, while elevated urethral closure pressure was proven in the majority of cases and radiologic examinations showed correction of the anatomic fault in 82% of the women undergoing surgery. Correct diagnosis is the most important antecedent of treatment in female urinary stress incontinence. Any surgical approach which affixes the neck of the bladder and the posterior part of the urethra to a stable support is sufficient to effect correction of the condition, provided the incontinence stems from a weakness in the closure mechanism of the urethra and not from some other cause.

Congenital polyp of the prostatic urethra.

Congenital polyp of the urethra is a rare cause of urine retention in male patients. Diagnosis is made via cystourethrography and is confirmed by transurethral biopsy. Although the recent literature contains several reports on the use of transurethral resection the preferred surgical procedure yielding the best results is transvesical excision of the polyp.

Early angiography in the management of post-renal biopsy hematuria.

A case is reported in which the value of early angiography in the management of post-renal biopsy hematuria is exemplified. The decision of whether treatment should be conservative or surgical is based on the precise anatomical delineation of the cause of hematuria and the chances of spontaneous remission. When necessary an operation guided by the angiogram can be limited to partial resection of the lesion-bearing region.