Paraneoplastic syndrome in squamous cell carcinoma of urinary bladder.

Hypercalcemia with metastatic tumor is a common clinical entity, but without metastasis, hypercalcemia as a manifestation of squamous cell carcinoma of the bladder is rare. We present a case demonstrating immunoreactive parathyroid hormone-like activity in a nonmetastasizing tumor. Hypercalcemia subsided after ablative surgery.

Surgical management of infantile (ectopic) ureteroceles: report of a modified approach.

Since 1970, our experience in managing 22 patients (24 renal units) with infantile (ectopic) ureteroceles suggests that no single procedure is universally applicable. Certain general principles, however, guide management strategy. First, preservation of the upper pole moiety is successful if there is functioning renal parenchyma on IVP (9 cases with one failure). Second, when extirpation is required, total ureterectomy-ureterocelectomy is unnecessary (13 cases with no reoperations specifically for stump extirpation). Third, urinary tract infections are fairly common in the first postoperative year (4 of 16 patients), being more common in children with common sheath ("double barrel") reimplantations. This review of our experience often showed the primary procedure to be long and difficult with significant blood loss. Although it did not occur in this series, devascularization of the lower pole ureter remains a danger. Therefore, a two-stage procedure was developed to obviate these problems. In the last 4 patients (5 renal units) in this series, the ureteroceles were first incised endoscopically. Six weeks later, reimplantation or upper pole nephrectomy-partial ureterectomy was performed. Adequate early decompression of the ureterocele resulted in less operative time and blood loss (average 27.5 cc for upper pole nephrectomy) at the subsequent procedure. We now prefer this method, especially in very young or compromised patients, although the follow-up time is inadequate to recommend it generally.

Fascial pathways of extravasation of blood in lower abdomen following angiography-anatomic and clinical correlation.

The extravasation of urine following traumatic rupture of the urethra or periurethral abscess is well known to clinicians. The extravasation of blood following angiography, in the same anatomical space, is rare. Extravasation of fluids in the lower abdomen, groin and external genitalia follows distinct anatomical pathways. This case illustrates the anatomical pathways and emphasizes their clinical importance.

Metastases to the penis from renal cell carcinoma.

Extensive venous communication among the pelvic, lumbar, penile and left renal veins may cause metastasis to the genitalia from left renal adenocarcinoma. To prevent this, we propose that during radical nephrectomy the spermatic and, lumbar veins be ligated immediately following the ligation of the renal artery and vein.

Delayed urinary fistula following abdominal perineal resection of rectum and anal canal.

Genitourinary dysfunction is one of the major complications of abdominal perineal resection. The onset may be in the remote postoperative period. We report a rare case of late perineal urinary fistula and pelvic urinoma which occurred 3 months following surgery.

Volvulus of cecum following simple nephrectomy.

We report a case of intestinal obstruction secondary to cecal volvulus following a palliative nephrectomy. Cecal volvulus and other causes of acute abdomen should be considered in postoperative patients who develop adynamic ileus undergoing retroperitoneal surgery.

Urinoma--a rare presentation of carcinoma of the bladder.

Urinoma as a presenting sign of carcinoma of the bladder, as occurred in this case, is rare. Aspiration of the cystic mass under sonography and chemistry of the fluid confirmed the diagnosis. The inferior extension of the urinoma on CT scan confirmed the gradual fading of Gerota's fascia into the retroperitoneum. Abdominal mass in the form of a urinoma is an uncommon presentation and only a few documented cases are reported in the literature. This case illustrates that the Gerota's fascia fades inferiorly into the retroperitoneum.