Pressure recording catheter.

A simple, inexpensive pressure-recording balloon system to determine abdominal or rectal sphincter pressures without difficulty is described.

Link between caudal regression and Vater syndromes.

A variant between caudal and regression and Vater syndromes is presented which was significant anomalies of the genitourinary tract. The patient has a normal 46XX karyotype with the following urogenital anomalies: solitary pelvic kidney with megacalycosis, high ureteral bud or diverticulum, and ectopic insertion of the ureter into the proximal urethra; as well as, sacral agenesis, vaginal atresia, aberrant gonadal tissue, and uterine agenesis.

Glans condom drainage system.

A form-fitting glans condom has been developed for use in small uncircumcised males with neurogenic bladders to avoid the problems inherent with diapers. The method to make the glans condom and early successful use in 19 of 33 patients are noted.

Papillary cystadenoma of epididymis: component of von Hippel-Lindau syndrome.

A case of epididymal cystadenoma, thought to be a component of the von Hippel-Lindau syndrome, is presented. The syndrome is reviewed, and the importance of long-term urologic follow-up for possible presentation of renal cell carcinoma is discussed.

Crossed fused renal ectopia.

An unusual form of crossed renal ectopia is presented. Both kidneys are at the same level on the same side with fusion throughout their entire lengths.

Comparative evaluation of quantitative glomerular filtration rate measured by isotopic and nonisotopic methods.

Good correlation of glomerular filtration rate (GFR) measured isotopically from plasma disappearance of Tc-99m-DTPA (Sn) was shown with inulin clearance, creatinine clearance, and graded radionuclide imaging. The isotopic GFR is a simple, urineless technique not requiring continuous infusion that enables one to perform simultaneous renal imaging with one radiotracer.

Factors influencing the pressure-flow-perfusion system.

The methodology of the "Pressure-Flow-Perfusion System' used in the "Whitaker Test' was examined for factors which influence intrinsic resistance of that system. Considerable pressure changes were incurred by varying the concentration of sodium diatrizoate, perfusing needle, temperature and flow rates. For each renal pressure-flow-perfusion test, the resistance must be determined because of the effect of each variable in altering the intrinsic resistance.

Variability of water urethral closure pressure profiles.

Water urethral closure pressure profiles were evaluated in 66 women for reproducibility between sequential studies in patients and 3 observers.

Penile tourniquet syndrome caused by hair.

We have described two circumcised children who developed a urethral fistula caused by long hairs constricting and ulcerating the penis. These cases are presented to remind physicians to examine the infant's penis when he presents with a swollen glans, abnormal urinary stream, and a parent with long hair.

Y-type urethral triplication.

A case of Y-type urethral triplication is reported. Urethrograms and urodynamics revealed the stenotic anterior urethras and a functional posterior urethral channel with a normal urethral pressure profile.

Analysis of methods to construct nomograms in uroflow studies.

A Monte Carlo simulation study to compare the effect of population form on three methods of nomogram construction was performed by taking 2000 random samples of size 5, 20, 50, 100, and 200 from populations with known percentiles. The 10th percentile was estimated by each of the three construction procedures. The three procedures compared were the upper 95 per cent nonparametric tolerance limit technique, the usual percentile approach, and a method which assumes a Gaussian (normal) distribution. Tenth percentile nomograms, classified by volume voided, were calculated by each of the three procedures for maximum flow rate determinations from 356 normal males of ages 1 to 12 years with body surface areas less than 1.1 m2. Nomograms of the three methods are validated with evaluations from two other groups of male children consisting of known abnormals with radiologically proven urethral obstructions and known normals who had repeated at home uroflow rates. The nonparametric tolerance limit approach gives conservative estimates and is superior in all cases from the standpoint of reducing false-negative results.

Management of total ureteral loss after kidney transplantation.

Loss of the ureter after transplantation is uncommon and is difficult to manage. A Boari flap can be used to replace the ureter. The authors describe two patients with total ureteral loss. In each a Boari flap was used, to create a pyelocystostomy in one case and a calicecystostomy in the other. Both patients had greatly reduced serum creatinine levels and no urinary tract infections 14 and 18 months, respectively, after operation.

Frequent recurrence of superficial bladder tumors in the periorificial region: possible predictor for delayed appearance of invasive intramural ureteric cancer.

Two cases of invasive lower ureteric cancer developed following frequent recurrence of superficial bladder tumors in the region of the ureteral orifice. The cancer focus could not be identified in the intramural ureter prior to intravenous urography which revealed hydronephrosis. When bladder tumors repeatedly develop near the ureteric orifice, careful investigations such as ureteral catheterization with a small brush for cytology or ureteroscopy are necessary for the early detection of invasive disease.

Analysis of the urethral pressure profile using a mechanical model.

Using a model of the urethra designed to ensure a predictable pressure profile along its length, we investigated optimal parameters for gas and water profilometry. In gas profilometry, the response characteristics of the machine, attributable to the highly compressible nature of gas, were shown to be the most important determinants of accuracy. Gas and water profilometry have drawbacks that make clinical results inaccurate. However, if all measuring parameters are carefully recorded and considered when a pressure profile is analyzed, system error can be decreased from 62 to 5% by using the optimal pull and flow rates determined by this study.

Gas cystometry in cases of continent bladder exstrophy.

Cystometry in 21 cases of closed continent bladder exstrophy revealed that 14 patients had a normal reflexic bladder. A simultaneous anal plug electromyogram showed an appropriate response in all patients when correlated with a cystometrogram.

Continence in cases of bladder exstrophy.

The relationship of the onset of continence, staged surgical procedures and continence length was investigated in 21 patients with closed continent exstrophy. Continence occurred within a year of operation in 13 patients and 10 of these 13 patients had a Young-Dees urethroplasty and Marshall-Marchetti-Krantz suspension. In 11 of these 13 patients the continence length was greater than 1 cm. In the remaining 8 patients continence was delayed beyong a year. Only 1 of these 8 patients had undergone both bladder neck procedures and in 5 patients the continence length was greater than 1 cm.

Comparison of techniques to determine continence zone.

The urethral pressure profiles for 36 patients were analyzed specifically for continence zone by 3 techniques: 1) triangle, 2) planimeter and 3) weight. Graphically, the best agreement was between the weight and planimetry methods but, statistically, there was a significant difference among techniques except for the subgroup that had the smallest continence area.

Y-type urethral duplication in male subjects.

A case of Y-type urethral duplication is described with urethrograms showing the anterior and posterior channels arising from the prostatic urethra. Postmortem studies revealed the dominant posterior channel and its relationships to the stenotic anterior channel and anus.

Carcinoembryonic antigen positive adenocarcinoma of a female urethral diverticulum: case report and review of the literature.

Paraurethral glands of the female urethra, which are assumed to be embryologically homologous to the male prostate gland, are possible origins for diverticular cancer of the urethra. A case of primary adenocarcinoma arising in a female urethral diverticulum is presented. Pathology revealed a columnar/mucinous type adenocarcinoma which stained positively for carcinoembryonic antigen (CEA) and negatively for PSA. Normal paraurethral ducts located near the urethra and normal urethral epithelium also stained positively for CEA. These findings suggest that the adenocarcinoma in our case originated from the paraurethral duct near the urethral lumen.