[Endovascular stenting in a stenotic solitary kidney; renal failure due to atherosclerotic renal artery stenosis]. / Stentplaatsing bij een stenotische mononier: nierfunctiestoornis door atherosclerotische nierarteriestenose.

In this article we present three patients with atherosclerotic renal artery stenosis in a solitary kidney. They developed progressive renal failure, hypertension or fluid overload which were resistant to drug therapy. As there were no other therapeutic options they were treated with renal artery stenting, with good clinical results. Although large trials have not shown that endovascular stenting has any advantages over medical therapy in atherosclerotic renal artery stenosis, we propose that if other options fail there is a place for stenting in renal artery stenosis in patients with a single functioning kidney.

Prenatal testicular torsion: diagnosis and natural course. An ultrasonographic study.

The aim of this study was to demonstrate the ultrasonographic features of prenatal torsion of the testis at presentation and during follow-up, with histological correlation post-orchidectomy. Between January 1985 and December 1999, 13 neonates with antenatal torsion of the testis were examined postnatally, at presentation and during follow-up, with high-resolution ultrasonography, including colour Doppler ultrasonography. Bilateral testis volume was evaluated [lengthxwidthxdepthx(pi/6)]. Ultrasonographic findings were correlated with histological findings (n=8) and findings at surgery. Moreover, in 1 patient the affected testis was postoperatively examined with ultrasonography in vitro. These findings were correlated with preoperative ultrasonography and corresponding histological slices. All patients (n=13) presented with a painless congenital scrotal mass. On the affected side no flow was found with colour Doppler ultrasonography. Testis volume on the affected and normal side showed mean values of 2.1 and 0.5 cc, respectively. On ultrasonography all patients showed scrotal swelling and a heterogeneous testis with hypoechoic central areas (necrosis). The tunica albuginea was thickened in all patients, with focal (n=2) or rim-like (n=11) hyperechoic reflections (calcifications) at the transitional zone between testis and tunica albuginea. In 9 patients follow-up ultrasonography showed progressive testis atrophy on the affected side. In 10 patients a contralateral hydrocele was found. Prenatal torsion shows a characteristic ultrasonographic pattern. In newborns with a scrotal mass, these ultrasonographic findings should suggest this diagnosis and delay in immediate surgery and/or oncological work-up may be appropriate.