Arne E. Nilson

Natural history of renal artery aneurysm elucidated by repeated angiography and pathoanatomical studies.

The findings from repeated angiographies in 16 female and 5 male patients with altogether 34 renal artery aneurysms were studied. The mean interval between the first and last angiography was 35 months. Seven patients had multiple aneurysms. Two to four angiographies were performed in each patient. They showed no change in 28 aneurysms and slight or minimal enlargement, thrombosis or calcification in the other 6. The clinical course was uneventful except for severe hypertension in 3 patients. No rupture occurred. Eight patients, of whom 5 had solitary, saccular aneurysms, were operated upon. Pathoanatomically, fibromuscular dysplasia or secondarily changed fibromuscular dysplasia was found in 7 of them. Four died of unrelated disease having been followed up for 55-204 months (mean 102 months). Nine were alive and symptomless at the end of follow-up 11-195 months (mean 97 months) after the first angiography. The study supports the view that the risk of rupture of a renal artery aneurysm is very small, and indicates that fibromuscular dysplasia is common even when the angiography shows solitary, saccular aneurysm only.

Treatment of urothelial tumors of the upper urinary tract by nephroureterectomy, renal autotransplantation, and pyelocystostomy

Nephroureterectomy, renal autotransplantation, and pyelocystostomy have been performed in eight patients with urothelial tumors of the upper urinary tract. One patient had tumors in a solitary kidney, two patients had bilateral tumors, and five patients had unilateral tumors. Three patients have had recurrent calyceal tumors which were successively managed by the transurethral route. In one patient the kidney had to be removed after 4.5 years because of infiltrating tumor recurrence. Two patients died; the renal pelvis of the graft was tumor free at autopsy in both cases. The other five patients are alive and free from tumor recurrence. The procedure implies increased radicality compared with conventional conservative treatment and simplified follow‐up. It may be considered in patients with bilateral tumors or tumors of a solarity kidney, and in selected patients with unilateral low‐grade, low‐stage tumors.

Fibroepithelial Polyp of the Ureter

Three patients with fibroepithelial polyp of the ureter are described with respect to clinical, radiographic and morphological characteristics. The importance and possibilities to reach at a correct preoperative diagnosis to allow conservative surgical treatment is stressed.

Angiographically Discovered, Non-Operated Renal Artery Aneurysms

Angiographies (a total of approximately 9 500) and patient records revealed 56 patients with renal artery aneurysm during the period 1960 to 1974. Fifteen patients were operated upon electively and 3 were lost for follow-up. Rupture occurred in four leading to acute nephrectomy. Thus, 34 patients were left for studies on the natural course. They were 29-82 years old (mean 58 years) at diagnosis and were followed for at least 90 months. Twelve were males and 22 females. The aneurysms had a diameter of 3-25 mm (mean 12 mm), were fusiform in 7 and saccular in 27 cases; 9 were calcified. Repeated angiographies were carried out in 7 patients at intervals of up to 73 months showing slight enlargement of one aneurysm, disappearance of another and no change in 5. Sixteen patients were alive at the end of the follow-up period 90-220 months (mean 157 months) after the first or only angiography. Eighteen patients died after 2-204 months (mean 84 months), 14 of cardiovascular disease unrelated to the renal arteries, 3 of malignant tumour and one of pancreatitis. Autopsy in 12 patients did not show rupture of any renal artery aneurysm. Thus, in a considerable number of patients the disorder was uncomplicated and compatible with a long life.

THIGH ADDUCTOR CONTRACTION DURING TRANSURETHRAL RESECTION OF BLADDER TUMOURS: EVALUATION OF INACTIVE ELECTRODE PLACEMENT AND OBTURATOR NERVE TOPOGRAPHY

Thigh adductor contraction occurred in 17 of 160 patients during transurethral resection of newly diagnosed bladder tumours. In 13 of the 17 patients contractions were abolished by changing the site of the inactive electrode from the buttocks to the thigh. The topographic relationship between the obturator nerve and the bladder wall studied radiographically and at autopsy showed that the distance between the bladder and the nerve considerably diminished with increasing bladder volume. Thus, when obturator nerve stimulation occurs during transurethral resection transposition of the inactive electrode from the buttocks to the thigh should be tried first to prevent further stimulation. Moreover, TUR at low bladder volume may reduce the frequency of obturator nerve stimulation.

Postcesarean Vesico‐Uterine Fistula

A case of postcesarean vesico‐uterine fistula in conjunction with a fibrous cord joining the anterior and posterior wall of the bladder is reported. The symptoms of menouria and amenorrhoea in the absence of urinary incontinence are explained by reference to the pressure gradients which normally exist in the bladder and the uterine cavity. The etiology, diagnosis and therapy of this and other reported cases are reviewed.

Conduit Urinary Diversion and Urinary-Tract Infection

The serum antibody titers against Escherichia coli and/or Proteus mirabilis were elevated in 26 of 80 patients (33%) with a conduit urinary diversion. Urographic findings were abnormal in 44 of these 80 patients (55%). Urography was normal in 59% of the patients with normal antibody titers, but in only 15% of those with elevated titers. Raised antibody levels against E. coli O antigen (>256 before and/or >32 after mercaptoethanol treatment of serum) were associated with wide upper urinary tract or calculi more often than were normal E. coli antibody titers. Raised titers against P. mirabilis (>256 before and/or >32 after mercaptoethanol treatment of serum) were associated with scarring of the renal parenchyma more frequently than were normal titers.A statistically significant association was found between “small” kidney area and raised serum antibody titers against E. coli or P. mirabilis. The frequency of “small” kidney increased with the time lapse after urinary diversion. At 3 to 11 months postoperativ...

Extracorporeal Surgery and Autotransplantation for Carcinoma of the Pelvis and Ureter

Multiple transitional cell tumours of the renal pelvis and proximal ureter of a solitary kidney were successfully managed by total ureterectomy, extracorporeal subtotal resection of the renal pelvis, autotransplantation, and calicovesicostomy. The method permits resection of a maximum of the uroepithelium of the upper urinary tract at the same time as it preserves available renal parenchyma. It also implies a new and exciting approach to the renal pelvis for endoscopic postoperative control and local treatment of the malignancy.

Angiography of the transplanted kidney.

Thirty angiographic examinations of transplanted kidneys were carried out in 24 patients.When the kidney function was satisfactory the angiographic appearances were characterized by a rapid passage of contrast medium, good filling of the peripheral branches, and a dense nephrographic phase with sharp delineation between the medulla and cortex.In kidneys with a reversible impairment in function the appearances were similar, although the passage time was sometimes slightly prolonged. The renal failure in these cases was probably caused by tubular necrosis or slight reversible rejection. The prognosis as to renal function was good.When the kidney function was impaired by irreversible rejection the appearances differed, showing marked prolongation of the passage time, absent filling of the peripheral branches, and low contrast density in the nephrographic phase.The angiographic examinations had no detectable adverse effects. It is concluded that angiography of the transplanted kidney is helpful to differentia...

Urodynamic Consequences of a Direct Pyelocystostomy at Autotransplantation of the Kidney

The urodynamic consequences of renal autotransplantation and pyelocystostomy were studied in 17 male and 3 female patients. The indications of the procedure were urothelial tumor of the upper urinary tract, remaining outflow obstruction after conventional pyeloplasty and recurrent stones. The mean observation time was 31 months (range 3-50 months). The micturition flow rate was unchanged. There was an insignificant increase in residual urine. No evidence of any clinically significant disturbance of the sensory or motor bladder innervation or reduction of the functional bladder capacity was found. Urethrocystography showed transient dilatation of calyces at micturition. Urinary tract infections, when present, had the same pattern as preoperatively. Thus, autotransplantation of the kidney with a wide, direct pyelocystostomy is consistent with essentially normal urodynamics of the transplanted renal pelvis and the bladder.