Bernard Fruchtman

Xanthogranulomatous Pyelonephritis: Detailed Analysis of 29 Cases and a Brief Discussion of Atypical Presentations

AbstractA detailed review of 29 cases of xanthogranulomatous pyelonephritis is presented. Focal involvement of the kidney was noted in 5 instances. An accurate preoperative diagnosis of xanthogranulomatous pyelonephritis is difficult because of its clinical and radiological similarities to various other renal lesions. Bilateral xanthogranulomatous pyelonephritis is extremely rare and segmental excision of the kidney, when technically feasible, may be curative.

Closure of the Bladder Neck in Patients Undergoing Continent Vesicostomy for Urinary Incontinence

The continent vesicostomy has been done on 24 patients, 10 of whom had severe urinary incontinence requiring closure of the bladder neck or urethra as well. Therefore, the bladder was converted to a closed cavity and intermittent catheterization is done through an abdominal stoma. No dressings or appliances are necessary. Bladder neck (or urethral) closure was successful in 8 of the 10 patients. One of the failures had been incontinent and was rendered continent on attempted bladder neck closure and there is urethral leakage at night in the other patient. Intermittent catheterization through a vesicostomy stoma has been cleaner and more aesthetically pleasing to the patients. The bladder neck closure has resulted in a dry perineum with fewer skin problems.

Xanthogranulomatous pyelonephritis: segmental or generalized disease.

Xanthogranul omatous pyelonephritis of the kidney usually occurs in association with urinary tract infection, obstruction and/or calculi. The diagnosis usually is made when a nephrectomy is performed for a non-functioning kidney and/or a mass indistinguishable from carcinoma on radiological as well as gross examination. Segmental excision of the kidney for focal xanthogranulomatous pyelonephritis has been used rarely in the past. Focal involvement of the kidney with xanthogranulomatous pyelonephritis was encountered in 4 instances at our institution. The diagnosis was made incidentally in 3 patients during segmental excision of the involved parenchyma and/or cyst wall. We believe that the xanthogranulomatous process probably starts as a localized involvement in some cases and, if excised during this stage, further destruction of renal parenchyma can be prevented successfully.

The continent vesicostomy: clinical experiences in the adult.

During a 2-year period continent vesicostomy has been attempted in 17 adults and a continent stoma has been achieved in all but 4 patients. Operative morbidity is low and there has been no operative mortality. Definition of precise indications and contraindications must await further experience but this operative procedure seems to be a useful alternative in the management of neurogenic bladder and incontinence.

Experience with Second-Generation Lithotripsy: Medstone 1050

Initial experience using the Medstone 1050 lithotripter, a spark-gap tubless machine that uses radiographic localization is herein reported. Over 250 patients have been treated with fracturization rates over 97% and three-month overall stone-free rate of 73%. The incidence of multiple treatments (14%), ancillary percutaneous nephrostomy (PCN) (1%), and percutaneous nephrostolithotomy (PCNL) (2%) is comparable to first-generation machines.