David Presman

Renal Papillary Necrosis in Sickle Cell Hemoglobinopathies

Approximately 65 per cent of patients with clinical manifestations of S-hemoglobinopathies show urographically demonstrable changes of renal papillary necrosis, regardless of the presence of urinary symptoms. With a more precise excretory urographic technique these changes can be diagnosed with greater accuracy without the need for sophisticated equipment. Excretory urography should be performed routinely in the evaluation of all patients with manifestations of S-hemoglobinopathy in order to diagnose papillary necrosis before the onset of urological symptoms.

A diagnostic method for retrocaval ureter.

Summary o 1. A case report of retrocaval ureter which was diagnosedpreoperatively and successfully repaired surgically is presented. 2. A method for the accurate diagnosis of retrocaval ureter is described. This consists of a retrograde pyelogram performed with a radiopaque ureteral catheter inserted into the vena cava through the saphenous vein.

Urologic complications of renal papillary necrosis

Fifty-six patients demonstrating roentgenographic evidence of renal papillary necrosis were reviewed. Seven patients had an acute fulminating form of the disease. Urologic complication incident to sloughed renal papillae required urgent surgical intervention. Management ranging from ureteral catheterization to nephrectomy in 3 of 7 patients is discussed, and associated disease states are scrutinized.

Potential Overstaging of Bladder Cancer by Computerized Tomography Scanning

We report 4 cases of bladder cancer that was overstaged by computerized tomography. In 2 patients the scans were performed after cystoscopy and bladder biopsy, and overstaging occurred secondary to artifacts produced at the time of biopsy. In the other 2 patients the scans were done before biopsy. In these patients perivesical and periprostatic infiltration interpreted on computerized tomography scans was not found in the surgical pathological specimens.

Spontaneous perinephric hematoma secondary to renal tumor.

Abstract 1. 1. Two case reports of spontaneous perinephric hematoma secondary to renal tumor are presented. In the first patient, the hematoma was extracapsular and the tumor was large. The second patient had a subcapsular hematoma and the kidney appeared grossly normal. Microscopic examination revealed a small carcinoma in the cortex which was the cause of the bleeding. 2. 2. The etiology of spontaneous perinephric hematoma includes a multiplicity of disease processes, the more common being nephritis, renal tumors, renal artery aneurysm, arteriosclerosis and periarteritis nodosa. It is of interest that no renal disease could be demonstrated in a significant number of reported cases. 3. 3. The possibility of a renal tumor being the cause of the bleeding should be kept in mind since a spontaneous hematoma may be the first clinical sign of this lesion. 4. 4. The diagnosis of perinephric hematoma is rarely made since the clinical picture and pyelographic findings are not pathognomonic. It should be suspected in all patients with a history of pain in the flank and presence of a renal mass together with evidence of internal bleeding. The most important diagnostic feature is low or decreasing hemoglobin and hematocrit. 5. 5. The treatment of choice is nephrectomy which is often a life-saving procedure. However, whenever possible the status of the opposite kidney should be determined preoperatively since the underlying cause of the bleeding may be bilateral

Management of interstitial cystitis with ileocecocystoplasty

Abstract Two patients rendered urinary cripples from contracted bladders secondary to interstitial cystitis underwent ileocecocystoplasty for bladder expansion. The technique and advantages of this procedure are outlined. Both patients have satisfactory voiding patterns, insignificant residual urine, and normal renal function up to two years. Although this procedure is performed infrequently, it can significantly benefit the patient with a severely contracted bladder.

What About the Other Kidney

Sophisticated diagnostic techniques have made the isolation of renal lesions more accurate. However, it must be remembered that simultaneous bilateral kidney pathology can exist in any patient. The most obvious lesion may not be the most important. Four cases are presented to illustrate this point.

Prostatitis following ureterolithotomy

Abstract 1. 1. The occurrence of low grade prostatitis as a late complication following ureterolithotomy is described. In a series of forty-one consecutive male patients upon whom ureterolithotomy was performed this complication occurred in eight patients, an incidence of 19.5 per cent. 2. 2. In these eight patients four high and four low ureterolithotomies were performed. 3. 3. The clinical picture in each patient was characteristic. Typical symptoms of prostatitis appeared during the convalescent period, between three and eight weeks postoperatively. Objective findings consisted of pyuria, a boggy prostate and numerous pus cells in the massaged prostatic secretion. 4. 4. Pathogenesis of the prostatitis is believed to be extension of infecting organisms from the site of the ureterolithotomy through the periureteral sheath and/or ureteral lymphatics downward to the prostate. 5. 5. It is fully realized that any conclusions drawn from a small series of cases may be questionable. However, the characteristic pattern of the clinical picture in these patients is highly suggestive of a definite causal relationship. It is hoped that further observations on this subject will be made by others so that a more objective evaluation may be made.