David W. Strong

Recurrent urothelial tumors following surgery for transitional cell carcinoma of the upper urinary tract.

A retrospective analysis of 74 cases of transitional cell carcinoma of the renal pelvis and ureter treated at this institution over the past 30 years is presented. When nephrectomy alone or incomplete nephroureterectomy was performed, subsequent transitional cell carcinoma developed in 30% of the ureteral stumps. Subsequent bladder carcinoma occurred in 25% of the patients with primary upper urinary tract carcinoma. The type of initial surgery performed did not appear to influence this incidence of subsequent bladder tumors. Contralateral upper urinary tract carcinoma developed in only one patient. When nephroureterectomy is performed for carcinoma of the renal pelvis and ureter, a cuff of bladder that includes the ureteral orifice should be removed to obviate recurrent disease in the ureteral stump. Since single‐incision nephroureterectomy did not include the intramural ureter in 50% of the cases in which it was performed, a second incision may be required for adequate exposure.

The Ureteral Stump after Nephroureterectomy

Herein we review 70 cases of transitional cell carcinoma of the upper urinary tract. When complete nephroureterectomy was not performed transitional cell carcinoma developed in 30 per cent of the remaining ureteral stumps. Single incision nephroureterectomy did not include the intramural ureter in 50 per cent of the cases in which it was performed. When nephroureterectomy is selected as treatment for carcinoma of the renal pelvis or ureter a cuff of bladder, which includes the ureteral orifice, should be removed. A second incision may be required for adequate exposure.

Bilateral spermatic cord torsion in the neonate.

A case is reported of torsion of the spermatic cord in a newborn. This experience re-emphasizes the necessity of a careful and complete examination of the newborn immediately after delivery. The presence of a scrotal mass that does not transmit light represents torsion of the spermatic cord until proved otherwise, and demands immediate surgical intervention if their is to be any hope of testicular salvage. If torsion is present contralateral fixation is necessary.

Transpublic urethorplasty for membranous urethral strictures

Six patients with traumatic membranous urethral strictures have undergone urethroplasty utilizing the traspubic approach with resection of a wedge of the symphysis pubis. Three patients are free of stricture, 2 required urethral dilatation in the early postoperative period only, and 1 patient requires dilation every three months. Four patients are completely continent of urine, 1 has mild stress incontinence, and 1 is incontinent because of a neurogenic bladder. This approach provides excellent exposure with minimal morbidity and allows an easy under-vision anastomosis.

Arteriovenous fistula complicating renal transplantation

A case of arteriovenous fistula of the major transplant vessels contributing to posttransplant hypertension hypertension and severe microangiopathic hemolytic anemia is reported. Improvement in blood pressure and correction of anemia followed ligation of the fistula. This case reinforces the need for diagnostic evaluation of all patients with sustained post-transplant hypertension.

Disseminated nocardiosis presenting as testicular abscess.

A case of a localized testicular abscess due to Nocardia asteroides in a patient on immunosuppressive therapy for a myeloproliferative disorder is reported. Subsequent fatal dissemination of the infection to the prostate, lungs, and liver occurred. This represents the second reported case of nocardiosis of the testis. Extrapulmonary forms of nocardiosis must be recognized so that appropriate treatment can be instituted prior to dissemination.

Seminoma testis tumor with ipsilateral pelvic kidney

Abdominal external beam radiation (3,000 rads) is our standard treatment for Stage A testicular seminoma. We have encountered 2 patients with localized seminomas, in each of whom excretory urography demonstrated an ipsilateral pelvic kidney. Because of significant risk of radiation nephritis and renal loss in the unshielded ectopic pelvic kideny, retroperitoneal lymphadenectomy is recommended in place of abdominal radiation.

Renal tuberculosis simulatingpolycystic kidney disease angiographically

Abstract A unique case of advanced bilateral renal tuberculosis is reported in which a false diagnosis of polycystic kidney disease was made by renal arteriography. Silent ureteral obstruction generated by the infectious process had produced a form of hydronephrosis in which the renal arterial branches were stretched around large, avascular cystic areas without obliteration of small vessels. This produced an angiographic appearance similar to that seen in adult polycystic disease. Following left nephrostomy drainage and antituberculous chemotherapy for one year, repeat renal arteriograms revealed marked improvement in size and function of the left kidney while the right kidney had become autonephrectomized.