Elliot Leiter

Preoperative Diagnosis of Renal Angiomyolipoma

Six cases of renal angiomyolipoma are reviewed. In 5 of these 6 cases a characteristics radiolucent fat sign was present overlying the renal mass. In 10 cases of hypernephroma selected only on the basis of a tissue diagnosis and the availability of a pre-injection scout film this sign was not present. The recent literature is reviewed on the radiographic diagnosis of angiomyolipoma. We conclude that angiography is not reliable in the differentiation of angiomyolipoma from hypernephroma. However, demonstration of a radiolucency on the pre-injection scout film is virtually pathognomonic of angiomyolipoma. Tomographic cuts without contrast injection may increase diagnostic accuracy.

Post-Traumatic Segmental Corpus Cavernosum Fibrosis: The Diagnostic Value of Cavernosography and the Surgical Correction by Cavernosum-Cavernosum Shunt

A case is reported of post-traumatic segmental corpus cavernosum fibrosis with subsequent loss of erection. Evaluation of such problems with cavernosography is essential. Surgical correction included resection of the fibrotic segment and a cavernosum-cavernosum shunt, which resulted in good erections.

Persistent fetal ureter.

Six patients have been seen with a peculiar ureteral lesion that has not been described previously. The lesion is characterized by either local segmentation or convolution and may represent either a persistent fetal ureter or a form of ureteral dysgenesis. Proximal dilatation, when present, has been less than the original radiographic appearance of high grade obstruction would lead one to expect. The ureteral lesions have disappeared progressively, suggesting that a period of conservative observation is warranted in similar situations.

Is nocturia of prostatism secondary to renal concentrating defect

An attempt was made to demonstrate a relationship between the nocturia of prostatism and decreased renal tubular concentrating capacity. Nos such relationship could be substantiated. In the absence of hydronephrosis, nocturia remains best attributed to detrusor instability and a decreased effective vesical capacity.

Genitourinary tract anomalies in lobster claw syndrome.

A child with ectrodactyly or lobster claw syndrome and bilateral ureterovesical junction obstruction is described. The embryogenesis of the kidney and the limb buds suggest that a close association exists between these 2 conditions. Therefore, it is important to investigate the urinary tract in all patients with limb deformities.

Bilateral herniation of renal pelves A complication of cutaneous pyelostomy

The first reported case of bilateral herniations of the renal pelves as a complication of cutaneous pyelostomy is presented. We describe a modification of the original surgical technique that may prevent herniation, based on fixation of the pelvis to the lumbodorsal fascia as well as the cut edge of the pelvis to the skin. In our patient the bilateral herniations were corrected by repairing the fascial defects and suturing of the pelvis to the fascia.

Ectopic ureterocele, hydroureter, and renal dysplasia An embryogenic triad

A review of the literature of the embryogenesis of ectopic ureterocele is presented. A theory linking the triad of ectopic ureterocele, hydroureter, and renal dysplasia to a primary intrinsic developmental abnormality of size and position of the ureteral bud is postulated.

Urinary fistula into ureteral stump after ileal conduit diversion

Despite ileal conduit diversion for urinary incontinence, an adolescent male with meningomyelocele continued to void per urethram postoperatively. Urologic investigation disclosed spontaneous fistulization from a ureteroileal anastomosis to a ligated ureteral stump, with resultant urinary drainage to the bladder. This unusual complication of ileal conduit diversion has not been reported previously. More attention should be directed to securing a watertight ureteroileal anastomosis. A careful single layer anastomosis is recommended to minimize urinary leakage without increasing the risks of stenosis and obstruction.