Francis F. Bartone

The Role of Percutaneous Nephrostomy in the Management of Obstructing Candidiasis of the Urinary Tract in Infants

We report on 5 neonates with obstructive urinary tract candidiasis in whom percutaneous nephrostomy had a major role in management. The advantages of percutaneous nephrostomy in this setting include prompt drainage of the obstructed renal pelvis or ureter, direct access to obtain specimens from the renal pelvis to confirm the diagnosis, direct irrigation of the fungus balls with amphotericin B and an access route for fragmentation of fungus balls by guide wire manipulation. In 3 cases percutaneous placement of the nephrostomy tube was successful in obtaining and maintaining access to the renal pelvis, while in 2 surgical intervention was required because of problems maintaining placement of the percutaneous catheters. Percutaneous nephrostomy with antegrade amphotericin B irrigation, coupled with systemic antifungal therapy, is the mainstay of treatment. The usefulness of ultrasonography in the early diagnosis of renal candidiasis also is emphasized.

Chitosan: Effects on Wound Healing in Urogenital Tissue: Preliminary Report

We conducted a survey of the effect of chitosan on wounds of the genitourinary system in dogs. Wounds were made in the kidney, ureter and penile foreskin. Chitosan caused no adverse effects on urogenital wound healing. A decrease in fibrosis was seen in the wounds treated with chitosan in all tissues studied. These observations suggest that the morbidity of urogenital surgery may be decreased by treating the wounds with chitosan.

Transabdominal Ultrasound Versus Excretory Urography in Preoperative Evaluation of Patients with Prostatism

Transabdominal ultrasound is superior to excretory urography when radiographic imaging of the urinary tract is indicated in patients with prostatism. We studied 53 patients with excretory urography and ultrasonography before prostatectomy. Patients with a history of microscopic or macroscopic hematuria, urolithiasis, renal failure or upper urinary tract anomalies were excluded from our study. Ultrasonography proved to be more accurate in defining prostatic size and configuration. Bladder wall thickness also was quantified more clearly with ultrasonography. We found 17 renal masses incidentally with excretory urography, although ultrasound was essential and superior to excretory urography in defining these masses in each case. We recommend that ultrasonography be used in lieu of excretory urography when imaging of the urinary tract is indicated before prostatectomy.

Pitfalls in Using Human Chorionic Gonadotropin Stimulation Test to Diagnose Anorchia

Previous studies have concluded that surgical exploration is unnecessary in genetic male subjects with nonpalpable tests who fail to respond to human chorionic gonadotropin. Lack of response suggested absent testicular tissue. We report on 2 patients thought to have anorchia because of lack of response to human chorionic gonadotropin stimulation. Testes were found in both patients. Genetic and phenotypic male subjects with nonpalpable testes who fail to have increased testosterone after human chorionic gonadotropin stimulation should undergo laparoscopy. If testicular structures are present at laparoscopy surgical exploration is indicated. Unresponsiveness to human chorionic gonadotropin may be evidence of nonexistent or dysfunctional Leydig cells rather than evidence of complete absence of testicular tissue.

Bilateral fibroepithelial polyps of ureter in a child

Presented here is the first case of bilateral ureteral polyps in a patient under eighteen years of age, with vivid colored intraoperative photographs. The importance of careful identification of the base of the polyp to reduce operative morbidity and the necessity of ureteral reanastomosis rather than simple excision of the polyp in children is emphasized.

Transperineal percutaneous I-125 implant of prostate

Although Iodine-125 seeds for interstitial radiation of prostatic cancer via the retropubic route is an established method of treatment, the retropubic implant technique has disadvantages: inadequate space for proper placement of the needles, possible bleeding from the prostatic venous plexus by the insertion of needles through these veins, and possible wound infection due to inadvertent puncturing of the bladder and/or rectum by the needles. A technique is described whereby Iodine-125 seeds for interstitial radiation are placed into the prostate through the perineum allowing more accurate placement of the seeds, assuring homogenous dose distribution, and decreasing the risk of bleeding and of bacterial contamination.

The Absence of Premalignant in Cryptorchid Testis before Adulthood

AbstractPrevious investigators have reported that premalignant changes in the form of abnormal germ cells can be detected in the crypt orchid and infertile adult testis. These cells are characterized by a thin rim of pale-staining cytoplasm, a large hyper chromatic nucleus and prominent nucleoli. We studied 113 biopsies from 102 patients to determine if these abnormal germ cells occur in the nonadult crypt orchid testis. The patients ranged in age from 3 months to 16 years. Evaluation of testicular tissue by light microscopy disclosed histological alterations in the un descended testis, which were those commonly ascribed to the un descended testis. However, none of the changes could be interpreted as premalignant. The abnormal germ cells described by other investigators were not found in any of these specimens.

Ureteral reaction to suture material

Dog ureters were anastomosed end to end using either chromic catgut, polyglycolic acid (PGA), polyglactin-910, or polypropylene sutures. Analysis of luminal diameters, fibrosis, scar vascularity, and inflammatory reaction four and seven months later indicated that in ureters of the uninfected dog the best results were obtained with polyglycolic acid. Ureters anastomosed with catgut gave results that were slightly less acceptable.

Cryptorchidism: Incidence of Chromosomal Anomalies in 50 Cases

We studied testicular tissue and peripheral blood samples for chromosomal anomalies in 50 consecutive patients who underwent orchiopexy. Of the 50 subjects 48 demonstrated karyotypes of 46XY in blood and testicular tissue, 1 had Klinefelters syndrome and 1 had mosaic trisomy 8 with a discrepancy between the blood and testicular chromosomal complement. Over-all, the study showed no significant discrepancy between the chromosomal complements of the testicular tissue and blood. The incidence of these anomalies is not statistically significant compared to the observed frequency of chromosomal anomalies in this age group.

Polyglactin 910 suture in urinary tract.

Cystotomies in guinea pigs and ureteral anastomoses in dogs were sutured with polyglactin 910. Silk and chromic catgut were used as control sutures in the bladders and chromic catgut in the ureters. Three months postoperatively in bladders sutured with polyglactin 910 small epithelial cysts were noted, which increased in size with time. In ureters sutured with polyglactin 910 cystic diverticula were observed eight months postoperatively. Because of the difference of tissue reaction to polyglactin 910 compared with catgut, further long-term studies are urged in different species of animals, prior to the clinical use of polyglactin 910 in the urinary tract.