Gary P. Kearney

Functioning and nonfunctioning cysts of the adrenal cortex and medulla.

Adrenal cysts are rare clinical and pathologic entities. The vast majority are minute in size, unilateral, and found in females at autopsy. They come to the physicians attention when they produce symptoms or are identified on x-ray studies. When symptomatic, they generally produce lumbar discomfort and gastrointestinal symptoms, and occasionally are palpable by abdominal examination. There is no significant agreement as to cause and pathogenesis of the disease. The most common histologic types are lymphangiomatous endothelial cysts, secondary to lymphangiectasis, and the fibrous wall or hemorrhagic pseudocysts. In many patients preoperative diagnosis is now possible with high quality nephrotomography, ultrasonography, and adrenal arteriography. The presence of a suprarenal mass with peripheral or laminar calcification strongly suggests the presence of an adrenal pseudocyst. Selective biochemical studies are mandatory to rule out the presence of an occult cystic pheochromocytoma, and adrenal cortical tumor. Adrenal cysts must be differentiated from all space-occupying lesions of the upper abdomen. Surgical exploration is recommended in almost all patients for accurate diagnosis and to rule out malignant disease or occult pheochromocytoma. The choice of the surgical approach should be planned to provide for safe and adequate exposure, depending on the size and location of the lesion. Careful dissection with preservation of the adjacent kidney, liver, and pancreas should be performed.

Cyclophosphamide and carcinoma of bladder.

A case of carcinoma of the bladder developing in a patient who received cyclophosphamide (Cytoxan) therapy for carcinoma of the breast is presented. Hemorrhagic cystitis si a well-documented complication of such therapy. Several recent reports of carcinoma of the bladder in patients receiving cyclophosphamide should make physicians aware of this potential association.

Venacavography, corticosteroids and surgery in the management of idiopathic retroperitoneal fibrosis.

Four patients with idiopathic retroperitoneal fibrosis were found to have characteristic obstruction and anterior displacement of the lumbar vena cava. Varying degrees of venous collateral circulation were present, depending on the degree of vena caval compression. All 4 patients underwent ureterolysis to relieve the hydronephrosis and to confirm diagnosis by biopsy. Two patients were treated with corticosteroids postoperatively. Followup venacavography demonstrated improved filling and decrease in the collateral circulation in these 2 patients. Of the remaining 2 untreated patients 1 was lost to followup and the other revealed no change. Diagnosis of idiopathic retroperitoneal fibrosis can be made if characteristic changes are present on inferior venacavography and may provide an objective measure for following the basic disease process during medical treatment.

Fournier’s Gangrene: An Approach to Its Management

Treatment of Fourniers gangrene (necrotizing fasciitis of the male genitalia) traditionally has involved extensive débridement in concert with broad-spectrum antibiotic administration. However, our management of 4 patients with Fourniers gangrene indicates that limited débridement with placement of through-and-through drains may provide a good result, with far less tissue loss. After surgery and prompt, individualized antibiotic treatment the patients showed rapid improvement in their over-all condition with a brisk defervescence and normalization of leukocytosis. Granulation of the wounds progressed rapidly without secondary infection. In 2 of the 4 patients some skin grafting was required but the areas involved were quite small.

Useful technique for long-term urinary drainage by inlying ureteral stent six-year experience☆

Endoscopically placed inlying ureteral stents have proved useful in the conservative management of patients with ureteral obstruction, urinary fistula, and malignancy and have obviated the need for operative intervention. In high-risk symptomatic patients with widespread malignancy, internal urinary diversion offers the opportunity for an improved quality of life without the surgical risk or potential morbidity of supravesical diversion. Potential candidates for this simple, safe, and effective technique include: those with postsurgical obstruction and/or fistula, retroperitoneal fibrosis, metastatic carcinoma, congenital ureteropelvic junction obstruction, as well as those with reversible obstruction from lymphoma and carcinoma of the prostate who are undergoing radiotherapy and/or chemotherapy. The focus of this report is on the technique we have found successful in providing us with stents that fit our individual patients. Readily available fabricated graduated ureteral catheter can be cut and shaped to particular measurements unlike prefabricated catheters. Minimal preparation time is demanded, and there is no need for extensive stocking of various catheter sizes.

Renal hemangioma: Diagnostic aspects and management techniques

Renal hemangiomas are rare lesions that demonstrate a spectrum of clinical, radiographic, and pathologic presentation. Angiographic differentiation from renal cell carcinoma is usually possible, and in such cases conservative management should be attempted. Hemangiomas are in some ways similar to arteriovenous malformations, but lack the rapid and pronounced pre-capillary shunting that characterize the latter. Three cases are presented, two managed surgically with one requiring nephroscopy for diagnosis, and one managed non-operatively. Brush biopsies of lesions with pyelographic characteristics of renal hemangioma should not be attempted without prior angiography.

Ureteral obstruction secondary to perianeurysmal fibrosis

Ureteral obstruction secondary to perianeurysmal fibrosis is rare. We have added 3 cases to the 61 cases previously reported in the literature. Perianeurysmal fibrosis should be included in the differential diagnosis of ureteral obstruction particularly when there is medial deviation of the ureters. Abdominal ultrasound is a valuable screening test to confirm the presence of perianeurysmal fibrosis. Treatment must be individualized for each patient, but the majority of patients will benefit most from preoperative urinary drainage followed by aneurysmectomy and ureterolysis.

An Improved Non-Intubated Cutaneous Ureterostomy Technique for the Normal and Dilated Ureter

Cutaneous ureterostomy is a simple procedure to perform but is attended by high morbidity owing to recurring abscesses, strictures and stenosis of the stoma. An improved technique applied to the diversion of 4 normal renal units and 3 dilated ureters is described. We have not experienced the complications mentioned in previous studies and none of the patients has required ureteral intubation in this small series with a 3-year followup.

Epigenetic risk score improves prostate cancer risk assessment

Early detection of aggressive prostate cancer (PCa) remains crucial for effective treatment of patients. However, PCa screening remains controversial due to a high rate of overdiagnosis and overtreatment. To better reconcile both objectives, more effective methods for assessing disease severity at the time of diagnosis are needed.

Radical nephrectomy, bench surgery and autotransplantation in the potentially malignant renal mass.

AbstractAutotransplantation is an accepted technique for the preservation of renal function in many complicated urological problems. This case represents the first use of this technique in the diagnosis and management of an avascular, solid, potentially malignant renal mass.