Gerald W. Ireland

Recanalization following vasectomy

Abstract Most authors have not differentiated between early and late recanalization following bilateral vasectomy for sterilization. Their reported recanalization rates probably reflect only early recanalization. Long-term follow-up semen examinations are required to document late recanalization. This regimen may be unacceptable to some patients and physicians. No symptomatic postvasectomy complication preceded the recanalization.

Renal trauma and preexisting lesions of kidney.

Abstract Preexisting lesions of the kidney with renal trauma were present in 15.4 per cent of children and 4.4 per cent in the all-age group. Half of these lesions were hydronephrotic kidneys while cyst, tumor, and abnormal position were found with much reduced frequency. When a minor injury results in renal trauma, evaluation must exclude an underlying preexisting lesion of the kidney.

Vesical Endometriosis in a Postmenopausal Woman: A Case Report

A case of endometriosis of the bladder extending into the bowel in a postmenopausal woman is reported. The origin of the tissue is mere conjecture. Five years before the onset of bleeding the patient had had an abdominal hysterectomy that may have seeded the adjacent vesical and small bowel tissue. It is hypothesized that the exogenous estrogen stimulated this tissue until it penetrated the bladder mucosa.

Comparison of ligation and fulguration methods

Abstract Bilateral vasectomy for sterilization using the electrofulguration technique has resulted in no early recanalization of the vas deferens, whereas recanalization did follow the vas ligation method. The operative discomfort and morbid state with minor wound complications were higher with the fulguration method than with the ligation method.

Comparison of Bricker and Wallace Methods of Ureteroileal Anastomosis in Urinary Diversions

Urinary diversion, as described by Bricker in 1950 was for use in adults who required pelvic exenteration for cancer. In this procedure, a 10 to 20 cm length of terminal ileum is isolated from the intestinal tract, and the continuity of the bowel re-established by open end-to-end anastomosis. The appendix is removed. The proximal end of the detached segment of ileum is closed. The ureters are divided from the bladder and anastomosed to the ileal segment, near its blind end through openings in the ileal wall cut to the exact size of each ureter. The distal end of the ileal segment is brought out to the surface of the abdomen in the right lower quadrant through a circular opening cut through skin, fascia, muscle and peritoneum and sutured to the skin to form a slightly protuberant ileal stoma. The various complications encountered with this procedure have prompted the introduction of several modifications. The Wallace method of ureteroileal anastomosis (1966) consists of splaying the distal ureters longitudinally. The medial edges are sutured together with a continuous 5-zero chromic catgut suture. The conjoined ureters are then sutured to the proximal ileal segment with a 4-zero chromic catgut suture at the apex of each ureter to the ileum and a continuous 5-zero chromic suture along the lateral edges. The entire anastomosis is retro- peritonealised. The ileal conduit is brought through the peritoneal cavity to the anterior abdominal wall where a stoma is constructed.

Trauma to the Genitourinary Tract: Evaluation and Management

Following trauma, urine should be examined immediately, by catheterization if necessary, as hematuria indicates injury to the urinary tract. Repeated clinical examination and observation are no substitute for immediate radiographic evaluation of the urinary tract to make an exact diagnosis of the injury. Surgical repair with drainage, when appropriate, reduces morbidity and preserves function.

Late stenosis of bowel segment of ileac conduit (pipe-stem loop).

Abstract Two cases of stenosis of the intraperitoneal bowel segment of an ileac conduit, “pipe stem loop” have occurred between two and five years after the surgery. The long time interval between surgery and appearance of the stenosis makes the ischemic etiology difficult to explain. A retrograde ileostogram is required to establish the diagnosis. Surgical correction by creating a new loop or a more conservative operation gives satisfactory results.