Giancarlo Masini

Conservative surgery for renal cell carcinoma

The authors present their clinical experience in conservative surgery for renal cell carcinoma, which was performed in two cases of simultaneous bilateral tumours, in a case of neoplasm in solitary kidney, in two cases of cancers with damaged contralateral kidney and in two cases of association between cyst and small tumour. All patients are alive and without evidence of residual or recurrent malignancy with a followup ranging between 6 months and 7 years. The pros and cons of the various surgical solutions are discussed.

Surgical treatment of rectourethral fistulae.

9 male patients with rectourethral fistula were treated. Fistulae were congenital in 1 case, iatrogenic in 6 cases and traumatic in 2 cases. In 8 cases we used an abdominoperineal approach with omentoplasty or peritoneal flap; in 1 case a perineal approach was made. In 2 cases it was also necessary to use a transpubic approach to the posterior urethra. Good results were obtained in all cases. The importance of a proper radiological investigation of the fistulous tract and the use of omentoplasty are both emphasized.

Treatment of Male Urethral Calculi

We treated 14 male patients for urethral stones during a 17-year interval. The calculi were located in the posterior urethra in 7 patients and in the anterior urethra in 7. Anatomical alteration of the lower urinary tract was an important predisposing factor, since 11 patients had history of bladder and urethral surgery or disease, 2 had an associated neurogenic bladder, 6 had urethral strictures or diverticula and 3 had concomitant bladder stones. Urethroplasty was performed in 5 cases, surgical removal of the stone in 3, retrograde manipulation inside the bladder in 4 and electrohydraulic endourethral lithotripsy in 2. The latter technique appears to be particularly effective for endoscopically accessible stones.

Experience with ureterocalyceal anastomosis

Experience with 10 cases of ureterocalyceal anastomosis is reported. Most cases involved scleroatrophic scarring of the pelvis after repeated stone surgery, and 1 case each for failed pyeloplasty, tuberculous stricture of the pelvis, transitional cell carcinoma of the pelvis and calyces, and ureteropelvic junction obstruction associated with renal malformation. Three patients had a solitary kidney. End-to-end ureterocalyceal anastomosis was performed in 5 patients; laterolateral in 1 case, and ureteropyelocalyceal anastomosis in the remaining 4. In 3 cases omentoplasty was also performed.

Pyelovesicostomy: An alternative to ureteropelvic junction-plasty in pelvic ectopic kidneys

Pyelovesicostomy was performed in 2 cases of hydronephrosis in pelvic kidneys secondary to ureteropelvic junction obstruction. In the first patient, who presented with a solitary kidney, the procedure was done after failure of a dismembered pyeloplasty, while in the second patient the procedure was performed electively. Both patients had sterile urines and stable renal function, although some dilatation persisted in the first case. The indications and the functional aspects of this surgical solution are discussed.

Ureteral motility after renal autotransplantation.

Twelve kidneys were autotransplanted to the internal iliac vessels in 11 patients for the treatment of renovascular hypertension. The ureter had been left unresected in all but one case, where a transuretero-ureterostomy was performed. A radiographic study of the ureteral motility was obtained during the postoperative period recording images every 1.5 s with a spot-camera system. The ureters appeared to follow different courses, due to the different surgical procedures. In all but two cases the transport of urine was obtained through separate boluses, frequency and direction of peristalsis were within normal ranges, and significant dilation was never observed.

Importanza Dello Studio Della Dinamica Della via Escretrice Nella Diagnosi E Nella Terapia Della Tubercolosi Urinaria

BElSCHER D. E.: Analysis of renal calculi by infrared spectroscopy. ]. Urol., 73; 653 (1955). BELLANATO J., CIFUENTES DELATTE L., HIDALGO A., SANTOS M.: Application of infrared spectroscopy to the study of renal stones. Urinary calculi. Int. Syrnp, Renal Stone Res., Madrid 1972, p. 237, Karger, Basel 1973. FRYE H., CHAN P.: Analysis of urinary calculi with ATR infrared spectrophotometry. Invest. Urol., 10; 144 (1972). GRIEYE J., ZAREMBSKI P. M.: Infrared spectroscopy in the clinical analysis of renal stones. Urinary Calculi. Int. Symp. Renal Stone Res., Madrid 1972, p. 231, Karger, Basel 1973. MONGIORNI R.: Sulla composizione chimico-mineralogica dei calcoli renali umani. Analisi qualiquantitativa per via diffrattometrica e fluorescenza X. G. Clin. Med., 52; 681 (1972). PRIEN E. L., PRIEN E. L. jr.: Composition and structure of urinary stone. Amer. Med., 45; 654 (1968). SUTOR D. J., WOOLEY S. E., MACKENZIE K. R, WILSON R, SCOTT R, MORGAN H. G.: Urinary tract calculi. A comparison of chemical and crystallographic analyses. Brit. J. Urol., 43; 149 (1971). SWINEHART J., PORRO T.: Biomedical applications. I. The clinical analysis of renal stones. Perkin-Elmer Infrared Applications Study, 7 (1969). TSAY Y.: Application of infrared spectroscopy to analysis of urinary calculi. J. Urol., 86; 838 (1961). WEISSMAN M., KLEIN B., BERKOWITZ J.: Clinical applications of infrared spectroscopy. Analysis of renal tract calculi. Anal. Chern., 31; 1334 (1959).