Gilberto Menezes de Góes

Extravesical ureteral implantation in kidney transplantation

Abstract Eighty-eight cases of kidney transplantation and extravesical ureteral implantation are reviewed with long-term evaluation. The total complication rate was 18.14 per cent, and in only 3.4 per cent have these complications been responsible for the death of the patients. The technique has been shown to be safe and useful for reestablishing the urinary transit in kidney transplantation.

Modified meatal advancement and glanuloplasty repair of distal hypospadias

Meatal advancement with glanuloplasty is indicated in cases of distal hypospadias. The principles of this operation are safe. Incorporation of urethroplasty with meatal advancement and glanuloplasty enables treatment of the more severe cases of distal hypospadias. We have used this modified operative technique in 10 boys with only 1 complication, which probably was related to the wrong choice of urinary diversion.

Transplantation of a Horseshoe Kidney

Abstract Horseshoe kidneys generally have not been used for transplantation. Their use has been described in only 3 cases, and in these cases the kidney was divided and transplanted into 2 recipients. We present a case in which a horseshoe kidney was transplanted successfully en bloc by its aorta-caval vascular pedicle to overcome the obstacle of a multiple renal arterial supply.

Carcinoma in diverticulum of female urethra.

A case of female urethral diverticulum is reported by the authors. It is a rare disease and about 31 cases have previously been described. An analysis is made in relation to the diverticulum of the urethra and to female urethral carcinoma. Emphasis is given on the semiology and the recently acquired diagnostic procedures, as these have led to an increased number of recognized cases. In the case presented, an extended resection and a definitive urinary derivation was performed, together with chemo- and radiotherapy. A follow-up of 2.5 years showed no signs of recurrence or metastases.

Vinblastine, Actinomycin D, Bleomycin, Cyclophosphamide and Cis-Platinum for Advanced Germ Cell Testis Tumors: Brazilian Experience

Disseminated germ cell testicular cancer proved to be highly sensitive to platinum-containing chemotherapy regimens. We present data concerning the treatment of advanced seminoma and nonseminomatous tumors in a developing country. We treated 30 patients with advanced germ cell testis tumors with 3 or 4 cycles of vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum. Surgical resection of residual masses was done 30 days after completion of chemotherapy in 18 patients. The histology of the primary tumor was seminoma in 13 patients and nonseminomatous tumors in 17. Toxicity was mild and no treatment-related deaths occurred. All 13 patients (100 per cent) with seminoma and 12 of 17 patients (71 per cent) with nonseminomatous tumors had a complete response to chemotherapy, and 1 of 17 patients was free of disease after a debulking operation and additional chemotherapy. A total of 3 patients with seminoma and 2 with nonseminomatous tumors had recurrences 5 to 8 months after an initial complete response and received additional chemotherapy (VP-16 regimen) with or without radiotherapy. Complete clinical response was achieved in 4 of 5 patients. Median followup was 24 months (range 8 to 38 months) in the 13 patients with seminoma and 28 months (range 9 to 58 months) in those with nonseminomatous tumors, and 13 (100 per cent) and 12 (71 per cent), respectively, are alive without evidence of disease. These data suggest that the protocol of vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum is highly effective and minimally toxic in the treatment of disseminated germ cell testicular cancer, inducing an 83 per cent long-lasting clinical remission. Seminomas seem to be equally or even more sensitive than nonseminomatous tumors to this platinum-containing chemotherapy regimen. Recurrence after initial complete response can be treated successfully with regimens containing VP-16.

Vesical haemangioma: Report of two cases

Two cases of vesical haemangioma and a review of the literature are presented. In one of the cases association with cutaneous “Blue Rubber Bleb Nevus” has been found.Vesical haemangioma is a benign tumour, probably of congenital origin, that occurs in young patients. The first symptom is generally haematuria, and diagnosis is confirmed by cystoscopy.The treatment of choice is partial cystectomy, and the most common histologic form is cavernous haemangioma.

Sacral agenesis: Why is it so frequently misdiagnosed?

Thirty-four patients with sacral agenesis were seen from 1954 to 1983, cases of meningomyelocele excluded. Five recognizable and consistent patterns of bone malformation were identified. Urodynamic examinations were done in 10 of the 34 patients. Their evaluation and response to treatment are analyzed; we tried to determine and establish the possible causes for its late diagnosis and consequences regarding the upper urinary tract.

A pull-through operation for the treatment of lesions of the posterior and bulbar urethra

Authors describe a pull-through operation for treatment of lesion of the posterior and bulbar urethra. Membranous and bulbomembranous stricture, recent rupture of posterior urethra and rectourethral fistula were approched by this surgical procedure.Modifications are introduced on this technique and for the first time it was used for the treatment of early lesions of the posterior urethra. Some conclusions may be drawn.1.The pull-through operation provided good functional results in 76.6% of the cases, irrespective of the etiology.2.Urethral caliber became normal in 86.66% of the cases; a comparison of the 3 groups showed that the etiology did not influence the results.3.An evaluation of the results showed that the urinary infection was independent of the etiology.4.An excretory urography of the upper urinary tract was normal in 77.27% of the cases irrespective of the etiology.5.The middle and lower urinary tract were normal in 42.85% of the cases.6.The greater the number of surgical interventions, previous to the pullthrough operation, the higher the incidence of poor results, as judged by urethrccystography.

Assessment of Hydroureteronephrosis by Renographic Evaluation under Diuretic Stimulus

42 dilated renal units, from 32 patients, were evaluated renographically with 131I, under diuretic stimulus, with the aim of differentiating between obstructed and atonic ureters. The results of this study are similar to the clinical follow-up and surgical findings in 88% of cases.

Surgical correction of peyronie's disease using nesbit's technique — An excellent way to reconstruct erectile potency

SummarySurgical correction of penile curvature due to Peyronies disease was done using the Nesbit operation originally described for repair of congenital curvatures. A modification of the technique was introduced using a skin incision over the local area where the ellipse was taken thereby avoiding unnecessary extended dissection. The results in 22 patients were satisfactory with minimal surgical complications. Good results, short-term hospitalization and simplicity of the technique make this approach the first to be considered in cases of surgical correction of Peyronies disease.