Kailash R. Kedia

Management of Initial Pyeloplasty Failure

AbstractEight children with 10 reobstructed renal pelves have been managed by reoperation. Successful relief of sepsis, leakage and continued progressive hydronephrosis has been accomplished by standard urological procedures, that is lack of tension, accurate approximation and gentleness in tissue handling.

Effect of phenoxybenzamine (dibenzyline) on sexual function in man

Phenoxybenzamine (Dibenzyline) has been extremely effective in treating patients with detrusor dyssynergia. Its minimal side effects include: mouth dryness, nasal congestion, drowsiness and fatigue, nausea and vomiting, palpitations, ejaculatory failure, and retrograde ejaculation. Nineteen men treated with phenoxybenzamine for detrusor dyssynergia reported ejaculatory failure during treatment; normal ejaculation returned after treatment was discontinued. Postmasturbation urine and semen samples were analyzed for sperm and fructose. The results of the study suggest that ejaculatory failure was due to the lack of seminal emission into the posterior urethra, rather than retrograde ejaculation. Some implications of this study are also discussed.

The Management of Advanced Bladder Carcinoma

Since October 1978, 25 patients with metastatic carcinoma of the bladder have been treated with cis-platinum, doxorubicin hydrochloride and cyclophosphamide. Patient selection for this protocol was relatively strict and included only patients who had measurable parameters. All 3 drugs (60 mg./m.2 cis-platinum, 40 mg./m.2 doxorubicin hydrochloride and 400 mg./m.2 cyclophosphamide) were given as a single dose every 4 weeks. Over-all, 19 of the 23 evaluable patients (82 per cent) responded to therapy. There were 5 complete drug-induced remissions and 14 partial remissions. Generally, the treatment was tolerated well and common toxic effects were myelosuppression, nausea, vomiting and alopecia. One patient died of septicemia as a result of agranulocytosis. These promising results seem to indicate the high degree of effectiveness of this combination chemotherapy against transitional cell carcinoma of the bladder.

Penile plethysmography useful in diagnosis of vasculogenic impotence

Pulse-volume recordings were obtained in 40 normal subjects and 62 patients with history of impotence. In office practice, this study proved to be valuable for estimating penile perfusion. Penile plethysmography is a unique and adaptable screening method for penile blood flow. It measures the contributions of all vessels at the root of the penis. Pulse-volume recordings also were found to correlate with the severity of pelvic angiographic patterns of occlusive disease. Further investigation is necessary to determine the precision with which the method can detect penile blood flow in patients with early vascular compromise.

Percutaneous Nephrostomy and Ureteral Injury

The courses of 6 patients with various forms or ureteral injury and disruption herein illustrate the value and worth of percutaneous nephrostomy drainage and study. The nature and degree of injury are ascertained, and sepsis and obstruction are managed without formal anesthesia or surgical intervention, leading to ultimate repair in a planned and orderly fashion.

Arterial embolization of renal allograft to control hemorrhage secondary to percutaneous nephropyelostomy.

AbstractPercutaneous nephropyelostomy is an accepted method for relieving obstruction of the upper urinary tract. We report a case of massive renal hemorrhage following removal of the percutaneous nephropyelostomy catheter. Treatment with angioinfarction of the bleeding branch of the renal artery was successful.

Transureteroureterostomy: an adjunct to cystectomy.

Eight elderly patients with carcinoma of the bladder have been managed over the last three years with cystectomy done along with transureteroureterostomy. The decision for surgery was dictated by intractable bleeding, disabling symptoms, and extensive recurrent lesions of life-threatening degree. All of these patients were a poor risk. All successfully had cystectomy with urinary diversions achieved by transureteroureterostomies in association with a cutaneous ureterostomy. The surgery was done extraperitoneally; the patients were usually ambulated quickly, and the need for long-term nasogastric tubes was obviated. The course and clinical management of these patients are discussed and advantages and disadvantages of this form of urinary diversion presented.

Spontaneous Ureteroileal Colostomy

AbstractWe report on 3 patients with spontaneous diversion of the urine to the bowel from functioning ureteroileostomy after cystoprostatectomy. Management of these complications has resulted in no serious problem and a conservative approach to this infrequent development is recommended.