Kenneth N. Walton

Gunshot Wounds of the Ureter: A 15-Year Review of 63 Consecutive Cases

We reviewed 63 consecutive cases of gunshot wounds of the ureter seen during a 15-year period. The importance of prompt recognition and aggressive surgical management is emphasized, with particular attention being placed on adequate debridement and spatulated splinted watertight ureteroureterostomy. Our philosophy of management for individual injuries is discussed along with our complications and results. This series is the largest reported to date of ureteral gunshot wounds.

Transluminal Balloon Dilation of Ureteral Strictures

Ureteral strictures are uncommon problems in urological practice. The nonvascular application of the Grüntzig balloon catheter is proposed as an alternative to surgery in some of these patients. We treated 6 ureteral strictures in 5 patients by balloon dilation with an 83 per cent success rate.

Experience with the Horton-Devine Dermal Graft in the Treatment of Peyronie’s Disease

We treated 15 patients with Peyronies disease surgically with the dermal graft technique described by Horton and Devine. Details of the preoperative management and surgical technique are provided. Return of normal sexual function without residual chordee or pain was achieved in more than 75 per cent of the patients, suggesting that this is the procedure of choice in the management of severe Peyronies disease.

10-Year Experience With Adenocarcinoma of the Bladder

Adenocarcinoma is an uncommon form of bladder carcinoma. We review our 10-year experience with primary adenocarcinoma of the bladder in 28 patients who were managed by a wide range of therapeutic modalities. Our data reaffirm the highly aggressive nature of this lesion. However, aggressive therapy is justified when feasible.

Ileal conduit urinary diversion. Ten-year review.

The experience with ileal conduit urinary diversion at Emory University and Affiliated Hospitals over a ten-year period is presented. Included in this review are patients with benign and malignant disease. The indications, technique, results, and complications of this type of urinary diversion are considered. Some differences between ileal conduit diversion of children and adults are discussed.

Nonmetastatic Bladder Cancer Associated with Hypercalcemia, Thrombocytosis and Leukemoid Reaction

We reviewed 4 patients with urothelial bladder cancer and hypercalcemia but without evidence of bony metastasis. Of the patients 2 presented with a leukemoid reaction (1 also had thrombocytosis). None of the patients had evidence of bone metastases or other causes of hypercalcemia, such as hyperparathyroidism, sarcoidosis or vitamin D intoxication. All 4 patients received aggressive therapy for the tumors. In each instance the serum calcium returned to normal following radiation therapy or tumor removal, lending support to the theory of humoral hypercalcemia of cancer. A diagnostic and therapeutic approach to such patients is outlined.

Secondary tumors of penis.

The penis, despite its rich vascular supply, is a very uncommon site of metastatic tumor. When present, the prognosis is extremely poor. Four cases of secondary tumors of the penis are presented and the literature reviewed.

Unusual cause of acute urinary retention in a child

A five-year-old child presented with a history of acute urinary retention for eighteen hours. Extensive diagnostic evaluation proved the presence of a retrovesical pelvic mass, which on surgical exploration was found to be an acutely inflamed appendix.

Hypertension as complication of vesicoureteral reflux in children

Eight cases are reported of female children presenting with hypertension and found to have primary vesicoureteral reflux with chronic pyelonephritis. In 6 patients renal function was essentially normal while 2 had azotemia and progessive renal deterioration. As a result of early surgical intervention in the form of antireflux procedures, occasionally combined with unilateral nephrectomy for renin-dependent lesions, 5 of the 8 had complete disappearance or amelioration of hypertension with stabilization of renal function. The interactions of each member of the triad--vesicoureteral reflux, pyelonephritis, and hypertension--are reviewed with emphasis on pertinent pathophysiologic concepts regarding their roles in the production of progressive renal deterioration.