Leon G. Lome

Varicocelectomy and infertility

Eighty males with varicocele underwent internal spermatic vein ligation as therapy for infertility. Semen quality improved in 78 per cent following ligation, and 51 per cent of wives became pregnant. The results in this series compare favorably with previous studies. We believe that spermatic vein ligation is a very successful adjunct in the treatment of the infertile male with varicocele.

Surgical management of ectopic ureterocele.

Nine patients with ectopic ureterocele, complete duplication, and nonvisualization of the upper renal segment are presented. All were managed with heminephrectomy and partial ureterectomy only. The procedure immediately controlled urosepsis, and ultimately was successful in the management of associated reflux. Excision of ureterocele and reimplantation of the ipsilateral ureter was unnecessary.

Primary malignant melanoma of urinary bladder

We report a case of primary malignant melanoma of the urinary bladder. Exclusion of other sites of melanoma confirmed the primary character of the tumor, and careful histologic examination proved it to be malignant melanoma. Six previously reported cases of bladder melanoma are reviewed. Therapy and prognosis are discussed.

Dynamic Renal Scan in the Non-Visualizing Kidney

Thirty-one patients with 35 non-visualizing kidneys on excretory urography were studied with 99mtechnetium-diethylenetriaminepentaacetic acid scintiscanning. In 11 cases good renal blood flow and concentration were demonstrated on nucleide scanning. All patients had significant parenchyma and recoverable renal function after appropriate surgical management. In 20 cases there was little or no blood flow on the scan. These patients either had a congenitally absent kidney or severely destroyed parenchyma. The 99mtechnetium-diethylenetriaminepentaacetic acid dynamic renal scan is a sensitive method for predicting renal salvageability of a kidney that fails to visualize on excretory urography.

Urologic complications of renal papillary necrosis

Fifty-six patients demonstrating roentgenographic evidence of renal papillary necrosis were reviewed. Seven patients had an acute fulminating form of the disease. Urologic complication incident to sloughed renal papillae required urgent surgical intervention. Management ranging from ureteral catheterization to nephrectomy in 3 of 7 patients is discussed, and associated disease states are scrutinized.

Renal dysplasia in horseshoe kidney

Abstract A sixth case of renal dysplasia associated with a horseshoe kidney is described. Modalities for preoperative diagnosis and the surgical management of this unusual anomaly are discussed.

Potential Overstaging of Bladder Cancer by Computerized Tomography Scanning

We report 4 cases of bladder cancer that was overstaged by computerized tomography. In 2 patients the scans were performed after cystoscopy and bladder biopsy, and overstaging occurred secondary to artifacts produced at the time of biopsy. In the other 2 patients the scans were done before biopsy. In these patients perivesical and periprostatic infiltration interpreted on computerized tomography scans was not found in the surgical pathological specimens.

Management of interstitial cystitis with ileocecocystoplasty

Abstract Two patients rendered urinary cripples from contracted bladders secondary to interstitial cystitis underwent ileocecocystoplasty for bladder expansion. The technique and advantages of this procedure are outlined. Both patients have satisfactory voiding patterns, insignificant residual urine, and normal renal function up to two years. Although this procedure is performed infrequently, it can significantly benefit the patient with a severely contracted bladder.