Lonnie W. Howerton

Infundibulopelvic dysgenesis: A spectrum ofobstructive renal disease

Infundibulopelvic dysgenesis is an obstructive process of the pyelocalyceal system that is responsible for a spectrum of congenital renal disorders. The site and degree of narrowing in the infundibulopelvic system produce the various congenital anomalies like hydrocalycosis, calyceal diverticula, ureteropelvic junction stenosis, and multicystic kidney. A classification with illustrative cases is presented showing a common pathogenesis of these congenital obstructive anomalies.

The management of testicular torsion in the acute pediatric scrotum.

From July 1976 through June 1981, 51 children with acute scrotal pain and swelling underwent surgical exploration. Testicular torsion (27 cases) and torsion of an appendage (18 cases) were the most common diagnoses. In the group with testicular torsion 5 testes were considered unsalvageable and these were removed. The remaining 22 testes, including those of questionable viability, were left in place. The early salvage rate of 81 per cent decreased to 50 per cent due to testicular atrophy found in the late followup period. The attempt to salvage all testes except those with obvious necrosis resulted in minimal morbidity. This approach is discussed in view of recent reports of long-term damage to the contralateral testis when an ischemic testis is not removed initially.

The Role of Ureteral Stenting in the Management of Surgical Injury of the Ureter

From 1965 through 1976, 35 patients with surgical injury of the ureter were treated by operations requiring ureteral anastomoses. Stenting devices were used in 31 patients with only 2 failures. Stents were omitted in 4 patients with 2 failures. We have been satisfied with and prefer stenting ureteral anastomoses in the management of surgical ureteral injury, particularly when there is delayed recognition of the injury or previous irradiation. Previous objections to stenting are unjustified.

The lower urinary tract in infants and children.

Urinary tract infection is extremely common and in pediatric practice such infections occurring repeatedly are generally considered an indication for excretory urography. In many instances, if the urogram is normal, the diagnosis is “cystitis” or “pyelonephritis,” and only medical measures are prescribed. A normal excretory urogram, however, does not exclude urinary tract obstruction, particularly in patients in whom serious damage has not resulted. “Pyelonephritis” is a diagnosis of exclusion in infancy and childhood, and until urinary tract obstruction has been ruled out by all possible means, the patient has not been adequately investigated (1, 2). Cystoscopy is relatively ineffective in evaluation of the posterior urethra and the bladder neck and a complete study of the urinary tract in patients with continuously infected urine must include a voiding cystourethrogram. This examination is the most efficient method of demonstrating obstructions in the bladder neck and urethra, and of analyzing the compe...

Bilateral or unilateral ureteroneocystostomy for unilateral reflux

Thirty-five cases of unilateral reflux treated by ipsilateral ureteroneocystostomy have been reviewed to determine the incidence of subsequent contralateral reflux. The low incidence (11 per cent) suggests that bilateral reimplant should not be performed routinely in patients undergoing surgery for unilateral reflux. Analysis of this group of patients failed to show any preoperative findings which would help to predict those in whom contralateral reflux is most likely to develop. Our study and the review of the literature suggest that those who demonstrate reflux in the contralateral ureter at any time prior to surgery are more likely to reflux subsequently; therefore, in this group of patients bilateral reimplantation is indicated.

Terminal Loop Cutaneous Ureterostomy: A Method of Urinary Drainage in Kidney Transplantation

A non-functional and permanently damaged lower urinary tract is no longer a contraindication to kidney transplantation. In patients with this disorder the ureter commonly is drained by an intestinal conduit. We have used terminal loop cutaneous ureterostomy as a method of urinary drainage in 3 patients with cadaver kidney transplants who have been followed for up to 8 years. The technique of terminal loop cutaneous ureterostomy and a report of these cases are presented.

Subcapsular orchiectomy with intracapsular testicular prosthesis for metastatic prostate carcinoma

Fifteen patients underwent subcapsular orchiectomy with placement of an intracapsular testicular prosthesis for hormonal treatment of symptomatic Stage D carcinoma of the prostate. Serum testosterone decreased to castration levels, and the intracapsular prosthesis was often indistinguishable from a normal testicle postoperatively. This new technique of castration may be considered an alternative in those patients reluctant to undergo other forms of orchiectomy.

Terminal Loop Cutaneous Ureterostomy: An Experimental Study and its Clinical Application

Terminal loop cutaneous ureterostomy is a technique to enhance the blood supply and, thereby, decrease the complication rate with stomas. An animal study and experience with 20 patients with long-term followup support this contention.

Decreased Fistula Formation with Modified Denis Browne Hypospadias Repair

Many surgeons have abandoned the Denis Browne technique of hypospadias repair because of the associated high rate of postoperative fistulas. We reviewed retrospectively 40 cases of perineal or penoscrotal hypospadias in which a previously described modification of the Denis Browne technique had been used. The low rate of associated postoperative fistula formation makes this modified technique a valuable procedure in selected cases of hypospadias.