Michael E. Gribetz

Ureteral injuries during vascular surgery.

The rapid increase in the number of vascular surgical procedures done has led to a new class of iatrogenic ureteral injuries. Vena caval ligation, bilateral lumbar sympathectomy, bypass procedures and abdominal aortic aneurysmectomy produce the majority of these injuries. Established principles useful in the repair of iatrogenic injuries following a gynecologic or colonic operation often are inapplicable.

Penile Denudation Injuries After Circumcision

We present 3 cases of iatrogenic phallic denudation that were managed successfully nonoperatively. The concept of conservative, nonoperative management should be considered in denudation injuries.

Desmoid tumor-ureteral fistula in Gardner's syndrome

Gardners syndrome (GS) is complicated by abdominal desmoid tumors in approximately 8% of cases. We describe two cases of ureteral obstruction and fistulization due to rapidly enlarging desmoid tumors. Initial management consisted of placement of ureteral stents to provide urine drainage from the kidney as well as from the collection in the cavities within the desmoid tumors.

Sarcomatoid carcinoma after radiation treatment of prostatic adenocarcinoma

We report 2 patients with conventional prostatic adenocarcinoma who developed sarcomatoid carcinoma of probable prostatic origin 6 and 2.5 years after radiation treatment (seed implantation and external beam). Our cases had histologic features consistent with those cases previously reported in the literature. The tumors consisted of spindle cells with large hyperchromatic nuclei and a pattern mimicking a sarcoma. Immunohistochemical studies showed the tumors to be weakly positive for EMA, CK7, and vimentin. Ki67 staining showed positivity in more than 50% of tumor cells. The tumors also stained diffusely positive for p53 and p63. PSA and PAP were negative. Clinically, the sarcomatoid carcinomas appeared to be of prostatic origin. The pathogenesis of the tumors is still uncertain but most likely represent a radiation-induced dedifferentiation of prostatic adenocarcinoma.

Female phallic urethra and persistent cloaca.

Accessory phallic urethra in the female newborn with a persistent cloaca is a rare entity. We present a variant with a cloaca that contained rectal, vaginal and bladder neck openings, as well as the proximal origin of the phallic urethra. The literature is reviewed.

Modification of and expanded indications of MAGPI procedure in hypospadias

Experience with the MAGPI (meatoplasty and glanuloplasty) procedure in hypospadias repair, a modification of the procedure, and expanded indications for its use are presented. The excellent cosmetic results attained warrant more widespread use of this procedure.

Single Vaginal Ectopic Ureter and the Vater Syndrome

Abstract We report on a 2-year-old girl with a nonfunctioning kidney, ureteral stricture and ectopic vaginal ureteral orifice associated with an imperforate anus and other congenital malformations. This case most likely represents a rare variant of the VATER syndrome. The literature is reviewed.

Ectopic ureterocele, hydroureter, and renal dysplasia An embryogenic triad

A review of the literature of the embryogenesis of ectopic ureterocele is presented. A theory linking the triad of ectopic ureterocele, hydroureter, and renal dysplasia to a primary intrinsic developmental abnormality of size and position of the ureteral bud is postulated.

Large Caliber Urethral False Passage After Catheterization: A Case Report

Abstract We report a case of a large false passage in the penile urethra, masquerading as a severely strictured urethra. Successful surgical repair was accomplished using the optical urethrotome.

High pressure pyelocalyceal reflux. Case presentation.

In the absence of vesicoureteral reflux or urinary tract obstruction, conservative management is advocated for children with recurrent urinary tract infection. Conventional radiographic studies and static nuclear imaging techniques, however, may fail to reveal a subclinical but significant structural or functional abnormality. Recurrent breakthrough infections during appropriate medical treatment and high pressure pyelocalyceal reflux may justify a more aggressive therapeutic approach. We propose that a pressure perfusion study with fluoroscopy and continuous pressure monitoring be performed preoperatively to help select those children in whom surgery is an acceptable alternative.