Paul M. Morrisseau

Percutaneous Renal Biopsy of the Solitary Kidney: A Contraindication?

We recently were presented with a patient from the nephrology service, with the request to perform open renal biopsy because of a solitary functioning kidney. We performed the open biopsy and the patient subsequently had a wound infection, leading us to question the recommendation in the literature stating that a solitary kidney is an absolute contraindication for percutaneous renal biopsy. In a review of the literature from 1951 to 1990, a total of 19,459 percutaneous renal biopsies has been reported with an overall complication rate of 2.1 to 10.8%, the majority (90%) of which did not require definitive treatment. Only 13 nephrectomies (0.06%) were required secondary to complications. The overall mortality rate was 0.08%. We reviewed 157 percutaneous renal biopsies done at this institution from 1985 to 1990 with a minor complication rate of only 5% and no major complications or loss of kidney function. The mortality rate was 0. Based on our study and a review of the literature, both showing an extremely small percentage of permanent loss of kidney function or mortality, we propose that a solitary kidney no longer be recommended as an absolute contraindication to percutaneous renal biopsy.

Acute obstructive renal failure secondary to granulocytic sarcoma (Chloroma)

We report an unusual case of bilateral ureteral obstruction secondary to granulocytic sarcoma of the uterine cervix. Proximal urinary diversion followed by radiation therapy to the tumor relieved the obstruction. The need for prompt diagnosis and treatment of this rare neoplasm is stressed.

Osler-weber-rendu syndrome: Urologist's view☆

Two patients had hereditary hemorrhagic telangiectasia with hematuria. Characteristic telangiectasia was demonstrated in the bladder, prostate, and prostatic urethra of 1 patient; the other had a bladder tumor. Pathophysiologic aspects and treatment of the syndrome are discussed. Hematuria in patients with hereditary hemorrhagic telangiectasia demands urologic investigation to rule out the common causes of urinary tract bleeding; conversely, this disease should be included among possible diagnoses in patients with hematuria of obscure origin.

Retrograde Percutaneous Nephrolithotomy: Urological Treatment of a Urological Problem

We present our experience during a 22-month period with the retrograde approach to gain renal access for percutaneous stone removal in 71 consecutive patients. The retrograde puncture technique is fast and accurate, and it allows the physician to perform a 1-stage operation, saving the patient time, frustration and expense. The Lawson technique was used in all patients and it was successful in all but 2. In those 2 patients the Hawkins-Hunter technique was successful. There were no intraoperative or postoperative complications related to this approach. Except for 1 patient who suffered a post-procedure pulmonary embolus, no transfusions were required. The targeted stone was removed in 1 procedure in 61 of 71 patients (86 per cent). Ten patients required another procedure to remove the targeted stone or a second stone. Percutaneous procedures still are required for certain stone problems or when extracorporeal shock wave lithotripsy is not readily available. The ability of the urologist to perform this easy procedure will allow him more choice in how to manage stone patients.

Incidence of late ureteral obstruction after antireflux surgery in infants and children

Forty infants and children who underwent antireflux surgery for primary reflux had long-term follow-up with intravenous pyelograms (IVP). The IVPs were evaluated for the incidence of late ureteral obstruction. Although 4 cases (5.5 per cent) of early ureteral obstruction were noted, no instances of late ureteral obstruction were found. After antireflux surgery, patients should have a follow-up IVP within the first six months to rule out the possibility of early ureteral obstruction. The need for performing periodic IVPs for many years postoperatively, when obstruction is absent in the immediate postoperative period, is questioned.

Ureteral transection secondary to lumbar disk surgery

Abstract We believe only 6 cases of ureteral injury during lumbar disk surgery have been reported. This additional case report points out the need for the orthopedist or neurosurgeon to be alert to this unusual complication in order to allow salvage of the involved kidney.