R. Lenzi

Surgical treatment of rectourethral fistulae.

9 male patients with rectourethral fistula were treated. Fistulae were congenital in 1 case, iatrogenic in 6 cases and traumatic in 2 cases. In 8 cases we used an abdominoperineal approach with omentoplasty or peritoneal flap; in 1 case a perineal approach was made. In 2 cases it was also necessary to use a transpubic approach to the posterior urethra. Good results were obtained in all cases. The importance of a proper radiological investigation of the fistulous tract and the use of omentoplasty are both emphasized.

Treatment of Male Urethral Calculi

We treated 14 male patients for urethral stones during a 17-year interval. The calculi were located in the posterior urethra in 7 patients and in the anterior urethra in 7. Anatomical alteration of the lower urinary tract was an important predisposing factor, since 11 patients had history of bladder and urethral surgery or disease, 2 had an associated neurogenic bladder, 6 had urethral strictures or diverticula and 3 had concomitant bladder stones. Urethroplasty was performed in 5 cases, surgical removal of the stone in 3, retrograde manipulation inside the bladder in 4 and electrohydraulic endourethral lithotripsy in 2. The latter technique appears to be particularly effective for endoscopically accessible stones.

Bladder Herniation after Transpubic Urethroplasty

We report 2 cases of bladder hernia following repair of complex posterior urethral strictures by transpubic bulboprostatic anastomosis and omentoplasty. One patient was treated successfully by repair of the defect with a synthetic mesh. The presence of concomitant pubic diastasis is thought to be a contributing factor, as well as the use of omentum to fill the dead space.

Serum beta 2 microglobulin levels in patients with renal cell carcinoma

SummarySerum B2m concentrations were evaluated preoperatively in 40 patients with renal cell carcinoma and normal renal function, as assessed by serum creatinine <1.4 mg/dl, and compared with those of 23 age-matched controls. Mean value ± SD was 3,088±966 ng/ml for renal cancer patients, while controls had a value of 1,800±240 ng/ml. Statistical analysis, performed by Student t test, revealed a very high degree of significance (p<0.0005). No statistically significant differences were found between groups of patients classified according to tumor stage and cell type. Seventy percent of renal cell carcinoma cases had preoperatively elevated serum levels of B2m.

Surgical treatment of vesicoureteral reflux with bilateral medialization of the ureteral orifices.

The technique of bilateral medialization of the ureteral orifices, as proposed by Gil-Vernet, has been used with minor modifications in a series of 14 patients for the surgical treatment of vesicoureteral reflux. Its major advantages are its technical simplicity and bilateral treatment in all cases.

Experience with Omentoplasty

A 6-year experience with omentoplasty is presented. During this period pedicled omentum was used in 145 procedures of reconstructive urologic surgery. On the basis of this experience the authors conclude that omentoplasty is an essential part in urological reconstructive surgery.

Free Full Thickness Skin Graft Urethroplasty: Indications, Technique and Results

AbstractThe indications, details of operative technique and results of 26 free full thickness skin graft urethroplasties are reported. This surgical procedure also has been used successfully for urethral reconstruction in patients who already had undergone 1-stage urethroplasty for serious post-inflammatory strictures. The involvement of the corpus spongiosum in the inflammatory process is discussed and spongioplasty is emphasized.

One-Stage Skin Graft Urethroplasty in Anterior Middle Urethra: A New Procedure

A new procedure with the use of a free skin patch graft for the surgical treatment of strictures located in the mid anterior urethra is described. To avoid the formation of a urethral diverticulum, the skin graft is sutured dorsally rather than ventrally and subsequently is fixed on the tunica albuginea of the corpora, which support the patch. We describe 4 different procedures according to the extent of the stenosis and the degree of involvement of the spongiosum tissue by the inflammatory process. The preliminary results obtained in a small series of 6 patients are presented.

Rupture of the bulb of the urethra: repair effectuated using a patch of human dura mater.

AbstractWe describe a case of traumatic rupture of the bulb of the urethra, which was repaired successfully using a patch of lyophilized dura mater.

Surgical Treatment of Male Urinary Incontinence

Between January 1975 and December 1981 we treated 34 men with urinary incontinence with surgical intercavernous embedding of the bulboperineal urethra along its entire length. The etiology of incontinence was sphincteric damage following either prostatectomy (30 cases) or pelvic trauma (4 cases). All patients had complete neurologic integrity of the detrusor, 25 (75 per cent) had complete urinary continence, 5 (15 per cent) experienced considerable improvement, while 4 were failures. Followup ranged from 7 years to 4 months. Details of the surgical procedure are described, preoperative and postoperative management is emphasized and results are presented.