Robert K. Vinson

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.

Endoscopic vesicourethropexy for stress urinary incontinence Experience at the medical center hospital of vermont

Forty-eight women with stress urinary incontinence underwent endoscopic vesicourethropexy between December, 1978, and December, 1982, at the Medical Center Hospital of Vermont or its affiliates. Four patients were lost to follow-up within six weeks, and 44 patients were followed for four to forty-one months. The overall success rate was 79.2 per cent. Failures occurred as late as fourteen months. The major complication rate was 33.3 per cent. Major complications included suprapubic abscess formation and prolonged urinary retention for up to six months. Though an obviously effective therapy for the correction of stress urinary incontinence, our success with endoscopic vesicourethropexy is less than that generally reported. Further, the incidence and nature of postoperative complications in our series provoke a greater awareness of the potential shortcomings of this procedure.

Urolithiasis from stapler anastomosis.

The simplicity of operation and versatility and speed of automatic stapling devices in the creation of ileal loops have been amply documented. Three cases of stone formation in the ileal loop, secondary to encrustation about the staples, are reported herein, and the modification to the surgical technic which would obviate this problem is presented.

Survival after radical cystectomy for invasive transitional cell carcinoma of bladder.

Forty-eight patients with invasive transitional cell carcinoma of the bladder underwent radical cystectomy over a ten-year period. Thirty-three patients also underwent pelvic lymph node dissection. Lymphadenectomy did not statistically alter the rate of operative mortality, morbidity, or over-all survival.

Bladder calculi formation during clean intermittent catheterization

Abstract Three cases are presented of bladder calculi occurring around pubic hairs introduced during clean intermittent catheterization.

Cystometry in upright position: accurate identification of decompensated bladder.

Cystometrograms obtained in the physiologic erect position have been found to picture accurately the classic decompensated bladder in women with recurrent urinary tract infections. The standard supine cystometrogram, however, may be inaccurate or normal in females with a history of infrequent voiding and prolonged vesical overdistention.