Robert Lich

Blastomycosis of the Genitourinary Tract

In a retrospective study of 51 cases of systemic North American blastomycosis 11 patients were found to have genitourinary tract involvement, the prostate and epididymis being most commonly affected. Diagnosis was made by culture of the fungus from urine, abscess or prostate secretions, morphologic identification of the characteristic organism in urine or secretions, or histologic examination of tissue specimens. Treatment with amphotericin B reduced the mortality rate of 90 per cent to as low as 10 per cent. Long-term followup is necessary because of a relapse rate of 10 to 15 per cent.

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.

Traveling bullets in genitourinary tract

A bullet lodged in the renal parenchyma, then migrated into the collecting system over a two-month period causing acute renal colic and necessitating removal by pyelotomy. A review of the literature discloses only 8 cases of projectiles migrating in the urinary tract, 5 involving metallic fragments and 3 involving bullets.

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...

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.

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.

A Method of Meatotomy

FIELD: medicine, urology. SUBSTANCE: the method deals with urethral restoration at hypospadias. One should dissect an ureteral meatus. Ellipsoidal dissection of penis skin is carried out beginning from proximal semicircumference of ureteral meatus towards glans penis. Wound edges of urethra are ligated with the edges of cutaneous incision. The method prevents restenosis of ureteral meatus. EFFECT: more stable cosmetic results. 2 dwg, 1 ex

Intermittent diurnal enuresis

Abstract A girl of four and a half years of age is reported who suffered with intermittent urine soilage. The child was found to have a duplicated hydronephrotic left kidney with an extra-urinary ureteral ostium. The urine soilage occurred by two mechanisms: (1) by muscular compression of the distended pyelectatic duplicated kidney and (2) during the night an overflow phenomenon. Heminephrectomy with total ureterectomy of the duplicated hydro-nephrotic ureter was curative and re-established this childs renal pattern morphologically and functionally.