Walter M. O'Brien

Adrenal metastases by renal cell carcinoma: Incidence at nephrectomy

Recently, there have been questions raised as to the results and feasibility of performing renal-sparing procedures for localized renal cell carcinoma. We reviewed the records of 72 patients treated with standard radical nephrectomy to determine the incidence of adrenal involvement and to determine if adrenal lesions were detectable by radiographic methods preoperatively. Four patients had evidence of adrenal involvement for an overall incidence of 5.5 per cent. All had upper pole lesions. Adrenal involvement in each case was apparent at surgery or on preoperative imaging studies. For patients with middle and lower pole localized renal cell carcinoma who have normal findings on preoperative computerized tomography scans, modified radical nephrectomy sparing the adrenal gland may be a surgical alternative to radical nephrectomy.

Priapism: Current concepts

The treatment options for the management of the patient with priapism have changed markedly within the past several years. When possible, the underlying cause of the priapism should be identified. Therapy should be guided by the results of aspiration of the blood-filled corpora cavernosa of the erect penis. Early intervention through pharmacologic manipulation or surgical shunting should not be delayed while trying conservative measures.

Percutaneous nephrostomy in infants.

We reviewed our experience with percutaneous nephrostomy placement in children less than one year of age during a five-year period. Placement was successful in 8 of 9 cases. There were no complications. The procedure favorably altered the outcome for each patient and was useful for reversing azotemia prior to surgical intervention for repair of an obstructed system (2 renal units), for providing drainage of pyonephrotic kidneys (3 renal units), for demonstrating inadequate recovery of renal function after relief of obstruction (2 renal units), and for replacing a surgically placed nephrostomy that was dislodged (1 renal unit). Our experience has encouraged us to accept the technique, and we believe that it is a valuable nonsurgical alternative that should be available to urologists managing infants with urinary tract pathology.

Acute scrotal swelling in henochschonlein syndrome: Evaluation with testicular scanning

Acute scrotal swelling may accompany Henoch-Schonlein syndrome and may be the presenting manifestation mimicking testicular torsion. Two patients with scrotal involvement were recently evaluated with nuclear imaging to assess testicular perfusion. One patient had normal perfusion, and the other had increased perfusion. Scan results allowed expectant management and avoided the need for exploratory surgery to rule out testicular torsion.

Epididymitis—An unusual presentation of colovesical fistula secondary to diverticulitis

A case of colovesical fistula secondary to diverticulitis that had the unusual presentation of epididymitis is presented. The current literature on diverticulitis involving the urinary tract is reviewed.

Neurogenic fibrosarcoma following radiation therapy for seminoma

We report a case of radiation-induced neurogenic fibrosarcoma that developed in a patient who received radiation therapy for seminoma. The sarcoma developed within the irradiated field after a latency period of nineteen years. Although the occurrence of a secondary neoplasm is unusual, this possibility should be included in the differential diagnosis of patients who present with tumor growth after a long interval following radiation therapy.