William F. Tarry

Urological Complications of Sickle Cell Disease in a Pediatric Population

We surveyed 321 patients 1 to 18 years old who were followed at the sickle cell clinic at the Childrens Hospital of Philadelphia between 1970 and 1984 for urological complications of the disease. Mean followup was 5 years and all patients exhibited a typical spectrum of hemoglobin types. The urological problems encountered were those cited in the literature, namely hematuria, urinary tract infection and priapism. Surprisingly few of our patients experienced significant renal bleeding. Although the number of patients with infection evaluated radiographically was small, the frequency of renal parenchymal scarring was disturbingly high despite the reported rarity of reflux in black subjects. Our survey and a review of the literature indicate that most sicklemic children with urinary infection are not subjected to urological evaluation. We question the wisdom of that policy. Finally, we found that priapism responds most often to nonsurgical therapy and that it rarely results in impotence in young sickle cell patients.

Impact of Stone Location on Success Rates of Endoscopic Lithotripsy for Nephrolithiasis

OBJECTIVESnTo determine whether stone location affects the stone-free rates of endoscopic lithotripsy for nephrolithiasis.nnnMETHODSnFrom January 2002 to August 2006, 245 patients with 272 stones, ranging from 4 to 20 mm in size, underwent ureteroscopy (URS) with laser lithotripsy at West Virginia University Hospital. The patients were followed up postoperatively with noncontrast spiral computed tomography, abdominal plain radiography, renal ultrasonography, or retrograde pyelography. Patients were considered to have been treated successfully if they had no residual stones. All pediatric patients were excluded, as were all patients with stones greater than 2 cm. Also, patients who had undergone previous shock wave lithotripsy, percutaneous nephrolithotripsy, or URS by an outside urologist were excluded.nnnRESULTSnA total of 86 kidney stones were treated with URS and laser lithotripsy. Of these, 81 (94.2%) were successfully treated. Five patients (5.8%) had persistent stones. All 18 upper pole stones (100%) were cleared, 23 (95.8%) of 24 middle pole stones were cleared, and 40 (90.9%) of 44 lower pole stones were cleared (P = 0.338).nnnCONCLUSIONSnURS is an important tool for treating nephroureterolithiasis with excellent success rates and minimal morbidity. The results of our study have shown that stone location does not significantly affect stone clearance rates when performing endoscopic lithotripsy for intrarenal calculi.

The Mayer-Rokitansky Syndrome: Pathogenesis, Classification and Management

Agenesis of the vagina in karyotypic female subjects may be accompanied by other defects of the urogenital system. We describe 8 cases that exemplify nearly all variants in the group of müllerian and renal anomalies that we identify as the Mayer-Rokitansky syndrome. We trace the association of system defects to errors of formation of the wolffian body. This structure is the progenitor of the gonad and wolffian duct, which although temporary in the female subject, gives rise to the ureter and is the path finder of the müllerian system. Errors of formation or premature atrophy of the wolffian duct, or intrinsic müllerian organizers lead to the array of anomalies in this syndrome. Vaginal agenesis was found to be associated with müllerian, renal or ovarian defects in numerous embryological combinations. We propose a müllerian classification, and describe the current diagnostic modalities and techniques of surgery.

Immunotherapy of Murine Transitional Cell Carcinoma of the Bladder Using Alpha and Gamma Interferon in Combination with Other Forms of Immunotherapy

BCG immunotherapy is very effective in the treatment of superficial transitional cell carcinoma of the bladder, but its significant toxicity may limit its use in some patients. In an effort to find less toxic and potentially more effective treatments we investigated the possible immunotherapeutic potential of combinations of Alpha Interferon (1000 IU) and Gamma Interferon (500 IU) with bacillus Calmette Guerin (BCG) (10(7) cfu), Interleukin-2 (4000 IU), and Keyhole Limpet Hemocyanin (50 micrograms.) in the MBT2 murine bladder cancer model. Significant reductions (p less than 0.05) in tumor incidence relative to the saline control, 83%, Day 35) was observed in groups receiving alpha interferon (42%), Keyhole limpet hemocyanin (42%), interleukin-2 (25%), alpha interferon + Keyhole limpet hemocyanin (17%), alpha interferon + interleukin-2 (33%), gamma interferon + BCG (42%), and gamma interferon + interleukin-2 (17%). All treatment groups with the exception of the group receiving gamma interferon had significantly reduced tumor volume (p less than 0.05) relative to the saline control. Combination treatment groups were significantly more effective than single agent treatments (p = 0.0057). The exhibited anti-tumor effect of these immunotherapeutic agents alone and in combination suggest that they may prove to be effective forms of immunotherapy for transitional cell carcinoma of the bladder.

Carcinosarcoma of the renal pelvis with extension into the renal vein and inferior vena cava

Abstract Renal tumors other than renal cell carcinoma rarely may invade the main renal vein and inferior vena cava. A case is reported of carcinosarcoma of the right kidney composed of transitional cell and giant cell elements with invasion into the inferior vena cava. Obstruction of the renal vein should be considered in patients with transitional cell carcinoma and an ipsilateral nonvisualized kidney on excretory urography.

COMPARISON OF PERCUTANEOUS ENDOPYELOTOMY WITH OPEN PYELOPLASTY FOR PEDIATRIC URETEROPELVIC JUNCTION OBSTRUCTION

PURPOSEnPercutaneous endopyelotomy has been shown to be effective in the management of ureteropelvic junction obstruction in adults and secondary ureteropelvic junction obstruction in children. There are little published data regarding endopyelotomy as a primary treatment in children.nnnMATERIALS AND METHODSnDuring 3 years we performed 8 endopyelotomies and 20 open pyeloplasties for primary ureteropelvic junction obstruction and compared the results. Preoperative ureteropelvic junction obstruction was detected by renal ultrasound, excretory urogram (IVP) or renal scan. All patients were followed 1.5 to 3 years postoperatively. The success of the procedure was determined by excretory urogram, renal scan or the absence of clinical findings, with 1 failure in each group.nnnRESULTSnThe overall success rates for endopyelotomy and open pyeloplasty were 88% and 93%, respectively. Hospital stays were essentially equal between the groups but operative time and hospital costs were higher for endopyelotomy.nnnCONCLUSIONSnEndopyelotomy may be performed effectively for primary ureteropelvic junction obstruction in children but with increased costs.

Radioimmunoassay of tissue steroids in adenocarcinoma of the prostate

Tissue steroid levels in 48 needle‐biopsy samples of adenocarcinoma of the prostate were quantified by radioimmunoassay (RIA). Tissue levels of dihydrotestosterone (DHT), estradiol‐17β, and estrone were correlated with tumor stage, histologic grade, and patient response to endocrine therapy. All patients with well‐differentiated carcinoma of the prostate had tissue DHT content greater than 2.0 ng/g while 35% of patients with moderately differentiated or poorly differentiated tumors had tissue DHT content less than 2.0 ng/g. DHT content appeared to be unrelated to tumor stage. Estradiol and estrone content correlated well with tumor grade but not with tumor stage. DHT levels were measured in 17 patients with symptomatic Stage D2carcinoma of the prostate. Thirteen patients with DHT content greater than 2.0 ng/g initially had an objective and/or subjective response to endocrine therapy. Four patients with tissue DHT levels below 2.0 ng/g had no response to hormonal therapy. Quantification of tissue DHT content by RIA is a promising method for predicting initial response to hormonal therapy in adenocarcinoma of the prostate.

Preventing warm ischemia with a polyurethane bag during renal transplantation

We have developed a technique that reduces the rewarm time during renal transplant vascular anastomoses by supporting the kidney in a slush-filled sterile polyurethane bag. There were no complications related to the use of this technique.