Wyland F. Leadbetter

Primary malignant lymphoma of the urinary bladder

Primary malignant lymphoma of the urinary bladder is a rare disease. A report of 2 cases treated at the Massachusetts General Hospital since 1959 is presented. Both have survived 5 or more years, one after radical surgery and one after aggressive radiation therapy. The clinical, pathologic, and therapeutic aspects of this disease are reviewed briefly.

Ileal Conduit Parastomal Hernias

Of 400 patients who underwent ileal conduit diversion between 1963 and 1972, 18 (4.5 per cent) had parastomal hernias. A poorly fitting appliance was the most common presenting symptom. The hernia was found most often in the superolateral quadrant of the stoma at the site of mesenteric attachment of the conduit. In situ and translocation repairs of the stoma are discussed.

Radiological evaluation of primary megaloureter. The aperistaltic distal ureteral segment.

Thirty-one patients with megaloureter (functional ureteral obstruction) have been encountered in the past thirteen years. Urographically, this disorder presents as a fusiform dilatation of the distal (pelvic) ureter, without pyelo-caliectasis. Cinefluoroscopy shows normal peristalsis in the proximally dilated ureter, but the contracting wave terminates abruptly when it reaches the adynamic distal ureteral segment. The juxtavesical aperistaltic “narrow” segment is not anatomically obstructed and does not permit vesicoureteral reflux as tested by retrograde catheter calibration and cystourethrography. In addition, no neurogenic bladder dysfunction is present.

MODERN TRENDS IN UROLOGY.

Although much remains to be done in solving urologic problems, significant progress has been made in the last 20 years, particularly in three areas.Cineroentgenography has made it possible to demonstrate vesicoureteral reflux, and studies have clarified its role in pyelonephritis. An operative procedure to check reflux has produced excellent results in more than 150 patients.Total urinary incontinence remains a distressing problem; however, certain technics have proved successful in correcting incontinence from various causes.The transvesicocapsular technic, an operation which combines the best features of suprapubic and retropubic prostatectomy, has improved results in this type of surgery.

Ileal Sleeve Procedure for the Decompensated Ureter

Publisher Summary This chapter discusses ileal sleeve procedure for the decompensated ureter. Ileal or sigmoid loop diversion, even if placed in the renal pelvis, has rarely resulted in a stable renal situation when serious ureteral and pelvic dilatation has been present. A method consisting of wrapping the ureter from renal pelvis to pelvic ureter with a segment of ileum, known as ileal sleeve, can be developed. The basis for this procedure was envisioned as assisted ureteral peristalsis by a close-fitting sleeve of ileum. The technique of the operation involves isolating a sufficient length of ileum with its vascular pedicle, opening the segment by longitudinal incision along its antimesenteric border, stripping the mucosa, narrowing it as necessary by longitudinal excision, and then applying it about the freed ureter as an isoperistaltic seromuscular sleeve. The sleeve is sutured snugly around and to the ureter.

Case 32-1966

Presentation of Case A fifty-eight-year-old woman entered the hospital because of a fracture. Four hours previously she had sustained a fracture of the left femur in a fall down a stairway. She had...