Zoran L. Barbaric

Magnetic resonance imaging of the perineum and pelvic floor.

The aim of this article is to review the magnetic resonance (MR) findings of pelvic floor descent and pelvic organ prolapse in women. In addition, a detailed grading system of pelvic organ prolapse and pelvic floor relaxation based on dynamic MR imaging is presented. The technique described here uses very fast MR sequences, is reproducible and easily learned by radiologists and technologists, is well accepted by patients, and provides as much information as traditional projectional X-ray imaging. Reference points are the pubococcygeal line and puborectalis muscle sling. The grading system is based on degree of organ prolapse through the hiatus and the degree of puborectalis descent and hiatal enlargement.

Percutaneous nephropyelostomy in the management of obstructed renal transplants.

Five percutaneous nephropyelostomies were performed on 4 patients with obstructed renal allografts. In all instances the procedure significantly influenced further management of these patients. It allowed pressure measurement within the obstructed collecting system, assessment of renal function after prolonged drainage, and anatomical delineation of the site of the obstruction using antegrade pyelography. Percutaneous pyelonephrostomy and drainage is a useful means to determine whether obstruction or rejection is the major contributor to renal failure following renal transplantation.

Nephromegaly in Hyperalimentation

Nephromegaly associated with hyperalimentation and its effect on renal function were studied. Renal size was determined in 44 patients receiving total parenteral nutrition (TPN). Of 26 patients in whom kidney size could be determined before and during TPN, all but one had normal-size kidneys before TPN. Six had no increase in renal size, and kidneys increased in size in 20. One or both kidneys became abnormally large in 9 patients. There was no detectable change in renal function and kidneys decreased in size upon discontinuation of hyperalimentation. Abnormal renal size bore no relation with weight gain or liver function tests.

Transluminal Dilatation and Stent Placement in Obstructed Ureters in Dogs Through the Use of Percutaneous Nephropyelostomy

Through an artificially created ureteral obstruction in the dog, a ureteral stent was placed with the aid of a percutaneous nephrostomy tube. The stent was removed after two weeks. This resulted in permanent relief of the obstruction in the treated animals. In contrast to this, the control animals remained completely obstructed with resultant hydronephrosis and loss of kidney. It is proposed that this method can be used in humans where nephropyelostomy had been placed and where surgical correction of the obstructed ureter is not feasible.

Percutaneous transperitoneal lymph-node biopsy as a means of improving lymphographic diagnosis.

Percutaneous transperitoneal fine-needle lymph-node biopsy was performed in 52 patients to establish a diagnosis of metastatic disease in nodal defects detected during lymphography. The procedure was found to be highly accurate, with few false-negatives and no false-positives.

The use of percutaneous nephrostomy and urinary alkalinization in the dissolution of obstructing uric acid stones.

Two patients are described who presented with complete urinary obstruction secondary to nonopaque uric acid stones. They were treated with percutaneous nephrostomy for urinary diversion and urinary alkalinization by local irrigation and oral sodium bicarbonate therapy with complete dissolution of the stone after 16 and 21 days of therapy. Percutaneous nephrostomy with urinary alkalinization is a reasonable, relatively safe alternative to surgical stone removal for patients with obstructing uric acid stones.

Percutaneous Nephropyelostomy in the Management of Acute Pyohydronephrosis

Percutaneous nephropyelostomy using the posterolateral approach was employed together with antibiotics and other supportive therapy as the initial step in the treatment of acute pyohydronephrosis, with gratifying results. Percutaneous nephropyelostomy is recommended as the procedure of choice for this specific clinical emergency.

Fluoroscopy-guided percutaneous transperitoneal fine needle biopsy of renal masses

Percutaneous transperitoneal fine needle biopsy is a harmless, easy to perform, and most direct procedure used to diagnose uncertain causes of ureteral obstruction and displacement of various parts of the urinary tract system. Frequently it is the least invasive method that can decide further treatment.

Renal Fascia in Urinary Tract Disease

The renal fascia is rarely detected on excretory urograms. When seen, it is usually associated with disease processes such as focal renal scarring, acute renal infection, renal calculi, and intrarenal and perirenal masses. In all cases of normal appearing kidneys with visualization of the renal fascia, undetected renal disease should be suspected.

Effect of abdominal perineal resection on genitourinary tract

One hundred ten patients at the UCLA Medical Center underwent abdominal resection from 1974 to 1980. The following effects on the urinary tract are discussed: surgical complications, anatomic changes, and functional complications. Urologic investigation and management of incontinence will be presented.