Vesicopyelostomy in the treatment of pelvic kidneys with pelviureteric junction obstruction: long-term follow-up.

The surgical management of 6 male patients with pelvic kidneys with pelviureteric junction obstruction is discussed. Two patients presented in advanced renal failure and 1 had peritonitis and septicaemia due to rupture of the renal pelvis. Vesicopyelostomy was preferred to pyeloplasty in 5 patients because of adhesions, multiple aberrant vessels, multiple stones, malrotation and the low pelvic position, but pyeloplasty was done in 1 case. Though vesicoureteric reflux was observed during voiding cystourethrography in all patients, no deleterious effect on the kidney was seen during the 3- to 5-year follow-up period.

Vesicovaginal fistulas of uncommon etiology.

We report 2 cases of vesicovaginal fistulas sustained during sexual intercourse. In our first case fistula formation was probably the result of physical disparity of the partners and a frightened, unprepared woman. In the second case increased friability caused by hormonal influence during menstruation and a urinary infection probably contributed to fistula formation. Both patients underwent a successful, transabdominal repair with omental interposition.

Surgery of the horseshoe kidney--an experience of 24 patients.

A decade (1973-83) of surgical experience in the management of the diseases of horseshoe kidney is presented. Calculus disease was the major pathological entity (80%) followed by ureteropelvic junction obstruction, nephrocarcinoma and polycystic disease, respectively. Three patients with calculi had, in addition, pyonephrosis and squamous cell carcinoma. Aortography offers maximum information about abnormal vasculature and other anatomical details in proper planning of surgical intervention. It is felt that a symphysiotomy and nephropexy may be considered when the horseshoe kidneys are being operated for calculus disease.

Pancreatic endometriosis presenting as a hypovascular renal mass.

We report a case of pancreatic endometriosis that presented as a renal mass. The patient had a history of recurrent left loin pain and pathological examination revealed pancreatic endometriosis, with huge cyst formation around the kidney. The clinicopathological features and the possible pathogenesis are discussed.

Calyco-ureteroplasty in the management of selected renal calculi.

Calyco-ureteroplasty was performed in 15 renal calculi patients with grossly deformed upper tracts. The procedure aimed to achieve total clearance of calculi, preserve renal function and check stone recurrence. At follow-up from 6 months to 7 years, there was no stone recurrence and all the patients maintained sterile urine cultures. There was both biochemical and radiological improvement in renal function. It is felt that this procedure may have a role in rehabilitating diseased renal units, preserves renal function and involves no parenchymal loss.

Effect of pyridoxine supplementation on recurrent stone formers.

Twelve recurrent stone formers with hyperoxaluria were administered pyridoxine-HCl (10 mg/day) daily for a period of 180 days. The pyridoxine status of the patients, as assessed by their erythrocyte transaminase activation indexes, improved significantly (p less than 0.001) after 180 days of supplementation as compared with the basal levels. Although urinary oxalate decreased significantly (p less than 0.05) by the 90th day of pyridoxine therapy, other parameters, e.g., urinary calcium, phosphorus, and creatinine, remained unaltered. Significant correlation was observed between erythrocyte glutamate pyruvate transaminase (EGPT) or erythrocyte glutamate oxaloacetate transaminase (EGOT) activation index and urinary oxalate excretion (p less than 0.01). Pyridoxine in low doses (10 mg/day) is of therapeutic value for hyperoxaluric stone formers.

Pregnancy specific proteins: suppression of in vitro blastogenic response to mitogen by these proteins.

Immunosuppressive properties of human chorionic gonadotropin (HCG), pregnancy specific B1-glycoprotein (SP-1), human alpha foetoprotein (AFP), and human placental lactogen (HPL) in mitogen-stimulated lymphocyte transformation were studied. A pregnancy serum containing high serum levels of these specific proteins was prepared from a number of pregnancy sera. The inhibitory effect of pregnancy sera on lymphocyte response to mitogen was examined after sequential removal of each of the proteins from the pregnancy serum by affinity chromatography. Greatest decrease in the suppression was observed when human chorionic gonadotropin (HCG) alone or human chorionic gonadotropin in combination with all other three specific proteins was removed from the pregnancy serum. Pregnancy specific B1-glycoprotein (SP-1) also significantly decreased the inhibitory effect of pregnancy serum. But the other two specific proteins (AFP and HPL) had minimal effect on the decrease an immunosuppression by pregnancy serum. However, even after removal of all the four pregnancy specific proteins from the pregnancy serum, complete return to normal values for lymphocyte transformation by mitogen was not observed, which indicates the presence of some other suppressive factor(s) in the pregnancy serum.

Effect of seminal plasma and its fractions on in vitro blastogenic response to mitogen.

Five fractions of human seminal plasma were isolated on Sephadex G-100 column. The in vitro effect of whole human seminal plasma and its fractions on the lymphocyte transformation induced by phytomitogen was studied. A significant inhibition of lymphocyte response to mitogen was observed with whole seminal plasma fractions I and III at a concentration of 100-200 micrograms/ml. However fraction II stimulates the in vitro human lymphocyte transformation induced by phytomitogen at a concentration of 200 micrograms/ml. Maximum amount of inhibition by whole seminal plasma and its fractions I and III was achieved by preexposure of lymphocytes to these antigens. Pre-exposure of lymphocytes to these antigens, followed by washing, does not result in suppression of lymphocyte response to mitogen. These observations suggest that the antigens of the whole seminal plasma or of fractions I, III, and II act by simple competition with mitogen for the receptor sites on the lymphocyte membrane. Therefore, the human seminal plasma may play an immunoregulatory role against the auto- or isosensitization towards spermatozoal antigens.

Operative management problems in nephrobronchial fistula.

During left subcapsular nephrectomy in a patient with nephrobronchial fistula, the purulent material entered the bronchial tree through the fistulous tracts and flooded the dependent right lung. Patchy atelectasis and later massive consolidation of the lower lobe of the right lung ensued ultimately causing her death. A plea is made to use double-lumen endobronchial tubes for anesthesia to prevent such spillover of purulent secretions to the contralateral lung from the kidney. The fistulous tracts should be divided as the first step during surgery, before mobilization of the kidney. In a suspected case, retrograde pyelography should be done preferably under local or regional anesthesia, so that the patient could cough out the contrast material and purulent secretion that might enter the bronchial tree under pressure during the procedure.

Urethro-cavernous fistula from blunt penile trauma.

An unusual case of traumatic urethro-cavernous fistula from the fall of a heavy object upon the flaccid penis is described. In the absence of clinical evidence of urinary extravasation, prompt performance of corpus cavernosography helped detect the existence of such a fistulous communication. Institution of prompt suprapubic urinary diversion avoided occurrence of undesirable sequelae to intracorporeal urinary leak and ensured uncomplicated spontaneous closure of the fistula.

Beta-adrenergic activity in human proximal urethra: a study with terbutaline.

Beta-adrenergic activity in the proximal urethra was studied in 15 patients with neurogenic bladder dysfunction owing to spinal cord injury or to neurogenic disease. Maximum urethral closure pressure was recorded before and after the administration of terbutaline, a beta-2 agonist. The average decrease in maximum urethral closure pressure after subcutaneous injection of terbutaline was 40.46 per cent and this was significant (p less than 0.001). The clinical implications of this finding are discussed.