Renal trauma in the west of Ireland--a regional review.

We herein present a regional review of the management of renal trauma in the west of Ireland. The majority of renal injuries occur as a result of blunt trauma and are amenable to conservative management. We sought to streamline the management of renal trauma in the west of Ireland. With the current restructuring of the Irish Health Service, it is important to acknowledge the role of the urologist in the management of trauma patients.

Procidentia: a reversible cause of hydronephrosis in an 80-year-old woman.

We describe an unusual presentation of hydronephrosis in an 80-year-old woman who was managed conservatively after transfer to a specialist unit. This case highlights the role of accurate history taking and a focused physical examination in elderly female patients presenting with renal failure and hydronephrosis.

One-stage Fowler-Stephens orchidopexy for impalpable undescended testis.

BACKGROUND: The Fowler-Stephens orchidopexy (FSO) is a well-described treatment for high maldescended testes where the limiting factor for successful placement in the scrotum is short testicular vessels. The operation involves division of these vessels. The testicular blood supply is then dependent on collaterals from the vasal artery. AIMS: To assess the long-term outcome of patients who underwent this procedure in our institution. METHODS: The medical records of 20 patients who underwent 22 FSO from 1978 to 1999 by one urologist (HB) were reviewed. Outcome was assessed in terms of testicular position and size. RESULTS: Age at operation ranged from 2 to 14 years (mean 5.8 years). All patients had a one-stage FSO and in two of them the procedure was bilateral. In five patients, FSO was preceded by a diagnostic laparoscopy. Mean follow up was 22 months (range 0-121 months). Overall, results were considered good in 18 of 22 testes (82%). CONCLUSION: Our results for the one-stage FSO are comparable with other procedures for the management of high maldescended testis.

Longevity of the Marshall-Marchetti-Krantz procedure.

BACKGROUND AND AIMS: The Marshall-Marchetti-Krantz procedure (MMK) is a vesico-urethral suspension, for the correction of urethral hypermobility in women with stress urinary incontinence. This study aims to describe the long-term outcome of the procedure. MATERIAL AND METHODS: 40 women with stress incontinence underwent the MMK. All operations were performed by one surgeon. Analysis of patients' notes yielded the early continence rate and perioperative morbidity. Long-term outcome was measured by means of a postal questionnaire with telephone contact to ensure maximum uptake. RESULTS: The immediate continence rate was 82%. Continence rates at up to 22 years follow-up (mean 8.5 years) is 61%. All failures occurred within 2 years of the operation. CONCLUSION: Patients still continent two years after the MMK will maintain continence in the long-term.

One-stage radical cystectomy for bladder carcinoma: operative mortality, cost/benefit analysis.

An analysis of cystectomies performed between September 1, 1969 and December 31, 1974 was conducted to determine the rates of morbidity (59 per cent) and operative mortality (4.1 per cent). Comparison of these figures for single operations with data published form other sources concerning staging of the therapeutic procedures suggests that there is no benefit for the patient relative to surgical morbidity or mortality if the latter course is followed. Conversely, prolongation of hospital experience, multiple operations, absence from productive activity and increased health care cost are associated with the staged procedures. Application of cost-benefit analysis suggests that this experience may act as a model to evaluate competing forms of therapy involving other disorders. When costs are not equivalent and benefits are the same the more expensive form of therapy should not be offered except for unusual circumstances.

Positive urinary cytology in patients without evident tumor.

Of 267 patients with a positive urinary cytology during a 5-year period 9 did not have a tumor identified at the initial diagnostic stidy, which included cytoscopy. However, a tumor was documented in 8 of these 9 patients between 1 and 61 months later.

Diagnosis and treatment of a urinary leak after ureteroileal conduit for diversion.

Of 1,120 cases of ileal loop urinary diversion reviewed from our hospital 21 postoperative loop leaks were noted (1.87 per cent). Definite indications for diagnostic studies of urinary extravasation include persistent postoperative azotemia, sepsis and/or urinary leakage via the drains. In this series 2 types of loop leaks were noted--an early postoperative leak within the first 24 hours and a leakage 6 to 12 days postoperatively. More aggressive management of postoperatively urinary extravasation is urged, especially in patients who had been irradiated and suffered leakage later on in the postoperative course.

One-stage radical cystectomy for bladder carcinoma: operative mortality, cost/benefit analysis.

An analysis of cystectomies performed between September 1, 1969 and December 31, 1974 was conducted to determine the rates of morbidity (59 per cent) and operative mortality (4.1 per cent). Comparison of these figures for single operations with data published from other sources concerning staging of the therapeutic procedures suggests that there is no benefit for the patient relative to surgical morbidity or mortality if the latter course is followed. Conversely, prolongation of hospital experience, multiple operations, absence from productive activity and increased health care cost are associated with the staged procedures. Application of cost/benefit analysis suggests that this experience may act as a model to evaluate competing forms of therapy involving other disorders. When costs are not equivalent and benefits are the same the more expensive form of therapy should not be offered except for unusual circumstances.

Family study of vesicoureteral reflux.

A retrospective analysis of 242 families revealed that the incidence of reflux among siblings of children with reflux was 2.2 per cent. In a prospective study of 24 families, 8 of 50 siblings (16 per cent) had reflux. Although the incidence of reflux in the prospective study is surprisingly high infections was absent in all affected siblings in whom cultures were obtained and in only 2 siblings (4 per cent) was surgical correction necessary.

Lactic dehydrogenase isoenzymes in human bladder cancer.

The lactic dehydrogenase isoenzymic patterns of normal, atypical and neoplastic urothelium were studied. In comparison to normal, the atypical urothelium had a significant increase in the LDH-V/I ratio. In neoplastic urothelium the LDH-I per cent was increased in low grade tumors, while the LDH-V per cent and LDH-V/I ratio was increased in high grade tumors. The findings in high grade tumors are thought to represent altered genetic expression with activation of the gene locus controlling M subunit synthesis.