Collecting duct carcinoma associated with oncocytoma.

Collecting duct carcinoma (CDC) is a rare, highly aggressive malignant neoplasm that arises from the collecting duct epithelium of the kidney. CDC was reported to coexist with renal cell and transitional cell carcinomas. We report a rare case of CDC associated with oncocytoma, confirmed by the characteristic histological appearance and immunohistochemistry. We also review the epidemiological, histological and immunohistochemical criteria for diagnosis, in addition to the genetic and cytogenetic aberrations reported in the literature. Identification and reporting CDC is important for the establishment of treatment strategies and monitoring prognosis.

Collecting duct carcinoma associated with oncocytoma

Collecting duct carcinoma (CDC) is a rare, highly aggressive malignant neoplasm that arises from the collecting duct epithelium of the kidney. CDC was reported to coexist with renal cell and transitional cell carcinomas. We report a rare case of CDC associated with oncocytoma, confirmed by the characteristic histological appearance and immunohistochemistry. We also review the epidemiological, histological and immunohistochemical criteria for diagnosis, in addition to the genetic and cytogenetic aberrations reported in the literature. Identification and reporting CDC is important for the establishment of treatment strategies and monitoring prognosis.

Efficacy of electrohydraulic lithotripsy in the ureter.

Since January of 1983, 62 patients with ureteral calculi had their stones fragmented with electrohydraulic lithotripsy via an antegrade approach percutaneously or retrograde approach ureteroscopically. Success was achieved in 97% of these cases, with insignificant ureteral perforations noted in eight. Follow-up via intravenous pyelograms obtained in 60 patients revealed no significant persistent hydronephrosis. It appears, therefore, that the use of electrohydraulic lithotripsy in the ureter utilized with direct vision endoscopes is safe, efficacious and relatively inexpensive.

Renal cell carcinoma invading the inferior vena cava: the use of the Greenfield filter to prevent tumor emboli during nephrectomy.

Renal cell carcinoma with tumor thrombus extension into the inferior vena cava occurs in approximately 5 per cent of the cases. Despite invasion of the inferior vena cava an aggressive surgical approach for these neoplasms is recommended but prevention of a tumor thrombus pulmonary embolus during operation is necessary. Placement of a suprarenal Greenfield filter, with its ease of insertion, excellent late patency rates and minimal morbidity, has made it the procedure of choice today. Preoperative venacavography with radiopaque marking of the tumor thrombus will prevent filter displacement, malpositioning and the awkward use of intraoperative venography, while shortening operative time and minimizing patient risk.

Renal carbuncle: diagnosis and management.

Six cases of renal carbuncle are presented. Nonstaphylococcal carbuncles now greatly outnumber those of staphylococcal origin. Diagnostic modalities are discussed. No radiologic or laboratory investigation is specific, but the diagnosis should be suspected in most cases if adequate attention is given the patient's signs and symptoms. Surgical treatment is recommended.

Urological disability in quadriplegia: a study of treatment and follow-up in 92 patients.

The urological aspects of a series of 92 quadriplegic patients are presented. The types of operations done to relieve outlet obstruction and the long-term follow-up with particular emphasis upon the urographic findings and the incidence of pyelonephritis are described and discussed.

Further observations on the cystometric and uroflowmetric effects of bethanechol chloride on the human bladder.

We evaluated the cystometric and uroflowmetric effects of bethanechol chloride on non-neurogenic, non-decompensated human bladders. Statistically significant changes were measured using cystometric and uroflowmetric parameters. We discuss the indications and methods for therapy with bethanechol chloride.

The use of prophylactic low dose heparin in transurethral prostatectomy.

Low dose heparin prophylaxis has proved effective in reducing postoperative thromboembolic complications in a series combining multiple types of surgical procedures. Our series comfirms its safety for transurethral operations. We recommend its use in patients with predisposing factors to thromboembolic complications.

Urodynamic evaluation of female stress urinary incontenence.

To understand further the urodynamics of female stress urinary incontinence 6 patients with this condition were studied before and after anterior vesicopexy. The evaluation included uroflowmetry, cystometry, urethral pressure profilometry, anatomical urethral length measurement with the subject in the supine and standing positions, demonstration fo stress incontinence and cystourethroscopy. These procedures, except cystometry and cystourethroscopy, were repeated 7 days and 4 to 6 weeks postoperatively in most patients. All patients had short preoperative functional urethral lengths and standing anatomical lengths and all were lengthened after the anterior vesicopexy. The urinary flow rate demonstrated decreased peak and average flow rates 1 week postoperatively but complete recovery 4 to 6 weeks later. We believe that this study reaffirms the importance of urethral length in the pathophysiology of female stress urinary incontinence and, by demonstrating decreased flow rates in the immediate postoperative period, draws attention to the need for careful observation of voiding after catheter removal to avoid bladder decompensation. The marked improvement observed in the 4 to 6-week postoperative period reveals that anterior vesicopexy does not obstruct the urethra since no tissue posterior to the urethra is used. These urodynamic studies have proved to be valuable adjuncts in the evaluation of female stress incontinence.