ABSTRACT
Only one case of a rare anomaly, a congenital defect in the integrity of the scrotal wall permitting egress of the testis to an ectopic extracorporeal location, has been previously reported. A second occurrence of this rare anomally is herein described with a proposed mechanism of occurrence. The condition is termed scrotoschisis.
Subject(s)
Scrotum/abnormalities , Testis/abnormalities , Humans , Infant, Newborn , MaleABSTRACT
Perforation of the urinary bladder associated with long-term indwelling catheter drainage is a rare and lethal iatrogenic disorder. Moreover, bladder perforation can occur in a variety of surgical settings. We report here several unusual situations: one in which a fibroid uterus probably played a role in pressure necrosis of a bladder with an indwelling catheter, one in which carcinoma of the prostate and faulty catheter drainage was present, and one in which pelvic radiation therapy was followed by bladder perforation. These three cases illustrate the clinical acumen required to recognize intraperitoneal perforation. The variety of presentations is suggested by the fact that one case was diagnosed preoperatively by cystogram, one was unexpectedly found at laparotomy for acute peritonitis, and one was discovered only at autopsy. One of the patients was diabetic, two had been treated for miliary tuberculosis, and all had a history of long-term urinary bladder catheterization. Bladder perforation can be prevented by several alternative methods of chronic bladder drainage. The diagnosis of the problem requires a high degree of clinical suspicion, aided by definitive cystograms. The treatment is surgical, including prompt repair of the perforation and drainage of the bladder.
Subject(s)
Catheters, Indwelling/adverse effects , Iatrogenic Disease , Urinary Bladder/injuries , Urinary Catheterization/adverse effects , Aged , Epithelium/pathology , Female , Humans , Male , Metaplasia , Middle Aged , Rupture , Urinary Bladder/pathologyABSTRACT
A case is presented in which ureteropelvic junction obstruction developed in a kidney that had apparently been normal at the time of contralateral nephrectomy for ureteropelvic junction obstruction nine years previously. Therapeutic implications are discussed.
Subject(s)
Kidney Pelvis , Nephrectomy , Postoperative Complications , Ureteral Obstruction , Child , Humans , Hydronephrosis/etiology , Kidney Diseases/complications , Male , Time Factors , Ureteral Obstruction/complicationsABSTRACT
Xanthogranulomatous pyelonephritis (XGP) can present with weight loss, anemia, leukemoid reaction, and generalized debility; there may be no signs or symptoms referable to the urinary tract. Confusion between XGP and renal adenocarcinoma is well recognized, but other malignancies can also be simulated. Case histories of patients with proved XGP whose clinical presentations suggested occult malignancies are recorded. Proteus urinary tract infection, calculi, and a nonvisualizing kidney on intravenous pyelogram should suggest the correct diagnosis. The pathology, bacteriology, diagnosis, and treatment are reviewed.
Subject(s)
Adenocarcinoma/diagnosis , Kidney Neoplasms/diagnosis , Proteus Infections/diagnosis , Pyelonephritis/diagnosis , Adult , Aged , Carcinoma, Transitional Cell/diagnosis , Diagnosis, Differential , Female , Granuloma/complications , Granuloma/diagnosis , Humans , Kidney Calculi/complications , Male , Middle Aged , Phlebography , Proteus Infections/complications , Proteus mirabilis , Pyelonephritis/complications , Pyelonephritis/diagnostic imaging , Urography , Xanthomatosis/complicationsABSTRACT
Ureteral obstruction occurred in 10% of the patients treated for prostatic carcinoma and most often was associated with poorly differentiated tumors. The response of ureteral obstruction to different forms of therapy was evaluated. Obstruction diminished in 22 of 25 orchiectomized patients (88%) but in only 1 of 6 patients receiving estrogen or antiandrogen therapy alone (17%). Patients who responded favorably to therapy had a significantly better survival than did non-responders. Patients treated early in the course of ureteral obstruction responded better than those treated late, while neither tumor stage nor grade correlated with response to therapy. Radiation therapy for endocrine-resistant ureteral obstruction was effective in only 2 of 8 cases (25%). The literature on ureteral obstruction from prostatic carcinoma and its treatment is reviewed.
Subject(s)
Androgen Antagonists/therapeutic use , Estrogens/therapeutic use , Prostatic Neoplasms/complications , Ureteral Obstruction/etiology , Acid Phosphatase/blood , Castration , Cyproterone/therapeutic use , Diethylstilbestrol/therapeutic use , Humans , Male , Maryland , Prostatic Neoplasms/pathology , Remission, Spontaneous , Time Factors , Ureteral Obstruction/drug therapy , Ureteral Obstruction/mortality , Ureteral Obstruction/radiotherapy , Ureteral Obstruction/surgeryABSTRACT
Although fungal urinary tract infections occur less frequently than bacterial urinary tract infections their incidence has increased during the last several decades and their clinical importance to the urologist should not be underestimated. Herein the pertinent literature on fungal urinary tract infections is reviewed, with emphasis on the predisposing factors, pathogenesis, host defense mechanisms and the clinical spectrum of the disease. An approach to the evaluation of positive cultures and therapy is presented.
