Epididymal calcification in genital filariasis.

Although calcification of the epididymis has been described occasionally in the histologic sections of sperm granuloma, epididymal tuberculosis, and filarial funiculoepididymitis, it has not been demonstrated radiologically. Two cases of epididymal calcification due to long-standing genital filariasis are presented. Both the patients presented with chronic bilateral funiculoepididymitis, and in one secondary sterility also developed due to destruction and calcification of both the epididymides. Calcification of the epididymis in filariasis appears to be due to calcification of the dead adult filarial worm. Radiologic demonstration of this calcification would help to differentiate various types of funiculoepididymitis.

Asymmetric prostatic hyperplasia simulating bladder tumor.

A rare case of hyperplasia of a single lateral lobe of the prostate presenting as a solitary intravesical filling defect is presented.

Spontaneous peripelvic extravasation of urine during pregnancy.

We have described a case of peripelvic extravasation of urine caused by lower ureteral obstruction from a breech presentation in a 20-year-old primigravida. The patient was successfully treated with cesarean section to relieve the obstruction, and systemic antibiotics.

Malignant fibrous histiocytoma of the kidney.

We report on a 33-year-old woman with malignant fibrous histiocytoma of the kidney. This malignant mesenchymal tumor is indistinguishable clinically and radiologically from a renal cell carcinoma. In our patient the tumor recurred locally following nephrectomy and metastasized to the lung. Post-nephrectomy radiation and chemotherapy may not alter the poor prognosis.

Primary vaginal stones.

Calculi composed of urinary salts rarely occur outside the urinary tract. In female subjects such calculi occuring in the vagina are uncommon, with only 26 cases reported thus far. These stones may be primary or secondary. Primary stones are formed in the vagina owing to the deposition of urinary salts as a result of continuous urinary leakage into the vagina. They have been described in association with urinary leakage caused by vesicovaginal fistulas, urethrovaginal fistulas, an ectopic vaginal ureter in a 7-year-old child and incontinence owing to a neurogenic bladder. A secondardy vaginal stone is formed around a foreign body in the vagina. Rarely, a vesical calculus may migrate into the vagina because of an ulceration of the vesicovaginal septum and grow in the vagina as a secondary calculus. Most of the reported cases are primary, struvite calculi associated with vesicovaginal fistulas. Because of their rarity we present 2 such cases occurring in patients with vesicovaginal fistulas.

Nephrogenic adenoma of urinary bladder associated with malakoplakia.

A case of nephrogenic adenoma occurring in a twelve-year-old black female child, associated with recurrent Escherichia coli urinary tract infection is described. The patient was followed for over six years and treated with repeated cystoscopic examinations and fulgurations of the lesion. Five years after the initial diagnosis, malakoplakia of the bladder developed in association with nephrogenic adenoma. There was no evidence of invasion of the bladder by the lesion during these six years. Electron microscopic study of nephrogenic adenoma indicated its origin from the urothelium. Nephrogenic adenoma of the bladder is to be considered as a benign metaplastic lesion of the urothelium and is to be treated with repeated cystoscopic fulgurations.

Tuberculosis of the male urethra.

Tuberculosis of the male urethra is a rare lesion, with only 21 cases reported in the literature. Two patients with tuberculosis of the urethra, who presented with multiple periurethral fistulas and a periurethral abscess, are described. In both patients there was associated genitourinary tuberculosis. Mycobacterium tuberculosis could be isolated from the urine and the exudate of the perineal ulcers. Biopsy from the perineal ulcers demonstrated tuberculous granulation tissue with tuberculous bacilli. Treatment consisted of suprapubic cystostomy and a 2-year course of antituberculous drugs, consisting of streptomycin, para-aminosalicylic acid and isoniazid. The urethral fistulas healed with this treatment. The urethral strictures were treated with repeated urethral dilations.

Prostatography.

The direct intraprostatic injection of ethiodol was done in 10 cases to visualize the prostate gland. Immediately after the injection the contrast material was distributed uniformly throughout the prostatic lobe, opacifying it with a fine reticular pattern (prostatogram). The size, shape and intravesical projection of the prostate could be studied accurately in all patients and the findings were confirmed at operation. All patients tolerated the procedure well without any local or systemic complications. Direct intraprostatic injection of the contrast material did not alter the gross nor the microscopic anatomy of the gland. Prostatography is a safe adjuvant radiologic procedure to obtain a 3-dimensional image of prostatic hypertrophy. This information would be useful in the proper planning of operative or radiation treatment of prostatic diseases. It also might be helpful in delineating the deep-seated suspicious prostatic nodules that are inaccessible for clinical examination.

Prostatic lymphography.

Direct intraprostatic injection of ethiodol was done in 12 patients with benign prostatic hypertrophy to visualize lymphatic drainage of the prostate gland. In all 12 patients lymphatics of the prostate could be visualized well. The findings of our study indicate that the prostate mainly drains through 3 sets of lymphatics: 1) the main and important set of lymphatics starts from the superolateral angle of the prostate and courses along the lateral pelvic wall to drain into the internal iliac lymph nodes, 2) some lymphatics drain into the lymph nodes in the presacral area and 3) in 45% of the patients lymphatics from the apex of the prostate travel along the course of the internal pudendal vessels to the internal iliac lymph nodes. From the internal iliac lymph nodes the drainage is to the common iliac lymph nodes and, finally, to the lumbar lymph nodes. Each lateral lobe of the prostate drains mainly into the ipsilateral group of lymph nodes with little crossover of lymphatics to the opposite side. All patients tolerated the procedure well and there were no complication during or after the procedure. We believe that this procedure is a safe, simple and direct method to visualize lymphatic drainage of the human prostate gland.

False positive findings on liver scans in carcinoma of kidney.

In most urologic centers, liver scan is a routine investigation for evaluation of carcinoma of the kidney. Herein are described 3 patients with carcinoma of the right kidney, who had abnormal liver scans and did not show any metastases on exploration and open liver biopsy. These false positive findings were found to be due to the extrinsic compression of the liver by the tumor. When interpreting the liver sacn in a patient with renal tumor on the right side, the possibility of this false positive finding due to extrinsic compression to be considered and an abnormal hepatic scan alone should not be a contraindication for possible radical surgery.

Corpus cavernosogram in the evaluation of carcinoma of the penis.

Treatment of carcinoma of the penis depends on the stage of the tumor, which is mainly clinical. A corpus cavernosogram was used preoperatively in 10 patients with carcinoma of the penis to assess the involvement of the corpus cavernosum, which is an important criterion in staging. In all 10 patients the involvement could be assessed correctly by this procedure, which was later confirmed by histology, and there were no complications. This is a safe, simple and valuable procedure to obtain additional information to stage correctly penile tumors preoperatively and plan the level of resection during penectomy.

Gallium-67 scintigraphy in the diagnosis of renal cortical abscess.

Clinical and radiologic diagnosis of a renal cortical abscess is difficult. A plain x-ray of the kidneys, ureters and bladder, an excretory urogram with nephrotomography, nephrosonography and renal angiography may not be helpful in the diagnosis. A case is presented of bilateral polycystic kidneys with a renal cortical abscess of the lower pole of the left kidney. An abscess could not be localized by the routine radiologic procedures. Gallium-67 scintigraphy demonstrated a renal cortical abscess of the left kidney, which was treated successfully by operation.

Radiotherapy in the treatment of carcinoma of the male urethra.

Carcinoma of the male urethra is an uncommon tumor. Four patients are reported in this investigation. All the patients belonged to the middle age group under the age of 45 years. None of them suffered from preivous urethral structure. The most unusual presentation was impotence due to the involvement of the corpus spongiosum of the penis. Urethrogram and urethroscopy with biopsy are the most useful aids in the diagnosis. All of them had epidermoid carcinoma nad were treated with external radiation therapy. Two patients with distal urethral lesions without metastases responded well with a 4 and 5 years survival and disappearence of the tumor. Two patients with extensive bulbomembranous lesions had palliation with relief of pain and partial regression of the tumor. Radiation therapy in a properly selected patient with an early lesion gives gratifying result.

Segmental nephrogram.

An obstructive nephrogram involving the entire kidney owing to an acute ureteral obstruction is a well known phenomenon. A nephrogram occurring in half of the kidney (segmental nephrogram) has not been described previously. A patient who presented with acute left renal colic is described. An excretory urogram revealed a segmental nephrogram, which was subsequently found to be caused by acute calculous obstruction of 1 of the 2 limbs of a bifid pelvis. The stone was removed through a left pelviotomy.

Malignant penile horn.

The fifth case of carcinoma within a penile horn is reported in a patient who also had erythroplasia of Queyrat of the glans penis. Penile horns should be considered as pre-malignant lesions, since a third of them undergo malignant change and they may be associated with a pre-malignant condition of the glans penis.

Anuria following silver nitrate irrigation for intractable bladder hemorrhage.

Intravesical silver nitrate has been used for intractable bladder hemorrhage. A case of anuria resulting from this technique is reported. The etiology of anuria in this patient was probably owing to obstruction from deposition of silver salts. The level of obstruction was the ureterovesical junction on 1 side and the collecting ducts at the renal papillae on the other side. Therapy consisted of vigorous endoscopic evacuation of deposited silver salts from the bladder and hemodialysis with good results.