Hypertension and multicystic kidney.

The optimal management of the asymptomatic patient with a multicystic kidney remains a dilemma. The risk of nephrectomy in a neonate or infant with this lesion is small and the morbidity is minimal. The alternative to elective nephrectomy is life-long follow-up with blood pressure determinations, beginning in infancy. We report herein two infants with multicystic kidney (MCK) in whom hypertension was cured by its removal. Since accurate blood pressure measurements are relatively difficult to obtain in infants and since periodic long-term follow-up is difficult in the best of circumstances, we are concerned that hypertension caused by a retained MCK goes undiagnosed perhaps more frequently than a review of the current literature suggests. Such hypertension may result in contralateral renal damage and arteriosclerosis, so that later removal of the MCK may not have a beneficial effect on the elevated blood pressure.

Ileocecal ureterosigmoidostomy: an alternative to conventional ureterosigmoidostomy.

We describe a 1-stage procedure that involves use of the ileocecal segment as an intervening urine conduit to the large bowel to achieve a continent diversion. The ureters are anastomosed end to end to the terminal ileum that is intussuscepted into the cecum. The cecum then is joined to the lower sigmoid by an end-to-side anastomosis. Mixed urine and feces are eliminated through the rectum. The results in 5 patients with exstrophy and 1 with epispadias between 5 months and 13 years old are reported. Ureteral reflux was not observed. Urinary tract infection developed in 2 patients. Ileocecal ureterosigmoidostomy is a reasonable alternative to intact ureterosigmoidostomy that may reduce the risk of development of cancer.

Adult segmental cystic disease of the kidney: a renal-sparing management approach.

Segmental cystic disease of the kidney is a rare entity with the gross and microscopic features of autosomal dominant polycystic kidney disease localized to only a portion of a kidney. We report a renal-sparing management approach to a patient in whom a multifocal cystic process localized to 1 pole of the kidney was recognized preoperatively. Since neither computerized tomography nor ultrasound can exclude an underlying neoplastic process, surgery remains indicated. However, an understanding of the spectrum of diagnostic possibilities can have an impact on planning the most appropriate surgical approach. We conclude that partial nephrectomy, with appropriate intraoperative pathological assessment, may represent a satisfactory renal-sparing therapeutic algorithm for the management of localized cystic disease.