Long-term survival with malignant melanoma metastatic to the bladder.

Malignant melanoma metastatic to the bladder is a relatively common autopsy finding, but rarely manifests clinically as it is usually a late finding in the course of the disease. Herein is the report of a case of muscle invasive malignant melanoma at the dome of the urinary bladder treated by radical transurethral resection with no evidence of bladder recurrence four years later.

Calculus formation on migrant surgical staples in urinary undiversion.

Urinary undiversion and bladder reconstruction has led to some of the most ingenious uses of bowel by urologists and will improve the quality of life for patients. The use of the stapler has helped create intussuscepted nipple valves that are more likely to be effective and less likely to extussuscept. Calculi can form on surgical staples exposed to urine and measures to prevent this have been described. We report a case in which there was rapid development in multiple calculi, each having a single staple as a nidus, following urinary undiversion using an antireflux intussuscepted stapled nipple valve in which the distal-most staples were removed from the staple cartridge to its use.

Ureteral response to the placement of metallic stents: an animal model.

Metallic self-expanding mesh stents are increasingly used in the urinary tract. Little is known about the histological reactions that such prostheses have on the surrounding tissue. The effects of self-expanded metallic stents in the histologically normal ureter were examined in four dogs. Three-mm. Gianturco-Roubin coronary artery stents were introduced into the distal left ureter after dilatation. Follow-up excretory urography, retrograde pyelograms and autopsy were performed on 2 dogs at 1 month and on 2 dogs at 6 months. In all 4 dogs, the ureters remained patent. Histologic examination of the ureter showed that the stents had not become incorporated within the wall of the ureter. Reactive changes seen in the epithelium included penetration of both epithelium and submucosa between the wire struts and areas of fibrosis in the submucosal layer. The use of metallic stents in histologically normal ureters may be limited in the long term by this inflammatory response.

Risk factors for upper tract deterioration in chronic spinal cord injury patients.

A total of 140 patients with neurogenic voiding dysfunction secondary to chronic spinal cord injuries was assessed initially at a tertiary care urodynamic center an average of 8 years after the acute injury. As a result of testing patients were divided into 2 functional urodynamic groups. Group 1 included 40 patients with an areflexic bladder, of whom 33 maintained normal upper tracts and 7 had significant upper tract deterioration. Group 2 included 100 patients with a hyperreflexic bladder, of whom 84 maintained normal upper tracts and 16 had documented upper tract deterioration. Maximum detrusor pressure during urine storage in group 1 with abnormal upper tracts was significantly higher than in those with normal kidneys (p less than 0.0001). Maximum detrusor contraction pressure during voiding in group 2 was significantly higher in those with abnormal upper tracts secondary to neurogenic outflow obstruction (p less than 0.0001). The most common outflow problem in this group was type 3 detrusor-sphincter dyssynergia. With guidelines thus developed for acceptable detrusor pressure in both types of bladder, silent upper tract damage can probably be prevented in most cases by proper and diligent followup and appropriate intervention, avoiding major morbidity and mortality in these high risk patients.

Effect of a metallic balloon-expanded stent on normal rabbit ureter.

Two-millimeter balloon-expanded Gianturco-Roubin coronary artery stents were placed in the 1-mm-diameter distal ureters of five normal rabbits. Retrograde pyelograms obtained immediately after stent placement showed no obstruction or extravasation of contrast material. Follow-up excretory urograms were obtained for each animal between 4 and 17 days, and autopsy was performed between 35 and 42 days. Findings at excretory urography and autopsy demonstrated severe obstruction at the level of the stent in each animal. Histologic examination of the resected ureter was performed. In four animals, the stent had penetrated into the wall of the ureter and a fibrous reaction had obliterated the lumen. In one animal, although the stent was still present within the lumen of the ureter, a fibrous reaction within the wall had destroyed the muscle layers and narrowed the lumen at the distal end of the stent. It is concluded that the 2-mm Gianturco-Roubin stent is unsuitable for placement in the 1-mm rabbit ureter.

Multilocular cyst (multilocular cystic nephroma) of the kidney: a report of 2 cases with an unusual mode of presentation.

We report 2 cases of multilocular cyst (multilocular cystic nephroma) of the kidney in children who presented with sudden rapid growth of a renal mass.

Popliteal aneurysms: an index of generalized vascular disease.

A review of 59 popliteal aneurysms in 38 patients seen over 10 years revealed that 34 (58%) aneurysms were symptomatic. Symptoms included gangrene (15%), ischemia due to thrombosis (38%) and embolism (5%). Patients with unilateral aneurysms (45%) were a median of 7 years younger than those with bilateral lesions (55%). The latter group had more frequent manifestations of occlusive disease, which included previous myocardial infarction, coronary artery bypass grafting and stroke. They also had more concomitant aneurysms, those of the abdominal aorta and femoral and iliac arteries being the most common. Management consisted of bypass grafting in 34 limbs and immediate amputation in 9; 16 inoperable limbs remained viable. At last follow-up (median 32 months) or time of death, 30 of 34 grafts were patent. Four grafts occluded, one perioperatively and the others at 4, 5, and 32 months respectively, resulting in two amputations. The cumulative patency rate in the asymptomatic group was 94% compared with 81% in the symptomatic group. These data illustrate that patients with popliteal aneurysms may have associated vascular disease, the likelihood of which is increased when aneurysms are bilateral.