Carcinoembryonic antigen positive adenocarcinoma of a female urethral diverticulum: case report and review of the literature.

Paraurethral glands of the female urethra, which are assumed to be embryologically homologous to the male prostate gland, are possible origins for diverticular cancer of the urethra. A case of primary adenocarcinoma arising in a female urethral diverticulum is presented. Pathology revealed a columnar/mucinous type adenocarcinoma which stained positively for carcinoembryonic antigen (CEA) and negatively for PSA. Normal paraurethral ducts located near the urethra and normal urethral epithelium also stained positively for CEA. These findings suggest that the adenocarcinoma in our case originated from the paraurethral duct near the urethral lumen.

Frequent recurrence of superficial bladder tumors in the periorificial region: possible predictor for delayed appearance of invasive intramural ureteric cancer.

Two cases of invasive lower ureteric cancer developed following frequent recurrence of superficial bladder tumors in the region of the ureteral orifice. The cancer focus could not be identified in the intramural ureter prior to intravenous urography which revealed hydronephrosis. When bladder tumors repeatedly develop near the ureteric orifice, careful investigations such as ureteral catheterization with a small brush for cytology or ureteroscopy are necessary for the early detection of invasive disease.

Management of total ureteral loss after kidney transplantation.

Loss of the ureter after transplantation is uncommon and is difficult to manage. A Boari flap can be used to replace the ureter. The authors describe two patients with total ureteral loss. In each a Boari flap was used, to create a pyelocystostomy in one case and a calicecystostomy in the other. Both patients had greatly reduced serum creatinine levels and no urinary tract infections 14 and 18 months, respectively, after operation.

Factors influencing the pressure-flow-perfusion system.

The methodology of the "Pressure-Flow-Perfusion System' used in the "Whitaker Test' was examined for factors which influence intrinsic resistance of that system. Considerable pressure changes were incurred by varying the concentration of sodium diatrizoate, perfusing needle, temperature and flow rates. For each renal pressure-flow-perfusion test, the resistance must be determined because of the effect of each variable in altering the intrinsic resistance.

Link between caudal regression and Vater syndromes.

A variant between caudal and regression and Vater syndromes is presented which was significant anomalies of the genitourinary tract. The patient has a normal 46XX karyotype with the following urogenital anomalies: solitary pelvic kidney with megacalycosis, high ureteral bud or diverticulum, and ectopic insertion of the ureter into the proximal urethra; as well as, sacral agenesis, vaginal atresia, aberrant gonadal tissue, and uterine agenesis.

Comparative evaluation of quantitative glomerular filtration rate measured by isotopic and nonisotopic methods.

Good correlation of glomerular filtration rate (GFR) measured isotopically from plasma disappearance of Tc-99m-DTPA (Sn) was shown with inulin clearance, creatinine clearance, and graded radionuclide imaging. The isotopic GFR is a simple, urineless technique not requiring continuous infusion that enables one to perform simultaneous renal imaging with one radiotracer.

Analysis of methods to construct nomograms in uroflow studies.

A Monte Carlo simulation study to compare the effect of population form on three methods of nomogram construction was performed by taking 2000 random samples of size 5, 20, 50, 100, and 200 from populations with known percentiles. The 10th percentile was estimated by each of the three construction procedures. The three procedures compared were the upper 95 per cent nonparametric tolerance limit technique, the usual percentile approach, and a method which assumes a Gaussian (normal) distribution. Tenth percentile nomograms, classified by volume voided, were calculated by each of the three procedures for maximum flow rate determinations from 356 normal males of ages 1 to 12 years with body surface areas less than 1.1 m2. Nomograms of the three methods are validated with evaluations from two other groups of male children consisting of known abnormals with radiologically proven urethral obstructions and known normals who had repeated at home uroflow rates. The nonparametric tolerance limit approach gives conservative estimates and is superior in all cases from the standpoint of reducing false-negative results.

A new familial syndrome of 46,XY gonadal dysgenesis with anomalies of ectodermal and mesodermal structures.

Two 46,XY phenotypic female siblings, aged 1 1/2 and 8 1/2 years, have peculiar facies, cardiac, renal, musculoskeletal, and ectodermal anomalies, short stature, streak gonads, and mild developmental delay. Previous reported cases of 46,XY gonadal dysgenesis have not had major associated malformations. These children present a new constellation of anomalies unlike those seen in other types of gonadal dysgenesis and represent a new familial syndrome of 46,XY gonadal dysgenesis.

Variability of water urethral closure pressure profiles.

Water urethral closure pressure profiles were evaluated in 66 women for reproducibility between sequential studies in patients and 3 observers.

Papillary cystadenoma of epididymis: component of von Hippel-Lindau syndrome.

A case of epididymal cystadenoma, thought to be a component of the von Hippel-Lindau syndrome, is presented. The syndrome is reviewed, and the importance of long-term urologic follow-up for possible presentation of renal cell carcinoma is discussed.

Analysis of the urethral pressure profile using a mechanical model.

Using a model of the urethra designed to ensure a predictable pressure profile along its length, we investigated optimal parameters for gas and water profilometry. In gas profilometry, the response characteristics of the machine, attributable to the highly compressible nature of gas, were shown to be the most important determinants of accuracy. Gas and water profilometry have drawbacks that make clinical results inaccurate. However, if all measuring parameters are carefully recorded and considered when a pressure profile is analyzed, system error can be decreased from 62 to 5% by using the optimal pull and flow rates determined by this study.

Parameters of gas urethral pressure profiles: part II.

Parameters of the carbon dioxide urethral pressure profilometry were examined in detail previously for reproducibility within subjects. In the current study we have extended that analysis to determine the relationship of these parameters between patient subgroups. Mean values for non-spina bifida male subjects showed the same pattern of increase across age groups, regardless of the measured parameter. These increases were significant for continence and functional lengths but not for closure pressure. Male subjects with spina bifida showed mixed responses across age but age was not a statistically significant factor for any of the 3 parameters. Female subjects were quite uniform in the mean values across age for continence and functional lengths regardless of diagnosis. Mean values for female subjects were not uniform for closure pressure and tended to decrease with age in contrast to continence and functional lengths. The parameter continence length has a between subject standard deviation that is relatively stable across age, sex and pathology, and may be used for a basis of comparison. However, standard deviations for functional length is least variable in most subgroups of sex, age and diagnosis.

Parameters of gas urethral pressure profiles: Part I.

Carbon dioxide urethral pressure profiles were analyzed under the same conditions for 113 spina bifida and 87 non-spina bifida patients categorized by sex and age. Either duplicate or triplicate measurements were obtained from each patient for parameters of continence length, closure pressure and functional length. The degree of reproducibility of each parameter varied depending on age, sex and diagnosis. Except for 1 age-sex category closure pressure exhibited the smallest degree of relative variation for spina bifida patients. Results for non-spina bifida patients were mixed in that the measurement of no one parameter resulted in a uniformly smallest degree of relative variation. Reproducibility based on within patient variability generally was least for the continence length.

Penile tourniquet syndrome caused by hair.

We have described two circumcised children who developed a urethral fistula caused by long hairs constricting and ulcerating the penis. These cases are presented to remind physicians to examine the infant's penis when he presents with a swollen glans, abnormal urinary stream, and a parent with long hair.

Pressure recording catheter.

A simple, inexpensive pressure-recording balloon system to determine abdominal or rectal sphincter pressures without difficulty is described.

Response times on urethral pressure profiles: carbon dioxide instrument.

This study shows that the response time between an actual event and a recorded event on a urethral pressure profile is a function of gas flow rate and gas circuit volume. Response times varied from 1.8 to 10.8 sec. Considerable variation was noted between flow setting and actual gas flow; therefore, calibration of the instrument's gas flow meter is recommended.