The dangerous ureter.

Seven patients with recurring transitional cell carcinoma of the urinary bladder were treated with repeated transurethral resections of these tumors and were given adjuvant intravesical chemotherapy or bacillus-Calmette Guerin (BCG) vaccine. Carcinoma either in the ureters or renal pelves subsequently developed in these patients. Unfortunately, 2 patients had inoperable tumors when the diagnosis was confirmed. When treating patients with recurring carcinoma of the urinary bladder, the possibility of upper urinary tract tumors developing must always be considered. Hence, the necessity of frequent urinary and ureteral cytology examinations proceeding to excretory urography, retrograde pyelograms, computerized tomography (CT) scans of the upper tracts, or ureteroscopy as may be necessary to locate small tumors or to diagnose carcinoma in situ.

Gas-forming infections in genitourinary tract.

Diabetes mellitus associated with urinary tract infections and ureteral obstruction can be predisposing factors leading to emphysematous pyelonephritis. Fever, flank pains, and a palpable renal mass, associated with dehydration and hyperglycemia, were the most frequent presenting symptoms associated with emphysematous pyelonephritis. Computerized tomography (CT) scan is the best method to identify a renal or perirenal abscess and its ramifications. Intravenous antibiotic therapy is determined by blood and urine cultures. Mortality was zero in patients treated by nephrectomy. One patient who had incision and drainage of a renal abscess died of sepsis, and 1 patient died of sepsis following incision and drainage of a prostatic abscess. Patients with cystitis emphysematosa require antibiotic therapy and relief of bladder outlet obstruction. Prostatic abscess is best treated by perineal incision and drainage. Periurethral scrotal abscesses should be incised, drained, and the overlying necrotic skin debrided. Early diagnosis and aggressive medical and surgical management of gas-forming infections of the genitourinary tract are vital.

Bilateral renal oncocytoma: report of 2 cases and review of literature.

We report 2 cases of synchronous bilateral renal oncocytoma treated by radical nephrectomy on 1 side and by partial nephrectomy on the other side. Long-term followup serves to confirm the noninvasive nature of this disease. We recommend conservative management based upon radiological and gross pathological findings.

Reversible hypertension due to carcinoma of the ureter.

A patient who presented with hypertension of recent onset was found to have unilateral hydronephrosis. Increased activity of the renin-angiotensin system was documented with renal-vein-renin concentrations. The hydronephrosis was due to a primary transitional cell carcinoma of the ureter. Following nephroureterectomy, blood pressure returned to normal and has remained so for two years.

Aids in diagnosis of suspect ectopic ureters in female patients.

When suspected ectopic ureters cannot be visualized by conventional methods, such as excretory urogram, nephrotomograms, or by intravenous indigo carmine, then direct injection of vaginal, suburethral, or paraurethral "swellings," which are in effect dilated terminal ureters, may confirm the diagnosis.

Carcinoma of prostate metastatic to prepuce and glans penis.

A case of adenocarcinoma of the prostate with metastases to the prepuce and glans penis is described. This is the second case reported. The various routes of tumor spread to the penis are discussed briefly, and the possibility of direct spread is postulated as the cause of "kissing" foreskin and glandular lesions.

Solitary infected renal cyst: report of 2 cases and review of literature.

Two cases of suppuration in solitary renal cyst are reported. The clinical history of acute pyelonephritis, avascular mass lesion of the kidney with ipsilateral pleural effusion (triad) seen in a female patient of child-bearing age is characteristic of this condition. Surgical management is satisfactory. Our Case 1 is the first reported case of solitary infected cyst that ruptured retroperitoneally, clinically mimicking a subphrenic abscess.

Iatrogenic renal artery thrombosis.

Renal calculi were removed from 2 women--in 1 case by renal bisection and in the other by nephrolithotomy. In each case a small bulldog clamp was applied to the renal artery for less than 30 minutes. Both patients suffered renal artery thrombosis necessitating nephrectomy. When the histories of these patients were reviewed the common factor found was oral contraceptives, suggesting that oral contraceptives may predispose to renal artery thrombosis.

Ectopic urethral ureter in the adult female.

The unusual presenting symptoms, clinical management and roentgenologic diagnosis of an instance of ectopic urethral ureter in four adult female patients are delineated in terms of the embryologic preface, the dysplastic upper renal segment and the lower urinary tract findings associated with urinary tract infections. Surgical management consists of heminephrectomy and partial ureterectomy. Total ureterectomy is necessary if reflux exists in the ectopic ureter, with a vesicovaginal or ureterovaginal fistula being a possible complication in the latter operation. Ureteroneocystostomy may be used in the treatment of an ectopic ureter if the corresponding renal segment is functioning adequately.