Secondary foci of primary tumors of the bladder in the upper urinary tract.

In 10 years the authors have observed 16 cases of upper urinary tract tumors, appearing from 2 to 16 years after the initial diagnosis of bladder carcinoma. Such lesions are more frequent than has been suggested in the literature and represent 25% of all tumors of the renal pelvis and ureter seen in our service during this period. We have shown vesicoureteral reflux directly in 6 cases, indirectly in a further 6 with suggestive signs in 3 more. We believe that reflux causing the implantation of desquamated tumor cells from the bladder tumor is the most important pathogenetic mechanism for upper urinary tract "recurrences." The interval between the initial diagnosis of bladder tumor and the appearance of secondary foci may be longer than 20 years. Prolonged surveillance is therefore necessary, particularly if vesicoureteral reflux has been shown.

[Radiological investigations to establish etiology in patients with hematuria. A report on nearly 2,000 consecutive cases (author's transl)]. / Le diagnostic étiologique des hématuries. Apport de la radiologie dans près de 2 000 cas consécutifs.

A prospective study was conducted in 1,878 patients found to have hematuria, among 11,000 new cases attending for consultation over a period of 27 months, who were then followed-up for several months to several years. The results confirmed some well-established facts but several unusual features were observed. Intravenous urography, when technically complete, detected urinary tract lesions in 60 p. cent of cases. Complementary examinations (cystoscopy, angiography, renal biopsy), which should not all be conducted systematically, but only as a function of the results of the IVU, the type of hematuria, and clinical and biological findings, considerably increase the percentage of positive results. The etiology remained obscure in less than 10 p. cent of cases but not all of these patients had benefited from a full range of complementary examinations, that should have been conducted. Associated anticoagulant treatment and the microscopic nature of the hematuria should never lead to delay in IVU examination, and a reassuring diagnosis of a benign lesion. The authors emphasize the high frequency of associated lesions. For this reason, a complete IVU should be conducted whatever the initial findings. Furthermore, the reassuring diagnosis of an atypical benign cause for the hematuria (renal cyst, prostatic adenoma, etc.) should not be too easily accepted before exploring the possibility of a second lesion, truly responsible for the hematuria and having an entirely different prognosis.

[Hyperselective blood sampling from the renal veins (author's transl)]. / Prélèvements sanguins hypersélectifs dans les veines rénales.

A method by substitution of venous catheters within the renal venous tree was used in 28 adult hypertensive patients suffering from focal parenchymatous lesions or stenosis of one branch of the renal artery with the aim of detecting a specific source of renin hypersecretion.

[Radiological signs of primary sarcoma of the kidney in adults : a report on 5 cases (author's transl)]. / Manifestations radiologiques des sarcomes primitifs du rein chez l'adulte. Cinq cas.

Primary sarcomas of the kidney are extremely uncommon and the results of their angiographic study are rarely reported. A study of five cases that were confirmed histologically demonstrates the absence of specific clinical and urographic findings. Arteriographic appearances are variable and not related to the histological type. The poorly vascularized forms are traditionally the most frequent (2 out of 5 cases) but are not fundamentally different from adenocarcinomas. The diagnosis can be suspected, however, when there is an infiltrating peripheral tumor extending well beyond the capsule. The hypovascularized pseudocystic forms raise the same arteriographic problems as the adenocarcinomas. Arteriography can diagnose malignancy, but the diagnosis of sarcoma is usually impossible before operation.

[Value of radiological investigations in patients with dysuria after prostatic adenomectomy (author's transl)]. / Intérêt de l'exploration radiologique chez les adénomectomisés dysuriques.

Dysuria is a relatively frequent complication after prostatic adenomectomy. The authors review 107 patients with this complication and demonstrate that radiological investigation, including a micturition study, preferably after IVU, shows the presence of an obstructive cause for the dysuria in the vast majority of cases (92.5%). There are two main types of obstructive lesion: - parietal stenosing lesions, - compression lesions. - The most frequent parietal stenosing lesions, apart from those of the bladder neck, are urethral stenoses. - Stenoses with total compression of the capsule are often the cause of severe dysuria. - Localized compression of the capsule and urethral stenosis usually cause only moderate dysuria. - An irregular lacunar image should suggest cancer of the prostate.

[Results of radiological studies of prostate lesions in patients with urinary tract tuberculosis (author's transl)]. / Etude readiologique des lésions prostatiques chez les tuberculeux urinaires.

The authors have reviewed the case-reports of 160 patients with urinary tract tuberculosis in whom a complete radiological examination of the lower urinary tract had been performed. They analyze the frequency and significance of any prostatic lesions and describe the most effective investigational procedures for demonstrating such lesions. They were observed in about 50% of patients as opacification of the prostatic cavities, and can be clearly demonstrated in the large majority of cases by micturition cystography after intravenous urography, provided a satisfactory technique hs been used. In those cases where intravenous urography does not permit an effective micturition study, retrograde opacification is necessary, preferably by suprapubic cystography, and in some well-defined cases, by retrograde uretrography. The search for any prostatic affection is not a t a speculative study as it can explain some of the symptoms presented by the patient, and enable specific therapy to be prescribed.

[A critical review of the variations in size of the kidney caused by increased diuresis in hypertensive patients (author's transl)]. / Les variations de taille du rein sous l'effet de l'hyperdiurèse dans l'hypertension artérielle. Etude critique.

The authors studied the validity of Wolf and Dorph's test (increase in size of the kidney with increased diuresis) performed during intravenous urography in hypertensive patients. The technical procedure is described, and the results reported: 1 032 kidneys were measured, of which 84 had been also examined by arteriography. The results are analyzed and compared to those obtained after the standard method of early consecutive films, with the following conclusions: -- the test is not as valid as is suggested by the authors who described it; -- the information supplied by the standard method is more consistent and precise; -- the results of these two series are not completely superimposable; -- that even if Wolf and Dorph's test can sometimes supply useful information, it must not be relied upon completely.

[Urinary lithiasis after renal transplantation. 9 cases (author's transl)]. / Lithiase urinarie après transplantation rénale. 9 observations.

Nine cases of urinary lithiasis following renal transplantation are reported. They differ from 15 cases in the literature in their development late after transplantation and in that no relation with hyperparathyroidism could be clearly demonstrated. We emphasise the difficulty of the clinical and radiological diagnosis of this little-known complication. The course is essentially similar to that in non-transplant patients with lithiasis.

[The radiological exploration of renal tumour syndromes [author's transl)]. / Exploration radiologique des syndromes tumoraux rénaux.

Four radiological examinations are available to the clinician for the diagnosis of renal tumour syndromes: intravenous pyelography with vascular nephrotomography is used to make an initial classification. Hypervascularised masses, usually malignant, remain the indication of choice for renal arteriography. Apparently avascular or doubtful masses should first be studied by ultrasound echotomography which offers the possibility of a second classification into fluid-filled tumours, the cystic nature of which may be confirmed by translumbar puncture followed by kystography, and solid or doubtful tumours, suggestive above all of a necrosed carcinoma. In this latter case, the indications for renal arteriography with the use of angiotensin, translumbar puncture or immediate exploratory lumbotomy must be decided in the light of individual cases and local preferences.

Angiographic study of renal vein involvement in renal cell carcinoma.

High dose selective renal arteriography was performed in 62 cases of renal cell carcinoma to study the patency of the renal vein trunk. Arteriographic findings were correlated with histopathology in all cases. In 35 cases of angiographic patency of the renal vein surgery always confirmed the findings. 11 false positive results were observed (the arteriographic diagnosis of venous involvement was not found at surgery). The authors believe that this method is easy and reliable; inferior cavagraphy is not necessary when arteriography shows the patency of the vein.

[Ureteral diverticulosis (author's transl)]. / Diverticulose de l'uretère.

We report here two new cases of ureteral diverticulosis. This condition is found usually in the man of the fifties who has most frequently an urinary tract infection or a prostatic adenoma. The roentgen findings are multiple out-poutchings of the lumbar ureter. Several factors are combined (constitutionnal, urinary tract infection, disordered ureteral-motility) to explain the creation of diverticules in the areas of weakness of ureteral wall, where penetrate the vessels.

[The diagnostic possibilities and limitations of arteriography in necrosed carcinomas of the kidney (author's transl)]. / Les possibilités et les limites diagnostiques de l'artériographie dans les cancers nécrosés du rein.

On the basis of a review of 186 cases of carcinoma of the kidney studied by arteriography in the Department of Radiology for Diseases of the Urinary Tract at Necker Hospital, the authors drew the following conclusions: 1. The diagnosis of carcinoma could be affirmed in the very great majority of cases and suspected in the others. 2. There were no instances of a reassuring false diagnosis (cyst). 3. A precise, rigourous and faultless technique, perfectly demonstrating the exteriorised part of the mass and attentive, thorough and careful interpretation of the films obtained, in particular with regard to the mass in its exteriorised portion, are always essential in order to obtain such results. In particular, the presence of a vascularisation of a discontinuous opaque band at the periphery of the mass in its exteriorised part indicates a strong suspicion of a necrotic malignancy and under no circumstances is an unreserved diagnosis of a cyst possible. 4. Diagnostic errors in the sense of false positives involving certain "thick-walled" cysts should be eliminated by pre-operative needle puncture. 5. The authors conclude by describing the method of radiological exploration which they feel to be desirable in practice following the discovery of a renal mass by intravenous pyelography.

[Radiological diagnosis of tumoral lipomatosis of the renal sinus. The role of arteriography (author's transl)]. / Le diagnostic radiologique de la lipomatose pseudo-tumorale du sinus rénal Place de l'arteriographie.

In twenty cases of pseudo-tumoral sinusal lipomatosis for which the patients had undergone renal arteriography, the authors investigated the urographical and arteriographical clinical signs by comparing them with the previously published data. After reviewing these various elements and considering the various possible diagnoses, they came to the conclusion that, although the arteriographic signs are quite distinctive, they are not absolutely essential for diagnosis of this disorder--which it should be possible to confirm unreservedly from the urographical data in all cases in which there are considerable anatomical lesions. A well-managed urographical technique and careful assessment of the facts should allow arteriography to be discarded, indications for this only being justified where there is an associated symptomatology, especially haematuria.

[The radiological diagnosis of pyelocaliceal tumors. Accent placed on the value of arteriography, especially after the angiotensin test (author's transl)]. / Le diagnostic radiologique des tumeurs pyélo-calicielles. Accent mis sur l'intérêt de l'artériographie, surtout après epreuve a l'angiotensine

From a study of 22 cases of excretory pathway tumors, which had undergone simple selective arteriography, complemented in certain cases by an angiotensin test, the authors were able to draw the following conclusions: -In those forms which show a pyelocaliceal lacuna on intravenous pyelography, arteriography does not help in making a diagnosis; in particular it does not help in distinguishing malignant forms from benign forms. It is therefore of no practical value and is not indicated in such cases. -In those forms showing caliceal amputation or a non functioning kidney on intravenous pyleography, arteriography nearly always enables the diagnosis of a tumor and confirms considerable parenchymal invasion. Its practical value is evident and it seems that it is always indicated in such cases. -Interpretation of the documents must always be thorough, looking for minor signs, while being aware of possible causes of error.