Segmental priapism.

A case report of a 27-year-old male with segmental priapism of the left proximal corpus cavernosum is presented. Treatment consisted in evacuation and irrigation of the corpus.

Prolapsed ureterocele.

Although rare, the prolapsed ureterocele constitutes a urologic emergency that can rapidly evolve to severe conditions due to congestion and necrosis, and to obstruction of the urinary tract. A simple external resection resolves the emergency, allowing a postoperative investigation of the whole urinary tract to be performed, in order to adequately prepare urinary reconstruction.

Assessment of hydroureteronephrosis by renographic evaluation under diuretic stimulus.

42 dilated renal units, from 32 patients, were evaluated renographically with 131I, under diuretic stimulus, with the aim of differentiating between obstructed and atonic ureters. The results of this study are similar to the clinical follow-up and surgical findings in 88% of cases.

Ureterocele of the lower pole ureter and an ectopic upper pole ureter in a duplex system.

We report an unusual case of a ureterocele in a duplex system, which was associated with an ectopic (vulval) upper moiety ureter. This is the second case reported in the literature of a ureterocele arising from the lower pole ureter. Surgical treatment consisted of removal of the upper segment of the kidney and its ureter. The ureterocele was excised and the lower pole ureter was reimplanted in the bladder. At followup 14 years postoperatively the patient was cured and free of urinary infection.

Nonrefluxing colonic conduit: efficiency and complications of ureterocolic anastomosis.

The efficiency of and complications in 65 cases of colonic conduit have been studied (64 cases of bladder exstrophy and 1 case of cloacal exstrophy). For the ureterocolic reimplantation, we employed the Leadbetter technique and a modified kelalis technique. The results after 1-12 years in 128 renoureteral units showed 28 complications (21 obstruction and 7 refluxing units). Other types of complications have been observed and reported in this work. The high incidence of obstruction was probably due to the long submucous tunnel in the ureterocolic reimplantation. We believe that the sigmoidal conduit is an adequate method for temporary or permanent diversion.

Treatment and prevention of complications after extravesical antireflux technique.

An extravesical antireflux technique was performed in 300 consecutive patients who presented primary vesicoureteral reflux (VUR). The following results are reported: Elimination of VUR in 99% of the cases without complications. Early complications reported include: urinary retention, suppurative pyelonephritis and fistulae. Urinary retention occurred in 2 patients presenting other congenital abnormalities. Vesicocutaneous fistulae occurred in 2 patients due to obstruction of the catheter for vesical drainage; they closed spontaneously under adequate drainage of the bladder. Suppurative pyelonephritis and/or anuria occurred in 6 patients due to transitory obstruction due to edema of the new vesicoureteral junction and were treated with bilateral nephrostomy and progressed with good results after withdrawal of the nephrostomies. Late complications included: persistence of VUR in 8 patients due to two types of technical failure, too short a tunnel and dehiscence of the muscular suture; obstruction of the new vesicoureteral junction in five ureters due to three causes, excessive dissection of the ureters, mucosal stenosis and stenosis of the new hiatus; contralateral reflux in 6 patients due to nonsystematical performance of endoscopic examination of the ureteral meatus preoperatively in the first series of 100 consecutive cases. On the basis of the results achieved, the authors give specific suggestions that allow the technical prevention of the small number of complications that may occur using the extravesical antireflux technique in the treatment of VUR.

Initial results of the complete reconstruction of bladder exstrophy.

A new, staged approach to reconstruction of bladder exstrophy utilizing four surgical procedures is presented. This approach presents all the complications usually seen in functional reconstruction of this anomaly.

Spermatogenesis before and after renal transplant.

Studies on the relationship of fertility and renal transplantation are relatively recent. Data related to the sexual aspects of uremic patients before and after renal transplantation are available. Information about spermatogenesis, as offered by testicular biopsy, is scarce. The present study has as its objective the quantitative analysis of testicular biopsies obtained pre- and postoperatively from the renal transplant patients after normalization of the renal function.

Renovascular hypertension in children.

Due to better methods of diagnosis, an increasing number of children with renovascular hypertension are being discovered. The disease itself has variable clinical manifestations, and an adequate laboratorial workup, including arteriography and renin assays, is mandatory in suspected cases. Treatment depends on the prognostic values of the renin assays and surgery cures 80% of the patients, either by nephrectomy or by revascularization techniques. Among these, renal autotransplantation gives better exposure of the operative field, and therefore better results. In most cases, systemic infection seems to be the main cause of the inflammatory reaction within the arterial wall that causes obstruction.

[Persistence of Muller's ducts in the male. A family observation (author's transl)]. / Syndrome de persistance des canaux mullériens. Une observation familiale.

The authors report two cases (in brothers) of the persistence of Muller's ducts (uterus and uterine tubes), whilst both individuals led a normal though infertile sex life. They presented with a bilateral inguinal hernia and a cryptorchidism. The precise diagnosis was made at surgery in the first, whilst the family history led to the diagnosis in the second. Both underwent bilateral orchidopexy, and hysterectomy with excision of the uterine tubes. The caryotypes were normal. Of anatomical interest was the fact that both had vas deferens included within the uterine wall but the there was no continuity between the epididymes and the testes. The latter contained seminiferous ducts, Sertoli cells and spermatogonia but no spermatocyte nor spermatozoa. On the basis of these cases, the authors emphasise their demonstrative nature: the presence of testes resulted by the secretion of testosterone in the induction of normal external genitalia whilst the absence of factor inhibiting Mullers ducts (or tissue resistance to this factor) resulted in the development of the uterine tubes and uterus.

Experimental comparative study of surgical and needle biopsies of the testis.

Testis biopsy was performed on 78 rats in order to compare needle and surgical biopsies. The rats were autopsied 7, 15, 30, 60, and 90 days after biopsy. Both techniques provided tissue of equally good quality for histopathological examination and led to irreversible hypospermatogenesis of the biopsied and the contralateral testes.