[Intermittent flank pain]. / Intermitterende flankpijn.

Flank pain is a common problem that can be caused by a variety of abnormalities. In this case report we describe two patients with intermittent flank pain with an unusual cause: intermittent ureteropelvic junction obstruction due to crossing of accessory renal vessels. Instant imaging at the time when the symptoms occur seems the best way to prevent delays in diagnosis and treatment.

[Follow-up investigation in urologic oncology, in particular nephrectomy due to renal cell carcinoma]. / Vervolgonderzoek in de urologische oncologie, in het bijzonder na nefrectomie wegens niercelcarcinoom.

Follow-up investigations in urologic oncology have a number of different objectives, with the literature possibly placing too much emphasis on the early detection of recurrences. Although everyone considers this to be the most important goal, it often lacks a solid scientific basis. Apart from the detection of recurrences, the literature presents other goals with respect to the follow-up of patients after nephrectomy due to renal cell carcinoma: evaluation of the therapy, advice and counselling, and training. These objectives provide sufficient reason to see the uro-oncologic patient for outpatients' check-ups on a regular basis. The follow-up scheme can often be specifically tailored to the individual patient.

[The wet umbilicus: maybe not an umbilical granuloma?]. / De nattende navel: misschien geen navelgranuloom?

Three infants, 1 girl aged 10 months and 2 boys aged 2 and 4 months, presented with a discharging umbilicus directly or shortly after birth. Echography and cystography showed three different causes: a cystic remnant of the omphalomesenteric duct, a persistent urachus and a persistent omphalomesenteric duct. All were successfully managed surgically. The most common cause of a discharging umbilicus is an umbilical granuloma. This is usually treated by application of silver nitrate. In some patients, however, the discharge may not disappear or may contain urine or faecal material. These cases should be referred and echography performed. In case of an anomaly of the urachus or the omphalomesenteric duct, surgical exploration is mandatory. The lesion should be excised en bloc, together with a part of the bladder or the bowel.

Laser therapy for carcinoma in situ of the penis.

PURPOSE: Carcinoma in situ of the penis, also referred to as Bowen's disease or erythroplasia of Queyrat, may lead to invasive squamous cell carcinoma. We assessed the results of laser therapy for carcinoma in situ of the penis. MATERIALS AND METHODS: From 1986 to 2000 we treated 19 patients with carcinoma in situ of the penis with the neodymium:YAG or carbon dioxide laser. Treatment was assessed retrospectively. No patient was lost to followup. RESULTS: No complications developed and cosmesis was excellent. After 2 to 4 months 3 patients (16%) received repeat treatment because of incomplete disappearance of the lesion. Mean followup was 32 months. True carcinoma in situ recurrent in 5 patients (26%) at an average followup of 25 months (range 6 to 75), while 1 had infiltrating carcinoma. All patients with carcinoma in situ underwent repeat laser treatment. CONCLUSIONS: In our experience laser therapy is appropriate initial treatment for carcinoma in situ of the penis with excellent cosmetic and functional results. This therapy is also suited for recurrence without the need for more mutilating therapy. However, the high incidence of recurrence indicates the need for careful followup and patient self-examination.

The efficacy of serial physical examination in penetrating abdominal trauma.

Over a 10-year period we reviewed the records of 370 consecutive patients with potentially penetrating abdominal wounds (48 gunshot and 322 stab wounds). Selective non-operative management for abdominal stab wounds was introduced, guided by serial physical examination. In our study the terms therapeutic and non-therapeutic laparotomies were used, the latter comprising negative as well as insignificant findings. Initially diagnostic peritoneal lavage and local wound exploration were used, but these methods were later abandoned. Mortality was 10.2% and morbidity 25% in the group of gunshot wounds and 1.2% and 8.6% in the group of stab wounds. During this period the rate of laparotomies for stab wounds decreased from 55% to 30%, while the rate of non-therapeutic laparotomies decreased from 24% to 0% in the last year. Delayed laparotomy did not cause death or increase morbidity. Our results support the concept of selective non-operative management of abdominal stab wounds using repeated physical examination. Peritoneal perforation and haemoperitoneum should not be an indication for routine laparotomy.