Adenocarcinoma from endometriosis causing urinary tract obstruction in a patient on oestrogen replacement therapy after hysterectomy. A case report.

A patient on oestrogen replacement therapy after hysterectomy developed endometriosis and adenocarcinoma. The involvement of the urinary tract and theories on the pathogenesis of endometriosis and adenocarcinoma in relation to oestrogen replacement therapy are discussed.

Acute focal bacterial nephritis or renal abscess? A sonographic diagnosis.

The radiological and sonographic findings of acute focal bacterial nephritis in 3 patients are presented. The sonographic appearance of a poorly marginated mass in the renal cortex, with echo amplitude less than the normal parenchyma and with poor transmission, should suggest the diagnosis of acute focal bacterial nephritis in a patient with pyrexia and a tender renal mass. These features of poor echogenicity and lack of posterior enhancement contrast with the presence of patchy echogenicity and posterior enhancement found in the renal abscess. This is of surgical importance, as the management may tend to be conservative in the one and surgical in the other.

Urinary continence in children with neurogenic bladders.

Seventy-three children with neurogenic bladder dysfunction were assessed for urinary continence over periods ranging from 6 months to 4 years. Acceptable continence was achieved in 35 (48%), the majority by means of intermittent clean catheterisation, usually with drug manipulation. Two children had tobe diverted purely for intractable incontinence. A plan of management for children with neurogenic bladder dysfunction is described.

Urethral strictures at Baragwanath Hospital.

The records of 258 patients operated on for urethral strictures at Baragwanath Hospital over a 40-month period were reviewed. The young, economically active man was mostly affected and gonorrhoea appeared to be the most frequent aetiological cause. Internal urethrotomy was the commonest procedure performed (64% of cases). Overall, a single procedure was done in 70% of the patients, whilst the remaining 30% had multiple operations. Eighty-eight per cent of the internal urethrotomies were successful. Good results were also seen with the other single-stage procedures, whilst a high percentage of 2-stage urethroplasties returned with complications. It is emphasised that the simplest, one-stage procedure necessitating the shortest hospital stay should be the elective treatment of choice in these patients.

Acute renal failure after use of radiographic contrast media.

The nephrotoxic effects of radiographic contrast media (RCM) used for excretory urography and angiography are described in 9 patients. These effects are usually temporary and reversible, but may be permanent. Predisposing factors resulting in renal damage are identified and discussed. These include diabetes, dehydration, myelomatosis, chronic renal failure of many causes and repeated administrations of contrast media with a short period. Suggestions are made in order to reduce the incidence and severity of functional renal impairment after administration of contrast media.

Current concepts in congenital vesico-ureteral reflux.

Primary vesico-ureteric reflux must be graded according to severity. Significant reflux up a dilated ureter appears to be an important factor in causing renal damage. There is evidence in favour of the theory that the renal deterioration seen in some cases of reflux can be explained on a congenital basis of site or origin of the ureteral bud and resultant dysplasia of the developing kidney. Surgery should be reserved for selected patients with significant reflux.

Intermittent catheterisation in congenital neurogenic bladder: a preliminary report.

53 children with congenital neurogenic bladders are currently managed on intermittent catheterisation. The problems of continence, urinary tract infection and upper tract deterioration have to date been controlled reasonably successfully and the need for urinary diversion appears to have been obviated. Complications have been negligible and parents and patients alike prefer this method to the Crédé manoeuvre.

Causes of renal deterioration in patients with meningomyelocoeles.

The patient records of 122 children with meningomyelocoeles were analysed in an attempt to find a common factor causing upper tract deterioration. The results clearly show that grade III reflux followed by obstructive hydroureter are the commonest factors associated with significant renal deterioration.

The angiographic evaluation of renal pelvic carcinoma.

The angiographic findings are described in 6 cases of renal pelvic carcinoma. An angiographic finding which has not hitherto been emphasised is a diminished branching of arteries in the kidney segment related to the pelvi-calyceal tumour--the "pruned-tree" appearance. This is generally associated with a deficiency of the nephrogram in the same segment. These appearances may be due to invasion of the renal parenchyma by tumour. However, the findings may occur also in the absence of parenchymal invasion by the tumour and therefore do not necessarily reflect the stage of the disease.