Laparoscopic management of incidentally noted omphalomesenteric duct remnant.

An adolescent undergoing laparoscopic varicocele ligation was incidentally found to have a persistent omphalomesenteric duct remnant. The fibrous band coursing between the umbilicus and terminal ileum was resected laparoscopically without difficulty. Remnants of the type presented herein should be removed to prevent subsequent complications.

Iliac vein compression syndrome: an unusual cause of varicocele.

Iliac vein compression syndrome is the phenomenon of nonthrombotic iliac vein obstruction caused by compression of left iliac vein between the right iliac artery and fifth lumbar vertebra. Affected patients usually present with unilateral leg edema. The condition is most often seen in women, in whom it may also be a cause of vulvar varicosities. Presented here is a case of idiopathic iliac vein obstruction associated with an ipsilateral varicocele in a young man. This varicocele was caused by multiple collateral venous channels and was resistant to surgical high ligation. This case illustrates an unusual cause of varicocele formation and an anatomic reason for failure of standard surgical therapy.

Prognosis of patients with unilateral renal agenesis.

The clinical course was reviewed in 157 patients with unilateral renal agenesis and a normal contralateral kidney for the purpose of establishing a prognosis. There were 85 males (54%) and 72 females (46%). The mean age at diagnosis of unilateral renal agenesis was 37 years. The mean years at risk was 56. Proteinuria (> 150 mg/24 h) was found in 19% of the 37 patients tested (P < 0.001), hypertension developed in 47% of the 47 patients tested (P = 0.010), and renal function (adjusted for age and sex) was decreased in 13% of the 32 patients tested (P = 0.001). An increased filtration fraction was found in 7 (54%) of 13 patients evaluated. At the completion of this study, 114 patients (73%) were alive, and the survival rate was similar to that of age-, sex-matched United States life tables. Forty-three patients (27%) died; 6 deaths (4%) were caused by renal failure. Our review indicates that patients with unilateral renal agenesis and a normal solitary kidney are at increased risk of proteinuria, hypertension, and renal insufficiency. Therefore, it is essential to have prolonged and careful follow-up and to employ strategies that maximize renal preservation.

Prognosis of children with solitary kidney after unilateral nephrectomy.

The clinical course of 138 children who underwent unilateral nephrectomy and had a normal contralateral kidney at the time of nephrectomy was reviewed. The diagnosis leading to nephrectomy included obstructive uropathy in 46% of the cases, reflux or pyelonephritis in 30%, Wilms tumor in 15%, hypertension in 4%, dysplastic kidney in 2% and trauma in 2%. Mean age at nephrectomy was 7.3 years and median followup was 24.7 years. Of the 138 patients 121 (88%) are well and 17 died, including 14 secondary to metastatic Wilms tumor and 1 of renal failure. Survival of nonWilms tumor patients was similar to that of an age-matched control group. In 30 patients 24-hour creatinine clearance and 24-hour urinary protein excretion were measured. Proteinuria (greater than 150 mg./24 hours) was found in 8 of the 30 patients (27%) (p less than 0.001), renal insufficiency developed in 9 (30%) (p less than 0.0001) and hypertension occurred in 10% (p greater than 0.10). Children with an acquired solitary kidney are at increased risk for proteinuria and renal insufficiency.

Strategies for ureteral catheterization after antireflux surgery by the Cohen technique of transverse advancement.

The Cohen technique for antireflux surgery is well established and provides excellent results. A major drawback with this technique is the difficulty in catheterizing the ureter postoperatively. We describe different strategies that can be used to catheterize the ureter successfully.