[Transsexualism as a clinical symptom of true hermaphroditism].

Transsexualism is incorrectly thought to be a disease of sexual centers (zones) of the brain but these sexual centers in the brain operate only in response to action of sexual hormones (androgens or estrogens) which are produced in the gonads and delivered to the brain by blood. In hermaphroditism the brain receives both androgens and estrogens. Transsexualism syndrome develops in cases when all sexual organs develop under the influence of one sex while sexual psychoorientation, sexual autoidentification and sexual behavior form under the influence of hormones of the other sex. Therefore, treatment of this syndrome should not consist of surgical correction of the sex according to psychic behavior of the patient but should be directed to detection of the gonad (or gonadal tissue) causing abnormal behavior and its removal. Gonad corresponding to sexual organs of the patient should be preserved. Of 19 patients with true hermaphroditism and 199 patients with false hermaphroditism observed by the authors 4 patients with true hermaphroditism had transsexualism.

[Hypospadia in females].

Hypospadia is a frequent birth deformity consisting in fissure of the posterior (lower) wall of the urethra. Hypospadia is characterized by shortening of the urethra and ectopia of the external urethral opening. This deformity often occurs in women but is rarely diagnosed because physicians are not well-informed about female hypospadia. Classification of anatomic variants of female hypospadia proposed by the authors includes low vaginal ectopia of the external urethral opening; high vaginal ectopia of the external opening of the urethra; urovaginal (vesicovaginal) fusion of the neck of the urinary bladder with vagina accompanied with enuresis; urogenital sinus in females (ectopia of the external urethral opening in the urogenital sinus); any of the above variants of female hypospadia in combination with false or true hermaphroditism. All the variants of female hypospadia must be surgically corrected as transposition of the external opening of the urethra from the vagina on the perineum under the clitoris in chronic urethritis, cystitis and vulvovaginitis or as urethroplasty in enuresis. Hypospadia, urogenital sinus and hermaphroditism--three anomalies of human urogenital system--combine rather frequently.

[A case of urethral transposition and vaginoplasty in the presence of urogenital sinus in women]. / Sluchai transpozitsii uretry i plastiki vlagalishcha pri nalichii mochepolovogo sinusa u zhenshchin.

A case of female false hermaphroditism is reported in a 30-year-old woman with urogenital sinus. This woman has undergone vaginoplasty and urethral transposition. The latter is not usually made in women with urogenital sinus. This leads to the position of the external urethral ostium in the depth of the newly formed vagina and, finally, to ectopia of the external urethral ostium or hypospadia. The result is that such woman suffers all life from urethritis, cystitis and vulvovaginitis.

[Variants of hermaphroditism (clinical findings)]. / Varianty germafroditizma (klinicheskie nabliudeniia).

False and true hermaphroditism (FH and TH) are often encountered in surgery for hypospadia. A clinically validated classification of various types and variants of hermaphroditism is proposed. FH is divided into male FH and female FH. TH also falls into two categories: TH without anomalies of external genitalia and that with these anomalies. The latter category has three variants: 1) all genitalia of males or females and some genitalia of the other sex; 2) some female and male organs in various combinations; 3) all organs of both sexes. All TH variants are illustrated by 5 case reports. These patients were thoroughly examined and their sex was surgically corrected.

[Acute ureteral obstruction (renal colic)]. / Ostraia obstruktsiia mochetochnika (pochechnaia kolika).

Acute ureteral obstruction is always associated with high intrapelvic hydrostatic pressure. Objective diagnosis of renal colic can be made by direct measurement of intrapelvic pressure (IPP). We propose a very simple device for estimation of IPP consisting of ureteral catheter and polyethylene tube 150 cm long. The device gives intrapelvic pressure in centimeters of urinary column. The figures obtained corresponded to those in measurement of IPP in cm of water column. In normal 187 examinees IPP ranged from 0.5 to 14.2 cm urinary column. Mean normal IPP in females was higher than in males. In 187 patients with renal colic IPP varied from 55 to 150 cm of urinary column. Mean IPP at the height of renal colic was in females and males 97.4 +/- 3.0 and 89.8 +/- 2.5 cm of urinary column, respectively. Thus, IPP in health and renal colic is higher in females than in males. In bilateral renal colic and colic in solitary kidney catheterization of the ureter is mandatory because of anuria. Ureteral catheterization is also indicated in cases of renal colic combination with attack of acute pyelonephritis. If ureteral catheterization is indicated, IPP pressure should be measured. This is important for diagnosis of both acute ureteral obstruction and pathogenesis of anuria.

[Surgical correction of hermaphroditism]. / Operativnaia korrektsiia germafroditizma.

By their documents people worldwide are of male or female gender. But in fact, four genders exist: male, female, hermaphroditism and eunuchoidism. Neonatologists must know how to diagnose minimum three sexual anomalies: true hermaphroditism, false male hermaphroditism and false female hermaphroditism. Such knowledge leads to surgical correction of hermaphroditism early in childhood. Six criteria of sex diagnosis is described: chromosomal (genetic) sex; gonadal (true) sex; hormonal sex; phenotypical (somatic) sex; psychological sex; legal sex. Variants of false male, false female and true hermaphroditism, principles of surgical correction of hermaphroditism are outlined. 3 true hermaphrodits are described. A 22-year-old and 13-year-old true hermaphrodits were operated to be a male and female, respectively. Sex correction is based on the patient's and his parents' will. This will, as a rule, coincides with a legal sex documented in the maternity home and sexual psychoorientation obtained from the associates.

[A rare variant of testicular teratoma]. / Redkii variant teratomy iaichka.

Tumors arising in human embryo from embryonic laying of an organ can be considered anomalies. Such tumors are renal adenomyosarcoma (Wilms' tumor), mesenchymoma and sarcoma botryoides of the prostatic gland, embryonal cancer of the testis, leydigocellular tumors of the testis and teratomas. Such anomaly as testicular teratoma occurs not rarely. However, testicular teratoma containing brain tissue is a rare finding. A case of teratoma of the left testis is reported in an 11-month-old infant. The tumor contained skin, appendages of the skin, cartilage, bone tissue, brain tissue, hair, fat.

[A rare and little-known form of hypospadias]. / Redkaia i maloizvestnaia forma gipospadii.

A case of a 2-year-old boy with a rare form of hypospadia is reported. The anomaly consisted of the absence of a part of the urethral stem along 1.6 cm. The defect was filled with urethral mucosa instead of the testicular skin. The penis was not deformed. The foreskin was hooded. The defect was identified as segmentary urethral hypoplasia. This is a rare variant of hypospadia in which the urethral defect is repaired not with the skin but the mucosa.

[A rare and little known variant of hypospadias]. / Redkii i maloizvestnyi variant gipospadii.

Hypospadia is a congenital defect presenting as different variants of dysplasia of the distal urethra with ectopy of the urethral external orifice and distortion of the penis. A variant of hypospadia not yet described in Russian medical literature was observed in a newborn boy. He had normal penis and scrotum, but on the under-side of the penis there was a site of thin skin protruding as a resonance bag in urination. At the site of the thin skin the back urethral wall was absent with a cavity covered by the thin skin. In urination urine filled the cavity blowing up the skin above it to the form of the resonance bag. This variant of hypospadia was designated as segmental urethral hypoplasia.

[The urological complications of contraception using intrauterine coils]. / Urologicheskie oslozhneniia kontratseptsii vnutrimatochnymi spiraliami.

Being a foreign body, intrauterine coil causes decubitus and inflammation of the adjacent tissues. Long-term carriage of the coil may give rise to endometritis, myometritis, parametritis, salpingo-oophoritis, tubo-ovarian inflammatory infiltrates. These infiltrates invade retroperitoneal pelvic fat and may obstruct pelvic ureters. Ureteral obstruction may bring about ureterohydronephrosis, pyelonephritis and renal calculi. The coil may be also responsible for chronic pyelonephritis. The authors have treated 64 females aged 18-45 years with urological complications due to intrauterine coils which stayed from 6 months to 14 years. 34 of them presented with attack of acute pyelonephritis, 29 with renal colic and acute pyelonephritis, 26 with renal calculi. To arrest renal colic and attack of acute pyelonephritis ureteral catheterization and renal pelvis drain were performed in 31 patients. One patient has undergone ureterolithotomy. 8 patients rejected removal of the coil and had recurrent renal colics and acute pyelonephritis attacks. Removal of the coil arrested pyelonephritis and lithogenesis in the kidney. In one case of coil removal there was injury to the uterine cervix and urinary bladder eventuating in vesicovaginal fistula.

PIP: According to various authors the frequency of inflammatory complications associated with the use of IUDs ranges from 2% to 8%. Gynecological surgery on account of purulent, inflammatory disease of the adnexa uteri associated with IUD use (4-7%), damaging the urinary bladder and the ureters, is not uncommon. At the urological clinic of Stavropol, Russia, a total of 64 women who were in the 18-64 year age range, had urological complications, and had worn IUDs for 6 months to 14 years were observed. 34 of them presented with acute pyelonephritis attacks, 29 of them with renal colic and acute pyelonephritis, and 26 with renal calculi. In 22 women the acute pyelonephritis attacks were treated with antibiotics and uro-antiseptics. 19 of the 29 women who had renal colic and acute pyelonephritis underwent catheterization and drainage of the renal pelvis, and all of them passed fine kidney stones after the removal of their catheters. Urethral catheterization and drainage of the renal pelvis were performed in 31 patients in order to arrest renal colic and acute pyelonephritic attacks. The catheters stayed in for 2-3 days. For all these women removal of the IUD was recommended. 1 patient underwent ureterolithotomy. 8 patients rejected the removal of the IUD and had recurrent renal colics and acute pyelonephritis attacks. Removal of the IUD arrested pyelonephritis and lithogenesis in the kidneys. In 1 case of IUD removal injury to the uterine cervix and urinary bladder occurred, resulting in a vesicovaginal fistula. The report concludes with the case of a 44-year old patient who had worn a plastic IUD for 14 years.

[Segmentary dysplasia of the perivesical portion of the ureter]. / Segmentarnaia displaziia okolopuzyrnogo otdela mochetochnika.

Four variants of segmentary dysplasia in paravesical ureter are described: segmentary aplasia, segmentary atresia, segmentary hypoplasia, fibrous block. Segmentary dysplasia manifests in the absence of muscular layer in the wall of paravesicular ureter. In fibrous block the layer is replaced by embryonal collagen fibers. These anomalies cause ureteral obstruction and ureterohydronephrosis. 72 operative interventions were performed. Reoperations were made in such complications as vesicoureteral reflux, stenosis of ureterocystoanastomosis. It is necessary to differentiate between ectopy of the ureteral ostium, ureterocele and ureteral dysplasia in the form of segmentary hypoplasia and/or fibrous block causing the obstruction in the paravesicular ureter.

[Varicocele as a symptom of renal venous hypertension]. / Varikotsele kak simptom pochechnoi vennoi gipertenzii.

Regional trans-scrotal antegrade venotesticulophlebography was used to study elements of renocaval anastomosis in 154 males suffering from varicocele. In 153 patients varicocele was caused by renal vein obstruction and hypertension, in 1 patient it resulted from iliac vein aneurysm obstructive for pelvic veins. In cases of renal vein obstruction on the left all the venous blood runs from the kidney along the testicular vein to the pampiniform plexus flowing further to the system of the iliac veins. Ligation or endovascular embolization of the testicular vein aggravates renal venous hypertension, but varicocele collapsed. The authors suggest discussion on methods of varicocele treatment.

[Antecaval pyelopyelic anastomosis in retrocaval ureter]. / Antekaval'nyi pielopieloanastomoz pri retrokaval'nom mochetochnike.

Conservative surgery in retrocaval ureter consists of either ureteric resection with ureteroureteroanastomosis or antecaval ureteropyeloanastomosis without ureteric resection. Ureteroureteroanastomosis is often complicated by ureteric obstruction at the site of anastomosis. The authors offer in retrocaval ureter to establish antecaval pyelopyeloanastomosis which excludes anastomosis obstruction. The operative procedure is described. Good results were achieved in 3 children and 1 adult male treated.

[Extracorporeal lithotripsy in the treatment of renal colic]. / Distantsionnaia litotripsiia v lechenii pochechnoi koliki.

Renal colic arises in acute ureteral obstruction and indicates a sharp rise in intrapelvic pressure (up to 150 mm Hg). The diagnosis of renal colic is made basing on direct and indirect measurements of intrapelvic pressure. Ultrasound in renal colic detects dilatation of the calices and pelvis on the colic side, ureterolith can be also revealed by ultrasound. The authors used extracorporeal lithotripsy for fragmentation of the stone and colic relief in 68 patients. The colic stopped in all the cases. This method is extremely valuable in cases when spasmolytic and analgetic drugs, other conservative modalities fail.

[Ureterocele in children]. / Ureterotsele u detei.

Types and variants of ureterocele are specified basing on 115 clinical cases and literature data. Three types of this anomaly exist: intravesical, cervicosphincteral and extravesical. Intravesical ureterocele can be orthopedic and ectopic. The latter has three variants: of accessory ureter, of partially double ureter, of non-double ureter. Ureterocele is frequently associated with low ectopy of ostium ureteric, double ureter. Ureterocele occurs neither in the ureter itself nor in high ectopy of the ostium ureteric. Extravesical ureterocele has many variants which differ in males and females. All ureterocele types and variants occur as unilateral or bilateral. The new diagnostic method is proposed: endovesical ureterocelegraphy.

[Bilateral pyeloureteral anastomosis in cervico-sphincteric ectopy of the ostia of both supernumerary ureters]. / Dvustoronnii ureteropieloanastomoz pri sheechno-sfinkternoi éktopii ust'ev oboikh dobavochnykh mochetochnikov.

The paper reports a case of bilateral hydronephrosis diagnosed by ultrasound intrauterinely in a girl of 11 months of age. At the age of 5 months the child had attacks of pyelonephritis. Clinical examination has established: double kidney and ureters, cervico-sphincteric ectopy of the ostia in both accessory ureters, hydroureter of both accessory ureters, hydronephrosis of the upper kidneys. The patient underwent two-stage operation.

[Anuria following extracorporeal lithotripsy]. / Anuriia posle distantsionnoi litotripsii.

Of 500 extracorporeal lithotripsies performed by the authors anuria arose in 2 cases on postlithotripsy days 3 and 5. There was also systemic intoxication of unclear origin.

[Interpelvic, ureteropelvic and interureteral anastomoses in duplication of the kidney and the ureter]. / Mezhlokhanochnye, mochetochnikovo-lokhanochnye i mezhmochetochnikovye anastomozy pri udvoenii pochki i mochetochnika.

The surgery is made to save both halves of the double kidney in mechanic obstruction or vesicoureteral reflux in the accessory or basic ureter. The affected ureter is always removed under anastomosis. The interventions are indicated in anomalies causing ureteral obstruction, ureterohydronephrosis, vesicoureteral reflux, pyelonephritis. They are frequently performed in ectopic ureterocele of the accessory ureter, in vesicoureteral reflux associated with intravesical high ectopy of the basic ureter ostium and normal ostium of the accessory ureter, in low intra- and extravesical ectopy of the accessory ureter ostium. The authors have conducted 21 operations in 20 patients: bilateral transureteroureteral, 2 intrapelvic, 1 ureteropelvic and 18 transureteroureteral anastomoses. The surgery was decided upon because of ectopic ureterocele of the accessory ureter, ectopic ureterocele of the accessory ureter with vesicoureteral reflux via ureterocele, high ectopy of the basic and low ectopy of the accessory ureter ostia with reflux, low ectopy of the accessory ureters ostia. Short- and long-term outcomes of all the operations were good.