Adenocarcinoma of the urachus masquerading as a right lower quadrant mass: a case report.

We report a patient who presented initially with a right lower quadrant mass which was attached to the anterior abdominal wall. The final pathological diagnosis was adenocarcinoma of the urachus, an exceedingly rare bladder tumor.

Intracavernosal injection therapy and other treatment options for erectile dysfunction.

In the United States, almost 30 million men have complete or partial erectile dysfunction. This disorder occurs in approximately 52% of men between 40 and 70 years of age; 70% of affected men younger than 35 years of age have psychogenic causes, and 85% of men older than 50 years of age have organic impotence. Furthermore, erectile dysfunction is exacerbated by the presence of such conditions as heart disease, diabetes, and hyperlipidemia and the medications used to manage them. Thus, a widespread segment of the population is in need of a safe and effective treatment strategy for restoration of normal sexual function. The technique of intracavernosal injection therapy was initially described in the early 1980s. During the subsequent decade, the effectiveness of various drug combinations and the associated side effects were demonstrated. In 1995, prostaglandin E(1) was approved for intra-cavernosal pharmacotherapy. It has proved highly effective for neurogenic, vasculogenic, and psychogenic erectile dysfunction, with reported response rates of 75 to 92%. The major side effect (albeit uncommon) is corporal fibrosis. Other options for treatment of erectile dysfunction are vacuum-erection devices and penile prostheses.

Desmoid tumor-ureteral fistula in Gardner's syndrome.

Gardner's syndrome (GS) is complicated by abdominal desmoid tumors in approximately 8% of cases. We describe two cases of ureteral obstruction and fistulization due to rapidly enlarging desmoid tumors. Initial management consisted of placement of ureteral stents to provide urine drainage from the kidney as well as from the collection in the cavities within the desmoid tumors.

High pressure pyelocalyceal reflux. Case presentation.

In the absence of vesicoureteral reflux or urinary tract obstruction, conservative management is advocated for children with recurrent urinary tract infection. Conventional radiographic studies and static nuclear imaging techniques, however, may fail to reveal a subclinical but significant structural or functional abnormality. Recurrent breakthrough infections during appropriate medical treatment and high pressure pyelocalyceal reflux may justify a more aggressive therapeutic approach. We propose that a pressure perfusion study with fluoroscopy and continuous pressure monitoring be performed preoperatively to help select those children in whom surgery is an acceptable alternative.

Modification of and expanded indications of MAGPI procedure in hypospadias.

Experience with the MAGPI (meatoplasty and glanuloplasty) procedure in hypospadias repair, a modification of the procedure, and expanded indications for its use are presented. The excellent cosmetic results attained warrant more widespread use of this procedure.

Annular constriction of the glans penis.

An otherwise healthy, 15-year-old white male adolescent presented with a hitherto unreported, traumatically induced, ringlike depression around the glans penis resulting from the circumferential entrapment of a fibrous strand within the glans during infancy. The surgical reconstruction of the lesion and the differential diagnosis of annular constricting lesions of the appendages are discussed.

Penile denudation injuries after circumcision.

We present 3 cases of iatrogenic phallic denudation that were managed successfully nonoperatively. The concept of conservative, nonoperative management should be considered in denudation injuries.

Female phallic urethra and persistent cloaca.

Accessory phallic urethra in the female newborn with a persistent cloaca is a rare entity. We present a variant with a cloaca that contained rectal, vaginal and bladder neck openings, as well as the proximal origin of the phallic urethra. The literature is reviewed.

Renovascular hypertension associated with a pelvic kidney and multicystic dysplasia.

We report on a 9-year-old boy with severe hypertension due to a variant of fibromuscular dysplasia of the renal artery supplying a functioning pelvic kidney. The other kidney proved to be a nonfunctioning multicystic remnant and several other congenital abnormalities of the genitourinary tract were present. Corrective vascular surgery was followed by normalization of arterial pressure and significant reduction of plasma renin activity. This is the first case report of renovascular hypertension due to renal artery stenosis in a single functioning pelvic kidney.

Unusual radiographic findings in ectopic ureterocele.

A case of an ectopic ureterocele with a cystic dysplastic upper pole and atretic proximal ureter was studied. A four-month follow-up showed marked decrease in the size of the dysplastic upper pole which is explained on an embryologic and pathophysiologic basis.

Ureteral injuries during vascular surgery.

The rapid increase in the number of vascular surgical procedures done has led to a new class of iatrogenic ureteral injuries. Vena caval ligation, bilateral lumbar sympathectomy, bypass procedures and abdominal aortic aneurysmectomy produce the majority of these injuries. Established principles useful in the repair of iatrogenic injuries following a gynecologic or colonic operation often are inapplicable.

Ectopic ureterocele, hydroureter, and renal dysplasia: an embryogenic triad.

A review of the literature of the embryogenesis of ectopic ureterocele is presented. A theory linking the triad of ectopic ureterocele, hydroureter, and renal dysplasia to a primary intrinsic developmental abnormality of size and position of the ureteral bud is postulated.