Potential overstaging of bladder cancer by computerized tomography scanning.

We report 4 cases of bladder cancer that was overstaged by computerized tomography. In 2 patients the scans were performed after cystoscopy and bladder biopsy, and overstaging occurred secondary to artifacts produced at the time of biopsy. In the other 2 patients the scans were done before biopsy. In these patients perivesical and periprostatic infiltration interpreted on computerized tomography scans was not found in the surgical pathological specimens.

What about the other kidney?

Sophisticated diagnostic techniques have made the isolation of renal lesions more accurate. However, it must be remembered that simultaneous bilateral kidney pathology can exist in any patient. The most obvious lesion may not be the most important. Four cases are presented to illustrate this point.

Renal papillary necrosis in sickle cell hemoglobinopathies.

Approximately 65 per cent of patients with clinical manifestations of S-hemoglobinopathies show urographically demonstrable changes of renal papillary necrosis, regardless of the presence of urinary symptoms. With a more precise excretory urographic technique these changes can be diagnosed with greater accuracy without the need for sophisticated equipment. Excretory urography should be performed routinely in the evaluation of all patients with manifestations of S-hemoglobinopathy in order to diagnose papillary necrosis before the onset of urological symptoms.

Urologic complications of renal papillary necrosis.

Fifty-six patients demonstrating roentgenographic evidence of renal papillary necrosis were reviewed. Seven patients had an acute fulminating form of the disease. Urologic complication incident to sloughed renal papillae required urgent surgical intervention. Management ranging from ureteral catheterization to nephrectomy in 3 of 7 patients is discussed, and associated disease states are scrutinized.