Nondilated obstructive uropathy.

Four patients presented with severe renal failure secondary to urinary tract obstruction, yet ultrasonography and/or computed tomography revealed only minimal dilatation in 1 patient and no dilatation in the other three. Two patients had prostate cancer, one had bladder cancer, and one had retroperitoneal fibrosis. In all cases, relief of obstruction led to a dramatic improvement in renal function. These cases, and others in the literature, illustrate that in certain settings severe urinary tract obstruction may be present in the absence of dilatation and hence may be missed by noninvasive imaging techniques. Nondilated obstructive uropathy should be suspected in any elderly patient who presents with the acute onset of oliguria in the absence of an identifiable cause, especially if there is a previous history of malignancy in the pelvis. Left undiagnosed, this potentially reversible cause of renal failure can lead to end-stage renal disease.

Octoson imaging in pediatric urology.

Ultrasonic imaging of infants and children using an automated transducer water-path delay scanning system (Octoson) overcomes many of the technical difficulties of contact B mode ultrasound imaging and computed tomography. These disadvantages relate to small patient size, motion artifacts, hypothermia, and lack of patient cooperation. Sedation may be required for either conventional study. The automated water-path system is soothing to small children, maintains the body temperature of infants, and avoids direct transducer contact. Sedation is not necessary. Excellent resolution, shorter scan time than computed tomography, and greater flexibility of patient and transducer positioning allows much more complete imaging information. In addition, the panoramic view obtained using this modality serves to demonstrate the complete lesion and its relationship to surrounding structures.

Percutaneous stone removal in horseshoe kidney.

A case of a thirty-three-year-old male who underwent a single-stage percutaneous ultrasonic nephrolithotripsy is presented. We believe this is only the third documented case involving a horseshoe kidney.

Acute scrotal swelling in children.

We have found that the blanket philosophy of emergency scrotal exploration in all cases of acute scrotal swelling in boys results in an unacceptably large number of unnecessary explorations. The use of specific aspects of the clinical examination, in conjunction with the radioisotope testicular scan in selected instances, has guided our management of 150 consecutive boys presenting with acute scrotal symptoms.

The effect of prepubertal spermatic cord torsion on subsequent fertility in rats.

This study was undertaken to determine the effects of various durations of testicular torsion in prepubertal rats on their subsequent fertility, and to determine whether these effects could be altered by removal of the torsioned testis. Sixty rats (35 days old) were subjected to 720 degrees unilateral spermatic cord torsion for 0, 1, 3, 5, 9, or 12 hours. The torsioned testis was then either detorsioned or removed. At 65 days of age each male was housed with two females for three weeks. Rats undergoing detorsion of the spermatic cord demonstrated a linear decrease in fertility with respect to the duration of torsion (r = -0.904). However, all of the animals undergoing unilateral torsion with subsequent orchiectomy were fertile, regardless of the duration of torsion. In addition, the percentage of females impregnated, the number of embryos produced, and the mean embryo size decreased with increasing intervals of torsion (r = -0.834 to r = -0.979); the sharpest decline occurred between 5 and 9 hours of torsion. All of these parameters were significantly lower (P less than 0.001 to P less than 0.05) in the detorsioned group as compared to the orchiectomized group. There was a decrease in seminiferous tubule diameter in the contralateral testis with respect to the duration of torsion (P less than 0.01). These data indicate that unilateral spermatic cord torsion in young rats significantly reduced their subsequent fertility with respect to duration of the torsion, and that this detrimental effect may be minimized if the damaged testis is removed rather than untwisted and replaced into the scrotum.

Congenital posterior urethral valves in an adult.

An adult male with posterior urethral valves who had obstructive urinary symptoms and painless gross hematuria is presented. The diagnosis, development, and treatment of posterior urethral valves is discussed. The importance of also treating the hypertrophied bladder neck is stressed.

Spontaneous intrapartum rupture of renal hamartoma.

Spontaneous rupture of a renal hamartoma during pregnancy is a rare condition. Increased blood volume, increased renal blood flow, and vascular changes secondary to a change in the hormonal milieu may predispose to rupture in pregnancy. The diagnosis is made difficult by a desire to proceed cautiously and avoid the inherent risks of interventional radiography, aggressive surgical therapy, or conservative management as well. However, a conservative approach may be successful in selected cases.

Urinary incontinence.

Accurate diagnosis and successful management depend on knowledge of the anatomy and regulatory physiology of micturition. Incontinence is classified according to its mechanisms--passive incontinence, active incontinence with or without complete emptying, and overflow incontinence. Approaches to management include pharmacotherapy, surgical procedures and important steps in supportive care. This is a problem of any age. Educating the patient is essential.

Ultrasonic examination of scrotum. Review of 108 cases.

Ultrasound is a reliable and safe method for the evaluation of scrotal anatomy. The usual method of ultrasonic examination has been contact scanning with a conventional articulated arm scanner. We herein report our experience in 108 cases using an ultrasonic technique which provides panoramic scans of the entire scrotum and precision tomographic plane placement without distorting the scrotum or causing patient discomfort.

Intussusception following resection of Wilms tumor.

Postoperative intussusception is a documented complication of pediatric surgical and pediatric urologic abdominal operations. In contrast to "primary" intussusception's triad of crampy abdominal pain, palpable abdominal mass, and "currant jelly" stools, postoperative intussusception is generally characterized by abdominal pain and vomiting. An abdominal mass is not usually palpable, and few children have bloody stools. Proper diagnosis and treatment may be delayed because of similar abdominal symptoms in children who may be receiving radiation and chemotherapy, or with prolonged ileus. Two children operated on for Wilms tumor demonstrate the need for awareness of this potential problem in the postoperative patient.

Simplified new approach to endoscopic photography.

Information obtained by endoscopic examination can be shared with others by viewing sequentially through the same endoscope, "teaching attachments" allowing viewing ports through the same instrument, drawings based on the observers' recollection of the findings, and by endoscopic photography. Of these methods, endoscopic photography has the important advantages of speed and faithfulness of reproduction. Herein, we describe a simple technique for endoscopic color still-photography with illustrations of normal and pathologic findings.

Surgery and immunotherapy in renal cell carcinoma involving inferior vena cava.

We herein report 4 cases of renal cell carcinoma with vena caval extension. Appropriate diagnostic studies and a planned surgical approach is the most effective treatment for intravascular spread. Accurate preoperative staging is important for a successful outcome. Although the technical challenges involved in performing a nephrectomy are substantial, these cases illustrate that standard nephrectomy with evacuation of tumor thrombus, ligation of the left renal vein, and even partial resection of the inferior vena cava can be performed with an acceptably low morbidity.

Nuclear imaging in the pediatric acute scrotum.

The acute scrotum in the pediatric patient frequently presents a diagnostic dilemma for even the most experienced clinician. In an effort to improve testicular salvage in equivocal cases, immediate surgical intervention has been recommended, despite a large number of unnecessary explorations. Evaluating the sodium pertechnetate Tc 99m radioisotopic scan in 46 boys, we found this study to be a rapid, reliable, sensitive, and noninvasive test that allows the selection of those patients who require immediate surgical intervention.