Renal-nonresponsive, bone-responsive pseudohypoparathyroidism. A case with normal vitamin D metabolite levels and clinical features of rickets.

Clinical signs of rickets developed in a previously healthy 13-year-old girl with normal features. She had hypocalcemia, hyperphosphatemia, elevated alkaline phosphatase and parathyroid hormone levels, and normal vitamin D metabolite levels, with osteitis fibrosa cystica on bone biopsy specimen. Her renal function was normal.

Primary realignment of posterior urethral injuries.

The records of 34 patients with posterior urethral disruptions secondary to blunt pelvic trauma who were treated with primary realignment were reviewed. Among the 29 evaluable patients there was a 38 per cent incidence of stricture (11 of 29), a 3 per cent incidence of incontinence (1 of 29) and a 15 per cent incidence of impotence (4 of 27). Primary realignment has a low morbidity and an acceptable rate of incontinence, impotence and stricture formation, and is recommended in the treatment of posterior urethral injuries.

Invasive bladder carcinoma managed by irradiation and surgery.

Four hundred forty-four patients with invasive vesical carcinoma were entered in a nonrandomized treatment program of preoperative irradiation and surgical extirpation of the primary lesion. Fifteen of the patients did not undergo surgery, and an additional 13 were found at operation to have an inoperable lesion. Thus, 416 patients, at risk for more than two years, were available for statistical study.

Renal cell carcinoma: long-term survival and late recurrence.

In a series of 506 patients with renal cell carcinoma survival was analyzed in terms of pathologic stage, histologic grade, and a combination of stage and grade. Data reveal that stage, grade and the combination are important prognostic indicators. Invasion of the renal pelvis is not an important factor in staging the disease.

Urinary tract reconstruction in renal transplantation. Mayo Clinic experience and review of literature.

Althrough rejection remains the most frequent cause of renal allograft failure, technical problems have contributed and continue to contribute to graft loss. Urologic complications may be caused by technical errors in the donor nephrectomy or in urinary tract reconstruction. During the past decade, however, with advances in medical and surgical management, the reported incidence of urologic complications in renal transplantation has declined steadily.

Cystectomy after radiotherapeutic ablation of invasive transitional cell cancer.

Of 282 patients with invasive bladder carcinoma treated by a combined protocol of preoperative irradiation and total or partial cystectomy 84 had no residual carcinoma in the surgical specimens. Of these 84 patients who have been at risk for 12 to 149 months 59 (70 per cent) are alive.

Regression of renal cell hepatic metastasis following removal of primary lesions.

Although spontaneous regression of metastatic renal cell carcinoma occurs it is so uncommon that it should not be considered the primary basis for recommending removal of the asymptomatic primary lesion. Such a recommendation should be made when other treatment modalitis are available to augment the factors influencing the patient-tumor interface. Spontaneous regression of a documented solitary liver metastatic lesion is reported.

Late ureteral obstruction mimicking rejection after renal transplantation.

Ureteral obstruction occurring five years or more after renal transplantation is uncommon and may mimic allograft rejection. In 2 patients who had received cadaveric renal allograft, ureteral obstruction was detected six and one-half and five and one-half years after transplantation. In both patients, surgery was needed to restore normal renal function and to prevent further renal damage.

Supravesical urinary diversion in renal transplantation.

Urinary diversion may be used in patients without a bladder or with irreversible, lower urinary tract abnormalities who might not otherwise be suitable candidates for renal transplantation. Three cases have been described to illustrate three different methods of supravesical urinary diversion that have been employed in association with renal transplantation.

Renal autotransplantation for upper ureteral stenosis.

In 2 cases of irreparable upper ureteral damage autotransplantation of the kidney with pelvioureteral anastomosis proved to be a satisfactory alternative to nephrostomy drainage or nephrectomy.

Surgical technic in en bloc bilateral cadaveric nephrectomy for transplantation.

En bloc bilateral cadaveric nephrectomy for transplantation has some advantages over excision of each kidney separately. There is also an advantage of single cannula perfusion through the aorta for two kidneys, especially when multiple renal arteries are present. The anatomic vascular variants are important, as are the incision and the approach to the suprarenal aorta and the lumbar venous drainage of the kidney.

Vesicoureteral reflux in adults.

Vesicoureteral reflux was detected in 200 adults seen in a 4 year period. In group 1 (no history of urinary tract infection and negative urine cultures), all patients had abnormalities on excretory urograms that were suggestive of reflux. In patients with a history of recurrent urinary tract infection (groups 2 and 3), the excretory urograms showed an abnormality in 79 per cent of those with negative cultures and in 83 per cent of those with positive cultures.

Urologic problems in renal transplantation.

Of 206 patients who underwent 221 consecutive renal homografts, two patients had major urologic complications. One patient had a partial ureteric obstruction requiring surgical intervention and ureterostomy. Another patient had a fistula at the ureteropelvic junction secondary to vigorous diuresis in the presence of acute retention; eventually nephrectomy was required, but the patient survived.

Caliceal diverticulum.

Records of 72 consecutive patients with caliceal diverticula, representing an incidence of 4.5 per 1,000 excretory urograms, were studied. Of these 72 patients, 39 per cent had a history of recurrent infections and an equal number had stone-containing diverticula.

Experience with lymphoceles after renal transplantation.

Of 215 patients who underwent renal transplantations at the Mayo Clinic, six (2.8 percent) developed perirenal lymphoceles. Diagnosis was made between 5 weeks and 14 months after operation.