Gas-forming infections in genitourinary tract.

Diabetes mellitus associated with urinary tract infections and ureteral obstruction can be predisposing factors leading to emphysematous pyelonephritis. Fever, flank pains, and a palpable renal mass, associated with dehydration and hyperglycemia, were the most frequent presenting symptoms associated with emphysematous pyelonephritis. Computerized tomography (CT) scan is the best method to identify a renal or perirenal abscess and its ramifications.

Miliary tuberculosis due to intravesical bacillus Calmette-Guerin therapy.

While receiving treatment for bladder carcinoma with intravesical BCG, a 78-year-old man developed a clinical illness and roentgenographic manifestation of miliary tuberculosis. The transbronchial lung biopsy demonstrated granulomas with giant cells. Treatment with antituberculosis therapy resulted in complete resolution of the illness.

An extrapleural approach with rib removal for the eleventh rib flank incision.

The transcostal extrapleural flank approach to the kidney requires an understanding of the anatomy of the thoracic and abdominal wall to prevent injury to the pleura and subsequent pneumothorax. Isolation of the intercostal neurovascular bundle, division of the lumbodorsal fascia inferior to the rib bed, and simultaneous dissection of the diaphragmatic insertion along the superior and posterior aspect of the twelfth rib toward the lumbocostal arch are necessary surgical maneuvers. This should be done prior to the release of the diaphragm, exposure of Gerota's fascia and positioning of a flank retractor.

The eleventh rib transcostal incision: technique for an extrapleural approach.

The transcostal extrapleural flank approach to the kidney requires an understanding of thoracic and abdominal wall anatomy to prevent injury to the pleura and subsequent pneumothorax. Isolation of the intercostal neurovascular bundle, division of the lumbodorsal fascia inferior to the rib bed and simultaneous dissection of the diaphragmatic insertion along the superior and posterior aspects of the 12th rib toward the lumbocostal arch are necessary surgical maneuvers before release of the diaphragm, exposure of Gerota's fascia and positioning of a flank retractor. Pneumothorax usually results from attempts to separate the pleura from the diaphragm, dissection within the intercostal space rather than along the diaphragmatic insertions and failure to release the diaphragm fully as far as the lumbocostal arch before placement of the retractor.

Amyloidosis of renal pelvis and urinary bladder.

We describe a patient with amyloidosis of renal pelvis and 2 patients with urinary bladder amyloidosis. Clinical presentation in all of the cases mimicked cancer of the respective sites. Clinical diagnosis of amyloidosis is not possible, making biopsy mandatory.

Survival of patients with unsuspected prostatic carcinoma after open prostatectomy.

This study is concerned with the clinicopathologic findings in 40 patients with unsuspected carcinoma of the prostate found at the time of open prostatectomy and the correlation of these findings with survival. There is a significant correlation between pathologic findings and clinical outcome.

Renal cell carcinoma: natural history and results of treatment.

We reviewed 166 cases of renal cell carcinoma. The presenting symptoms varied from vague backache to hypovolemic shock. The most common symptoms were pain, hematuria, a palpable mass and hypertension.

Presence of H-Y antigen and testis in 46, XX true hermaphroditism, evidence for Y-chromosomal function.

Endocrinologic and serologic studies of a 2-year-old child with the chromosomal complement 46,XX and ambiguous genitalia suggested the preoperative diagnosis of true hermaphroditism. Urinary and serum androgen production in response to human chorionic gonadotrophin was in the range expected for normal males, implying presence of cryptic testicular tissue. Moreover, detection of H-Y antigen, a cell surface component associated with testicular differentiation and coded or regulated by a Y-chromosomal gene, indicated presence of Y-chromosomal material.

Ectopic urethral ureter in the adult female.

The unusual presenting symptoms, clinical management and roentgenologic diagnosis of an instance of ectopic urethral ureter in four adult female patients are delineated in terms of the embryologic preface, the dysplastic upper renal segment and the lower urinary tract findings associated with urinary tract infections. Surgical management consists of heminephrectomy and partial ureterectomy. Total ureterectomy is necessary if reflux exists in the ectopic ureter, with a vesicovaginal or ureterovaginal fistula being a possible complication in the latter operation.

Ureteropelvic junction obstruction in nephrolithiasis. An etiologic factor.

Obstruction is rarely accepted as the sole cause of calculi. We have reviewed 106 cases of nephrolithiasis for which surgery was performed at the St. Luke's Hospital Center during the past ten years.