Hydronephrosis caused by cystocele. Treatment by colpopexy to sacral promontory.

A case of marked bilateral hydroureteronephrosis due to extreme prolapse of the bladder is reported. This latter condition led also to obstructive urinary tract symptoms and residual urine. After repair of the cystocele in an unusual way by fixation of the vaginal vault to the sacral promontory, the caliber of the upper urinary tracts became almost normal and postvoiding residual urine disappeared.

Bladder neck incision in the female: a hazardous procedure?

Anterior bladder neck incision was carried out in 32 female patients suffering from difficult, mostly incomplete, bladder emptying. All patients underwent a full urodynamic investigation with voiding cystourethrography and endoscopy. Detrusor failure was observed in 20 patients; in the remainder, a mechanical iatrogenic bladder neck obstruction was held responsible for inefficient voiding.

Extended bladder neck incision for outflow obstruction in male patients.

Thirty-two male patients with mechanical or functional bladder outlet obstruction were treated by bilateral endoscopic bladder neck incision. In three cases a repeat incision was necessary. Subjective cure or improvement was obtained in 81%.

The value of intravesical prostaglandin E2 and F2 alpha in women with abnormalities of bladder emptying.

A clinical study of intravesical prostaglandin E2 (PGE2) and F2 alpha (PGF2 alpha) in the treatment of 13 female patients with difficulties in emptying their bladder is reported. Urodynamic investigations were performed before and after instillation of the drug. Although 3 patients had some reduction in residual urine volume, the remainder showed no obvious change and no patient experienced subjective improvement.

The use of indomethacin in the treatment of idiopathic bladder instability.

55 patients suffering from voiding disorders associated with primary detrusor instability, have been treated with indomethacin. All patients have remained resistant to conventional medical treatment. 7 patients did not complete the clinical trial.

Fibroepithelial polyp of ureter.

Fibroepithelial polyp of the ureter, a mesodermal benign tumor, is extremely rare. Four cases of our own prompted us to review the world literature on this subject (108 documented cases since 1950). The mode of presentation, etiology, clinical features, and treatment modalities of this lesion are discussed.

Prolonged bladder distension in the management of the unstable bladder.

We treated 63 patients with urinary symptoms associated with uninhibited detrusor contractions on cystometry by prolonged bladder distension. All patients had received drug therapy previously without success. Fourteen patients whose symptoms relapsed after a previous distension or who failed to obtain any improvement have had repeat distension.

Cold knife optical urethrotomy.

Cold knife optical urethrotomy with the Sachse urethrotome was used in 44 patients with urethral strictures. Appraisal if the results, after a mean follow-up of fourteen months, showed 77.3 per cent success rate regarding urine flow rates and 81.

Transection of the bladder as a method of treatment in adult enuresis nocturna.

Ten adults with enuresis were treated by bladder transection. Urodynamic assessment was carried out before and after the operation. No significant urodynamic changes were recorded following transection.

Anterior vaginal repair, cause of troublesome voiding disorders?

Clinical experience and urodynamic observations in 85 female patients with voiding disorders after anterior vaginal repair are presented. Iatrogenic or persistent urinary stress incontinence (72%), irritable trigone syndrome (48%), bladder outlet obstruction (40%), unstable bladder (25%) and recurrent cystitis (23.5%) were the most frequent findings.

[The place of surgery in the treatment of testicular tumors other than seminoma (author's transl)].

Surgery plays an important part in the treatment of non seminomatous testicular tumors. An oncologically correct technique of orchidectomy is the first essential if the better prognosis of these tumors, noted in the past decade, is to be further improved. The testis should be removed through an inguinal approach.

Uretero-neo-cystostomy in renal transplantation. Is an antireflux mechanism mandatory?

We report a retrospective analysis of 120 kidney transplantations in which a simple end-to-end ureteric implantation in the bladder without antireflux mechanism was made. From this study no greater incidence of vesico-ureteric reflux could be demonstrated and, even when present, reflux neither interfered with graft function nor caused an increased incidence of recurrent urinary tract infections. The incidence of other urological complications (leakage, obstruction) being equal, this very simple technique yielded in our hands the best results and we recommend its use in kidney transplantation.

Has bromocriptine a place in the treatment of the unstable bladder?

A clinical study of bromocriptine in the treatment of 18 patients with an unstable bladder is reported. All patients had previously received drug therapy and/or vesical distension, without success. Ten of the 18 patients had side-effects, and 2 of these did not complete the study.

Successful management of postoperative hemorrhage of the kidney by selective transcatheter embolization.

A case is reported where postoperative hemorrhage from the kidney was successfully managed by selective transcatheter embolization of the bleeding vessel. A review of the literature reveals that only three papers have been published dealing with selective embolization for controlling hemorrhage from the kidney. Our case is another illustration of the possibilities and usefulness of this method of treatment in the management of persistent postoperative hemorrhage.

Epidermoid cyst of the testis.

Surgical exploration of a mass in the right testis revealed an epidermoid cyst. In the literature some controversy exists on surgical treatment of this lesion. Orchiectomy seems to be recommended although several patients treated by simple enucleation had an uneventful follow-up from 6 to 15 years.

Intrarenal arteriovenous fistula following renal allograft biopsy.

Arteriovenous fistulae in renal allograft are rarely mentioned in papers dealing with vascular complications after renal transplantations. 2 cases of such central fistulae are reported. In our patients the fistulae remained asymptomatic and were incidentally detected, so that neither surgical nor medical measures had to be taken.

The treatment of chronic pyelonephritis with carindacillin.

Forty-two patients with a radiologically confirmed diagnosis of chronic pyelonephritis were treated with 1 g carindacillin every 6 hours over a period of 6 weeks. An underlying urological disease was present in 84% of the 38 patients for whom sufficient data were available for evaluation. The results of carindacillin treatment, as judged by bacteriological evaluation 1 month post-treatment, were good in 12 (32%) and moderate in 9 of the patients.

Flavoxate hydrochloride in the treatment of detrusor instability.

42 patients with 'unstable bladder' were treated with flavoxate hydrochloride. A previous treatment with parasympathicolytic drugs (propantheline bromide and/or emepronium bromide) was unsuccessful. The instability of the detrusor was proven by a urodynamical investigation.

Renal transplantation into an ileal conduit.

Since the selection criteria for renal transplantation have become less stringent as a consequence of improved graft survival and decreased mortality, patients with severe structural anomalies of the lower urinary tract can now benefit from renal transplantation into an ileal conduit. This is illustrated by two succesful cases. The opertative procedure is discussed, and the possibilities for the future are mentioned.