Biomedical subjects
Publications and source records attributed to F J Leary.
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.
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.
Poorly opacified calculi that are completely obscured by high-density contrast media can be delineated by pneumopyelography. Three examples of pneumopyelography are presented.
Instillation of cytotoxic compounds into the bladder elicits an effect that is based on contact of the agent with the mucosal cells. In the female dog, the distribution of this contact is characteristically in the lower portion of the bladder, and the dome of the bladder is almost invariably spared. Study with formalin indicates that the amount of mucosal contact is best increased by distention of the bladder to full capacity. These findings have significance in the use of topically active agents for the treatment of bladder cancer.
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. In one other instance, urinary extravasation was suspected without substantiation and with uneventful recovery of the patient. The total incidence of major urologic complications was less than 1%, with no related deaths.
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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. In all six patients, renal function decreased and eventually a lower quadrant abdominal mass developed. Ipsilateral leg edema, fluid retention, and development of diastolic hypertension should also increase suspicion as to the possibility of lymph collection in the perirenal space. Excretory urography with tomography delineated the lymphocele in each instance; B scan ultrasound may be an additional valuable diagnostic tool. Drainage procedures readily restored normal renal function and, in one instance, drainage also restored the blood pressure to normal. Percutaneous needle aspiration seems to be a temporary measure only, and marsupialization is the preferred definite procedure.
During a 15-year period, 200 patients with hematospermia were seen at the Mayo Clinic. General physical examination, including digital rectal palpation and urinalysis, was performed on all 200 patients. Of these, 26 had no additional urologic evaluation. In the remaining 174 patients, cystoscopy and K.U.B. roentgenography were done. The results of urologic evaluation in the 174 patients revealed various minor abnormalities in 64; however, in no instance was there significant urologic disease. During follow-up of five to 23 years in 150 of the 174 patients, 106 had no further hematospermia whereas 44 had recurring hematospermia, which persisted in some for more than ten years. None of these patients developed any significant disease related to the hematospermia. In our experience, the occurrence of hematospermia in an otherwise asymptomatic man with normal findings on physical examination, including digital rectal examination, seems not to be associated with the presence of, and does not lead to future development of, significant urologic disease.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.