Biomedical subjects
Publications and source records attributed to J M Garat.
We present 4 cases of megautricle emphasizing the relationship between it and the ejaculatory ducts. We develop an embryogenic hypothesis to explain the different forms of megautricles in relation to the seminal pathway.
Surgical management of long strictures of the posterior urethra is difficult and there is no concrete method that guarantees excellent results. The use of bladder mucosa has become established in the 1980s as treatment for anterior urethral reconstruction in hypospadias repair. We report 2 difficult cases (multioperations) of membranous urethral strictures treated with free tubularized bladder mucosal grafts with good initial results.
A case of unilateral kidney herniation through a cutaneous pyelostomy stoma is reported. Our purpose is to point out the likely causes of this complication and its correction.
We report a case of a somewhat dilated ascending and descending ureteral segment penetrating into the thorax with moderate symptoms. The diagnosis was made by excretory urography. To our knowledge, our case represents the first such report in the literature.
This report is based on 7 children with balanitis xerotica obliterans. Of these patients 5 had stenosis of the urethral meatus that required meatotomy and the postoperative results were good. The frequency of balanitis xerotica obliterans in children at our center, as well as the findings of other authors, suggests that possibly more cases would be diagnosed during infancy if all dried foreskin were examined systematically.
Pseudolymphomas are reactive processes which by their morphology can be confused with lymphomas. They have been described in non-lymphoid organs (gastrointestinal tract, lung, breast, etc.), although cases have also been reported in the spleen. In this article we present the case of a 3-year-old child in whom the location was in the testes. It is the 4th case reported in the literature and the first in a child. The main criteria for establishing such a diagnosis are the delimitation of the lesion, the presence of mature lymphocytes intermingled with other cells which are mainly plasma cells of polyclonal type and the formation of lymphoid follicles with active germinal centers. A differential diagnosis within the testicle should be made with the lymphoma (primary or secondary), the leukemic infiltration and the seminoma with marked stromal lymphoid reaction.
Three further cases of bladder hemangioma are reported. Two were adults, with a previous history of hematuria, diagnosed by endoscopy and treated by external radiotherapy. The other case was an 8 year old child, diagnosed by radiologic, CT scan and endoscopic examinations and confirmed by histology, for whom an attitude of expectant prudence was adopted.
A child with massive hematuria, produced by cyclophosphamide-induced cystitis, was treated with open bladder instillation of formalin. To prevent vesicoureteral reflux, we inserted two Fogarty catheters. Intraoperative retrograde cystography was made to confirm that there was no reflux, extravasation or passage of contrast per urethra. The postoperative result was good with cessation of hematuria.
Three further cases of perineal ectopic testis are reported and the published literature reviewed. Etiopathogenicity is discussed and emphasis placed on the need for perineal exploration in all cases of absence of testes from the scrotum. The most effective route of approach for repair is an inguinal one allowing replacement of the testis into the corresponding hemiscrotum without difficulty. Because of the histopathologic features involved, prognosis is better than that of cryptorchidism.
A neurogenic bladder was the presenting syndrome in three cases of spinal cord traction. Of the typical symptomatic triad: neuro-orthopedic, cutaneous and urologic, the latter was of primary importance. Symptoms in the first case were incomplete bladder retention with distention of upper urinary tract, right-sided vesicorenal reflux and renal insufficiency. Six months after excision of a sacral lipoma and freeing of the filum terminale, micturition had become normal without residue, and renal function normalized. Right-sided reflux was corrected by submucosal advancement surgery with good results. The clinical history was more suggestive in the second case. Although inaugural symptoms were mictional, there was foot paralysis and a retrosacral lipoma above an abnormal hairy tuft in the upper part of the gluteal cleft. Operation revealed the presence of a dermoid cyst and a lipoma. Their excision combined with section of the filum terminale allowing ascension of the medullary cone. Marked clinical and urodynamic improvement was obtained with normal micturition and disappearance of incontinence. An anti-reflux operation suppressed residual reflux with good urographic results. Marked improvement in mictional disorders was obtained also in the 3rd case after excision of a sacral extradural lipoma and section of the filum terminale, allowing objective ascension of the medullary cone by 4 cm. A very detailed analysis was conducted of similar cases reported in the literature, about 2% of neurogenic bladders in children being affected. The importance of early diagnosis is emphasized as well as the essential need to establish a precise diagnosis of the lipoma of cauda equina and of medullary fixation. Early neurosurgery is justified by the high frequency of improvement in cases treated in this way.
Atresia of the cervix is a rare congenital anomaly of the female genital system. We describe a girl with urinary retention caused by hematometra and other urinary malformations, for which prior operations had been performed.
2 new cases of blind-ending branches of bifid ureters in children are reported. Clinical and diagnostic features as well as treatment of this pathology are presented. The authors emphasize the differential diagnosis of blind-ending ureteral diverticula, suggesting the possibility that the single congenital diverticulum is actually a dilated blind-ending ureter.
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Two new cases of Wolfram's syndrome associated with progressive urinary tract dilatation are reported. The possibility of anatomic outlet obstruction or neurogenic bladder was eliminated radiologically and urodynamically. Dilatation of the urinary tract was considered to be a consequence of high diuresis associated with diabetes insipidus. A very important improvement in bilateral urinary tract distension was achieved with bladder drainage while dDAVP therapy dramatically decreased the daily urinary output. A review of diabetes insipidus and its urological implications is presented.
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The authors describe two new cases of polyorchidism. In the first case, they removed a testis which had a better seminal line than the testis preserved. In the other case, a conservative attitude was adopted. A review of the literature is followed by a discussion of the benefits of conservative therapy.