Secondary pyeloureterostomy with an intact ureter.
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Humans↗
Biomedical subjects
R G Middleton
Publications and source records attributed to R G Middleton.
Ileal substitution of the ureter in renal transplantation.
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Adult↗
Radical prostatectomy for stage B2 prostatic cancer.
It has been suggested that patients with large, localized prostatic carcinomas (stage B2) may not be good candidates for radical prostatectomy. Inaccuracy of the rectal examination is a particular problem with a lesion of this type. Unrecognized extension beyond the prostatic capsule, especially into the seminal vesicles, is well known and unsuspected involvement of pelvic lymph nodes may be present. Patients with clinical stage B2 prostatic carcinoma who seemed to be potentially good candidates for radical prostatectomy have been subjected to pelvic lymphadenectomy for staging. All of these patients have a normal chest x-ray, serum acid phosphatase, excretory urogram and radioisotope bone scan. During a 101/2-year interval 87 patients with clinical stage B2 prostatic carcinoma underwent staging pelvic lymphadenectomy. Of these patients 24 (28 per cent) had positive pelvic lymph nodes and were excluded from consideration for radical prostatectomy. Fifty patients with clinical stage B2 prostatic carcinoma and proved negative pelvic lymph nodes have been subjected to radical prostatectomy: 43 (86 per cent) had tumor confined to the prostate on histologic examination of the radical prostatectomy specimen, 6 (12 per cent) had microscopic capsular invasion and 2 (4 per cent) had microscopic invasion of the seminal vesicles. Radical prostatectomy seems justified when there is a high likelihood that the tumor truly is confined to the substance of the prostate. In our experience pelvic lymphadenectomy has enabled us to select appropriate patients with stage B2 prostatic carcinoma for radical prostatectomy.
Adult↗
Ureteral replacement with a new polyurethane prosthesis.
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Animals↗
Single stage repair of rectourinary fistula.
The treatment of 2 prostato-rectal fistulas by a single stage York Mason repair and cystostomy is described. We realize that the therapy of rectourinary fistulas should be individualized and for the ill or septic patient the 3-stage treatment including colostomy is safe and conservative. However, for the patient in good condition the 1-stage repair seems to be an effective shortcut.
Aged↗
Coma from hyponatremia following transurethral resection of prostate.
Even though hyponatremia may occur following transurethral resection of the prostate (TURP), only 14 patients of a large TURP population deteriorated to a comatose state as a result of hyponatremia. These patients were generally older, with larger prostates, and longer resection times than the average for transurethral resection of the prostate. They also consistently had serum sodium levels postoperatively of near 120 mEq./L. or below. It was noted that obtundation can occur immediately or be delayed several hours. Even though no deaths occurred, awareness of the possibility of post-TURP hyponatremia and prompt treatment with hypertonic saline were shown to reduce morbidity significantly.
Aged↗
Urologic manifestations of chronic granulomatous disease of infancy.
Chronic granulomatous disease of infancy is a rare hereditary disease that may have urologic manifestations. We describe 2 brothers who had intense cystitis and typical x-ray findings characteristic of this disease. The etiology, incidence and treatment of chronic granulomatous disease of infancy are discussed.
Child, Preschool↗
Ventriculoureteral shunt for hydrocephalus without nephrectomy.
The urinary tract has been used previously for shunting of cerebrospinal fluid. However, nephrectomy has always accompanied the procedure, making it less appealing despite adequate relief of hydrocephalus. By using reimplantation of the ureter and a psoas hitch we have performed the first reported ventriculoureterostomy without nephrectomy. To date the results in 3 patients have been excellent from a neurosurgical and urologic standpoint.
Cerebrospinal Fluid Shunts↗
Routine use of the psoas hitch in ureteral reimplantation.
Previously, the psoas hitch had been advocated only for difficult cases of ureteral implantation, especially when there had been inadequate ureteral length. However, during the last 10 years the paoas hitch in association with a modified Paquin technique has been used routinely at this institution for ureteral reimplantation. The technique has been used in all unilateral cases and in most bilateral reimplants. Results have been excellent. The psoas hitch allows for a long submucosal tunnel, with a fixed relationship between the ureter and posterolateral bladder wall. Intermittent hydronephrosis is not seen with this method of reimplantation and there have been no voiding disturbances.
Humans↗
Vasovasostomy and semen quality.
During a recent 8-year 4-month period 205 men underwent bilateral vasovasostomy. Of those patients for whom followup information was available 43 per cent have produced a pregnancy. Semen analyses after vasovasostomy revealed good sperm counts for the most part but generally reduced sperm motility and viability. Efforts are underway to evaluate whether the defect may be the result of abnormal epididymal function or of sperm agglutinating or immobilizing antibodies.
Adult↗
Extracorporeal corpus-venous shunting for priapism.
We report a case in which extracorporeal circulation was used as an alternative to other forms of corpus-venous shunting and resulted in complete detumescence and maintenance of potency. The relative simplicity and the ability to repeat the procedure in cases of recurrent priapism suggest this as a reasonable form of treatment in patients who do not respond to conservative measures.
Adult↗
Supranormal nuclear content of 5 alpha-dihydrotestosterone in benign hyperplastic prostate of humans.
We investigated the concentration of nuclear and cytosolic 5 alpha-dihydrotestosterone and 3 alpha-androstanediol in benign prostatic hyperplasia (BPH) in men. The endogenous content of the androgens was quantitated by radioimmunoassay after isolation of the nuclear and cytosolic fractions by classical differential centrifugation techniques. The mean dihydrotestosterone content was about four-fold higher (P < .01) than normal in the nuclear fraction and two-fold higher (P = .05) in the cytosolic fraction in periurethral tissue from hyperplastic prostates. The mean 3 alpha-androstanediol values were approximately one-third of normal in both the nuclear (P < .01) and cytosolic (P < .01) fractions in glands with BPH. In BPH tissue the ratios of dihydrotestosterone to androstanediol content in both the nuclear and cytosolic fractions was significantly higher (P < .01) than the ratio in normal prostate. Our data suggest that elevated intranuclear dihydrotestosterone but not 3 alpha-androstanediol may be causally related to the development of BPH in aging men.
Aged↗
Reversal of vasectomy without magnification of the site.
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Humans↗
Surgical approach to large müllerian duct cysts.
Failure of the müllerian duct system to undergo complete involution in the male embryo may result in cystic dilation of these remnants. When these cysts attain great size, they may become paopable abdominally and cause voiding symptoms. A case is presented and the operative approach described. A suprapubic approach affords the best exposure for the complete removal of large müllerian duct cysts.
Adult↗
Hypertension in childhood from renal vein thrombosis.
A case is presented of a 1-year-old boy with hypertension resulting from abnormal renin production by the right kidney. The kidney had undergone infarction and atrophy secondary to renal vein thrombosis. The left kidney remained normal despite inferior vena cava thrombosis because of the development of collateral venous circulation. The hypertension was cured by right nephrectomy. The child remains normotensive and with a normal serum creatinine at 1-year followup.
Humans↗
Neonatal adrenal hemorrhage.
The neonatal adrenal gland is vulnerable to traumatic hemorrhage. With the correct interpretation of clinical, laboratory and radiographic data the diagnosis can be made non-operatively. We review 6 cases of acute neonatal hemorrhage. Trauma during or shortly after birth occurred in 4 cases and all 6 newborns had jaundice and anemia. Operative intervention rarely is necessary either for the diagnosis or treatment of intracapsular adrenal hemorrhage in the newborn.
Adrenal Gland Diseases↗
The use of fluorescein in radical inguinal lymphadenectomy.
Necrosis with slough of skin flaps is a common and distressing complication after radical inguinal node dissection. Conventional methods to predict viability of dermal flaps are notoriously unreliable. Intravenous fluorescein has been shown to be a reliable indicator of the adequacy of blood supply to dermal flaps in experimental models and in radical mastectomies. Fluorescein has been used in 6 separate node dissections for carcinoma of the penis. In all cases fluorescein reliably delineated viable skin flaps and its use can help decrease the morbidity rate in inguinal node dissection.
Carcinoma, Squamous Cell↗