Thirteen cases of cutaneous transureteroureterostomy.
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Biomedical subjects
Publications and source records attributed to W De Sy.
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30 patients with neurogenic bladder dysfunction were treated with intermittent self-catheterization. Since the application of this method, urine loss has disappeared almost completely and the urinary infection rate has decreased. In some cases there was radiological improvement of the upper urinary tract. In all the other patients no kidney deterioration was found on intravenous pyelography. In most cases the method brought a real improvement in social life.
In a series of 180 neoureterocystostomies, 177 were successful. Only 3 failure occurred: 1 remaining reflux and 2 obstructions. The operative technique is described and discussed. The advancement procedure of Glenn and Anderson is found to be an excellent technique for the cure of nearly all cases of vesicorenal reflux.
The results of ureteral reimplantation in 8 neurogenic bladders with a high outflow resistance and severe trabeculation are presented. Operation was successful in all cases. The conditions for a successful intervention in these cases are: (1) previous or simultaneous treatment of the high outflow resistance: intermittent catheterization was found to be an excellent method for this purpose, and (2) the submucosal tunnel should be created preferably upon the trigone which is the only place free of trabeculation. High outflow resistance and severe trabeculation should no longer be considered as contraindications for antireflux surgery in the neurogenic bladder.
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A simple method is presented for demarcation between different arterial areas, which allows the performance of nephrotomies with minimal bleeding and subsequent renal ischemia. The thermal gradient that exists between the segment with occluded blood supply and the adjacent ones retaining their blood supply is defined by a liquid cholesterol crystal sheet.
The results of antireflux operations in 41 cases of primary and 9 cases of secondary vesicoureteral reflux in adults are presented. Reflux was eliminated in all cases and there were no postoperative complications. Most patients had a long history of urinary tract infection preoperatively, which was eliminated in 64.1 per cent of the cases after surgical correction of the reflux. A relapse of infection occurred in 30.8 per cent of these cases. Chronic pyelonephritis remains active in 5.1 per cent of the cases. There were 6 patients with serum creatinine levels higher than 1.8 mg. per cent who underwent a successful antireflux procedure without an increase of serum creatinine levels. An antireflux operation should be preferred over long-term conservative management in most cases of symptomatic vesicoureteral reflux in adults less than 50 years old.
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The evolution over a 12-year follow-up period from only slightly damaged kidneys to end-stage renal disease due to sterile ureteral reflux is reported.
The early results of 15 urethral strictures operated by one-stage urethroplasty with free skin graft are excellent. The technique is described.
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Renal infection is an indication for surgical treatment of a solitary calyceal stone. It must be proved however, that the infection is localised to the kidney before deciding on operation, as this may be very difficult and produce severe complications. Bladder washout seems to be an excellent technique to differentiate the localisation of the infection.
Plasma androgens [testosterone (T), 17beta-hydroxy-5alpha-androstan-3-one (DHT), androst-4-en-3,17 dione(A), and dehydroepiandrosterone (DHEA)] as well as 17 hydroxyprogesterone were measured in a group of patients (age 60-80 yrs.) with benign prostatic hyperplasia (BPH) just before prostatectomy and compared to values obtained in subjects of similar age without signs of BPH. The most important difference was observed in the mean DHT level which was significantly (P less than 0.025) higher than in the control group; mean T and free testosterone levels in BPH patients were slightly higher (P less than 0.05) in the age group 70-80 yrs; whereas in age group 60-70 mean values were similar to those observed in normal controls. Mean A, DHEA and 17 OHP and E2 levels were not significantly different in BPH patients when compared to age matched controls. 2-5 months after prostatectomy, T and DHT levels were significantly higher than immediately preoperatively. The preoperative stress may have influenced the preprostatectomy values.
The first case of blunt ureteral disruption with external urine fistulization is presented. Reanastomosis with temporary urine diversion by a nephrostomy tube was successful. A review of the literature since 1950 revealed only 49 cases that proved this pathology should be considered in the differential diagnosis of post-traumatic hematuria or the development of mass in the flank. Nephrectomy is no longer used since a thorough attempt at reconstructive surgery will provide good functional results.
The analgesic effect of intravenous meptazinol at various dosage levels was studied in 30 patients suffering from acute renal colic. Out of a total of 41 injections (dose range: 20 to 120 mg.) a favourable analgesic response was recorded on 39 occasions. The onset of action was rapid with the minimun duration of action of 1 hour. Higher doses increased the drug's action but were accompanied by nausea and dizziness. There was no overall effect on blood pressure or heart rate.
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