Acta chirurgica Academiae Scientiarum Hungaricae最新文献

Nine cases of female urethral diverticuli were successfully operated in the years between 1978 and 1980. The anatomic pathophysiology of female urethral diverticuli is discussed according to the currently accepted international and Hungarian terminology. A new modified surgical method is described and the possibilities opened by its adequate application are outlined. No postoperative urethrovaginal fistula has ever been observed. It is emphasized that the new surgical method can only be applied to large diverticuli with a narrow neck. In the interest of the patient co-operation between the urologist and gynaecologist is indispensable.

The urological complications of surgical interventions are discussed on the basis of the authors' clinical material collected over six years. Mainly fistulas and inflammatory complications occurred due to gynaecological operations performed by abdominal penetration. The possibilities and incidence of complications, as well as the diagnostic methods used for their detection and the applied therapies are reviewed. The importance of the proper choice of restituting surgical interventions is stressed. Complete anatomical and functional restoration and preservation of the organ are attempted. Attention is called to the importance and possibilities of preventing complications due to injuries. In the reduction of the incidence of urological complications after gynaecological operations, beside prevention, a close co-operation with the urologist is necessary as well as post-operative check-ups even in symptomless cases.

In the years between 1971 and 1979 in the Department of Urological Surgery of the Municipal Weil Emil Hospital in 16 of the 72 coral calculi filling the renal pelvis primary (so-called uric acid) calculi were found to which lytholysis was applied. Fifty-six cases (secondary calculi) were operated, in the majority by conservative surgery (40 cases), 16 patients were nephrectomized. The incidence of coral stones is twice as high in women as in men. Congestion and infections play the major role in their pathogenesis, hypercalciuria is less frequent. Up-to-date possibilities of examination ensure the proper plan of the operation. Complete removal of the stones, abolishment of congestion and infection and postoperative care are very important in the prevention of relapse. In 21 of the 72 cases congenital malformation as was found as a source of congestion. There are various types of conservative operations. Quite often the renal parenchyma is incised, and in this case the peduncle has to be ligated. By cooling the kidney the hypoxic time can be prolonged quite considerably. In the course of the operation the kidney must be made free of stones as the incidence of relapses is high. Analysis of the removed coral stones showed that 68% of them consisted of carbonate-apatite-struvite.

In 12 years the authors treated 97 patients with suppurative nephritis in their Department. They performed 78 conservative operations and 19 nephrectomies. The symptomatology and diagnosis of the disease are briefly discussed. Attention iscalled to the importance of early diagnosis and the earliest possible surgical intervention. The dangers of unfounded antibiotic treatment and of chemotherapy are pointed out as these might mask the classical symptoms and render early diagnosis more difficult.

After having reviewed the anatomy and physiology of vesicoureteral reflux, the authors claim that in the case of appropriate indication and technique of the operation good results can be expected of plastic surgery. They stress that the indications of the operations for obstructed reflux have considerably narrowed. Conservative treatment beside long-term disinfection of the urine and removal of the focus results in the majority of cases--mainly when the patients are small children--, in the abolishment of vesico-ureteral reflux. In about 50% of the discovered refluxes surgical intervention is necessary, but also in these cases the administration of antibiotics is indispensable.

In five years 938 transurethral resections were performed in the Department of Urology of Semmelweis University Medical School. The indications were in 483 cases tumours of the bladder, in 179 adenoma of the prostate and in 182 cancer of the prostate; the indications of the remaining cases were miscellaneous. The indications, most important surgical parameters, postoperative complications and treatment of transurethral resections are discussed from the authors' point of view. The results prove the advantages of transurethral resection and confirm its importance as a basic surgical intervention in urological practice.

The literature on perineal neoplasms is reviewed and their incidence, the method and effectiveness of their surgical treatment analyzed. The prognosis of perineal neoplasms is tragic: according to published data 50% of the patients die within two, 92% within four years. The benign or malignant nature of perineal tumours can be judged only on the basis of histological tests. Attention is drawn to the necessity of the early surgical removal of perineal tumours. In the case of a 66-year old woman the histological diagnosis was gelatinous adenocarcinoma. To the best of the knowledge of the authors no similar case has been reported in the literature.