Transactions of the American Association of Genito-Urinary Surgeons最新文献

Orchiopexy of high intra-abdominal testes with division of the internal spermatic artery and vein is associated with subsequent testicular atrophy in a significant percentage of cases. We herein describe 2 patients in whom arterial supply and venous drainage to the testis were maintained using microvascular anastomosis. The internal spermatic artery and vein were anastomosed to the deep inferior epigastric artery and vein. Patency of the vascular anastomosis was verified by subsequent radionuclide examinations and selective arteriography in 1 patient.

Of 63 patients with reflux and renal atrophy renal dysplasia was found in 9.5%. Pyelonephritis was apparent in 81% of the atrophic lesions. Urinary obstruction or ectasia was apparent in each case with dysplasia and only 2 were associated with histologic evidence of pyelonephritis. Pyelonephritis appears to be a major causal factor in atrophy occurring in renal units with reflux. Early urinary tract obstruction or distension may predispose to renal dysplasia.

Operative treatment of microphallus has been proscribed in recent reports. It is not indicated for the more common endocrine type because of deficient gonadotropin, primary testicular disorder or end-organ defect. However, an operation may be quite necessary for the other form owing to defective morphogenesis--the anomalous type. Representative cases provide evidence that the method of treatment depends on the type of microphallus.

A positive saralasin test in patients with angiographic evidence of renovascular disease and other positive functional tests gives further assurance that these patients will achieve normal or substantially reduced blood pressure postoperatively. In our experience with proved renovascular hypertension there was a 19% incidence of falsely negative saralasin tests. Therefore, saralasin should not be used as the sole screening test in hypertensive patients suspected of having surgically correctable lesions. There is a direct correlation between elevated renin activity and a positive saralasin test. In some patients saralasin may be more sensitive than any other currently used test to detect overactivity of the renin-angiotensin system. This would determine those patients with technical errors in renin sampling and assays. Of the 16 patients (all normotensive) who had 6-month followup tests 5 had elevated peripheral renin activity, probably owing to furosemide stimulation. Of these 5 patients 2 had a positive postoperative saralasin test, raising the question of potential falsely positive responses in cases of essential hypertension and coincidental non-functional renal artery stenosis. Patients with high renin essential hypertension may respond to saralasin, even in the absence of renal artery lesions. A saralasin test should be done in a hospital where all specific conditions can be met and potential complications handled promptly.

During the last 20 years 500 girls with recurrent urinary tract infection and documented reflux were seen in private practice. All patients received medical treatment for 3 to 48 months (an average of 15 months) after which the 250 who were not cured underwent a corrective operation. The primary reason for an antireflux operation is to protect the kidney from the damaging effect of a combination of high pressure and infection. Thus, the criteria for operation included persistent infection, renal changes typical of previous pyelonephritis, major reflux and abdominal or flank pain. The surgical cure rate after careful long-term followup approaches 98%. The medical cure rate at the end of 2 years reached 88%. This experience has enabled the establishment of a rigorous point system, providing common denominators regarding indications for operation. It emphasizes the desirability of attempting a medical cure for at least 1 year after urethral dilatation, except when major orifice defects and major reflux exist. This system should help to increase communication and coordination of efforts among the pediatrician, radiologist and urologist.

The simple, rapid and satisfactory method of the transvesical Harris-Hryntschak open prostatectomy is described. When this technique is used bleeding is reduced to an average of 85 ml. and visibility is improved by the local injection of a synthetic vasoconstrictor, ornithine-8 vasopressin, before enucleation. Hermostasis is obtained by tamponade with fine sutures occluding the bladder neck. Bladder closure is with heavy watertight, purse-string sutures. A "time and motion" study has reduced the usual operating time to 15 to 20 minutes with an intraoperative transfusion rate of 2.3%.