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

The recognition of secondary causes of hypertension, such as renovascular disease and aldosteronism, can be enhanced by stimulation and suppression of the 2 limbs of the renin angiotensin system. Normal values have been established in unstimulated and stimulated conditions. Saline infusion suppresses plasma aldosterone normally. Patients with proved adenomas do no suppress renin and are outside the well established ranges of normal suppression. Likewise, furosemide will stimulate renin release. Patients with proved aldosteronism are outside the normal ranges of plasma renin activity. These maneuvers also are useful in discriminating renovascular hypertension, particularly when achieving differential renal venous collections under stimulated conditions (after furosemide and tilting). By stressing this system (with furosemide stimulation or saline suppression) one can discriminate better secondary hypertension by the failure to respond normally.

Patients about to undergo vasectomy, retroperitoneal lymph node dissection, pelvic radiotherapy or chemotherapy frequently wish to store semen for future artificial insemination. The probability that this will result in a pregnancy is approximately 33% and the logistics are complicated. These problems are discussed and a cost analysis is presented. A list of semen banks presently storing homologous human semen and registered with the American Association of Tissue Banks also is presented.

Cystolysis, a procedure for the selective supratrigonal denervation of the bladder, was used in 6 patients with intractable interstitial cystitis and in 4 patients with an uninhibited neurogenic bladder. Good results were obtained in both groups of patients.

The urine of normal persons, as well as that of stone formers, contains inhibitors to crystallization of calcium oxalate. To ascertain differences, if any, between these 2 groups we measured nucleation rate, growth rate and total mass produced in an analytic system with 5% urine added to 95% synthetic urine that did not contain large organic molecules. We also observed the effects of addition of uromucoid to the synthetic solution. Normal urine and stone-forming urine contained significant inhibitors to total mass of calcium oxalate dihydrate crystals precipitated but total crystal mass was not significantly different between the 2 groups. Growth rate was significantly less in experiments with the urine of stone formers. The other major difference found in stone-forming urine was significant enhancement of nucleation rate when compared to normal urine. Since addition of uromucoid produced these same growth inhibition and nucleation enhancement effects but did not affect total crystal mass, we hypothesize that uromucoid has an important part in producing the differences noted between normal and stone-forming urine.

Six children have undergone reconstruction of the urinary tract 14 months to 14 years after supravesical diversion for neurogenic bladder dysfunction. Five are continent: 4 by intermittent catheterization and 1 by voiding to completion. One child is just beyond infancy and wets but is not yet on a systematic program. One boy was considered a technical failure despite incontinence because of progressive hydronephrosis from a non-compliant bladder but he subsequently had an augmentation cystoplasty. Urinary undiversion into a neurogenic bladder is an acceptable option as an alternative to ileal conduit revision or for reasons of patient preference, provided bladder storage capacity is adequate at acceptably low resting pressures, without incontinence.

The papillae are involved in renal disease and, hence, are an inextricable consideration in intrarenal surgical procedures. Guide lines for their management are newly emergent and, consequently, tentative. If divided along intra-arterial planes they appear to heal with little functional impairment. Resections of papillae, which are limited to the intracaliceal portions, involve no medullary structures and heal without apparent dysfunction.

Simultaneous bilateral renal cell carcinoma has been treated in 5 patients at our hospital during the last 6 years. Improvements in radiologic diagnostic techniques are responsible for the increased detection of these lesions. Results of surgical management are reported. Angiographic embolization of renal cell carcinoma has proved to be a useful method to manage patients with solitary kidneys or those with severe medical problems contraindicating an operation, and our results with this approach are described.