Urologic manifestations of postpolio syndrome

To determine the character and prevalence of bladder dysfunction among persons with a history of polio, we conducted a survey of randomly selected polio survivors. The survey solicited information on the acute episode of polio and the nature of late-onset neurologic symptoms that could be attributed to postpolio syndrome. There were 242 female and 88 male respondents to the study. Symptoms attributable to postpolio syndrome were present in 87.2% of female subjects and 73.9% of male subjects. Respondents with postpolio syndrome had a significantly greater prevalence of urologic symptoms than seen among respondents without postpolio syndrome, although no dominant pattern of voiding dysfunction was noted. The early onset of erectile dysfunction was more common among male subjects with postpolio syndrome than among male subjects without postpolio syndrome. Genuine stress incontinence was seen in 36.3% of the survey population. Sixteen women with postpolio syndrome underwent surgical repair for urinary incontinence, with a success rate of 60.5%. Bladder disorders are common among persons with PPS, but further clinical and urodynamic data are necessary to define the nature and magnitude of this dysfunction.     

Urologic manifestations of laurence-moon-biedl syndrome

Although uremia is the major cause of death in more than 30 per cent of patients with Laurence-Moon-Biedl syndrome, little attention has been paid to this rare syndrome in the urologic literature. We herein report on 3 patients with this syndrome.     

Femoral neuropathy caused by iliacus hematoma

Two cases of femoral neuropathy caused by iliacus hematoma occurring during anticoagulant therapy are described. The pathogenesis and the clinical picture of this particular pathology are discussed and the necessity of early surgical decompression is emphasized.     

Urologic manifestations of polyarteritis nodosa.

Polyarteritis nodosa is an unusual condition that infrequently presents with signs and symptoms essentially confined to the urinary system. Such a case necessitating bilateral nephrectomy owing to hemorrhage is described. The pathologic findings, pathophysiology and etiology of the condition as well as treatment by renal transplatation are discussed.     

Urologic manifestations of paroxysmal nocturnal hemoglobinuria.

A long-term study of 17 patients with paroxysmal nocturnal hemoglobinuria revealed an unexpectedly high incidence of functional and anatomic renal abormalities. All patients demonstrated varying degrees of hematuria and proteinuria distinct from hemoglobinuria. All patients also had granular casts in multiple urinalyses. Evaluation of renal function revealed hyposthenuria, abnormal tubular function and declining creatinine clearance. Radiologically, one or more of these demonstrated enlarged kidneys, renal cortical infarcts and thinning, papillary necrosis, acute renal atrophy, retroperitoneal hematoma and ureteral infarction, which were confirmed by autopsy studies. Hypertension developed in 7 patients. Urinary tract infection was uncommon and no patient had a clinical history compatible with chronic or acute pyelonephritis. Contrary to usual opinion our compatible clearly showed evidence of frequent and widespread renal pathology in paroxysmal nocturnal hemoglobinuria most likely due to repeated microvascular thromboses similar to the venous trombosis involving other organs in this disorder. Since most of these patients present initially to urologists knowledge of this entity is mandatory.     

Urologic manifestations of AIDS

A retrospective analysis of 60 patients with Acquired Immune Deficiency Syndrome (AIDS) seen between 1981-1985 was performed to determine the genitourinary manifestations of this disease. Twenty-two per cent were found to have significant proteinuria, while 7 per cent had nephrotic syndrome which was associated with an extremely rapid demise. Renal insufficiency occurred in 27 per cent and renal biopsy results, when abnormal, revealed focal and segmental glomerulosclerosis. Pyuria was found in 52 per cent of patients, and urinary tract infections occurred in 20 per cent. Atypical pathogens including Candida, Salmonella, Acinetobacter calcoaticus, and cytomegalovirus were encountered.     

Urologic manifestations of AIDS

The frequency of urological manifestations of AIDS appears to be increasing at the present time: between 1985 and 1988, 38 HIV1 seropositive patients were examined in the Urology department. In seven cases, the positive serology was discovered during investigation of a urogenital infection and 21 patients suffered from declared AIDS. The reasons for admission to hospital were: urogenital infection: 14 cases, dominated by epididymitis (7) and prostatitis (5), characterized by their frequent progression towards abscess formation; tumours: 6 cases, including 5 Kaposi sarcomas of the penis; and, lastly, neurological manifestations, chronic renal failure and urological diseases unrelated to AIDS. This study indicates that serology should be performed routinely in cases with a known risk factor and/or with an atypical urogenital condition, particularly infectious. The adoption of aseptic techniques and rigorous protection of the entire surgical team is now absolutely necessary.     

Urologic manifestations of aortocaval fistulas

The authors report two cases of aortocaval fistula, resulting from the rupture of an abdominal aneurysm, and revealed by lumbar pains and hematuria. In both cases, the left kidney was mute, and was possibly responsible for the hematuria.     

Urologic manifestations of wegener granulomatosis

Wegener granulomatosis is a disease characterized by necrotizing granuloniatous angiitis involving the upper and lower respiratory tracts and the kidneys. The introduction of cyclophosphamide in. the treatment of Wegener granulomatosis has dramatically altered the rapidly fatal course of the disease and has altered our thinking regarding its management. Recently we have cared for 3 patients who demonstrated a dramatic spectrum of urinary tract pathology related to Wegener granulomatosis. The cases presented offer three points for consideration by the urologist: (1) the manifestations of the disease in the genitourinary tract can be varied and can present in a dramatic fashion; (2) the rapid progression of renal failure and the nearly uniform mortality associated with the disease have changed largely because of the use of cyclophosphaimide; and (3) our approach toward patients with renal failure on the basis of Wegener granulomatosis can be altered, and renal transplantation is certainly feasible with the increased longevity afforded these patients by eyclophosphamide.     

Urologic manifestations of drug therapy

Numerous drugs used for a variety of medical conditions may be involved in urologic disease or dysfunction. Manifestations include sexual dysfunction, voiding disturbances, incontinence, renal impairment, urolithiasis, obstructive uropathy, urothelial tumors, and others. The office urologist thus must be aware of the possibilities, which are listed and discussed briefly.     

The anatomical basis for femoral nerve palsy following iliacus hematoma

With increased use of anticoagulant agents, femoral neuropathy subsequent to hemorrhage within the iliacus muscle has become a frequent clinical problem. The mechanism for this type of femoral nerve palsy was studied in dissections of the iliac region and by injections of latex into fascial planes in that area. In most dissections, up to four fascial layers, parallel to the iliacus sheath, could be identified. Variable states of fusion of these layers often produced up to three pouches, separated by loose connective tissue or fat. These fasciae (called "lamina peritonealis," "lamina transversalis," "lamina preiliaca," and "lamina iliaca") appear to be variable adult remnants of distinct fascial layers present in the posterior abdominal wall during embryological development, and serve to strengthen the intrinsic fascia of the iliacus muscle. Latex injected into the iliacus sheath spread from the midlumbar region to the femoral triangle, surrounding, compressing, and stretching the femoral nerve in different parts of its course. These observations suggest an anatomical basis for femoral nerve palsy during iliacus hematoma.     

Femoral nerve palsy secondary to traumatic pseudoaneurysm and iliacus hematoma

The authors report a case of traumatic femoral nerve palsy caused by a pseudoaneurysm of the iliolumbar artery and a iliacus muscle hematoma. This case report details not only the classic history and physical findings seen in patients such as this one, but also illustrates an unusual source of the hematoma and a discussion of its treatment. A 20-year-old man was assaulted and presented to the authors's institution with a 1-week history of severe pain in the left anterior thigh and groin, weakness in the left quadriceps muscle, and numbness in the anterior thigh and medial distal leg. Imaging studies demonstrated a large, 9.4 x 6.4 x 5.2-cm iliacus hematoma as well as a pseudoaneurysm originating from the left iliolumbar artery. The patient underwent angiographic embolization of the pseudoaneurysm followed by surgical evacuation of the hematoma. The embolization was performed before surgery to prevent any possible rebleeding from the pseudoaneurysm during evacuation of the hematoma. Femoral nerve palsy caused by traumatic iliacus hematoma is an infrequent diagnosis often missed because of its insidious presentation. In this case, embolization of the iliolumbar artery pseudoaneurysm followed by surgical evacuation of the hematoma resulted in a nearly full recovery of the femoral nerve as of the last follow-up examination.     

Urologic manifestations of nonurologic diseases gastrointestinal disorders

A variety of common, gastrointestinal diseases result in significant genitourinary tract pathology. In general, knowledge of these associated disease processes permit rapid and accurate diagnosis and treatment. The underlying thread is the recognition of one pathophysiological process to explain patterns of a single disease.