Obstructed ureteroileal conduits: antegrade catheter drainage

The ileal loop method of supravesical urinary diversion may be complicated by strictures of the ureteroileal anastomosis, the ileocutaneous stoma, or the ileal loop itself. These strictures may produce hydronephrosis with a resultant deterioration of renal function. Decompression via percutaneous nephrostomy is frequently indicated, either as an antecedent to corrective surgery or as a permanent method of urinary drainage. A technique is described which extends the percutaneous nephrostomy to allow placement of drainage catheters from below. This obviates flank catheters and permits antegrade drainage of urine through the preexisting ileocutaneous stoma into the usual collecting appliance. The method has been applied successfully in three patients.     

Applications of thin needle aspiration biopsy in urology.

Percutaneous thin needle aspiration biopsy was done on 34 patients for better staging of malignant disease by study of opacified lymph nodes, on 12 patients to eliminate the possibility of a malignant etiology of ureteral obstruction and on 7 patients with potentially metastatic soft tissue or visceral lesions. Ideally, a positive biopsy should change subsequent patient management and may eliminate the need for an exploratory operation. A significant number of falsely negative results occur and, for this reason, a negative biopsy should not affect subsequent patient management.     

Transluminal angioplasty of the renal arteries

Transluminal dilatation of renal artery stenosis for hypertension produces results similar to those of surgery for renal vascular hypertension while avoiding the major morbidity and mortality associated with surgery. In combination with intravenous digital subtraction angiography, it allows the work-up and treatment of this commonly suspected disease with minimal morbidity. It is a much less expensive procedure than surgery. The previously advocated, very involved and expensive preprocedural work-up is also now unnecessary. In patients with suitable lesions and, particularly, in patients who have already experienced some renal dysfunction, percutaneous angioplasty is the technique of choice for improving both renal function and hypertension in the presence of renal artery stenosis.     

Histiocytosis and a leukaemoid response. A case report.

A patient with all the clinical signs of Letterer-Siwe disease is reported. The patient was unusual in that he had a severe leukaemoid reaction. To our knowledge, only 2 similar patients with reticulo-endotheliosis, histiocytic skin infiltration and leukaemoid reaction have been reported. It is possible that the disorder may represent a variant of the histiocytic proliferative disorders, characterized by both histiocytic and myeloid hyperplasia, and is thus similar to myelomonocytic leukaemia. However, it differs from the latter condition in that there is proliferation of monocytes and granulocytes in soft tissues rather than in the blood.