A case of a renal artery stenosis and ipsilateral renal cell carcinoma with long term results is reported. A 65-year-old man with renovascular hypertension, renal insufficiency, and nephrotic range proteinuria presented with an incidental renal cell carcinoma. Concomitant in situ left partial nephrectomy and splenorenal arterial bypass was achieved. The patient is doing well without evidence of malignancy, stable renal function, markedly improved proteinuria and stable blood pressure more than three years later. The techniques of this procedure are detailed and underscore the possibility of successful removal of a renal cell carcinoma with preservation of renal function despite renal artery stenosis.

Scott A. Slavis

George S. Ganesan

Claudia Swift

Ronald C. Ruppert

Renal Artery Stenosis and Ipsilateral Renal Cell Carcinoma: Description of an In Situ Partial Nephrectomy and Splenorenal Arterial Bypass

Anthony R. Stone

Roscoe S. Nelson

Evaluation and Management of Male Urinary Incontinence

Spinning top urethra (STU) denotes a particular urethral configuration that is a dilated posterior urethra mainly seen in young girls or women. STU deformity arises secondary to detrusor instability, leading to a rise the intravesical pressure against a closed sphincter. We describe a case of spinning top urethra in a 30-year-old woman who presented with lower urinary tract symptoms and left flank pain.

P.N. Dogra

M.S. Ansari

Spinning Top Urethra and Lower Urinary Tract Dysfunction in a Young Female

The results including the complication and continence rates for 3 types of continent urinary diversion were evaluated. From 1992 to 1998 we performed 58 continent urinary diversions after radical cystectomy for invasive transitional cell carcinoma (TCC) of the urinary bladder. All three types of continent diversions and ileal loop procedures were discussed and patient preferences were determined. The patient preference rate for continent urinary diversion was 96.6%, and half of these patients wanted to be completely dry. Mean age of the patients was 58.2 years. Of the 58 patients, 9 (15.5%) had a Kock pouch, 15 (25.8%) had a Kock neobladder and 34 (58.6%) had sigmoidorectal pouch (Mainz-II pouch). Early and late complication rates of the three different continent diversions were evaluated. The number of complications, such as urine leakage, pyelonephritis, hydronephrosis, reflux and stone formation, were similar in all three types of diversions. Two (5.9%) Mainz pouch II patients who had stopped oral alkalinization demonstrated severe hyperchloremic acidosis. Spontaneous pouch rupture occurred in 1 of the Kock pouches. Reoperation rates were higher with the Kock pouch and Kock neobladder cases. Daytime continence rates for the Kock pouch, Kock neobladder and Mainz II pouch were 77.7%, 86.7% and 100% respectively. Even though complete dryness may not be achieved in every patient, orthotopic bladder substitution appears to be the best choice after radical cystectomy. Although it carries the risk of life-long oral alkalinization therapy, the Mainz pouch II is associated with an excellent continence rate and may be a good alternative for patients who desire to be dry.

Cengiz Girgin

Akif Sezer

Kutan Ozer

Huseyin Tarhan

Ahmet Bolukbasi

Gozen Gurel

Comparison of Three Types of Continent Urinary Diversions in a Single Center

There are more than 200,000 end stage renal disease (ESRD) patients who are potential transplant candidates and more than 100,000 previously transplanted renal recipients with functioning allografts in the United States 1. Fifty-seven percent of these patients are male and forty percent are greater than 50 years of age 2, 3. Diabetes is the most common cause of kidney failure. It is evident that many patients are at high risk for development of urologic problems and thus it is estimated that the average urologist will care for up to ten of these patients yearly4. Thus a review of the genitourinary (GU) evaluation and management of these patients is timely.

Peter N. Bretan

GU Evaluation and Management of Renal Transplant Candidates and Recipients

A Cowper&#39;s syringocele in an adult is rare. Ten cases are reported in the world literature. The authors report a case of painful haematuria due to the presence of a Cowper&#39;s syringocele in an adult. The classification of lesions of the Cowper&#39;s gland is discussed together with common symptoms and differential diagnosis.

Matthew B.K. Shaw

Owen Cole

Timothy R. Terry

Cowper&#39;s Syringocele Causing Painful Haematuria in an Adult

Darius A. Paduch

Steven J. Skoog

Diagnosis, Evaluation and Treatment of Adolescent Varicocele

Siamak Daneshmand

Adenomatous Polyp of the Verumontanum Causing Bladder Outlet Obstruction

Sex reassignment (male to female surgery) is a standard operation which is aimed at constructing female genitalia and obtaining a cosmetic and functional result that is similar to that of a normal female subject. The ideal surgical procedure has not yet been described, but the various techniques which have been proposed in the literature are similar. The most cumbersome maneuver of the procedure is that of creating a neovaginal cavity inside the perineum. This step is generally carried out by means of blunt dissection between the rectal wall and the prostate, but most of the surgery is blindly performed without visual control. In these conditions, the risk of rectal injury is high, and may lead to severe intraoperative complications. Microlaparoscopy allows for a direct observation of the perineal dissection from inside the peritoneal cavity, thus avoiding risk of rectal injury. The technique is simple to perform, is non-invasive, and only 15 minutes are added to the operation.

S. De Stefani

C. Trombetta

M. Raber

G. Savaco

U. Moro

E. Belgrano

Microlaparoscopy in Sex Reassignment Surgery

A pilonidal sinus is a subcutaneous sinus containing hair. It is most commonly found in the natal cleft of hirsute men. Here we describe the unusual finding of a pilonidal sinus arising on the male foreskin.

Hugh F. O'Kane

B. Duggan

C. Mulholland

J. Crosbie

Pilonidal Sinus of the Penis

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