Biomedical subjects
Publications and source records attributed to A W Wyker.
Diverticula of the male posterior urethra are uncommon and usually acquired. We report a case of a large posterior urethral diverticulum that developed after radical retropubic prostatectomy. The etiological factors of male diverticula are discussed.
Extracorporeal shock wave lithotripsy was used for the treatment of 1,252 kidneys and ureters with calculi during a 10-month period at the authors' medical center. Before lithotripsy was performed, excretory urography, radiography, renography, computed tomography, and ultrasound studies were done, when necessary, to locate the calculi. Nine calculi in five kidneys could not be fragmented with lithotripsy. Of 895 patients with calculi less than 2.5 cm in diameter, only 13 (1.5%) required interventional procedures to clear the calculi, whereas of 161 patients with calculi greater than or equal to 2.5 cm, 36 (22.4%) required nephrostomies. A column of calculous debris in the mid and distal portions of the ureter (steinstrasse) was seen in 171 instances (13.6%) after lithotripsy; 62% required interventions. The most common intervention required for successful lithotripsy was retrograde ureteral catheterization. Evaluation and treatment of patients with urolithiasis were largely dependent on radiography and excretory urography.
Among 1,500 patients treated with extracorporeal shock wave lithotripsy, 1,300 had calculi less than 2.5 cm in diameter and 200 had calculi of 2.5 cm or larger. Although most patients did well and required no further radiologic intervention, 178 interventional radiologic procedures were performed. Urinary tract obstruction often developed in patients with large stones when the collecting system filled with stone fragments (steinstrasse). Nephrostomy was performed in 5.3% of the total patient population and in 29% of the patients with stones measuring 2.5 cm or more. Only 1.8% of the patients with calculi smaller than 2.5 cm required radiologic intervention. When the obstructed collecting system could not be crossed with conventional angiographic techniques, the stone fragments were removed through a percutaneous nephrostomy tract either by flushing or by suctioning with a pulsating water jet.
The diagnosis of obstructive uropathy may be difficult in the occasional case in which there is little or no dilatation of the collecting system. A case is presented in which anuric renal failure resulted from encasement of the ureters by tumor. The excretory urogram revealed a delayed pyelogram and a dense nephrogram with minimal dilatation of the collecting systems. The combination of a dense nephrogram and delayed pyelogram should raise the possibility of obstruction, regardless of the appearance of the collecting systems.
Between 1961 and 1976, 13 carefully selected female patients with neurogenic bladders and incontinence refractory to other conservative therapy (9 patients) or deteriorating upper urinary tracts (4 patients) underwent anterior urethral transposition. Followup averaging 6 years revealed minimal stomal problems and excellent preservation of renal function. The surgical technique with modifications is presented.
Two cases of renal cell carcinoma associated with polycystic disease of the kidney are presented. The literature is reviewed and the angiographic findings are discussed. These cases suggest that angiography is necessary to make the diagnosis of renal tumors associated with renal polycystic disease.
The technique of intraoperative compression cystourethrograms is described. This procedure has proved to be a safe, reliable objective means of determining adequate destruction of the valvular tissue is complete, the characteristic dilatation of the posterior urethra seen on preoperative cystourethrograms immediately disappears.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.