Biomedical subjects
Publications and source records attributed to G Menezes de Góes.
Although rare, the prolapsed ureterocele constitutes a urologic emergency that can rapidly evolve to severe conditions due to congestion and necrosis, and to obstruction of the urinary tract. A simple external resection resolves the emergency, allowing a postoperative investigation of the whole urinary tract to be performed, in order to adequately prepare urinary reconstruction.
42 dilated renal units, from 32 patients, were evaluated renographically with 131I, under diuretic stimulus, with the aim of differentiating between obstructed and atonic ureters. The results of this study are similar to the clinical follow-up and surgical findings in 88% of cases.
We report an unusual case of a ureterocele in a duplex system, which was associated with an ectopic (vulval) upper moiety ureter. This is the second case reported in the literature of a ureterocele arising from the lower pole ureter. Surgical treatment consisted of removal of the upper segment of the kidney and its ureter. The ureterocele was excised and the lower pole ureter was reimplanted in the bladder. At followup 14 years postoperatively the patient was cured and free of urinary infection.
The efficiency of and complications in 65 cases of colonic conduit have been studied (64 cases of bladder exstrophy and 1 case of cloacal exstrophy). For the ureterocolic reimplantation, we employed the Leadbetter technique and a modified kelalis technique. The results after 1-12 years in 128 renoureteral units showed 28 complications (21 obstruction and 7 refluxing units). Other types of complications have been observed and reported in this work. The high incidence of obstruction was probably due to the long submucous tunnel in the ureterocolic reimplantation. We believe that the sigmoidal conduit is an adequate method for temporary or permanent diversion.
An extravesical antireflux technique was performed in 300 consecutive patients who presented primary vesicoureteral reflux (VUR). The following results are reported: Elimination of VUR in 99% of the cases without complications. Early complications reported include: urinary retention, suppurative pyelonephritis and fistulae. Urinary retention occurred in 2 patients presenting other congenital abnormalities. Vesicocutaneous fistulae occurred in 2 patients due to obstruction of the catheter for vesical drainage; they closed spontaneously under adequate drainage of the bladder. Suppurative pyelonephritis and/or anuria occurred in 6 patients due to transitory obstruction due to edema of the new vesicoureteral junction and were treated with bilateral nephrostomy and progressed with good results after withdrawal of the nephrostomies. Late complications included: persistence of VUR in 8 patients due to two types of technical failure, too short a tunnel and dehiscence of the muscular suture; obstruction of the new vesicoureteral junction in five ureters due to three causes, excessive dissection of the ureters, mucosal stenosis and stenosis of the new hiatus; contralateral reflux in 6 patients due to nonsystematical performance of endoscopic examination of the ureteral meatus preoperatively in the first series of 100 consecutive cases. On the basis of the results achieved, the authors give specific suggestions that allow the technical prevention of the small number of complications that may occur using the extravesical antireflux technique in the treatment of VUR.
Due to better methods of diagnosis, an increasing number of children with renovascular hypertension are being discovered. The disease itself has variable clinical manifestations, and an adequate laboratorial workup, including arteriography and renin assays, is mandatory in suspected cases. Treatment depends on the prognostic values of the renin assays and surgery cures 80% of the patients, either by nephrectomy or by revascularization techniques. Among these, renal autotransplantation gives better exposure of the operative field, and therefore better results. In most cases, systemic infection seems to be the main cause of the inflammatory reaction within the arterial wall that causes obstruction.
Studies on the relationship of fertility and renal transplantation are relatively recent. Data related to the sexual aspects of uremic patients before and after renal transplantation are available. Information about spermatogenesis, as offered by testicular biopsy, is scarce. The present study has as its objective the quantitative analysis of testicular biopsies obtained pre- and postoperatively from the renal transplant patients after normalization of the renal function.
A new, staged approach to reconstruction of bladder exstrophy utilizing four surgical procedures is presented. This approach presents all the complications usually seen in functional reconstruction of this anomaly.
Testis biopsy was performed on 78 rats in order to compare needle and surgical biopsies. The rats were autopsied 7, 15, 30, 60, and 90 days after biopsy. Both techniques provided tissue of equally good quality for histopathological examination and led to irreversible hypospermatogenesis of the biopsied and the contralateral testes.
A case of female urethral diverticulum is reported by the authors. It is a rare disease and about 31 cases have previously been described. An analysis is made in relation to the diverticulum of the urethra and to female urethral carcinoma. Emphasis is given on the semiology and the recently acquired diagnostic procedures, as these have led to an increased number of recognized cases. In the case presented, an extended resection and a definitive urinary derivation was performed, together with chemo- and radiotherapy. A follow-up of 2.5 years showed no signs of recurrence or metastases.
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A new technique for microvascular anastomosis of the polar artery to the renal artery, end to side, is presented. It was performed in 5 cases of renal transplantation with a successful result in all.
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