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Nesbit's technique of excising ellipses of tunica albuginea has been effective in correcting chordee in children. We have used this technique successfully in adults for the correction of 19 congenital and traumatic curvatures, as well as those resulting from stable Peyronie's disease. All patients retained potency and reported excellent correction of the deformities. We believe that Nesbit's operation is the procedure of choice for the correction of disabling adult penile curvature.

We favor initial non-operative treatment (suprapubic cystostomy drainage only) for prostatomenbranous urethral injuries in children and adolescents. Non-operative treatment usually results in uncomplicated strictures that can be corrected by a 1-stage transperineal or transpublic operation 4 to 6 months later. A hands-off diagnostic approach, which relies on excretory urography and retrograde injection urethrography to demonstrate partial and complete tears, eliminates the need for blind passage of catheters, an invasive procedure that may lead to complicated strictures unsuitable for a 1-stage repair. If a 1-stage repair is planned it is necessary to determine the length of the stricture, whether there are local complications and whether the anterior urethra can be widely mobilized. The radiographic techniques used to plan a corrective operation and to evaluate the results are described.

Intrarenal reflux found during voiding cystourethrography in children has been suggested to be a significant factor in the production of renal damage. To investigate its incidence and effect on renal growth the records and roentgenograms of 150 children with known vesicoureteral reflux were reviewed. Of these children 15 had evidence of intrarenal reflux. Their IVPs were studied for signs of renal parenchymal damage at the time of the initial voiding cystogram as well as up to 4 years later. Evidence of renal damage was seen in 4 of the 15 patients with intrarenal reflux. These same 4 children had gross vesicoureteral reflux.

We evaluated the anterior extravesical ureteroneocystostomy technique in 184 consecutive renal transplants done in 2 consecutive calendar years. Complications included 5 cases of ureteral and 1 of pelvic necrosis, and 2 of ureteral obstruction, with a ureteral complication rate of less than 4 per cent. All cases of pelvic or ureteral necrosis except 1 were seen in cadaver donor kidneys that were imported from other centers. No bladder complications were seen. Pelvioureteral obstruction, presumably of congenital origin in the cadaver donor, was discovered in the kidney after transplantation in 2 cases and was corrected successfully by pyeloureterostomy to the native ureter. The extraordinary simplicity of this technique, coupled with improvement in the complication rate, makes it our procedure of choice.

We reimplanted 121 ureters by the Cohen technique. A modification is introduced for difficult cases, making the Cohen technique more adaptable for dilated ureters and small bladders. Radiographic studies obtained at least 6 months after reimplantation revealed only 1 case of persistent reflux (grade I), no case of contralateral reflux and no obstruction. Even though the series included 35 ureters with grade V primary reflux and 7 primary obstructive megaureters, only 7 ureters were tapered. This finding suggests that the Cohen method might require tapering in a smaller percentage of cases compared to other reimplantation techniques.

We reviewed 105 patients with rupture of the membranous urethra in whom impassable strictures developed. With 16 years being the division between children and adults there were 73 adults and 32 children. We prefer to repair these strictures with the mobilized anterior urethra if this can be accomplished satisfactorily, rather, than using skin substitution urethroplasties. The mobilized anterior urethra was used in 90 patients: 63 adults and 27 children. The anterior urethra in the remaining 15 patients had been damaged either by a previous operation or by previous disease and needed skin substitution urethroplasty. Techniques, complications and results in the 3 types of repair are presented.

As many as 50 per cent of explorations for intrascrotal masses result in orchiectomy for benign disease. The most common diagnoses are hydrocele, epididymitis and benign testicular tumors. Many of these diagnoses could be made before orchiectomy if the tunica vaginalis and, occasionally, the tunica albuginea were opened, and the lesion biopsied. However, violation of the testicular tunics traditionally has been considered taboo because of the dangers of tumor seeding. In 1906 Chevassu suggested inguinal exploration and occlusion of the testicular vessels before biopsy of suspicious lesions. We have added scrotal hypothermia, double ligation of the gubernaculum before its division and irrigation with distilled water to provide a procedure that adheres to the principles of good cancer surgery. Its use during inguinal explorations for suspicious intrascrotal masses in 5 patients led to a benign diagnosis and preservation of the testis in 3 instances without subsequent testicular atrophy. Its judicious use can decrease the incidence of orchiectomy for benign disease.

Abnormalities of the lower urinary tract are relative contraindications for kidney transplantation that have been overcome by corrective operations or construction of conduits. In our 2 patients with posterior urethral valves and defunctionalized lower urinary tracts kidney transplantation with ureteroneocystostomy and later resection of the valves resulted in satisfactory bladder function and normal voiding patterns. Therefore, urinary diversion was completely avoided.

Stone formation in renal allografts is rare. Although infection or renal tubular acidosis can predispose to calcium deposition in a renal allograft, hyperparathyroidism is usually an accompanying factor. Parathyroidectomy is recommended as the treatment of choice when stone deposition or nephrocalcinosis occurs after transplantation. The reported case demonstrates that aggressive therapy is also necessary to eliminate calculi from the urinary system to avoid mechanical obstruction, continued infection or renal paraenchymal damage.

We herein analyze the results of partial bladder resection in 61 patients with stage A transitional cell carcinoma. Staging was based on preoperative evaluation, operative findings and postoperative microscopic study of the specimen. In 54% of the patients with high grade malignancies local recurrences were noted and the patients eventually died of the disease. There were no recurrences in patients with low grade tumors. Therefore, the grade of bladder carcinoma should be considered when patients are chosen for this operation.

Our experience in the management of difficult vesicovaginal and urethrovaginal fistulas is presented. The fistulas were secondary to radiation damage and extensive local fibrosis owing to previous attempts to repair surgically. Satisfactory surgical repair of the fistulas was obtained by interposition of viable gracilis muscle and labial fibrofatty tissue at the repair site. The patients have been followed for 1 to 2 years postoperatively.