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Autonomic dysteflexia is a pathologic reflex which occurs in patients with a spinal cord lesion above T7. The most dangerous manifestation of this reflex is marked increase in systolic and diastolic blood pressure. The trigger is the distension of the urinary bladder, urethra, rectum, or intestine. It can and does occur during radiological examinations such as cystourethrography, loopography, and probably during the barium enema. Because of possible deleterious consequences of marked hypertension, blood pressures in these patients should be continuously monitored during the examinations and appropriate measures immediately instituted should the reaction occur.

Uroradiological examinations on 33 patients subjected to abdomino-perineal resection were analyzed. The most common finding was medial displacement of both ureters, with the right one frequently crossing the midline. Bladder deformity, sometimes severe, was present in all patients. Localized ureteral narrowing due to stricture or recurring neoplasm was found in 30% of the patients examined. Other common complications included retrovesical abscesses, periurethral abscesses, urethral fistulas and strictures, and bladder retention. All these findings were more prominent in men.

In support of the thesis that MRI may replace more invasive angiography in some applications, a total of 28 MR sections are presented to illustrate the vascular anatomy of the abdomen in coronal, transverse and sagittal planes. More than 20 vessels are identified ranging in size from the aorta to the left inferior adrenal vein and the spermatic veins. There is no anatomic continuity in sections made in the coronal and transverse planes; sequential sections of a single patient are presented in sagittal and parasagittal planes, however. The polarity of the images is reversed for ease of comparison with angiograms.

Angiography and nephroangiography has been performed 3 and 6--10 weeks after induced trauma to 18 rabbit kidneys. The lesions, mimicking crush trauma or surgical ectomy, were repaired using a cyano-acrylate. Perinephric tissue was adhered to the wound and made repair easier in crush trauma. In the resected kidneys it constituted a new pelvic wall. The angiographies demonstrated that in essence only the directly traumatized arteries were abnormal, that the cortical lesions were very small and the venous drainage unimpaired. The function, assessed on urograms, was good. No ureteric obstruction was present.

Percutaneous nephrostolithotomy has proved to be a safe and effective approach to the management of upper tract calculi, which is associated with a low rate of significant complications. Bowel perforation is an unusual complication of this technique. We report a case of a nephrocolic fistula following percutaneous nephrostolithotomy, and discuss the diagnosis and management of this rare complication.

Five percutaneous nephropyelostomies were performed on 4 patients with obstructed renal allografts. In all instances the procedure significantly influenced further management of these patients. It allowed pressure measurement within the obstructed collecting system, assessment of renal function after prolonged drainage, and anatomical delineation of the site of the obstruction using antegrade pyelography. Percutaneous pyelonephrostomy and drainage is a useful means to determine whether obstruction or rejection is the major contributor to renal failure following renal transplantation.

The relatively common occurrence of ureteral obstruction in patients with known malignancy elsewhere presents an interesting clinical problem. In those who have undergone abdominal surgery or radiation therapy for malignancy, it is difficult to determine whether ureteral obstruction is the complication of therapy or of recurrent metastatic carcinoma. Transperitoneal thin-needle aspiration biopsy provides an acceptable alternative in determining the true cause of the obstruction. This procedure is competitive with explorative surgery and laparoscopy and is much more specific than CT, excretory urography, and other imaging modalities. In our series of 32 patients, biopsy revealed metastatic tumor in 18 patients, thus altering their clinical management.

Percutaneous nephropyelostomy using the posterolateral approach was employed together with antibiotics and other supportive therapy as the initial step in the treatment of acute pyohydronephrosis, with gratifying results. Percutaneous nephropyelostomy is recommended as the procedure of choice for this specific clinical emergency.