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Oxalate nephrosis resulted in progressive renal failure in 4 patients after jejunoileal bypass for morbid obesity. In general, increased levels of oxalates in the blood and urine of such patients result from enhanced absorption of exogenous oxalates. Urinary calculous formation is determined further by concomitant deficiency of inhibitor substances, whereas oxalate nephrosis probably occurs as a result of oxalate deposition in renal interstitium via the blood stream. Clinical manifestations of oxalate nephrosis include pain, infection, hematuria and renal failure. Routine postoperative renal function studies and early renal biopsy in suspicious cases are urged to establish early diagnosis. Continued deterioration of renal function, despite therapy with oxalate restriction and oxalate binding agents, indicates a reversal of the bypass to preserve unaffected renal substance.

In patients with refractory Peyronie's disease, satisfactory sexual rehabilitation with correction of chordee and amelioration of local pain and tenderness can be achieved with wide excision of the plaque, followed by grafting with the tunica vaginalis from the testes. However, one must be extremely careful in assessing and selecting patients for surgery, and at least six months of observation must be allowed. The surgical outcome is most gratifying in patients with “mature” or well-demarcated plaques with progressive chordee. Finally, strict adherence to surgical principles to prevent graft contracture or to minimize its effects is urged.

The original concept of laparoscopy developed as a branch of cystoscopy. Since the use of the Nitze cystoscope at its inception, laparoscopy has kept pace with the innovations in our cystoscopic inventory. The recently emerging interest of urologists in utility of the laparoscope for a variety of urologic surgery is a welcome renascence of this procedure, which has been used mainly by our gynecologic colleagues, in part because of our own lack of pursuit in its development. Laparoscopy should now become an integral part of our urologic teaching and practice.

During a 30-month interval 26 patients underwent pyelolithotomy or upper ureterolithotomy through the dorsovertical lumbotomy approach. The intraoperative course and postoperative performance were compared to those in a similar group of patients operated upon using the standard flank incision. Our analysis established the superiority of the dorsovertical lumbotomy incision for all factors evaluated, especially postoperative drainage, analgesic use and hospital stay. The surgical steps are described in detail and the relative contraindications are discussed.

In male patients with extravesical ureteral ectopia the ectopic orifice does not cause urinary incontinence and the diagnosis is often delayed. We describe our experience with 12 male patients who had extravesical ureteral ectopia. According to the embryologic phenomena leading to such anomalies we have classified them into mesonephric ductal ectopia and urogenital sinus ectopia. Distinctive clinical and radiologic features of these 2 types of ureteral ectopia are discussed. Guide lines to surgical therapy are based upon the type of ectopia, function of the affected kidney or renal segment and whether a single or duplicated ureteral system is affected.

Ureteral strictures occurring after ureterolithotomy may not be recognized until obstruction or recurrent stone impaction occurs in the area. We describe our treatment of this problem in 9 patients. Management varied from conservative treatment in patients having no discernible renal function on the affected side to various forms of reconstruction or reimplantation, depending upon the situation and site of the stricture. All patients were followed for a minimum of 2 years without complications. The etiopathogenesis and other methods of treatment available for this problem are discussed.

During the last 12 years 18 patients with urinary calculi were found to have associated cystic renal disease. We herein describe the difficulties in diagnosing and in treating this group, which included patients with simple single renal cysts, multiple cysts of 1 or both kidneys and polycystic renal disease. Renal calculi may be caused by or perpetuated by renal cystic disease. After spontaneous passage or surgical removal renal calculi may recur as long as renal cysts continue to cause urinary stasis owing to obstruction and distortion of the renal calices. Superimposed renal infection may cause further difficulties in diagnosis and treatment. The timely removal of calculi and the relief of obstruction caused by the cysts and stones are emphasized. We further recommend the judicious use of antibiotics, correction of electrolyte disturbances and prolonged followup in an attempt to prevent future calculous disease.

We present our experience during a 22-year period with the management of 53 patients in whom vesicoureteral reflux was associated with obstructive prostatic disease. There were 45 cases of benign prostatic hyperplasia and 8 cases of carcinoma of the prostate. After prostatectomy medical management of reflux was successful in controlling urinary infection in 34 patients and an operation was performed in 19. Each patient was followed for at least 1 year.

Of 269 patients with bladder neoplasms treated during a 20-year period 47 had associated vesicoureteral reflux. All 47 patients were followed for 3 years or more, or until death. Upper urinary tract transitional cell cancer developed in 3, each of whom had recurrent bladder cancer. Among the 222 patients who had vesical cancer without reflux transitional cell carcinoma of the ureter developed in only 1, 11 years after transurethral resection for a bladder tumor. The incidences of upper tract transitional cell cancer in patients with and without vesicoureteral reflux were 6.4 and 0.44 per cent, respectively, which support the suggested role of reflux in disseminating or seeding of cancer cells from the bladder into the upper urinary tract. Patients with bladder cancer and associated vesicoureteral reflux have an approximately 15-fold greater risk of upper tract cancer developing compared with those without reflux. We recommend vigilant scrutiny of patients with recurrent bladder cancer and associated vesicoureteral reflux for early detection of upper urinary tract transitional cell carcinoma.