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Background. Single wedge biopsy of cadaveric kidneys from donors older than 55 is currently the standard method of evaluating their viability for transplantation. The degree of glomerulosclerosis presently determines whether a kidney can be transplanted, but most biopsies sample only the subcapsular region and may not accurately represent the true renal architecture. Our study evaluated the accuracy of transplant suitability determinations based upon the single wedge biopsy of cadaveric kidneys. Methods. We took kidneys that were refused by UNOS centers on the basis of biopsy results, examined their histology in detail, and reviewed donor medical histories. Sections were taken from the upper, lower, and mid-portion of each kidney and stained with the periodic acid Schiff stain. Percentage and location of glomerulosclerosis and other relevant pathology were then determined in each section. We compared our findings with the results of the original wedge biopsies obtained at the time of procurement. Results. Nine kidneys were obtained and examined. The wedge biopsies at the time of procurement showed glomerulosclerosis ranging from 8 to 36% (median 17%). The multiple kidney sections we analyzed showed fewer sclerosed glomeruli, ranging from 3 to 15% (median 7%, P

Background/Purpose: The optimal surgical technique for orchiopexy is controversial. Studies have shown that adequate fixation can be obtained using a subdartos pouch alone; however, transparenchymal suture fixation with a permanent suture frequently is used to provide additional security and for the treatment and prevention of testicular torsion. In previous studies, the suture has been placed through the tunica albuginea. This could have a detrimental effect on future spermatogenesis. Polypropylene has been shown to have the least histological change and is considered to be the suture of choice. However, polypropylene is a stiff suture and can be disconcerting for the patient when left in place. Polytetrafluoroethylene (PTFE) is a soft, permanent suture used widely in vascular surgery because of its handling characteristics. In this study, the authors compare the histological changes caused by PTFE and polypropylene. Methods: Bilateral orchiopexies were performed in 36 Sprague-Dawley rats. All rats were 27 to 31 days old and weighed 75 to 100 g at the time of orchiopexy. The animals were divided into 3 groups receiving polypropylene and PTFE, silk and PTFE, or polypropylene and silk. After 30 days, all rats were killed, and the testes were harvested. The testes were step sectioned and examined for histological changes. These changes were graded by a pathologist in a blinded fashion. Results: The data obtained were statistically analyzed. The superficial histological changes associated with transparenchymal fixation by polypropylene, PTFE, and silk were significantly different, but the parenchymal changes were not. Conclusions: PTFE causes no greater histological change than polypropylene. In light of the PTFE's softness and superior handling characteristics, the authors recommend the use of PTFE when a permanent suture is used in orchiopexy.

The combination of bladder exstrophy and gastroschisis has not been reported previously. The authors describe this rare combination of congenital anomalies, as well as the successful multidisciplinary management of this unusual problem.

An 11-year-old boy with bladder extrophy was treated ultimately with an ileocystoplasty and a catheterizable stoma. In attempting to drain his bladder via intermittent catheterization, the catheter became lodged. This case details the surgical treatment of a knotted catheter in an urinary reservoir.

A 34-year-old white man presented elsewhere with a painful lesion on the left side of the penis 6 months in duration. He was otherwise healthy. On voiding some spraying of the urinary stream was evident. Physical examination revealed no lymphadenopathy. Biopsy revealed squamous cell carcinoma. Computerized tomography (CT) of the abdomen and pelvis was negative for lymphadenopathy. Partial penectomy was performed, and diagnosis was stage T2 squamous cell carcinoma of the penis based on TNM classification. Margins were negative, and the grade was intermediate. The patient was referred to us. He refused inguinal node dissection, and sentinel node biopsy with lymphoscintigraphy was performed 2 months postoperatively. Injections of 11.1 mbq. technetium (Tc) radioisotope filtered (pore size 0.22 m.) with 0.3 cc sulfur colloid throughout the left distal part of the penis were in a semicircular pattern, just past that midline. Radiographs taken immediately showed 2 lymph nodes had taken up the Tc (fig. 1). Then 2.5 cc isosulfan blue were injected into the penis in a similar manner. A g probe was used to locate the lymph nodes which were areas of intense g radiation. Small incisions were made over the areas of intense radiation. Dissection was taken down to the lymph node aided by the probe and readily visible blue dye (fig. 2). The first lymph node gave off 3,900 counts per second. Following its removal the background radiation was only 35 counts per second. The second lymph node gave off 3,461 counts per second. Following its removal the remaining radiation was 50 counts per second. The lymph nodes were about 8 mm each. Pathological evaluation was negative for metastatic disease in both lymph nodes. At 2-month followup the patient was well. Physical examination was negative for cancer recurrence and lymphadenopathy. At 10 months after partial penectomy and 8 months after lymphoscintigraphy there was no disease recurrence.