Search

Hypertension in children often is curable surgically. In many instances the causative lesion will be segmental and either vascular or parenchymal. We report on 5 children with a segmental lesion in whom the elevated segmental renal vein renins correctly predicted cure of the hypertension following partial nephrectomy.

Splenogonadal fusion is a rare anomaly to be included in the differential diagnosis of testicular masses. It is often associated with congenital defects, including peromelia and micrognathia. A case is presented and the literature reviewed.

Tumors originating in horseshoe kidneys are rare; only 21 cases of Wilms tumor reported in horseshoe kidneys. A seven-month-old girl with Wilms tumor arising from the isthmus of a horseshoe kidney is reported. The literature is reviewed, and surgical considerations are discussed.

Patients with multicystic kidneys that remained undetected for many years are currently our best source of information on the long-term fate of this type of renal dysplasia. We review 24 cases with adequate data reported in the literature and add 3 personal cases. Significant problems that were encountered and were related to these retained multicystic kidneys include abdominal pain, erroneous diagnosis of renal agenesis leading to repeated unrewarding medical studies for abdominal pain, abdominal mass and renal neoplasm arising in the dysplastic kidney.

Ureteral strictures are uncommon problems in urological practice. The nonvascular application of the Grüntzig balloon catheter is proposed as an alternative to surgery in some of these patients. We treated 6 ureteral strictures in 5 patients by balloon dilation with an 83 per cent success rate.

The histories of 22 infants presenting during the first year of life with obstructive uropathy due to posterior urethral valves were analyzed to determine outcome and prognostic features. Mean patient age at the time of the initial surgical intervention was 39 days, and the mean duration of followup inclusive of renal function data was 5.8 years. One patient died (5 per cent) and one had end stage renal disease. The mean preoperative and postoperative serum creatinine concentrations during the initial hospitalization were 3.1 and 1.4 mg. per dl., respectively. Neither value was significantly predictive of the creatinine concentration at final followup. In contrast, the nadir creatinine value during the first year of life correlated significantly with final renal function. Children with nadir creatinine values less than or equal to 0.8 mg. per dl. by 12 months of age maintained creatinine levels less than or equal to 1.1 mg. per dl. at the time of final evaluation, whereas children with higher values during the first year of life were likely to have progressive renal failure. Of 19 final creatinine determinations 6 were normal and 5 exceeded 1.5 mg. per dl. Proteinuria, hypertension, renal biopsy findings, urinary infection, unilateral nephrectomy and type of surgery did not correlate significantly with functional outcome. Followup studies of longer duration are needed to determine the ultimate outcome of these patients, more than half of whom had some degree of renal insufficiency at final evaluation.

Neonatal bladder rupture is rare. A review of the literature revealed less than 16 cases. A case of posterior urethral valves and associated neonatal ascites due to bladder perforation is presented.

We report a case, which we believe to be the first, of urachal carcinoma presenting as vesicoenteric fistula.

The penis, despite its rich vascular supply, is a very uncommon site of metastatic tumor. When present, the prognosis is extremely poor. Four cases of secondary tumors of the penis are presented and the literature reviewed.