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Ureteroileal stenosis represents a serious postoperative threat to the obstructed kidney and open revision in these patients often is difficult. We evaluated 9 patients with 10 ureteroileal strictures who were treated with semirigid fascial dilators (1), balloon dilation (4) or a combination of balloon dilation and percutaneous intraureteral surgery (4). All 5 patients who had semirigid fascial or balloon dilation alone had early recurrence of the strictures. However, in 4 patients dilation in conjunction with percutaneous intraureteral incision of the stricture through a flexible choledochonephroscope resulted in short-term resolution of each ureteroileal stricture. However, by 6 months these strictures had recurred in 50 per cent of the patients.

The established treatment for ureterointestinal anastomotic strictures is open surgical revision. In an effort to evaluate the efficacy of endourological surgery for this problem, we compared 7 patients (9 strictures) who underwent open revision to 6 patients (7 strictures) who underwent endoscopic incision and balloon dilation of the stricture. The success rate (that is patent ureter and no stent) was 89 per cent for the open revision group and 71 per cent (5 of 7) for the endoscopic group. All open revisions required use of general anesthesia, while 3 of the endoscopic procedures were performed with the patient under assisted local anesthesia. The endoscopic group had markedly shorter hospitalization, decreased blood loss, diminished patient discomfort and no postoperative complications.

IN RECENT years, computed tomography (CT) has been found extremely useful in the diagnosis and management of renal masses. Computed tomography provides an accurate morphological picture of the renal mass, and its precise contrast resolution allows identification of characteristic attenuation values as well. Often, the CT diagnosis is conclusive enough to obviate further diagnostic or preoperative radiological studies.CYSTComputed tomography is highly accurate in the diagnosis of the simple renal cyst and, therefore, is reliable in the differentiation between a cyst and a renal neoplasm. Renal cysts may be cortical, intrarenal, or parapelvic and can be diagnosed confidently when the mass fulfills the following CT criteria: (1) uniform, near-water density attenuation values, (2) imperceptible thickness of wall if a portion of the cyst projects beyond the surface of the kidney, (3) sharp separation from normal renal parenchyma, and (4) lack of enhancement after intravenous (IV) administration of contrast (Fig