The Journal of urology
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The Journal of urology · Apr 1991
Correlation of testicular color Doppler ultrasonography, physical examination and venography in the detection of left varicoceles in men with infertility.
High resolution color Doppler ultrasound is a noninvasive means of simultaneously imaging and evaluating the blood flow to the testes. To define the ability of color Doppler ultrasound to detect clinically evident as well as subclinical varicoceles men referred to our urology division with oligospermia and infertility underwent spermatic vein venography of the left testis if there was physical examination and/or color Doppler ultrasound evidence of a varicocele. ⋯ Of 5 patients with a normal physical examination but with color Doppler ultrasound evidence of a varicocele 4 had a confirmatory venogram, and 1 of 2 patients with a varicocele on physical examination and a normal Doppler ultrasound had a positive venogram. These data suggest that color Doppler ultrasound of the testis may more appropriately direct further invasive testing and therapy of infertile men than physical examination alone.
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The Journal of urology · Feb 1991
Management of posterior urethral strictures secondary to pelvic fractures in children.
Bulboprostatic anastomotic urethroplasty was performed in 20 children with posterior urethral strictures secondary to bony pelvic fractures. The approach was perineal in 4 children and transpubic abdominoperineal in 16, with good postoperative results in 100 and 62.5%, respectively. In some children the urethral disruption occurred within the prostate itself and not at the prostatomembranous junction. ⋯ In the case of common prostatomembranous disruption displacement of the urethra may be significant. In such cases a transpubic approach is preferable. If the proximal sphincteric mechanism is deranged, it can be managed at the same time.
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The Journal of urology · Jan 1991
Case ReportsBladder outlet obstruction due to pelvic lipoma: computerized tomography, magnetic resonance imaging and radiographic evaluation.
We report an unusual case of long-standing bladder outlet obstruction due to pelvic lipoma in a 31-year-old white man. The mass was evaluated by plain film, computerized tomography and magnetic resonance imaging. The differential diagnosis of fat-containing extraperitoneal pelvic masses is discussed.
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The Journal of urology · Nov 1990
Comparative StudyArteriographically determined occlusive disease within the hypogastric-cavernous bed in impotent patients following blunt perineal and pelvic trauma.
To determine the presence, location and pattern of arterial occlusive disease within the hypogastric-cavernous arterial bed in impotent men following blunt perineal and pelvic trauma, we reviewed the selective internal pudendal arteriograms of 20 patients with a history of blunt perineal and 7 with blunt pelvic trauma who had immediate development of impotence. Arteriographic studies of 104 other impotent patients also were reviewed and compared. Patients with persistent impotence immediately after blunt pelvic and perineal trauma had significantly different patterns of arteriographically demonstrated occlusive disease within the distal hypogastric-cavernous arterial bed consistent with the site of the traumatic injury. ⋯ The incidence of a solitary arterial lesion in the cavernous artery without proximal disease was significantly higher (p less than 0.05) in patients with blunt perineal trauma (48%) than in those with blunt pelvic trauma (8%). It is hypothesized that blunt trauma without immediate impotence may be a potential risk factor for later development of arterial vasculogenic impotence, and that unrecognized or seemingly innocuous trauma may be a factor in cases of idiopathic impotence. Patients without trauma and with vascular risk factors have a more diffuse pattern of arteriographically demonstrated arterial lesions.
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The Journal of urology · Sep 1990
Case ReportsResection of nonrenal retroperitoneal tumors with large vena caval thrombi using cardiopulmonary bypass and hypothermic circulatory arrest.
Cardiopulmonary bypass with deep hypothermic circulatory arrest is a useful adjunct in the operative management of renal cell carcinoma associated with large vena caval thrombi. We present 2 patients with nonrenal retroperitoneal tumors and extensive vena caval thrombi who underwent successful surgical treatment with this method. ⋯ Cardiopulmonary bypass with deep hypothermic circulatory arrest is effective in decreasing the operative risk and improving the feasibility of resection in complex surgical cases. Consideration should be given to its use in a wider range of indicated procedures.