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Complications of voiding cystourethrography are infrequent. We report a rare complication of knotting of the catheter within the bladder, necessitating surgical removal of the catheter through the urethra.

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The authors report a child who presented with massive hematuria after blunt trauma to a hydronephrotic kidney (ureteropelvic junction stenosis). The insertion of a nephrostomy tube effectively decompressed the injured kidney and enabled an early reconstructive repair of the stenosed ureteropelvic junction.

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STUDY OBJECTIVE: To evaluate the opioid-sparing and analgesic effect of diclofenac sodium in ambulatory nonimmersion extracorporeal shock wave lithotripsy (ESWL). DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Large referral hospital. PATIENTS: Twenty-seven ASA physical status I and II patients with upper renal tract nephrolithiasis. INTERVENTIONS: ESWL was performed with a sedative-analgesic technique. Diclofenac sodium 75 mg or an equal volume of saline was given intramuscularly 45 minutes prior to the procedure. Fentanyl and midazolam were added to maintain adequate sedation and analgesia. MEASUREMENTS AND MAIN RESULTS: Demographically, both groups were comparable. In the diclofenac sodium group, heart rate was slightly higher, treatment time was shorter, more shock waves were administered (p < 0.02), and less fentanyl was required (p < 0.02). Mean arterial pressure was lower and arterial oxygen saturation by pulse oximeter was higher in the diclofenac sodium group. There were no differences between the groups in voltage, stone size, fragmentation, dose of midazolam administered, or overall assessment by both the doctors and patients. CONCLUSIONS: Patients administered diclofenac sodium received a greater number of shock waves, required less fentanyl, and showed a marginal improvement in hemodynamic stability and oxygenation during ambulatory nonimmersion ESWL.

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A new, original self-retaining intraurethral catheter (IUC), 30-60 mm long, was inserted into the urethra and bladder neck in 34 patients with urinary retention due to benign prostatic hyperplasia. The placement of the IUC is easily done under local anesthesia in the outpatient clinic. Before insertion, all the patients had had an indwelling catheter for weeks or months. In 29 patients (85.3%) the IUC was left in place from 2-38 weeks (mean 13.8). These patients voided satisfactorily and were fully continent. In 5 (14.7%) the IUC had to be removed after several days because of severe frequency or residual urine, the result of improper placement of the IUC. In 4 other patients (11.8%) the IUC was removed after 3-12 weeks because of obstruction by stones after extracorporeal shock wave lithotripsy, or because of difficulty in voiding during therapeutic diuresis for pulmonary edema. Based on our experience, it is suggested that this new device may avoid the use of the standard indwelling catheter in patients with urinary retention caused by intravesical obstruction. It may also be an alternative to prostatectomy in patients at high risk for surgery.

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We report a case of an elderly female with a history of long-standing urinary tract infection, who developed sudden macroscopic hematuria. A renal clear-cell carcinoma with diffuse pyelonephritis and malakoplakia was discovered at nephrectomy. This is the first neoplasia of the kidney associated with malakoplakia ever published.

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The authors report 25 cases of primary stenosis of the pyelo-ureteric junction (PUJ) in terms of their clinical and histological features. Based on a semi-quantitative study of the histological modifications, the authors attempt to determine whether these modifications are primary and therefore responsible for the stenosis of the PUJ or wether, on the contrary, these changes are secondary to the stenosis. After studying 25 children and adults, it appears that these histological signs are primary and responsible for the malformation: rarefaction of the muscle layers (24 cases out of 25), fibrosis of the sub-mucosa or intermuscular layer in every case, presence of valvular mucosal folds in every case but one.

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The authors report 3 new cases of inverted bladder papillomas, the first presenting with hematuria and the others at the time of urological examination for dysuria due to prostatic hypertrophy. Intravenous urography showed the tumour as a regular polycyclic filling defect of the base of the bladder. Macroscopically, such tumours are polypoid, whitish-grey and firm in consistency. Histologically, they are surrounded by a thin paramalpighian epithelium from which there is deep penetration of layers of tumour with an intact basal membrane and well differentiated paramalpighian type tumour cells without mitosis. The authors feel that this particular type of benign tumour develops from the sub-trigonal glands of Home, passing via the intermediate stage of the islets of von Brunn. The special histological characteristics of these inverted bladder papillomas suffice to distinguish them from other epithelial tumours with an uncertain prognosis.

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