6 cases of parameatal urethral cysts are reported in 3 males and 3 females. The condition is considered to be rare. The aetiology is thought to be obstruction of the para-urethral ducts possibly due to infection. The treatment of choice is complete excision.
Objective To compare renal cell carcinomas (RCCs) presenting incidentally in patients referred for lower urinary tract symptoms (LUTS) with those presenting symptomatically, by stage, intervention and outcome. Patients and methods The case notes of all male patients (100) diagnosed with RCC between 1991 and 1998 were reviewed and modes of presentation recorded. The patients were divided into two groups: those who were referred with LUTS (frequency, urgency, hesitancy, poor stream, nocturia) and in whom RCC would not have been suspected and was thus detected incidentally on routine ultrasonography; and all patients in whom carcinoma might have been suspected from their symptoms but, for the purposes of this study, also included patients in whom RCC was diagnosed during ultrasonography for unrelated intra-abdominal pathology. Details of diagnostic imaging and clinical staging were similarly recorded for both groups and where surgical intervention was undertaken, histopathological data were also noted.The clinical course and long-term outcome of incidentally detected tumours was then compared with their symptomatically presenting counterparts. Results The mean (range) follow-up for all patients was 30 (1.5±96) months; for those in the incidental group it was 31 (1±86) months and in the symptomatic patients 29 (1±96) months. Organ-con®ned disease was found in two-thirds of patients with incidental tumours and in 38% of those in whom the tumour may have been suspected; the difference was statistically signi®cant (chi-squared test P<0.05). The mean (SD) size of tumours discovered incidentally and in symptomatic patients was 5.9 (1.94) cm and 9.2 (3.39) cm, respectively; this difference was also statistically signi®cant (t-test, P<0.001). Of the 24 patients with incidentally detected tumours, 14 (58%) were alive with no recurrence, and of the 76 presenting symptomatically, 27 (35%) were alive with no recurrence at the last follow-up; disease survival curves showed a statistically better survival rate for those with organ-con®ned tumours. Conclusion Incidentally diagnosed RCC represents a signi®cant proportion of those who are ultimately diagnosed with the malignancy. Opportunities which arise for appropriate screening of the upper tracts during routine urological investigations (e.g. ultrasonography of the upper tracts in patients referred for LUTS) should be endorsed, contrasting with the more traditional approach, which argues that it yields no ultimate survival advantage.
Summary:Purpose: Intraoperative magnetic resonance imaging (IMRI) is an extremely useful neurosurgical tool in surgeries in which the extent of resection is known to have a significant impact on outcome. Residual hippocampus is the most common cause of recurrent seizures after temporal lobectomy for medial temporal lobe epilepsy. Although the risk/ benefit ratio of a policy of universal radical hippocampal resection is not known, we hypothesized that IMRI would aid in the intraoperative assessment of the extent of hippocampal resection and assist in accomplishing a complete hippocampectomy.Methods: Five consecutive patients with medically intractable medial temporal lobe epilepsy underwent a radical amygdalohippocampectomy as part of the their surgery for epilepsy. IMRI was used before surgery and after an initial resection. The quality of images was assessed. Postoperative MR images were evaluated by a radiologist to determine the extent of resection of the amygdala, hippocampus, and parahippocampal gyrus.Results: There were no perioperative infections. After a mean follow-up of 10 months, all patients are seizure free. T 1 -weighted coronal intraoperative images were judged adequate at visualizing the medial structures in all patients. T 2 and fluid-attenuated inversion recovery (FLAIR) images did not provide useful information. Postoperative MR images indicated that a complete hippocampectomy had been achieved in all patients.Conclusions: IMRI is a useful adjunct in the surgical treatment of medial temporal lobe epilepsy and perhaps the most reliable method of standardizing a complete hippocampectomy. T 1 -weighted coronal images are the most helpful sequence.
The patterns of venous drainage of the testis and scrotum have been evaluated in patients with varicocele by a variety of radiological procedures, including left renal venography, and at the time of operation by ascending venography and retrograde injection of contrast medium into prominent varicosities. These studies have allowed classification of the system of veins involved in the condition into several groups, including involvement of the internal spermatic vein alone, pure cremasteric varicocele, mixed internal spermatic and cremasteric varicosities in one or both systems with valvular incompetence or mere dilatation without apparent incompetence of valves. As a result, an anatomical approach to the surgical management of varicocele is suggested which attempts to place the operative treatment on a more rational basis appropriate to each case.
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