General features. Haemangiomas are benign vascular tumours. They can regress spontaneously as a result of fibrosclerosis, suggesting a conservative approach wherever possible. Asymptomatic haemangiomas do not require treatment. Renal haemangioma. In all, 198 cases have been reported. The lesion is usually solitary and unilateral and occurs most often in the pyramid, and in the mucosa or subepithelial tissue of the pelvis. In some cases a tentative diagnosis of haemangioma has been made by means of selective renal angiography and pre- or per-operative renoscopy. Partial nephrectomy is recommended in cases of minor haemangioma. Ureteric haemangioma. Six cases have been described. When haemangioma is suspected a conservative operation is recommended. Bladder haemangioma. A total of 106 cases have been reported. Many of the tumours had the characteristics of an iceberg, with considerable extravesical extension making endoscopic management less suitable because of the possibility of massive haemorrhage or recurrence. Consequently, many authors prefer local excision. In the case of endoscopic treatment the patient should be prepared for open surgery. Urethral haemangioma. Twenty cases have been described. The lesions often extend further than is immediately apparent. Endoscopic management is recommended for small lesions and, in the case of more extensive lesions, open exploration is advised followed by appropriate urethral reconstruction.

Urinary acidification ability, acid-base status and urinary excretion of calcium and citrate were evaluated in 10 women with bilateral medullary sponge kidney (MSK) and in 10 healthy women. Patients with MSK had higher fasting urine pH compared to normal controls (p < 0.01). Four patients had incomplete renal tubular acidiosis (iRTA), 3 had hypercalciuria, and 5 patients had hypocitraturia. The 24-hour urinary excretion of calcium was increaed in the females with MSK (5.23 ± 0.78 mmol) compared to the healthy females (3.49 ± 0.29 mmol) (p < 0.02), and increased in MSK patients with iRTA (7.32 ± 1.45 mmol) compared to patients with normal urinary acidification (3.83 ± 0.12 mmol) (p < 0.01). The patients with iRTA had reduced levels of plasma standard bicarbonate (20.5 ± 1.0) after fasting compared to patients with normal urinary acidification (23.8 ± 0.8) and healthy women (22.7 ± 0.6) (p < 0.01), and reduced levels of 24-hour urinary excretion of citrate (0.93 ± 0.25 mmol) compared to patients with normal urinary acidification (3.58 ± 0.51) and healthy women (2.78 ± 0.49) (p < 0.005). A positive correlation was found between the degree of acidosis during ammonium chloride loading and urinary excretion of calcium (r = 0.71, p = 0.02), and a negative correlation between the degree of acidosis during ammonium chloride loading and urinary citrate excretion (r = 0.87, p = 0.001). The results suggest that defective urinary acidification might play an important role in the mechanism of hypercalciuria and hypocitraturia in patients with medullary sponge kidney. Furthermore, our data suggest that in the group of patients with bilateral MSK there might be two categories. In one category, iRTA is present. The main metabolic lithogenic factors in this group appear to be increased urinary excretion of calcium, decreased urinary excretion of citrate and increased urine pH. The other category does not have iRTA, and the metabolic abnormalities related to stone disease are much less pronounced.

In a consecutive series of 62 patients with renal carcinoma transvascular embolization has been evaluated in regard to its limitations, complications, influence on the surgical procedure and success of treatment. Of 47 planned embolizations 36 could be accomplished. Total embolization was achieved in 29 of the 36 cases (81 per cent). One case was complicated due to displacement of the embolization material to the femoral artery. The subjective impression of the surgeon was that embolization facilitated nephrectomy, although this could not be proved by objective measurement of the duration of operation and perioperative blood loss. Survival after embolization and nephrectomy was no better than after nephrectomy alone.

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A multifocal cavernous hemangioma was found in the renal pelvis of a young male, in whom intermittent macroscopic hematuria developed. Selective angiography was found to be normal on two occasions. By means of preoperative ureterorenoscopy a presumptive diagnosis of hemangioma was made. Nephrectomy was performed because the location of the lesion precluded partial nephrectomy.