This study demonstrates that the chemical composition of urinary calculi can be accurately determined by CT scanning in an in vitro setting.

Transurethral sphincterotomy is a commonly performed operation in spinal cord injury patients. Sixty-three patients who have had transurethral sphincterotomy were evaluated at our spinal cord injury unit for the risk and possible predictors of long-term outcome associated with this procedure. In addition to history and physical examination, all patients had urine culture, blood urea and creatinine, intravenous pyelogram and/or KUB with renal ultrasound, 4 channel videourodynamics, voiding cystourethrogram, and cystocopy when indicated. Their mean age was 53 years, and their level of injury was cervical 32, thoracic 25, and lumbar 6. The mean time since injury was 27 years (3-50), and the mean follow-up since their last sphincterotomy was 11 years (2-30). The mean number of sphincterotomies was 1.74 (1-4). Urine culture revealed bacteruria (asymptomatic) in 48 and sterile urine in 15 patients. Renal function was normal in 61 patients and abnormal in 2 patients. Videourodynamics revealed detrusor hyperreflexia in 60, detrusor areflexia in 3, abnormal detrusor compliance in 9, and detrusor sphincter dyssynergia in 34 patients. The mean Leak point pressure was 36.4 cm H2O (5-100), and the mean maximum detrusor pressure was 54.7 cm H2O (12-100). Nineteen (30%) patients had significant upper tract complications including; renal calculi, atrophic kidney, vesicoureteral reflux, and renal scarring with impaired renal function. Fifty percent of upper tract complications developed more than 2 years after sphincterotomy. Thirty patients had lower tract complications including; recurrent symptomatic urinary tract infection, bladder stones, urethral diverticulum, urethral stricture, bladder neck stenosis, and recurrent epididymitis.(ABSTRACT TRUNCATED AT 250 WORDS)

We report a case of a large perforated adenocarcinoma of the rectum manifesting as an ischiorectal abscess progressing to Fournier's gangrene in an insulin-dependent diabetic man. Recognition and management of this rare syndrome in the setting of a common disease is discussed.

Extracorporeal shockwave lithotripsy (SWL) is currently accepted as an effective noninvasive treatment for a wide variety of urinary tract calculi. However, the bioeffects of high-energy shockwaves on renal parenchyma have yet to be fully elucidated. The objective of this study was to measure the acute changes in regional renal hemodynamics associated with SWL utilizing dynamic gadolinium-DTPA-enhanced magnetic resonance imaging (MRI). Seven patients who underwent SWL for renal calculi had an MRI study within 4 hours after the treatment. To assess renal hemodynamics, a bolus of Gd DTPA (0.03 mmol/kg) was administered, and dynamic contrast enhanced images was obtained. Regions of interest (ROI) were defined over the cortex and medulla to obtain signal intensity-v-time curves. The contralateral kidney in each patient was used as the control. The initial slope of the contrast-enhanced signal intensity-v-time curve was used as a measure of the perfusion index (PI). In six patients, perfusion imaging showed a consistent trend of decreased cortical flow (29+/-8%) and a concomitant increase in medullary flow (34+/-14%) in the region of the kidney that was targeted with SWL in six patients (86%). This study shows that renal hemodynamics are modified by SWL. We hypothesize that this change represents a shunting of flow from cortex to medulla in an attempt to prevent ischemia of the medulla.