Alan H. Bennett

Polychlorobiphenyl congeners, p,p'-DDE, and sperm function in humans

Abstract170 seminal samples from fertile men, men with idiopathic oligospermia or azoospermia and men status post vasectomy were analyzed for 74 polychlorobiphenyl (PCB) congeners,p,p′-DDE, mirex, and hexachlorobenzene using the technique of glass capillary gas chromatography with electron capture detection. Low concentrations of 32 PCB congeners were measured (mean total PCB residue of 5.8 ng/g wet weight). The application of multiple linear regression analysis to the data is described and the result is critically evaluated. There is a correlation between sperm motility and count. There are indications that the concentrations of three PCB congeners (2,4,5,2′4′5′- and 2,4,5,2′3′4′-hexachlorobiphenyl and 2,4,5,3′4′-pentachlorobiphenyl) are inversely correlated with sperm motility index in samples with a sperm count less than 20 million cells/ml. The implications of the discerned associations are discussed.

An Improved Vasoactive Drug Combination for a Pharmacological Erection Program

Papaverine hydrochloride (smooth muscle relaxant), phentolamine mesylate (alpha-adrenergic blocking agent) and prostaglandin E1 (vasodilator and smooth muscle relaxant) were combined to produce a potent vasoactive drug therapy for use in a pharmacological erection program. Doses of 2.5 cc papaverine (30 mg./cc), 0.5 cc phentolamine (5 mg./cc), 0.05 cc prostaglandin E1 (500 micrograms./cc) and 1.2 cc 0.9% normal saline were combined to produce a vial of 4.25 cc for patient convenience. Twenty unit vials were made from the 1 cc vial of prostaglandin E1, the most expensive ingredient. The solution is physiologically active for at least 6 months and can be stored at room temperature although refrigeration is recommended. The pH of the solution is 4. This vasoactive drug combination has been used in 116 patients for diagnostic testing and subsequent treatment. A dose of 0.25 cc has been effective for diagnosis and treatment in the majority of patients with mild to moderate arteriogenic and/or venogenic and diabetic impotence. For patients with neurogenic dysfunction 0.1 to 0.125 cc was the usual dose. Two patients had a prolonged erection requiring irrigation, 1 on the day of initial testing and 1 on home therapy. Pain at the site of injection or during intercourse was noted in only 2 patients and to date no fibrosis or plaques have been found.

Reconstructive Surgery for Vasculogenic Impotence

A multidisciplinary approach was used to diagnose 12 patients with vasculogenic impotence. Deep dorsal vein ligation was performed in 8 men to treat venous incompetence. Venous arterialization according to the technique of Virag was used in 4 men to treat arterial inflow insufficiency. A 75 per cent success rate was noted for the correction of venous incompetence. With an average followup of 1 year, excellent success was achieved in re-establishing corporeal blood flow with the technique of venous arterialization plus creation of a venocorporeal shunt.

Management of bladder stones: Should transurethral prostatic resection be performed in combination with cystolitholapaxy?

We report our institutional experience and review the literature in the management of bladder stones, with particular attention to combined cystolitholapaxy and transurethral prostatectomy. Vesical calculi are associated with obstructing prostatic hypertrophy two thirds of the time. Combined cystolitholapaxy and transurethral resection of the prostate have significant morbidity.

Penile xenon (133Xe) washout: A rapid method of screening for vasculogenic impotence

The radioactive inert gas xenon (133Xe) is a well-established isotopic indicator used to assess vascular status in many organ systems. We employed xenon-133 to evaluate male impotence. Xenon-133 was injected subcutaneously at the level of the coronal sulcus in the detumescent state. Using the gamma camera, sequential images were obtained and computer-generated curves calculated. The clearance time for 50 per cent washout of the injected 133Xe (T1/2) was then calculated for each patient, as well as a control group. Preliminary findings indicate a correlation with such established techniques of evaluating erectile impotence as history, physical examination, penile pulse Doppler tracings, and brachial-penile blood pressure index. The xenon-133 washout study was a rapid, minimally invasive, reproducible, and cost-effective method of screening those impotent patients for vasculogenic etiology of their erectile impotence. We recommend the addition of this method to the surgeon engaged in the care of impotent males.

Applications of Microsurgery in Urology

The applications of microsurgery in urology have increased in the decade since urologists first used such techniques. The primary uses for microsurgery in urology at first were vasovasostomy, vasoepididymostomy, and testicular autotransplantation. Penile revascularization has recently become another procedure for which microsurgery is used with increasing frequency. As more urologists learn the techniques, other urologic applications for microsurgery surely will develop.

Use of single J urinary diversion stents in intestinal urinary diversion

A review of the past twenty months of intestinal-urinary diversion with use of the single J urinary diversion stents at Albany Medical Center Hospital and the Albany Veterans Administration Medical Center resulted in no ureteroileal anastomotic fistulas. Thirty-seven stented anastomoses were performed in 19 patients.

Non-Incisional Therapy for Priapism

During a 4-year period 7 patients with priapism were managed successfully with a non-incision treatment program. Three were treated by hypotensive anesthesia with sodium nitroprusside, 2 by the Winter procedure (creating a temporary cavernospongiosum shunt) and 2 by combining hypotensive anesthesia and the Winter procedure. Causes of the priapism were pelvic infection in 1 patient, sickle cell trait in 2 and post-hemodialysis in 2. The cause was not known in 2 cases. Of the 7 patients 5 were potent before the onset of the priapism and remained so after treatment. No complications of therapy were noted and hospitalization averaged 1.4 days, with 5 patients being discharged the day after treatment. Our experience with these 7 patients indicates that creation of a vascular shunt by an operative technique may not be necessary to alleviate priapism.

Single ectopic ureter: unusual presentation in adult male.

We present a case of an unusual and late presentation of a single ectopic ureter in an adult male. The patient presented with gross painless hematuria. The left ureter draining a dysplastic kidney terminated in the ipsilateral seminal vesicle.

Placement of penile prosthesis during surgery for malignancies

Insertion of either a semirigid or inflatable penile prosthesis at the completion of surgery for various malignancies was performed. Twelve men had implants and were followed at least one year with excellent results. Careful preoperative sexual counseling with the patients spouse is recommended and adds immeasureably to the mental well-being of the patient in the postoperative period. Penile prostheses can be placed easily after radical cystectomy, radical prostatectomy (perineal or retropubic), urethrectomy, and bilateral orchiectomy. Penile prosthesis placement may also be recommended for patients with less than adequate erectile function who may be undergoing pelvic lymphadenectomy with 125I implantation for prostatic carcinoma.