Alphonse Pfau

The pH of the Prostatic Fluid in Health and Disease:Implications of Treatment in Chronic Bacterial Prostatitis

AbstractThe pH of expressed prostatic secretion was measured in men with and without inflammatory prostatic disease. Whereas the pH of expressed prostatic secretion was acid with a mean of 6.7 in men without inflammatory prostatic disease, it reached a mean of 8.1 in those with chronic bacterial prostatitis. Return of expressed prostatic secretion to acid values after cure of the disease occurred after at least 2 years.The implications are discussed of the elevation of the expressed prostatic secretion pH in chronic bacterial prostatitis on its effective treatment. The markedly alkaline pH of expressed prostatic secretion in chronic bacterial prostatitis is the probable cause of the ineffectiveness of the short-term cotrimoxazole treatment and the only partial success of the more effective longterm treatment in this disease. In the presence of such a pH the aminoglycosides are recommended as an additional effective antimicrobial drug in cases of chronic bacterial prostatitis not responding to cotrimoxazol...

Recurrent urinary tract infections in premenopausal women: prophylaxis based on an understanding of the pathogenesis.

We studied 56 sexually active premenopausal women with a normal genitourinary tract but with persistent introital colonization by enteric gram-negative bacteria who were prone to suffer recurrent urinary tract infections. Sexual intercourse was revealed as a major factor in inducing recurrent urinary tract infections, usually within 24 hours, by transferring the pre-existing introital bacteria into the bladder. Abstention from sexual activity without any additional treatment prevented the development of new urinary tract infections in these women despite persistent introital enteric bacterial flora. Urinary tract infections occurred after onset of sexual activity in all but 2 of the premenopausal women in this study. The 25 premenopausal women with recurrent urinary tract infections were subjected to early postcoital prophylaxis consisting of bladder voiding and the administration of a single tablet of either cotrimoxazole (80 mg. trimethoprim plus 400 mg. sulfamethoxazole), nalidixic acid (500 mg.), nitrofurantoin (50 or 100 mg.) or sulfonamides (500 mg. sulfisoxazole or 250 mg. sulfamethizole). Whereas 70 urinary tract infections occurred during a mean 8-month followup before treatment only 4 occurred during the mean 12.5-month followup after introduction of post-coital prophylaxis (none occurred on co-trimoxazole or nalidixic acid therapy and only 1 infection occurred on nitrofurantoin therapy). Sulfonamides are not recommended as post-coital prophylaxis because of the higher incidence of breakthrough infections. Post-coital prophylaxis with co-trimoxazole, nalidixic acid or nitrofurantoin proved to be simple, economical and efficient, and is recommended in the prevention of recurrent urinary tract infections in otherwise normal premenopausal women.

The Bacterial Flora of the Vaginal Vestibule, Urethra and Vagina in Premenopausal Women with Recurrent Urinary Tract Infections

Gram-negative enteric bacteria, mainly Escherichia coli, form the predominant microbial flora of the introitus, vagina and urethra in women with a normal genitourinary tract but who are prone to suffer recurrent urinary infections. The infections in these women tend to occur in greater numbers and persist for long intervals, compared to normal control women who never experience urinary infections and in whom the main introital, vaginal and urethral microbial flora consists of lactobacilli and staphylococci. The appearance of gram-negative enterobacteria in the normal and control subjects usually is a rare and transitory event. The majority of urinary tract infections that developed in our population during this study was preceded by a persistent similar gram-negative vulvovaginal and urethral microbial flora. However, prolonged spontaneous intervals occurred occasionally during which the introital, vaginal and urethral cultures were free of gram-negative bacteria, with simultaneous intervals free of infection. Nevertheless, all of these intervals ended with documented urinary tract infections. The introital culture is a reliable mirror of the vulvovaginal and urethral microbial flora and, therefore, it is adequate in the study of urinary infections in women.

The Bacterial Flora of the Vaginal Vestibule, Urethra and Vagina in the Normal Premenopausal Woman

A study of 100 healthy, premenopausal women demonstrated that lactobacilli and staphylococci are the predominant normal bacterial flora in the vaginal vestibule, urethra and vagina, with diphtheroids, streptococci and micrococci occurring in decreasing order. Gram-negative enterobacteria are a rare occurrence in the normal bacterial flora of the vaginal vestibule (7 per cent), urethra (9 per cent) and vagina (6 per cent). A second study of 10 healthy premenopausal women in whom serial examinations were done confirmed the findings of the first study and revealed that when gram-negative enterobacteria do colonize the normal vaginal vestibule, urethra and vagina colonization is of a transitory nature since enterobacteria tend to disappear spontaneously.

Management of ureteropelvic junction obstruction associated with lower polar vessels

Four cases of hydronephrosis due to ureteropelvic junction (UPJ) obstruction by lower polar vessels are presented. Regular propagation of peristaltic waves across a patent UPJ and rapid emptying of the pelvis were the basic conditions before accepting the lower polar vessels as the primary cause of the hydronephrosis. Transposition or division of the lower polar vessels, accompanied sometimes by a limited lower polar nephrectomy dependent on the resultant ischemia, without any pyeloplasty was the selected procedure in each of the cases. No hypertension and no immediate or delayed postoperative complications occurred in any of our patients. Relief of symptoms, a remarkably improved postoperative pyelogram, and a sterile urine were achieved in all our cases. Detection of every case in which the lower polar vessels play a primary role in the establishment of UPJ obstruction is urged since transposition or division of these vessels in such cases is a superior procedure to pyeloplasty.

Neurofibromatosis and hypertension.

A case of generalized neurofibromatosis (von Recklinghausens disease) associated with hypertension is presented. Adequate repair of the unilateral main artery stenosis did not result in cure of the hypertension because of diffuse neurofibromatous lesions of the smaller renal vessels. Review of the literature reveals that neurofibromatosis of the large and small renal vessels should be suspected in every hypertensive patient with these lesions below the age of eighteen. In view of the fact that vascular neurofibromatosis is a dynamic and spreading disease, surgery of the renal vessels should be reconstructive as much as possible.

Unilateral chronic pyelonephritis and hypertension: Coincidental or causal relationship?

Three patients with well documented unilateral chronic pyelonephritis (UCP) of bacterial origin, one hypertensive and two normo-tensive, were presented. Removal of the contracted kidney in the hypertensive patient did not eradicate the hypertension. An attempt was made to define UCP as closely as possible. The clinical, roentgenologic, bacteriologic, functional and pathologic criteria of UCP was described. But, as other conditions may mimic the roentgenologic, functional and pathologic picture of UCP, a history of recurrent urinary tract infection accompanied by a documented unilateral renal bacteriuria is the basic requirement for a sustained diagnosis of UCP. In view of these more exacting criteria in the diagnosis of UCP, and its water and salt-losing functional pattern, UCP is a rare cause of hypertension, in the majority of cases the association of UCP with hypertension is merely coincidental.

Congenital varicella causing neurogenic bladder and anal dysfunction.

An infant with congenital varicella syndrome due to maternal varicella zoster is presented. Unlike other reports in which such infection caused multiple congenital defects, our patient suffers from atonic bladder and anal dysfunction as the sole manifestation of congenital varicella syndrome. Attention is called for maternal varicella as a possible cause for limited neurologic damage in the fetus.

Orthotopic Renal Autotransplantation in the Treatment of Renovascular Hypertension

Severe hypertension non-responsive to medical therapy was discovered in a 27-year-old woman in the third trimester of pregnancy. Renal arteriography after delivery revealed bilateral renal artery stenosis. The right kidney was smaller than the left one. The differential renal function studies, rather than the renal vein renin measurements, identified which side was causing the hypertension. An attempt at primary repair of the right renal artery failed. Orthotopic renal autotransplantation, using saphenous vein grafts that were interposed between the renal veins and the inferior vena cava, and between the segmental renal arteries and the abdominal aorta, reduced the blood pressure to normal values.