C.J. Godec

URETHRAL INJURY DUE TO EXTERNAL TRAUMA

Fifty-six patients with urethral injuries comprised 35 involving the posterior urethra and 21 involving the anterior urethra. Immediate retrograde urethrography confirmed the clinical diagnosis made when blood was found at the external urinary meatus after external trauma. Traffic accidents caused most of the posterior urethral injuries and were associated with severe injuries to multiple systems and a significant mortality rate (34 per cent). Primary realignment of the urethral injury by a urethral catheter in all cases of urethral rupture (plus a suprapubic cystostomy in most of these cases) resulted in a stricture rate of 62 per cent on follow-up. However, only half of these strictures required surgical correction. The incidence of incontinence was 10 per cent and of impotence 38 per cent.

Intractable Hematuria and Formalin

Massive hematuria, which is most frequently caused by radiation for pelvic malignancies, after treatment with cyclophosphamide or secondary to aggressive anticoagulation, represents a vexing problem for the practicing urologist. The existence of numerous therapeutic approaches results from the lack of an effective therapeutic modality. Lately, formalin seems to offer a new hope for the treatment of intractable hematuria. Analysis of published results after treatment with formalin revealed generally excellent results regarding control of hematuria. Nevertheless, the complication rate of formalin application is surprisingly high, including vesicoureteral reflux and hydroureteronephrosis as local reactions and systemically tubular necrosis with anuria. Our series of patients is presented with a detailed description of a patient who was afflicted with a vesicovaginal fistula following formalin instillation. Formalin can serve as excellent therapy for massive hematuria. If attention is paid to the concentration and to the technical details of its instillation the noxious side effects can be minimized or prevented in the majority of cases.

Acute electrical stimulation for urinary incontinence.

Acute or maximal electric stimulation of the pelvic floor muscles has been used in incontinent patients who are suitable candidates for electrical stimulation, but unwilling or unable to use the anal plug electrodes. Seventeen of 20 patients had relief or improvement of their incontinence. However 5 of these 17 patients had a relapse of symptoms on follow-up, requiring a repeat treatment with acute or maximal electrical stimulation.

Emphysematous Pyelonephritis in a Solitary Kidney

Emphysematous pyelonephritis in a solitary kidney was present in a diabetic patient with servere electrolyte imbalance, hyperglycemia, oliguria and electrocardiographic changes suggestive of myocardial infarction. Percutaneous nephrostomy was performed as a life-saving procedure and a week later a large matrix stone obstructing the renal pelvis was removed. The optimal therapy with a surgical or conservative approach is discussed. The use of percutaneous nephrostomy as an initial lifesaving procedure is suggested.

Quantification of Erection

In the study of impotence the objective measurement of erection is not yet available. The commercially available nocturnal penile tumescence device records penile expansion only. Penile stiffness and intracavernosal pressure have not been measured. We only developed a penile model in which the simultaneous measurement of expansion and intraluminal pressure could be recorded. In the patient a similar measuring system has been used in acutely produced penile erection and serves as a point of reference to be compared to spontaneous erections recorded at night with the nocturnal penile tumescence device. The ratio between the artificial acute erection and the spontaneous nocturnal erection was calculated and aided in the evaluation of impotence.

Simultaneous occurrence of transitional cell carcinoma and urothelial adenocarcinoma associated with xanthogranulomatous pyelonephritis

We report on a patient with xanthogranulomatous pyelonephritis, in situ transitional cell carcinoma, and focal prosoplasia revealing abrupt conversion of transitional epithelium to moderately well-differentiated adenocarcinoma. The etiology and pathogenesis of mucinous adenocarcinoma in the renal pelvis very likely involves the prosoplastic transition of pre-existing transitional carcinoma to adenocarcinoma. The urologist should be aware of the increased possibility of this tumor developing in a patient with longstanding infection, and frozen section should be performed more often because the gross structure of the tumor frequently appears normal. This permits the urologist to change his surgical strategy if frozen section is positive for tumor.

Correlation Among Cystometry, Urethral Pressure Profilometry and Pelvic Floor Electromyography in the Evaluation of Female Patients with Voiding Dysfunction Symptoms

Abstract We herein evaluate the correlation among cystometry, urethral pressure profilometry and pelvic floor electromyography in 137 female patients. The predominant symptom was frequency in 40 patients, urge incontinence in 31 and stress incontinence in 66. There appeared to be a correlation between urge incontinence and a hyperreflexic cystometrogram but no correlation was noted between either frequency or stress incontinence and the cystometrogram profile. The urethral pressure profile showed a correlation between stress incontinence and the lowest profile measurements. Frequency and urge incontinence had similar profile measurements except for maximum urethral planimetry. Electromyography showed that the external urethral sphincter had a different finding than the levator ani or the external anal sphincters in all 3 groups of female patients. The external urethral sphincter had a higher percentage of denervation than the other 2 muscles, especially in the stress incontinence group.

Cholinergic receptors in corpora cavernosa

In a group of 13 patients who underwent penile surgery, a small amount of cavernosal tissue was removed and examined for content of cholinergic receptors. Three patients did not display any amount of cholinergic receptors. Values in the other 10 patients ranged from 34 to 136 femtomols. In another group of 61 impotent patients with some degree of preserved erectile capacity, cholinergic stimulation was administered to the patients and the response monitored. Preliminary data displayed improved erectile capacity in 41 per cent. Further studies are needed to identify impotent patients who might respond favorably to cholinergic stimulation.

Does testicular mass always require orchiectomy

Surgical exploration of a testicular mass should follow the basic principles of cancer surgery, including an inguinal approach, occlusion of the spermatic vessels, opening of the tunica vaginalis, and careful exploration of the testicle, epididymis, paratesticular structures, and spermatic cord. In a very few patients, when intratesticular lesion is small and moveable and can be seen through the tunica albuginea, and if there is a long history of scrotal mass, then the tunica albuginea should be opened and intratesticular exploration performed. The opening of the tunica albuginea should be opened and intratesticular exploration performed. The opening of the tunica albuginea does not violate the principles of cancer surgery, and for a few selected cases can prevent unnecessary orchiectomy. The incision of the tunica albuginea should no longer represent a surgical taboo to the urologist. Six cases of rare, benign intratesticular tumors are presented along with a rare indication for intratesticular exploration and testicle-preserving surgery.

The role of Minnesota Multiphasic Personality Inventory in evaluation of erectile dysfunction

AbstractThe Minnesota Multiphasic Personality Inventory represents an important adjunct in the screening process for erectile dysfunction. In 69 impotent patients who underwent Minnesota Multiphasic Personality Inventory evaluation the configuration of inventory scales could not identify a specific impotent personality type.The use of the Minnesota Multiphasic Personality Inventory does not definitively reveal the etiology of the dysfunction but it offers an understanding of the emotional reaction of the patient to penile implantation. Thus, it can prevent the use of inappropriate treatment and the development of adverse reactions to implantation.