Colin Markland

The Effect of Pharmacological Agents on Ejaculation

Infertility in a patient on pharmacological agents with sympatholoytic activity was found to be caused by ejaculatory failure owing to absent contraction of the seminal vesicle, ampulla and ductus deferens, rather than the previously accepted reason of retrograde ejaculation. These findings suggest that pharmacological agents producing alpha-adrenergic blockage may produce temporary interference with ejaculation, suggesting investigation of their use as reversible male contraceptives.

Calculi complicating renal transplantation into ileal conduits

In 2 patients with renal transplants into ileal conduits renal calculi developed proximal to stenosis of the ureteral-ileal anastomosis, These are the only cases of urinary calculi in 600 consecutive transplants. The pathogenetic factors contributing to sepsis and stasis in such cases are reviewed and precautions suggested.

Posterior urethral valves managed by cutaneous ureterostomy with subsequent ureteral reconstruction.

Six boys, 2 weeks to 5 years old, underwent cutaneous ureterostomy for massively dilated upper urinary tracts secondary to obstruction by posterior urethral valves. Cutaneous ureterostomies had been performed elsewhere in 2 patients. Two patients underwent transurethral fulguration of the valves initially with no improvement. Blood urea nitrogen, creatinine and serum electrolyte values continued to increase and, therefore, cutaneous ureterostomies were performed with dramatic improvement. Two patients presented with sepsis, one of whom had a positive blood culture. Both children had severe pyonephrosis and after the conditions improved with medical treatment cutaneous ureterostomies were done. The total number of surgical procedures required for all patients was 59, including renal biopsies, nephrostomies and cystoscopies. No kidneys, except for the severely dysplastic ones, were lost and all patients resumed normal growth rates and have had no urinary tract infections. All laboratory values are within normal limits.

Control of male fertility report of a workshop.

34 speakers participated in a workshop on the control of male fertility and the information they presented is summarized in this report. Possible targets for contraceptive action include: 1) the anterior pelvic ganglia with its adrenergic neurons 2) interference with a sperm-coating protein 3) use of small molecular weight compounds in the permeable epididymis and 4) enzyme inhibitors which affect sperm motility. Vasectomy is discussed including the relative lack of success in achieving pregnancy (30%) after successful restoration of the vas. The use of reversible valves and other occluding devices also has problems in restoring normal sperm count. Use of chemical methods of vas occlusion has a higher failure rate than that of standard vasectomy. No adverse effects of vasectomy on the endocrinological status of the patients have been detected. Data on antibody development in vasectomized men suggest there is large variability (20%-50%) in the number who develop sperm-immobilizing and sperm-agglutinating activity.