David M. Drylie

Herpesvirus Type 2 in the Male Genitourinary Tract

A population study of 190 randomly selected male patients with no history of genital herpesvirus infection revealed a high incidence of herpesvirus type 2 in genitourinary specimens. This indicates that men serve as a reservoir of genital herpesvirus.

Ultrastructural Alterations in the Adluminal Testicular Compartment in Men with Varicocele

Testicular biopsies from 21 otherwise healthy men with diagnosed varicocele were processed for light and electron microscopy. Whereas germ cell morphology and tissue architecture of the basal testicular compartment appeared normal, cellular mophology and intercellular associations of the adluminal testicular compartment were variably altered. In affected tubules, spermatid nuclear and acrosomal morphology was abnormal and sloughing was evident. Spermatids were maloriented relative to Sertoli cells, and Sertoli-germ cell junctional complexes appeared to be structurally abnormal. Contradistinctly, Sertoli-Sertoli cell junctional complexes appeared unaffected. Results from this study indicate that testicular disruption in varicocele is a phenomenon of the adluminal compartment, that the Sertoli cell is, in fact, more sensitive to perturbation of the testicular environment than are germ cells, and that the Sertoli cell is the primary intratubular site of alteration leading secondarily to spermatogenic disruption.

Preoperative Angioinfarction of Localized Renal Cell Carcinoma Using Absolute Ethanol

A total of 25 patients with renal cell carcinoma underwent angioinfarction of the tumor using absolute ethanol. An average of 15 ml. absolute ethanol was injected into the main renal artery through a balloon occlusion catheter. Complete cessation of renal arterial flow could be demonstrated in all cases. The post-embolization syndrome of pain, nausea, vomiting, hypertension and fever was minimal compared to other methods of renal artery occlusion. Of the patients 21 underwent post-infarction transabdominal radical nephrectomy without intraoperative or postoperative complications attributable to the injection of absolute ethanol. No damage to extrarenal tissue was noted at operation. Subsequent surgical dissection was facilitated, particularly in cases of large tumors when control of the renal pedicle often is difficult. Median blood loss was 725 ml. In light of recent reports concerning the benefit of angioinfarction and nephrectomy in metastatic disease a similar approach may be applicable to localized disease. This pilot study shows the safety of preoperative angioinfarction with absolute ethanol and may be used as a reference for future randomized prospective studies comparing angioinfarction and nephrectomy to nephrectomy alone for localized renal cell carcinoma.

Retrograde Nephrostomy and Percutaneous Calculus Removal in 30 Patients

We used a new technique, retrograde nephrostomy, to provide intrarenal access for percutaneous calculus removal in 30 consecutive patients. Under fluoroscopic control, we maneuvered cystoscopically a 5F and 9F coaxial catheter pair over a guide wire into the calix selected for nephrostomy. Then, a sheathed 20 to 21 gauge needle was passed through the 9F catheter into the flank to create the nephrostomy. Eight patients were given general and 22 intravenous sedation and local anesthesia for nephrostomy placement and calculus removal. Retrograde nephrostomy and subsequent calculus removal were completed successfully in 90 and 83 per cent of the 30 patients, respectively. There were 6 complications and 3 failures among the first few patients due to inferior equipment and inexperience with the technique. Over-all, we found that retrograde nephrostomy provided reliable, precise intrarenal access and we believe that it could become an alternative technique to aid in percutaneous calculus removal procedures.

Herpesvirus Type 2: Study of Semen in Male Subjects with Recurrent Infections

Semen from 30 healthy male subjects with recurrent infections with herpesvirus type 2 was obtained when subjects were free of lesions and surveyed by tissue culture for an infectious virus in an attempt to elucidate the transmission of this disease. Inclusion bodies compatible with herpesvirus were found in tissue cultures of semen from 2 participants but an infectious virus could not be cultured directly from any sample. The data suggest that herpevirus type 2 is not ubiquitous in semen of male subjects with recurrent genital infections. The possible role of seminal inhibitors and a defective virus in causing the observed results is discussed, as are the current theories of herpesvirus type 2 transmission.

Herpesvirus type 2: Isolation from seminal vesicle and testes

Reproductive tissues from 10 recent male cadavers were examined. Herpesvirus type 2 was isolated from testes, seminal vesicle, or both in 4 cases. This is the first report of the isolation of herpesvirus type 2 from human seminal vesicular tissue. The data support previous evidence that herpesvirus type 2 can be isolated from the reproductive tissues of males without active or prior infection and suggest that these tissues may serve as a reservoir for transmission of this virus. The study also documents, for the first time, the ability to culture herpesvirus type 2 in organ explants from cadaveric reproductive tissues with the subsequent release of infectious virus.

Carcinoma of the male urethra.

Between February 1965 and November 1981 we treated 10 men with transitional or squamous cell carcinoma of the urethra. Treatment consisted of radiation therapy alone in 5 patients, operation alone in 4 and a combination of irradiation plus operation in 1. Radiation therapy produced local-regional control in 4 of the 5 patients with carcinoma of the distal or prostatic urethra, and 3 were completely free of disease at 5 years. The only complication of irradiation was urethral stricture in 3 patients, which was treated successfully by periodic urethral dilation. None of the patients treated by an operation alone or with irradiation achieved local-regional control.

Malignant evolution of penile horn

We report a rare case involving evolution of a penile horn into a neoplastic lesion. This patient was treated with surgical excision and external radiation because of the invasive characteristics of the lesion.

Absolute ethanol renal angioinfarction for control of hypertension

Six patients (11 renal units) underwent ethanol renal angioinfarction for medically uncontrollable hypertension. The mean preablation blood pressure was 175/112 mm Hg despite antihypertensive medications. Five of the patients demonstrated elevated renal vein renin levels prior to angioinfarction. Hypertension was improved in all 6 patients, during a mean follow-up period of fifty-one months. Systemic hypertension was completely eliminated in 4 patients. Two patients continue to require antihypertensive medication to control their hypertension. There were no major complications directly related to intra-arterial injection of ethanol. Transcatheter renal ablation employing intra-arterial injection of absolute ethanol for control of severe hypertension appears to be a safe and efficacious procedure. It should be considered an alternative to nephrectomy in selected high-risk patients.

Postdiversion precystectomy irradiation for cancer of the bladder.

This is the first report of a 4‐year prospective trial of integrated irradiation and cystectomy in the management of advanced bladder carcinoma. Patients are treated sequentially with staging laparotomy and urinary diversion, highdose preoperative irradiation (5,000 rad/30 treatments/42 days), and total cystectomy. Twenty‐eight consecutive patients have been entered into the study; all had Grade III or IV tumor or clinical evidence of invasion (Jewett Stage B1‐D1). Local control has been achieved in 21 of 22 patients, and the 4‐year actuarial survival is 54%. The initial staging procedure not only defines inoperable patients, but also allows completion of urinary diversion prior to small bowel irradiation with fewer anastomotic problems. Acute and chronic complications have been minimal, and there have been no treatment‐related deaths. Cancer 43:1032‐1036, 1979.