Dennis D. Venable

Single-Blind, Multicenter, Placebo Controlled, Parallel Study to Assess the Safety and Efficacy of Intralesional Interferon α-2b for Minimally Invasive Treatment for Peyronie’s Disease

PURPOSE We investigated the efficacy and safety of intralesional interferon alpha-2b for the treatment of Peyronies disease. MATERIALS AND METHODS A total of 117 consecutive patients with a mean age of 55.1 years who had Peyronies disease were enrolled in a single-blind, multicenter, placebo controlled, parallel study to determine the efficacy and safety of intralesional interferon alpha-2b therapy (Schering, Kenilworth, New Jersey), including 62 who received placebo and 55 who received interferon alpha-2b. Saline (10 ml) in controls and interferon alpha-2b (5 x 10(6) U) were administered biweekly for 12 weeks. Each patient was evaluated for penile curvature, plaque size and density, penile pain, erectile function and penile hemodynamics before and after study completion. Improvement in these parameters was statistically compared between the groups. RESULTS A total of 53 patients in the control arm and 50 in the interferon alpha-2b arm completed the study. Improvement in penile curvature, plaque size and density, and pain resolution was significantly greater in patients treated with interferon alpha-2b vs placebo. The increase in mean International Index of Erectile Function scores was not significantly different between the groups. Penile blood flow improvement was observed in interferon alpha-2b treated patients but not in those who received placebo. The decrease in the number of penile vascular pathologies was significantly higher in interferon alpha-2b cases. Side effects, mostly flu-like symptoms, which were frequently noted in patients on interferon alpha-2b, were mild to moderate in degree and of short duration. CONCLUSIONS This single-blind, multicenter, placebo controlled, parallel study demonstrates that intralesional interferon alpha-2b at a dose of 5 x 10(6) units biweekly for 12 weeks is effective and safe as minimally invasive therapy for Peyronies disease.

Penetrating trauma to the male external genitalia

BackgroundWe report on 40 patients with penetrating trauma to the external genitalia. Initial evaluation and management, operative findings, and treatment outcomes are reviewed.MethodsWe retrospectively reviewed the medical records of all patients presenting to our facility with penetrating trauma t

Modification of the Anterior Perineal Transanorectal Approach for Complicated Prostatic Urethrorectal Fistula Repair

Rectoprostatic fistulas can pose challenging problems for surgical reconstruction. We describe and illustrate the successful repair of a difficult, post-traumatic prostatic urethrorectal fistula by combining use of a vascularized scrotal dartos flap interposition with a modified anterior rectal wall flap fistula repair (Parks technique). An anterior perineal transanorectal, transanorectal, transsphincteric approach provided excellent operative exposure as well as a direct path for the perineal pedicled dartos island flap en route to the fistula repair site.

Unusual Metastatic Patterns of Prostate Adenocarcinoma

While prostatic adenocarcinoma is associated classically with osseous or lymphatic metastasis, it can present clinically with protean manifestations. We describe 4 cases that demonstrate unusual patterns of metastatic spread, including isolated supraclavicular mass, pleural effusion, suprapubic and genital skin metastasis, and priapism. Newer immunohistochemical staining techniques for prostate specific antigen and prostatic acid phosphatase can assist in localization of the metastatic adenocarcinoma to a prostatic origin.

Testicular microlithiasis as a predictor of intratubular germ cell neoplasia

Sonographically detected testicular microlithiasis is an uncommon condition, which in recent years has been demonstrated with increased prevalence in patients with testicular tumors. We report a case of a 31-year-old man with left testicular carcinoma and right intratubular germ cell neoplasia diagnosed by biopsy of the right testis at the time of left radical orchiectomy. In this case, preoperative ultrasound revealed right testicular microlithiasis, signaling the presence of intratubular germ cell neoplasia. We propose ultrasound as a noninvasive tool for selecting patients for testicular biopsy.

The incidence and implications of renal cell carcinoma in cadaveric renal transplants at the time of organ recovery.

BACKGROUND With the exception of primary central nervous system tumors, organ recovery is no longer considered from donors with known malignancy. Because intrathoracic and intraabdominal organs are usually recovered before the kidneys, we examined the incidence of renal cell carcinoma in cadaveric donor kidneys at the time of organ recovery. This would establish the theoretical risk of transplanting donor organs from a patient with a known renal malignancy. METHODS In cooperation with the Louisiana Organ Procurement Agency, we reviewed the records of all patients who were cadaveric kidney donors in the state of Louisiana between September 1991 and October 1997. Information was reviewed and analyzed on donor age, sex, race, past medical/surgical history, cause of death, and the findings at the time of organ recovery. RESULTS A total of 553 consecutive cadaveric donors were identified, with 1106 kidneys recovered. Of the 553 cadaveric donors, 5 (0.9%) were noted to have an incidental renal cell carcinoma. All tumors were identified in separate donors; that is, none of the tumors were bilateral. None of the five donors had documented symptoms referable to their urinary tract. All tumors were either T1 or T2 by the tumor, node, metastasis classification system, and no evidence of nodal or distant metastatic disease was present. In one case, the contralateral kidney, heart, and liver were transplanted before the tumor was identified. In the remaining four cases, all organs (renal and nonrenal) were discarded. CONCLUSIONS Renal cell carcinoma is rarely found during renal recovery from a cadaveric donor. However, because the kidneys are usually recovered after the intrathoracic and intraabdominal organs, careful palpation of the kidneys and exploration of any abnormalities is mandated to avoid transplanting any organs from a donor with a known renal malignancy.

Anatomic, functional, and pathologic changes from internal ureteral stent placement☆

The anatomic, hydrodynamic, functional, and pathologic changes associated with unilateral internal ureteral stenting were evaluated in 20 female canines. Selective glomerular filtration rates (GFR) were measured with technetium 99m diethylenetriamine pentaacetic acid (DTPA) renal scans (N = 14) prior to and several weeks after unilateral internal stent placement. Cystometry and cystography were done at weekly intervals to determine if reflux occurred and to measure the intravesical pressure to produce this reflux (N = 16). Ureteral lumenal capacities of mid 6-cm ureteral segments of stented and unstented ureters were compared. The mid-ureteral lumenal volumes were three times greater in the stented ureters (p < 0.002). There were no significant differences in the selective GFR before and after stenting. Low-pressure vesicoureteral reflux occurred at a mean intravesical pressure of 13.7 cm of water and was present in 84.6 percent (11/13) of the canines whose stents did not migrate or obstruct from encrustation. There were no significant alterations in serum chemistries or blood counts. Fluoroscopic imaging also showed ineffective ureteral peristalsis. This study confirms that internal ureteral stents cause vesicoureteral reflux and significant lumenal dilation without altering renal function.

Ultrasound of polyorchidism : case report and literature review

We report a case of polyorchidism that was suggested preoperatively by scrotal sonography. A review of the literature on this rare anomaly discloses a previously underemphasized association with malignancy.

Ultrasound Guided Percutaneous Renal Biopsy Using an Automatic Core Biopsy System

With real-time ultrasound visualization and an automatic core biopsy system 23 percutaneous renal biopsies were performed with the use of local anesthesia in 22 patients. Adequate tissue for diagnosis was obtained in all 23 cases, with 1 patient undergoing bilateral renal biopsy and 1 requiring repeat biopsy. One patient had an asymptomatic perirenal hematoma and 1 experienced a single episode of transient gross hematuria. There were no major complications. The use of an automatic core biopsy system guided by real-time ultrasound is an important technique that may be added to the urological armamentarium.

Tensile strength of cadaveric fascia lata compared to small intestinal submucosa using suture pull through analysis.

PURPOSE The modified pubovaginal sling has become popular as first line treatment for stress urinary incontinence. With the increasing use of cadaveric fascia as a sling material, widespread shortages are prevalent, hence limiting its availability. The increased morbidity with the use of synthetic sling materials and autologous fascia has stimulated investigation of other sling materials. We evaluated the tensile strength of 4 suture types, and compared tensile strength of cadaveric fascia lata to porcine small intestinal submucosa using suture pull through analysis to assess their efficacy and durability for use in anti-incontinence procedures. MATERIALS AND METHODS Suture breaking load was determined using 2 and 1-zero polypropylene suture, and 2 and 1-zero polyglactin suture. Freeze dried gamma irradiated human fascia lata and freeze-dried small intestinal submucosa were evaluated. Suture was fixed to sling material using the cross fold technique. Mean suture breakage and suture pull through were determined using a tensionometer by measuring the load applied to the sling/suture system. Statistical analysis was performed. RESULTS Mean suture breakage load was greatest with 1-zero polyglactin (8.10 pounds) and least with 2-zero polypropylene (3.68 pounds). Mean suture breakage strength was similar for 1-zero polypropylene and 2-zero polyglactin at 5.26 and 5.40 pounds, respectively. Mean suture pull through load using 1-zero polypropylene suture and the cross fold technique was 5.64 pounds for cadaveric fascia and 2.74 pounds for small intestinal submucosa (p <0.0001). Maximum load was limited by the suture strength when using cadaveric fascia, whereas, maximum load was limited in small intestinal submucosa by its inherent tensile strength. However, using a new technique for suture fixation to the small intestinal submucosa, we were able to increase significantly mean suture pull through load to 3.36 pounds (p = 0.008). Additionally, with this new technique small intestinal submucosa allowed gross stretching before suture pull through that was not seen with cadaveric fascia. CONCLUSIONS Despite the current standard use of 1-zero polypropylene suture for pubovaginal sling fixation, our data suggest that 1-zero polyglactin suture is the strongest, and its use with pubovaginal sling fixation warrants further investigation. Using the cross fold technique and 1-zero polypropylene suture, tensile strength was greatest with cadaveric fascia compared to small intestinal submucosa. Although small intestinal submucosa was not as strong as cadaveric fascia, our persuasive preliminary data suggest that further investigation is warranted in the use of small intestinal submucosa and other suture fixation techniques, and its observed stretch capacity. Hence, with further studies small intestinal submucosa may remain a viable option for pubovaginal sling material.