Donald E. Praiss

Intraurethral Condylomas Acuminata: Management and Review of the Literature

We report 4 cases of intraurethral conylomas, the last one representing the first reported successful management of total urethral and intravesical condylomas in a male patient. The literature is reviewed and recommendations for management based on the modalities available are given.

Urethrography Manifestations of Venereal Warts (Condyloma Acuminata)1

Intraurethral spread of venereal warts is a serious complication. Urethral involvement may be extensive and is associated with severe irritative symptoms. Spread to the bladder is possible. Recurrences are frequent and eradication difficult. We describe the urethrographic appearance of intraurethral verrucae and believe it to be strongly suggestive of the diagnosis. Voiding cystourethrography is recommended, and satisfactory visualization may be obtained with either voiding or retrograde urethrography. Voiding urethrography following intravenously administered contrast (excretory voiding cystourethrography) is particularly advantageous since it avoids the need for urethral instrumentation and, therefore, cannot contribute to retrograde spread of these contagious growths.

Functional Role of Spermagglutinating Antibodies in Men

The presence of spermagglutinating antibodies in blood and semen has been associated with reduced fertility in men. In this study 203 men were screened for infertility. An antibody measurement was performed on the blood and semen of each patient. Each semen specimen was also examined for spontaneous agglutination. Twelve patients with a positive reaction in the blood underwent a sperm-cervical mucus contact test. We have attempted to correlate the findings in blood with the observed functional results in semen and cervical mucus. We believe that these simple tests should be included in the infertility work-up in order to determine the presence of immune infertility.

Statistical Comparison of the Parameters of Semen Analysis of Whole Semen Versus The Fractions of The Split Ejaculate

The split ejaculate has proven to be a reliable method for concentrating sperm in a small volume. However, there is some controversy whether the spermatozoa in the most sperm-rich fraction of the split ejaculate has better motility than the spermatozoa in whole semen. In this study, at least two specimens of whole semen and two split ejaculates were obtained from 45 infertile males. The mean values for the parameters of the semen analysis were compared statistically. Our data indicate that increased sperm density is a consistent finding with the split ejaculate, even for severely oligospermic men. However, improved sperm motility with the split ejaculate is more variable. On the other hand, patients with mild oligospermia (10 to 40 million sperm/ml of whole semen) and high semen volumes (greater than 5.0 ml) demonstrated improvement in all parameters in the split ejaculate.

Use of papaverine during vasovasostomy

The fibrotic portion of the vas deferens is excised during the performance of a vasovasostomy until a satisfactory lumen appears on each side of the old scar. The lumen on the testicular side usually is dilated because of chronic high pressure at the site of the occlusion. On the other side the lumen of the abdominal vas usually is much smaller by comparison. A successful vasovasostomy depends on a precise mucosal-to-mucosal alignment despite the discrepancy in lumenal diameters. 2-layer anastomoses have been popularized to achieve this precise alignment. In an attempt to equalize the lumenal sizes during the anastomosis the smooth muscle relaxant papaverine (30 mg/ml) was applied to the abdominal side of the vas. Approximately 1-3 ml were dripped onto the cut end of the vas and after 1 minute the lumen was gently dilated by the lateral spring action of an angled jewelers forceps. This maneuver provided a wider lumen with excellent mucosal relaxation for the 2-layer anastomosis. Figure 1 shows the freshly cut end of the abdominal vas. The lumen measured less than 1.0 mm. When an angled jewelers forceps was introduced into the lumen the jaws barely separated by lateral spring action. Following the application of 1-3 ml of papaverine (30 mg/ml) the jaws separated to a distance of almost 1.5 mm. At this point the lumen appeared to be considerably dilated and the mucosa was relaxed for a precise 2-layer anastomosis. If the abdominal vas and its mucosa failed to relax in response to papaverine then this usually implied persistent fibrotic tissue. In these cases additional vas was removed on the abdominal side until the tissue demonstrated adequate relaxation following another application of papaverine and dilatation with the angled jewelers forceps. This maneuver seemed to be helpful for determining the adequacy of the dissection. The application of papaverine has been utilized during 61 vasovasostomies which have been followed up at least 6 months. Followup semen analyses have demonstrated 49 patients with greater than 20 million sperm/ml and greater than 40% motility. 3 patients remained azoospermic. In 4 patients late azoospermia developed. Thus far 31 pregnancies (50.8%) have been reported for all categories. Additional pregnancies are anticipated with time. It is believed that the application of 1-3 ml of papaverine (30 mg/ml) to the abdominal vas is a simple and helpful maneuver during a vasovasostomy.

Preoperative urography in hypotensive patients with severe trauma

In hypotensive patients with severe trauma including renal injuries, the preoperative urogram is generally of poor quality. In many instances these patients are taken to the operating room with no films at all. We have proposed a protocol for the resuscitation of severely injured patients, following which we performed a carefully monitored high-dosage urogram. We demonstrated in 16 patients that diagnostic films can be obtained even in severely injured patients who were initially in shock.

An Estimate of the Fertility Potential of the Fractions of the Split Ejaculate in Terms of the Motile Sperm Count**Presented at the Thirty-Fifth Annual Meeting of The American Fertility Society, February 3 to 7, 1979, San Francisco, Calif.

The motile sperm count is a simple index which is equivalent to the product of sperm density (millions of sperm per milliliter) and percentage of motility (motile sperm per 100 sperm x 0.01). Since other studies have demonstrated a positive correlation between this index and the pregnancy rate, it has been hypothesized that the motile sperm count could be useful for expressing the potential fertility of individual semen specimens. Collection of semen by the split ejaculate technique and subsequent artificial insemination homologous (AIH) with the best split fraction has been used for the treatment of oligospermia. We calculated the motile sperm count for whole semen and the first fraction of split ejaculates from 45 men who were studied for infertility. Subsequently, 15 couples agreed to AIH with the first fraction of the split ejaculate. The data indicate that the motile sperm count may be a reasonable index for comparing the potential fertility of the semen specimens and thereby estimating the chances of successful AIH.