Durwood E. Neal

TAMM-HORSFALL AUTOANTIBODIES IN INTERSTITIAL CYSTITIS

Interstitial cystitis presents a diagnostic and therapeutic challenge. Although many etiologies, including autoimmunity, have been proposed its pathogenesis remains obscure. Tamm-Horsfall protein has been identified in the superficial urothelium of patients with interstitial cystitis demonstrating abnormal urothelial permeability. Eight patients with a clinical diagnosis of interstitial cystitis underwent cystoscopy and bladder biopsy. Characteristic cystoscopic findings were present, and each patient had chronic inflammation and mast cells by histopathological analysis. Preoperative anti-Tamm-Horsfall protein serum antibody (IgG) titers were determined by enzyme-linked immunosorbent assay (range 500 to 8,000, mean 2,750). A control group of 8 patients with a negative urological history also had titers of 0 to 500 (p = 0.02). The humoral response to Tamm-Horsfall protein in these patients suggests a role for Tamm-Horsfall protein in interstitial cystitis. Measurement of serum Tamm-Horsfall protein antibody may prove to be useful as a noninvasive diagnostic test in patients with this disease.

Renin production after experimental extracorporeal shock wave lithotripsy: a primate model.

Since the advent of extracorporeal shock wave lithotripsy (ESWL) concern has surfaced as to the long-term risk of the development of hypertension, as well as risk to the developing kidney. To study this concern 8 infant and 3 adult rhesus monkeys (Macaca mulatta) underwent treatment with the XL1 experimental lithotriptor to 1 kidney varying the amount of voltage and shocks. Followup consisted of measurement of renin levels and quantitative renal scans, using 131iodine hippurate to calculate effective renal plasma flow. In the infants a slight change was noted in the absolute effective renal plasma flow of the treated kidney versus the untreated side but it was not statistically different. When indexed to body surface area in the growing animal, there was a statistically significant decrease in renal function. However, peripheral renin levels were markedly elevated in the infants at 3 weeks, and they gradually declined during the 6-month period, although levels remained elevated over baseline. The adults also had central renin levels drawn from the renal vein on the treated side, and there was a close correlation with the peripheral levels, which peaked at 3 weeks and returned to normal. Thus, it seems that at least in the short term renin production is increased in infants more than adults. This finding may be an indicator as to renal damage and is a possible explanation for hypertension occurring after ESWL.

Analysis of Suicide Risk in Patients with Penile Cancer and Review of the Literature

Abstract The treatment for penile cancer has been shown to cause harmful psychiatric symptoms as well as have detrimental effects on well‐being. In the past several years, alternatives to total or partial penectomy have emerged, such as chemotherapy, radiation, penile sparing, and laser ablation therapies. A more specific breakdown for penile cancer is in order as the therapy has the potential for life changing surgery. We examined the Surveillance, Epidemiology, and End Results (SEER) database (1973‐2013), comprising 28% of the United States population. International Classification of Diseases, Tenth revision codes C60.8‐C60.9 and the International Classification of Diseases‐Oncology codes 8010/2, 8010/3, 8051/2, 8051/3, 8052/2, 8052/3, 8070/2, 8070/3‐8072/3, 8074/3, 8076/3, and 8083/3‐8084/3 were used. Age, race, marital status, and clinicopathologic variables were studied. We used contingency tables of suicide rates; mid‐P exact test was used for analysis. There were 13 suicides noted in 6155 patients with squamous cell carcinoma of the penis. All patients that committed suicide had undergone a surgical intervention. Certainly, penile cancer after treatment has a powerful effect on quality of life as increased depression and sexual anxiety have been documented in postoperative patients. This is in contrast to the observed suicide rate. Despite the reported negative psychological effects in patients with penile cancer, suicide rates are among the lowest of all urologic malignancies.

MP95-09 DECREASING TREND IN STONE DISEASE: ARE MEN DOING SOMETHING RIGHT?

RESULTS: SA patients have an 8.9% incidence of nephrolithiasis, compared to 5.5% of the non-SA control (p<0.001). SA patients also have higher rates of metabolic comorbidities (p<0.001). After adjusting for age, gender and comorbidities, the risk of nephrolithiasis remained significantly increased in the SA group (hazard ratio [HR]1⁄41.35; 95% confidence interval [CI]1⁄41.23-1.47; p<0.001). Greater HRs of nephrolithiasis were observed for male patients (1.21; 95% CI1⁄41.09-1.35; p<0.001) and those aged 20-39 years (1.25; 95% CI1⁄41.06-1.46; p<0.01) in the SA cohort. Risk of nephrolithiasis in SA patients increased significantly with concomitant diabetes mellitus, hypertension, hyperlipidemia, and morbid obesity. CONCLUSIONS: The study provides evidence that patients with SA have an increased risk of subsequent nephrolithiasis compared with patients without SA. Young male SA patients with concomitant comorbidities are at the greatest risk for nephrolithiasis formation.

FRII-09 CONSERVATIVE KIDNEY TRAUMA MANAGEMENT AND CONSERVATIVE POLITICS: HOW SIR WINSTON CHURCHILL'S PHYSICIANS MAY HAVE SAVED THE WESTERN WORLD

Cross College where he gave up sports in order to attend science labs. Staying close to home, he attended Harvard Medical School. After completing his internship at Peter Bent Brigham Hospital, he joined the Army where he met Colonel James Barrett Brown, Chief of Plastic Surgery at Valley Forge General Hospital in Pennsylvania. Together, they treated soldier’s burns and were eye witnesses to the consistent rejection of skin grafts. They observed that the closer the genetic relationship between the donor and recipient, the slower the rate of rejection of the skin grafts. After leaving the military, Dr. Murray pursued research on this concept, working for years with a renal transplant team at Brigham. Then, in 1954, Dr. Murray had the opportunity to take his bench research to the bedside when identical twin Richard Herrick was hospitalized with life threatening chronic nephritis. Amid harsh criticism and skepticism, Dr. Murray and his team prepared for the first human kidney transplant, which they successfully performed on December 24, 1954. He would go on to perform the first successful transplant in a nonidentical recipient and the first cadaver transplant. CONCLUSIONS: Dr. Murray was awarded the Nobel Prize in 1990 and praised for his perseverance in the field at a time when his work was heavily criticized. In addition to his professional accomplishments, he was also a loving husband of 67 years, a father to 6 children and grandfather to 18 grandchildren. The work of Dr. Murray transformed the realm of transplant medicine and continues to give the gift of life to thousands of people to this day.

FRII-01 THE IMPACT OF VENEREAL DISEASE DURING WORLD WAR I: HUGH HAMPTON YOUNG AND THE CHASTE OF AMERICAN SOLDIERS

INTRODUCTION AND OBJECTIVES: The effect of venereal disease (VD) during World War I (WWI) was an underappreciated morbidity afflicting American soldiers. Along with mental illness and tuberculosis, VD was one of the most common non-combat related causes for soldier disability. The objective of this study is to review the impact of VD on the American military during WWI and to highlight the role of Hugh Hampton Young in assisting commanding officers in combating VD amongst their ranks. METHODS: A review of medical journals and historical textbooks was performed in order to give a comprehensive dissertation of the impact of VD on the American military during WWI. RESULTS: Prior to American involvement in WWI, prevalence of VD (primarily gonorrhea) among Allied forces was estimated to be 11-25%. Soldiers with gonorrhea were unable to fight and were problematic for commanding officers. VD was mainly the result of unsanctioned brothels in Europe, as soldiers frequented these establishments in an attempt to escape the rigors of war. With the arrival of American soldiers in France and their unregulated use of French prostitutes, General John Pershing became aware of this public health dilemma and immediately notified Secretary of War Newton Baker. Baker, with knowledge of President Wilson’s Presbyterian background and American civilian conservatism, subsequently instituted a policy that commanding officers were responsible for the general health of their soldiers. To aid the commanding officers, General Pershing enlisted the assistance of Urologist Dr. Hugh Hampton Young to Europe in May 1917 as Director of the Division of Urology in the American Expeditionary Force. American soldiers were ordered to be chaste and prohibited from encountering French women. Soldiers found to have VD were subject to irrigation of the bladder and penis with potassium permanganate and threatened with ‘court martial’. Commanders failing to keep VD to a minimum among their soldiers were at risk of losing rank. As a result of these combined efforts the prevalence of VD in the American military decreased after the institution of the policy, and was considerably lower than Allied forces from other countries. CONCLUSIONS: VD was an important public health dilemma for soldiers during WWI resulting in significant morbidity and affecting a soldier’s ability to perform in combat. With the assistance of Hugh Hampton Young, American military leaders were able to institute policies to counter the effects of VD and concomitantly maintain American conservative morals overseas. For his efforts, Dr. Young was promoted to Colonel in 1918 and received the Distinguished Service Medal in 1919.

Infections and Infertility

Genitourinary tract infections and other inflammatory conditions are known contributors to male-factor infertility.1,2 Their effects are still not entirely understood, but there are strong associations. Because male-factor infertility accounts for 30% to 50% of infertility cases,3 and genitourinary infections are ubiquitous, these associations are of great interest. Because these infections are both preventable and treatable, much study has been done in this field. Unfortunately, there is a paucity of confirmatory data on the etiology of the process and treatment efficacy. The difficulty in most of the research on the association between infection and infertility has been in proving the presence of a causal agent. Thus, it is problematic to assess the efficacy of any given treatment modality. In females, there is little doubt that early, aggressive antibiotic therapy is beneficial in preventing secondary tubular damage due to pelvic inflammatory disease.4 Furthermore, localized infections in the vagina are known to limit fertility, and aggressive, curative treatment is beneficial to fertility rates.5 The low incidence of symptoms and physical findings in the male proves to be daunting in the evaluation of treatment. When there is an absence of a proven causative organism, the results of any treatment may not be evaluable. When the final common pathway is pregnancy and the semen analysis is usually not definitive, one may be dealing simply with probabilities. It may be best to divide this discussion into infections versus noninfections; however, the line between these two is frequently indistinct.