George M. Suarez

Pathogenic Significance of P-Fimbriated Escherichia Coli in Urinary Tract Infections

The over-all aim of this study was to determine the pathogenic significance, and bacteriological and serological characteristics of P-fimbriated organisms isolated from a general population of patients with bacteriuria. A P-receptor specific particle agglutination test was used to identify P-fimbriated bacteria among 2,010 isolates from male and female patients with bacteriuria (age range infancy to 91 years). Of the 2,010 isolates 206 (10.2 per cent) were positive for P-fimbriae by the P-receptor specific particle agglutination test. Only Escherichia coli was found to be P-fimbriated, with an incidence of 21.5 per cent among 956 Escherichia coli isolates. The critical characteristic of pyelonephritic strains of Escherichia coli was P-fimbriation. In cases of nonobstructive acute pyelonephritis 100 per cent of the infecting bacteria were P-fimbriated. The data indicated clearly that the serotype, biotype, presence of type 1 fimbriae (mannose sensitive), undefined mannose-resistant adhesions, hemolysin production and motility of P-fimbriated Escherichia coli were clinically unimportant differential strain characteristics and not indicative of the virulence of P-fimbriated Escherichia coli within clinical syndromes. Isogenic P-fimbriated Escherichia coli strains were isolated from noncompromised patients in all clinical categories, that is pyelonephritis, asymptomatic bacteriuria and cystitis. A variety of bacterial strains appears to be capable of causing acute pyelonephritis in the presence of obstructive uropathic conditions, regardless of P-fimbriation. Therefore, P-fimbriation becomes a noncritical factor in compromised patients. The P-receptor specific particle agglutination test is a simple and rapid method to determine whether bacteria are P-fimbriated and may be an important screening method to identify those bacteria isolated from individuals at risk for nonobstructive acute pyelonephritis.

Clinical experience with mentor alpha I inflatable penile prosthesis: Report on 333 cases

Penile prostheses are a well-established form of therapy for erectile dysfunction. We report our experience with 333 cases using the Mentor Alpha I inflatable penile prosthesis. With a follow-up period of 15.4 months, there were 25 (7.5%) complications with 15 (4.5%) major complications that required reoperation. We also review the advantages and the procedures for implanting the penile prosthesis on an outpatient basis or a one-day hospital stay.

NEW METHOD FOR MANAGEMENT OF DETRUSOR INSTABILITY: TRANSDERMAL SCOPOLAMINE

We report on the results of a pilot study using transdermal scopolamine in the management of detrusor instability (DI). Numerous agents have been used for the management of DI, however, many are associated with poor patient compliance and significant side effects. We have successfully used transdermal scopolamine on 3 patients with DI with good subjective and objective results.

Use of infrapubic incision for insertion of mentor Mark II inflatable penile prosthesis

Abstract This study reports the experience with 35 men who were implanted with a GFS Mark II inflatable penile prosthesis. The advantages of using the connectorless prosthesis with a reservoir/pump are reviewed.

Ochronosis of prostate presenting as advanced carcinoma

Ochronosis is the clinical manifestation of alkaptonuria, a rare inborn error of metabolism. It is characterized by widespread pigmentation of the fibroconnective tissues, arthritis, and passage of dark urine. Prostatic involvement is usually limited to the incidental finding of calculi within the gland. Herein, we report a case of diffuse ochronotic involvement of the prostate clinically presenting as a neoplasm.

Ultrasonography in evaluation of mechanical problems of inflatable penile prosthesis

A simple noninvasive and relatively inexpensive new technique utilizing real time sector ultrasonography for evaluation of mechanical failure in inflatable penile prosthesis is presented.

Percutaneous Removal of Intrarenal Bullet

We report a case in which percutaneous access was used for endourological removal of a bullet lodged within the renal parenchyma.

Use of Standard Contraceptive Diaphragm in Management of Stress Urinary Incontinence

The management of stress urinary incontinence (SUI) consists of either surgical intervention and/or pharmacologic manipulation. Twelve patients with SUI were evaluated for management by the use of a fitted standard contraceptive diaphragm. Complete resolution of SUI was achieved in 11 of 12 patients (91%). Two of the 12 patients achieved continence but withdrew from the study because of associated discomfort from the diaphragm, therefore, complete resolution of SUI was achieved in 9 of 12 patients (75%).

Male infertility: 1. Patient evaluation

Although the cause of male infertility is often obscure, proper evaluation can reveal physiologic abnormalities on which a concept of management can be based. Evaluation includes history taking, physical examination, laboratory studies, semen analysis, radiographic studies, and occasionally, testicular biopsy and other studies. The history and physical examination are the foundation of evaluation and may provide clues to diagnosis. However, semen analysis is the most informative test in evaluation of male infertility. For optimum results, proper collection techniques must be followed and data must be carefully interpreted.