J. Vincent Thomalla

Infectious Complications of Penile Prosthetic Implants

An infectious complication involving placement of a penile prosthesis is a disastrous event. A review of more than 300 devices placed between 1979 and 1984 at this center reveals an infectious complication rate of 8.3 per cent. Perioperative risk factors predisposing to infection included reoperation for technical failures, inadequate antibiotic coverage (specifically for Staphylococcus epidermidis), failure to perform a circumcision at the time of placement in uncircumcised patients and simultaneous placement with an artificial urinary sphincter device. No group of patients nor type of prosthesis was more susceptible to the development of a postoperative infection.

Induction of Cloacal Exstrophy in the Chick Embryo Using the CO2 Laser

We have developed a model for cloacal exstrophy in the chick embryo using the Cavitron AO 300 CO2 laser. Embryos between 68 and 76 hours of development have been injured caudal to the omphalomesenteric vessels in the region of the tail bud in ovo. This has resulted in the induction of cloacal exstrophy in 5 of 59 chicks that survived ten days after injury. Evidence from this model suggests that cloacal exstrophy is caused by early disruption of the cloacal membrane or that group of cells responsible for its subsequent development.

Renal transplantation into the reconstructed bladder.

In our experience with 821 renal transplants performed between 1974 and October 1987 we used the native or reconstructed bladder of the patient in all but 2 instances. Seven patients have undergone enterocystoplasty and subsequent renal transplantation, while 1 underwent bladder augmentation after transplantation. Of these 8 patients 4 have functioning grafts 6 months to 7 years after transplant or reconstruction. Renal transplantation coupled with enterocystoplasty in properly selected patients has acceptable morbidity and should be considered as an alternative to other forms of urinary diversion in allograft recipients.

Perforation of urinary bladder by intrauterine device.

Perforation of the uterus by an intrauterine device (IUD) is not an uncommon complication of this means of birth control. Comparatively, however, perforation of the bladder is uncommon, having been reported only seven times previously in the literature. This additional case is presented with review of the current literature and discussion of uterine and bladder perforation by an IUD.

The Manifestation and Management of Late Urological Complications in Renal Transplant Recipients: Use of the Urological Armamentarium

The incidence of urological complications in renal transplant patients is well documented. The majority of these complications occur in the early postoperative period; late occurrences (more than 3 months) are much less common. We have had experience with 7 patients who presented with late complications 3 months to 7 years after transplantation: ureteral obstruction occurred in 4 patients, ureteral disruption or laceration in 2 and neurogenic bladder with hydronephrosis in 1. Management of these patients has been varied and has included cystoscopic stent placement, Boari flap, ureteropyelostomy, ureteroneocystostomy, bladder augmentation and urinary undiversion. Grafts have been salvaged in 6 of 7 patients. Transplant patients who present with late urological complications can be challenging. However, the potential for intervention and graft salvage is excellent.

Ventral Preputial Island Flap Technique for the Repair of Epispadias with or without Exstrophy

The preputial island flap technique introduced by Duckett for repair of severe hypospadias has met with much clinical popularity. We report the use of a modification of this technique for repair of epispadias in 3 boys with exstrophy of the bladder and in 1 with penile epispadias. The results have been excellent in 3 cases and good in 1. Minimum followup has been 18 months.

Posterior urethral valves in siblings.

The etiology and incidence of posterior urethral valves is unknown. We report on a pair of non-twin siblings with identical pathology stemming from type I posterior urethral valves as well as discordance in a pair of monozygotic twins. Familial posterior urethral valves have been reported before in both twin and non-twin siblings. The occurrence of identical pathology in non-twin siblings suggests the possibility of an inherited trait as does its occurrence in identical twins. However, non-identical clinical manifestation is as common as is identical presentation in both groups. There are also instances of discordance in monozygotic twins suggesting the possibility of a random mutation. As such, we recommend urologic evaluation of the male siblings of affected patients with posterior urethral valves. Further prospective and retrospective analyses are needed to define the genetic etiology of valves.

Fatal transitional cell carcinoma of bladder in renal transplant recipient

The risk of development of a malignancy as a consequence of long-term immunosuppression is well documented. Herein, we report the course of a renal allograft recipient in whom a fatal transitional cell carcinoma of the bladder developed eighteen years following transplantation.

Renal Transplantation in a Patient With an Artificial Urinary Sphincter Device

Use of the artificial urinary sphincter device has become widespread. We describe the successful transplantation of a renal allograft into a recipient with an artificial urinary sphincter. Pretransplant placement of a sphincter, intraoperative avoidance of the prosthetic device and proper urinary drainage perioperatively make the artificial urinary sphincter device a feasible means to provide continence in a renal transplant recipient.

A, B and H antigens in normal urothelium: an immunohistochemical study using monoclonal antibodies with the avidin-biotin complex technique.

Immunohistochemical staining for the A, B and H blood group antigens was studied in 61 normal human ureters using monoclonal antibodies with avidin-biotin complex application. Thirty-seven of these were archival material, and 24 were processed prospectively. In 100 per cent of the prospectively processed ureters, A, B and H antigens were demonstrated corresponding to the blood type of the source. Archival material stained for A, B and H 65 per cent, 50 per cent and 100 per cent of the time, respectively. Serial sampling of prospectively processed ureters showed diminution of staining with prolongation of immersion in formalin. A characteristic staining pattern was found in ureters from patients with type B blood.