Jerry W. Sullivan

Priapism: Review of 34 cases

One hundred ninety-seven cases of priapism have been recorded in the medical files of Charity Hospital Louisiana in New Orleans from 1938-1982. One hundred seventy-two adults and 25 children were registered in this series. Ninety-three per cent of the patients with priapism were black, and 86 patients of this group underwent 93 surgical procedures. The cases of 34 patients treated between July 1, 1981, and December 31, 1982, were thoroughly reviewed. Sixteen patients had a previous history of priapism. Average delay between onset of symptoms and presentation to the hospital for treatment was thirty hours. Sickle cell screens were obtained in 28 patients and were positive in 17. Twenty-nine patients were initially treated conservatively, with 17 priapisms eventually resolving, but the remaining 12 patients required surgical intervention. Overall, 50 per cent of the 34 patients had surgery. All of the surgical cases resolved satisfactorily with the Winter procedure. Complications with this procedure were uncommon, but postoperative bandaging was the chief cause of morbidity. Follow-up for at least six months revealed comparable sexual potency (80-83%) in either conservatively or surgically managed patients.

The Partial Dependency of Human Prostatic Growth Factor on Steroid Hormones in Stimulating Thymidine Incorporation into Dna

Growth factors stimulating DNA synthesis in mouse 3T3, human DU145, and LNCaP were partially purified from human benign hyperplastic and cancerous prostates. These factors have a high affinity for heparin sepharose and are eluted from the heparin-sepharose column, at 1.2 to 1.9 M NaCl. In normal prostates, the high affinity human prostatic growth factor occurred only in extremely small amounts. The high affinity growth factors stimulate DNA synthesis in 3T3, DU145, and LNCaP. Stimulation was significantly enhanced by 5 alpha-dihydrotestosterone and 17 beta-estradiol in the androgen sensitive LNCaP cell line. SDS-PAGE and isoelectrofocusing confirmed that the partially purified factors had a molecular weight of 18 kDa and acidic isoelectric points of pH 3.6 and 4.7.

Glomus tumor of glans penis.

Glomus tumor is an infrequent skin lesion and a rare lesion on the male genitalia. This is the second reported case of this lesion on the penis.

A +20% Adjustment in the Computed Tomography Measured Ureteral Length Is an Accurate Predictor of True Ureteral Length Before Ureteral Stent Placement

PURPOSE The correct length of a ureteral stent is important in minimizing postplacement discomfort and stent migration. We describe and validate a method to accurately measure the ureteral length. MATERIALS AND METHODS The ureteral length in 48 patients undergoing ureteral stent placement for urolithiasis was measured by computed tomography (CT) (total thickness of axial slices between the ureteropelvic junction and ureterovesical junction) and adjusted up by 20%. The adjusted CT measurement of ureteral length was compared with direct intraoperative measurement using scatter plot and Pearson correlation coefficient. Correlation coefficients were also calculated between intraoperative ureteral length and various body habitus measurements such as the height, weight, and waist circumference. RESULTS Median patient age was 62 years. The median stone diameter was 7.5 mm (1-20). The ratio of left- to right-sided stones was 2:1. The stone location was in the proximal ureter in 45.8%, distal ureter in 37.5%, kidney in 10.4%, and midureter in 6.3%. Symptoms included adnominal/flank pain (93.8%) followed by nausea/vomiting (39.6%) and gross hematuria (16.7%). Median creatinine was 1.4 (0.8-3.6 mg/dl) and median WBC was 8.6 (2.8-17.6). The median ureteral length was 25.8 cm (19.2-29.4) on the CT scan and 25.5 cm (19.0-29.0) on the intraoperative measurement (p=0.57). The Pearson correlation coefficient between the two measurements was 0.979. In contrast, the height, weight, and waist circumference correlated poorly with intraoperative ureteral length measurements (r=0.34, 0.19, and 0.40, respectively). CONCLUSION CT-measured ureteral length adjusted up by 20% is a reliable method to accurately measure the true ureteral length. This method is superior to traditional indirect methods that rely on body habitus measurements.

MP6-04 THE IMPACT OF TRAINING DENSITY ON PROSTATE CANCER DETECTION: AN ANALYSIS OF OVER 2000 PROSTATE BIOPSY CASES PERFORMED BY UROLOGY RESIDENTS

INTRODUCTION AND OBJECTIVES: There is wide variability in the number of prostate biopsies performed by residents. Residency programs reported a vast range in number of cases per trainee in 2010 and 2011 (13-540, 17-329, respectively). This study investigates the impact of caseload density (number of biopsies completed over a given time period) on the likelihood of a positive biopsy result. METHODS: We examined 2,046 prostate biopsy procedures performed by first-year urology residents. Residents were divided into high-density (HD; first 10 cases in 15 days) and low-density (LD; first 10 cases in >15 days) training groups. The primary endpoint was the likelihood of cancer diagnosis. The frequency of cancer detection in the initial 10 cases was compared to that of the subsequent cases using generalized estimating equation models that account for correlated observations and control for multiple covariates. RESULTS: High-density training achieved significantly more consistent results compared to LD training. In the HD group, the odds ratios (OR) of detecting cancer ranged from 0.83 (p1⁄40.50) to 1.09 (p1⁄40.84) when comparing the first 10 cases with subsequent sets of 10 cases up to 50 cases (Figure). The cancer detection rate was unchanged comparing the first 50 cases with the subsequent 50-100 cases (OR1⁄41.40, p1⁄40.06) and >100 cases (OR1⁄41.17, p1⁄40.16). In contrast, LD residents showed significant and progressive improvement in their ability to detect prostate cancer during the first 50 procedures (OR up to 2.54, p1⁄40.018) before reaching a plateau at 41-50 cases. CONCLUSIONS: Training density may play an important role in medical and surgical residency education. For prostate biopsy, high-density training (first ten cases within 15 days) appears to result in more consistent cancer detection rate during subsequent procedures. We conclude that high-density training is likely to achieve earlier attainment of proficiency thereby obviating the need for large case numbers and allowing residents more time to master other procedures.