John G. Gregory

Acute Epididymitis in Boys: A 5-Year Retrospective Study

A retrospective study was undertaken of 25 children with epididymitis seen at our pediatric hospital during the last 5 years. The symptoms and signs in these patients were evaluated, as well as the results of urinalysis, urine culture, excretory urogram, scrotal scan, exploration and white blood count. The presence of underlying urological problems was particularly sought for and found to be rare prior to epididymitis. The treatment and results are reviewed.

Oxalate Stone Disease After Intestinal Resection

There have been 543 jejuno-ileal bypass patients screened for the presence of urinary calculi 1 to 6 years postoperatively. Of these patients 9 per cent have had 1 to 2 calculi during the followup and 3 per cent have had multiple calculi. Ninety-four per cent of the recovered calculi consisted entirely of calcium oxalate. Seven patients had a history of stones before the bypass, 6 of whom have had additional stones postoperatively. To define the conditions associated with stone formation in these patients measurements of serum and urinary oxalate concentration, urinary calcium oxalate saturation, urinary crystal size distribution, and the rates of intestinal oxalate absorption and urinary crystallization have been performed on patients who did and did not have stones postoperatively. On the basis of these studies it appears that the patients in whom stones formed differ from those in whom they did not form only in the rate of urinary crystallization and in the number of large crystal particles present in the urine. Evaluation of current therapeutic modalities in terms of the capability to correct these stone-forming characteristics and to reduce actual calculus formation reveals that the only successful regimen is that which includes an extreme reduction of oxalate ingestion.

The inflatable penile prosthesis: failure of the rear tip extender in reducing the incidence of cylinder leakage.

Of 184 patients who have received an inflatable penile prosthesis at our institution since 1974, 43 per cent have undergone reoperation, the majority of which were owing to cylinder leakage. Comparison by life-table analysis of cylinders placed before and after introduction of the rear tip extender does not show an improvement in cylinder survival to date.

Osteomyelitis of the Pubic Symphysis After Urologic Surgery

Osteomyelitis represents a pyogenic infection of the bone and marrow. The diagnosis is based on specific criteria and often is difficult to make. Herein we present 2 cases initially thought to represent osteitis pubis but subsequently proved to be osteomyelitis and compare the 2 entities with emphasis on differential diagnosis and treatment. Despite certain differentiating characteristics the correct diagnosis is often uncertain without histologic examination. Since the treatment of these 2 entities is quite different equivocal cases should undergo surgical exploration and bone curettage. This procedure will enable definite diagnosis to be made and proper treatment to be instituted.

The Inflatable Penile Prosthesis, Reoperation and Patient Satisfaction: A Comparison of Statistics Obtained from Patient Record Review with Statistics Obtained from Intensive Followup Search

Of 179 patients who received the inflatable penile prosthesis 43 per cent have required reoperation, 60 per cent of which were performed for mechanical failure. An attempt to evaluate the adequacy of chart review in assessing current function and patient satisfaction was made by comparing reports obtained by chart review to those obtained by direct patient interview. Results showed that if chart review alone was used malfunction would have been underestimated by 13 per cent and patient satisfaction overestimated by 21 per cent. The importance of direct followup in evaluating patients with the inflatable penile prosthesis is demonstrated.

Treatment of post-orchiectomy hot flashes with transdermal administration of clonidine

The occurrence of hot flashes in men after bilateral orchiectomy for prostatic carcinoma can be bothersome and difficult to treat. Transdermal clonidine was administered to 7 patients with such symptoms. In 3 patients the hot flashes were ablated and in the remaining 4 the number and frequency of attacks were considerably reduced. No significant side effects were encountered. We suggest that transdermal clonidine (0.1 mg.) administered weekly can safely control undesirable hot flashes in men after bilateral orchiectomy.

Intermittent Catheterization: Evaluation of Complete Dryness and Independence in Children with Myelomeningocele

We studied 46 children in active followup who have been managed by nonsterile intermittent catheterization to achieve continence. All patients were given maximum therapeutic doses of supplemental medication to improve dryness. Of the patients 33 per cent were noncompliant and, therefore, wet, 30 per cent were wet despite full compliance with the program, and only 24 per cent were completely dry and wearing regular underclothing. Nine children experienced side effects from the supplemental medications that were severe enough to warrant discontinuation of the drug. Of the 46 patients 19 have been removed from the catheterization program and currently are being managed by other modalities. Only 11 of the remaining 27 patients currently managed by catheterization perform the procedure independently. Results suggest that intermittent catheterization does not provide independence or social continence in many patients.

Scrotal scanning: present value and limits of interpretation.

Forty-three testicular scans have been performed on 38 patients presenting with various scrotal symptoms. Scan diagnosis correlated correctly with the clinical findings in 86 per cent of cases. The most common cause of false positive testicular scan was found to be hydrocele. The mechanism responsible for this observation has been explored in a rat model. A false negative diagnosis was made in 2 cases owing to a small retracted scrotum in 1 patient and a markedly late discovered torsion in the second.

Urologic complications of ileal bypass operation for morbid obesity.

Preoperative, operative and postoperative data from a sampling group of 435 ileal bypass patients have been tabulated and computer-analyzed. Genitourinary disorders other than stone disease have been insignificant. Patients with stones and those without stones have been compared and the significant data tabulated. The incidence of stone disease is 6 per cent. All but 1 stone consisted of calcium oxalate. Oxalate levels were normal preoperatively and elevated in 60 per cent postoperatively. The stone formers are among the heaviest members of the studied population, they have the greatest amount of ileum bypassed and the greatest amount of 1 year weight loss. Correlations between these observations and possible pathways of metabolic stone disease are made.

The management of vesicoureteral reflux in the pediatric neurogenic bladder.

An integrated method of management has been used in 29 children with neurogenic bladders and vesicoureteral reflux. Radiological followup reveals that resolution or improvement of reflux occurred in 48 per cent of the renal units managed by close observation only, 48 per cent managed by intermittent catheterization, 75 per cent managed by vesicostomies and 100 per cent in which the ureters were reimplanted. As in the non-neurogenic bladder successful management of reflux and prevention of upper tract deterioration can be achieved by conservative management as well as by ureteroneocystostomy. A protocol of management is outlined.