Julian S. Ansell

Etiology manifestations and therapy of acute epididymitis: prospective study of 50 cases.

There were 50 patients with acute epididymitis who were evaluated prospectively by history, examination and microbiologic studies, including cultures for aerobes, anaerobes, Neisseria gonorrhoeae, Chlamydia trachomatis and Ureaplasma urealyticum. Escherichia coli was the predominant pathogen isolated from the urine of men more than 35 years old, while Chlamydia trachomatis and Neisseria gonorrhoeae were the predominant pathogens isolated from the urethra of men less than 35 years old. The etiologic role of Escherichia coli and Chlamydia trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine or urethral cultures for these agents. Chlamydia trachomatis epididymitis accounted for two-thirds of idiopathic epididymitis in young men and often was associated with oligospermia. Of 9 female sexual partners of men with Chlamydia trachomatis infection 6 had antibody to Chlamydia trachomatis, of whom 2 had positive cervical cultures for this organism and 2 others had non-gonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with Chlamydia trachomatis epididymitis and should be offered to the female sex partners.

Urological Trauma in the Pacific Northwest: Etiology, Distribution, Management and Outcome

A computer-assisted review identified 184 patients with genitourinary tract injuries among 5,400 hospitalized for trauma. Particular attention was directed to the controversial groups of patients with blunt renal and posterior urethral injuries. Management of renal injuries was based on clinical criteria. Subsequent renal exploration was necessary in only 1 of 115 patients with renal contusions, or simple or deep lacerations who underwent initial expectant management. Followup was available in all patients with severe renal injuries and in 53 per cent with renal contusions or simple lacerations. Parenchymal loss was noted on an excretory urogram in only 1 patient and none suffered hypertension, hydronephrosis or other sequelae. A staged approach was preferable to immediate repair of posterior urethral injuries. Seven patients managed by initial cystostomy drainage followed by secondary urethral repairs did well. Primary realignment was complicated by stricture, incontinence or impotence in 3 of 6 patients.

Some observations on catheter care

FOR YEARS urologists have been dedicated to the elimination of the catheter as a means of urinary drainage. Their success in removing this urinary prosthesis is epitomized in CREEVY’S remarkable achievement of 0.6 per cent mortality in a series of 1000 cases of prostatectomy [l]. DEBENHAM and WARD in Great Britain [2] have gone so far as to attempt prostatectomy suns catheter although their mortality and infection figures are no improvement on those of others for the same procedure with catheter drainage. It is somewhat embarrassing then for an urologist to have to come to the defense of the urinary catheter when he and his predecessors have worked so hard to effect its safe removal from patients. However, because misleading charges have been cast at the catheter in the recent past [3], one whose practice involves the temporary use of this device is moved to defend the proper care of the catheter and to castigate those whose abuse has given it a poor reputation. This paper is divided into three parts. The first deals with single catheterization: the second is concerned with the problem of the indwelling catheter, and finally the closed drainage system of catheter care employed on the Urology Service at the University of Washington Hospital will be discussed. Single diagnostic catheterization. Clean-voided midstream specimens should be used for diagnostic urine cultures wherever feasible [4]. SANFORD’S revival of the colony count originally suggested by MARPLE [5] as a means of differentiating contaminants from pathogens has been most useful. However, there are situations in which diagnostic or therapeutic catheterization is unavoidable and PRYLES et ~2. [6] and JACKSON and GRIEBLE [7] suggest that the incidence of infection during a carefully carried out catheterization, while definite, is very low. This is also borne out by the series of 200 single catheterizations carried out in a local institution by TURCK et al. [8] in which no contamination resulted. In this respect it may be well to cite the work of PRYLES [6] who followed closely a group of children subsequent to catheterization. All were free from urinary tract infection within a period of 4-6 months following catheterization. Thus, while organisms were introduced into the urine of the children during catherization and in apparently significant quantities, long-term infection was not a complication. While properly collected clean-voided specimens may be used in most instances for making the diagnosis of bacteriuria in children, catheterization, when properly done, should not be withheld for fear of producing urinary tract infection. While all physicians should be alert to the

Ureteropelvic Junction Obstruction in Infants and Children: Functional Evaluation of the Obstructed Kidney Preoperatively and Postoperatively

We evaluated 14 children with primary ureteropelvic junction obstruction, using preoperative excretory urography and renal imaging with the renal cortical labeling agent 99mtechnetium dimercaptosuccinic acid. All children with a reduction in function of 10 per cent or more in the obstructed kidney had severe calicectasis; others with severe calicectasis had minimal functional loss. Renal scanning with dimercaptosuccinic acid discourages surgery in the questionably obstructed kidney and encourages repair in the severely obstructed kidney. In 10 children who had followup renal imaging after repair relative function was not significantly different.

Urinary reflux via the vas deferens: unusual cause of epididymitis in infancy.

Summary Urinary reflux into the vasa deferentia and seminal vesicles can take place with obstructive lesions of the urethra in infants. In such cases epididymitis may occur, which should alert the physician to the possible existence of such a lesion. In these cases complete urologic evaluation with excretory urography, cystourethrography, and endoscopy should be carried out as indicated. Two cases are presented of epididymitis, which, when drained, resulted in temporary urethrovasocutaneous fistulas. Review of the literature has revealed only one previous case report of this complication in infants. 8

The Use of Self-Retained Ureteral Stents in the Management of Urologic Complications in Renal Transplant Recipients

Nineteen self-retaining ureteral stents were used to manage postoperative ureteral obstruction and fistulas in 12 renal transplant recipients. In 3 patients with ureteral obstruction and 2 with a fistula placement of the self-retaining stents for 4 to 6 weeks allowed the complication to resolve. In 3 patients with ureteral obstruction placement of the self-retaining stents allowed for stabilization of the condition and reduction of immunosuppression therapy before an open surgical repair. In 6 patients self-retaining ureteral stents were used to protect the high risk anastomosis done at an open surgical repair of a complication. Placement of a self-retaining ureteral stent may be the best choice in the early management of ureteral obstruction and fistulas in transplant recipients.

Lack of Agreement Between Subjective Ratings of Instructors and Objective Testing of Knowledge Acquisition in a Urological Continuing Medical Education Course

Objective scores from multiple-choice questions before and after a postgraduate course were compared to subjective ratings of the instructors at a 3-day seminar. The objective mean scores after the course were significantly higher than the scores before the course (p less than 0.0001). There was no correlation between test results and subjective ratings of instructors.

Echinococcal cyst of the kidney.

A renal echinococcal cyst presenting with ureteral obstruction is described. Characteristic diagnostic features, including renal angiography, are discussed. Whereas partial nephrectomy is appropriate for a small closed renal cyst, total nephrectomy is indicated for most large or open cysts.

Cysts of the Ducts of Cowper’s Glands

We describe 4 patients, 3 of whom were children, with cysts in the ducts of Cowpers glands. Presenting symptoms were testicular pain and urethritis. Voiding urethrography with dilute contrast medium is the best diagnostic aid short or urethroscopy. The cysts were effectively treated by avulsion with a bent wire.

The artificial bladder: A historical review

The search for the ideal surgical replacement for all or part of the urinary collecting system continues. A wide variety of biologic and nonbiologic substitutes have been tried. Even though much experience has been gained in this area, the use of artificial material remains at an experimental level and needs further development. This review presents the history, problems, and developments of the replacement of the urinary bladder by nonbiologic materials.