Keith W. Kaye

Deep Posterior Compartmental Syndrome: A Serious Complication of the Lithotomy Position

We describe a case of deep compartmental syndrome after use of the dorsolithotomy position. This condition is associated with significant morbidity unless recognized and treated immediately. This patient suffered a slight residual neuromuscular impairment. We review the pathogenesis, diagnosis, treatment and prevention of this condition, which in its early stages often mimics deep venous thrombosis.

Detailed Caliceal Anatomy for Endourology

A thorough understanding of caliceal anatomy is required to interpret excretory urograms and to perform safely endourological manipulations. Caliceal angles, posterior rotation of the lateral renal margin and caliceal placement in relation to the lateral aspect of the body were studied in 26 right and 24 left kidneys. Differences between kidneys found to be Brödels types from those of the Hodson type, and the significance of these findings for performing nephrostolithotomy are described.

Tamponade nephrostomy catheter for percutaneous nephrostolithotomy

Hemorrhage from the nephrostomy tract is the most common major complication associated with percutaneous nephrostolithotomy. The tamponade nephrostomy catheter is a new addition to the endourologists instruments; it is expressly designed to achieve immediate tamponade of the nephrostomy tract. The large-diameter, occlusive balloon (36F) is carried on a 14-F nephrostomy tube which is passed over a 5-F ureteral stent. As such, the catheter not only tamponades the nephrostomy tract but effectively drains the renal pelvis, while maintaining ureteral access.

Comparison of Doppler examination and retrograde spermatic venography in the diagnosis of varicocele

The accuracy of the Doppler stethoscope is compared with that of retrograde spermatic venography in the diagnosis of varicocele in 39 subfertile men. In the 38 cases in which left-sided venography was successful, there was a good correlation between the radiographic and Doppler results in 33 cases (87%). The five failures were all false-negative results in patients without clinically diagnosed varicoceles. In the 33 cases in which right-sided venography was successful, there was a good correlation between the radiographic and Doppler results in 17 patients (52%). This low sensitivity on the right side appears to be a minor drawback, because right-sided reflux almost always occurs in conjunction with left-sided reflux, and therefore varicocele would be diagnosed in these patients despite the false-negative Doppler finding. Unlike venography, the Doppler study is noninvasive, inexpensive, and easy to perform. We conclude that it should be part of all studies of varicocele and infertility and that it may prove sufficiently accurate for use in controlled studies of the effectiveness of varicocelectomy and the role of subclinical varicocele in the pathogenesis of infertility.

Renal Anatomy for Endourologic Stone Removal

A transparent kidney model that shows the position of the calices in relation to the surface can be fabricated easily and is invaluable in planning percutaneous nephrostolithotomies and other endourological procedures.

Prostate specific origin of dipeptidylpeptidase IV (CD-26) in human seminal plasma.

PURPOSEnA number of peptidases which can metabolize certain bioactive peptides and growth factors have been identified in seminal plasma. Our goal in this study was to determine molecular properties and the tissue source(s) for one of these peptidases, dipeptidylpeptidase IV (DPP IV), in human seminal plasma.nnnMATERIALS AND METHODSnWe measured the activities of DPP IV with the dipeptide glycylprolyl-p-nitroanalide and its molecular forms using immunoblotting of seminal plasmas of men who were vasectomized or with different sperm concentrations, and in prostatic and seminal vesicle secretions of men undergoing prostatic surgery.nnnRESULTSnDPP IV in seminal plasma of vasectomized men was a membrane associated dimer comprised of subunits of approximately 110 kDa. Its activity did not differ in seminal plasmas of vasectomized, azoospermic, oligozoospermic and normozoospermic men indicating no correlation with the concentration of sperm originally present in the semen. The DPP IV antigen (CD -26) and enzymic activity were present in prostatic secretion, but absent from that of the seminal vesicles. These data indicate that the prostate gland is the primary source of DPP IV activity in seminal plasma. There was little variation in its activities in repeat seminal plasma samples from the same individual, and there was no change in its activity with age to 50 years.nnnCONCLUSIONSnDPP IV in seminal plasma was derived from the prostate gland and it may be useful as a bioindicator of prostate function and/or disease with age in men.

Outpatient Hydrocele and Spermatocele Repair under Local Anesthesia

We performed 20 hydrocele repairs and 18 spermatocelectomies using Lords techniques on outpatients under local anesthesia. The only complication was delayed wound healing early in the series when tight pressure dressings were used. We now use only a simple dressing and a scrotal support. This method for these operations reduces the cost by 74 per cent compared to inpatient procedures under general anesthesia. This safety and cost-effectiveness argue strongly for performance of most hydrocele repairs and spermatocelectomies as outpatient procedures under local anesthesia.

Ultrasonographic anatomy of normal prostate gland: Reconstruction by computer graphics

Computer graphic reconstructions of the prostate were made in both the transverse (axial) and longitudinal (sagittal) planes at different levels on the basis of the normal anatomic model of McNeal. Additional images then were created to give a picture of what the ultrasonogram should look like at each level, and these were compared with actual ultrasonograms of the normal prostate. A precise yet simple terminology is suggested for prostate ultrasonographic descriptions.

Presence and characterization of two protein kinase activities in human seminal fluid

The presence of two protein kinase (ATP: protein phosphotransferase, EC 2.7.1.37) activities has been demonstrated in human seminal fluid, utilizing partially dephosphorylated phosvitin and lysine-rich histones as model acceptor substrates. Both kinase activities were maximal in the presence of MgCl2 and a sulfhydryl-protecting agent such as dithiothreitol; however, the histone kinase was stimulated to a greater extent by the latter. The histone kinase displayed a broad shoulder of activity at pH values of 7.1 to 7.6 with optimal activity at pH 8.0, and was inhibited by increased ionic strength (53% at 160 mM NaCl) and by the cyclic AMP-dependent protein inhibitor from rabbit muscle. The kinase activity towards phosvitin exhibited a broad pH profile with maximal activity at pH 7.2, was slightly stimulated by NaCl (20% at 160 mM), and was unaffected by the cyclic AMP-dependent protein kinase inhibitor. Kinetic studies revealed more than one apparent Km for the protein substrates and ATP. These differences in enzymic properties of kinase activities towards phosvitin and lysine-rich histones strongly indicate the presence of multiple enzymes. It appears that the histone kinase activity is attributable to the free catalytic subunit of a cyclic AMP-dependent enzyme. The protein kinase activities of seminal fluids from vasectomized men were 12-20% of those found for seminal fluids of normal men. This suggests that sperm may be a major source of protein kinase activities in seminal fluid.