Leonard H. Finkelstein

Epilation of hair-bearing urethral grafts using the neodymium:YAG surgical laser.

Nonhair-bearing skin should be used when grafting is necessary during urethroplasty for stricture or hypospadias repair. Occasionally, this is not possible or hair-bearing skin is used inadvertently. Traditionally, electrocoagulation has been the method used for epilation when intraluminal hair has become a problem, such as interfering with flow, as a focus for recurrent urinary tract infection or acting as a nidus for calculus formation. Electrocautery also is performed during grafting in an attempt to prevent the growth of hair when hair-bearing skin is used. Unfortunately, due to lack of penetration the hair follicles are not destroyed and the epilating procedure fails or is only partially successful. The neodymium:YAG surgical laser can photocoagulate tissue to a depth up to 5.0 mm, and thus, has the ability to destroy hair follicles. We report 4 cases presenting with clinical problems directly related to hair-bearing urethral grafts successfully treated by neodymium:YAG laser epilation.

Priapism Associated with Intranasal Cocaine Abuse

Cocaine abuse has escalated to epidemic proportions in the United States. In addition to the social and economic problems associated with the recreational use of this agent, a variety of medical complications have been reported. The occurrence of priapism with intranasal use has not been documented previously. We report a case of priapism secondary to intranasal cocaine abuse and describe the possible neurochemical etiology for this phenomenon.

Vesicoileal fistula: an unusual complication following the use of formalin for control of refractory post-irradiation bladder hemorrhage.

Abstract A case involving a vesicoileal fistula, an unreported complication of bladder formalin instillation for control of refractory hemorrhage after irradiation, and a review of the literature on the use of formalin are reported

Flow cytometric determination of ploidy in prostatic adenocarcinoma and its relation to clinical outcome

Flow cytometry was used to measure the DNA content in paraffin-embedded archival specimens of prostatic adenocarcinoma. The specimens were from 49 patients who were found to have adenocarcinoma of the prostate at the time of transurethral resection of the prostate for bladder outlet obstruction. At initial presentation, 34 of these patients had clinically localized disease and 15 had metastatic disease. The authors studied the relationship of DNA ploidy to clinical stage, histologic grade, disease progression, and duration of survival. Their results indicate that regardless of the clinical stage at presentation, the mean time to disease progression is longer in a patient with a DNA diploid tumor when compared with that in a patient with a DNA aneuploid tumor (18.1 months vs 6.5 months, respectively). Additionally, mean time of survival was longer in a patient with a diploid tumor than in a patient with an aneuploid tumor (31.6 months vs 9.6 months, respectively).

Fracture of the penis

Fracture of the penis — rupture of the tunica albuginea — is rare. Blunt trauma to the erect penis is usually the cause. We present the case of a patient who was treated surgically with good results. Diagnosis and emergency management of this problem are reviewed.

CO2 Laser Surgery in Urology

The characteristics, advantages, and disadvantages of the CO2 laser to various clinical situations in urologic surgery are described and evaluated. Conditions treated routinely with the laser are presented and future possible uses discussed.

Transurethral resection of the prostate combined with neodymium-YAG laser photocoagulation of residual tissue

Transurethral resection of the prostate (TURP), as now performed, utilizes electrosurgical technique for resection of prostate tissue and control of bleeding. Upon completion of the procedure a shell, or rim of residual tissue is left lining the fibrous anatomic capsule of the prostate gland. Postoperative bleeding in varying degrees usually occurs. This requires either continuous or intermittant bladder irrigation to prevent clot formation and occlusion of the indwelling urethral catheter.Transurethral resection of the prostate (TURP), as now performed, utilizes electrosurgical technique for resection of prostate tissue and control of bleeding. Upon completion of the procedure a shell, or rim of residual tissue is left lining the fibrous anatomic capsule of the prostate gland. Postoperative bleeding in varying degrees usually occurs. This requires either continuous or intermittant bladder irrigation to prevent clot formation and occlusion of the indwelling urethral catheter.