Louis R. Cos

Vasovasostomy: Current state of the art

Multiple techniques have been used for reanastomoses of the vas deferens after partial bilateral vasectomy. These procedures may be divided into 3 categories: macroscopic surgical loupe magnification and microscopic. At the University of Rochester Medical Center in Rochester New York vasovasostomy is performed with a surgical operating microscope and includes a 2-layer closure. All patients are hospitalized for 1 day. 2 separate upper vertical hemiscrotal incisions are made. If inguinal extensions are required the incisions are extended cephalad. The entire scrotal contents are delivered out of the wound and after the vasectomized ends of the vas are identified and carefully mobilized the occluded ends including the granuloma are sharply excised with a scalpel or fine sharp scissors. The presence of sperm in the semen at the time of vasovasostomy favors a good result but its absence is not an absolute prognosticator for failure. Once the presence of sperm is confirmed the proximal end of the vas canal may be irrigated with saline to decrease sperm concentration at the level of the anastomosis discouraging formation of a sperm granuloma. 87 vasovasostomies were performed at Strong Memorial Hospital of the University of Rochester School of Medicine and Dentistry. The overall patency rate was 75% with pregnancy rate of 46%. All those cases lost to follow-up were not included. The patency rate is based on 66/87 (75%) and the pregnancy rate 32/69 (46.3%). The average sperm count 6 months postoperatively was 21 million/ml; the mean motility score was 46% with an average 51% of normal forms. A table lists the results of 943 vasovasostomies performed by 19 surgeons using 6 techniques over the last 6 years. The best technical results (90% patency) were obtained with the microscopic 2-layer unstented technique. The best pregnancy rates were obtained with loupe magnification and a 1-layer stent technique. This discrepancy brings up the subject of a possible immunologic factor in the final results of vasovasostomy. Analysis of current information available leads to the following conclusions: the results of vasovasotomy have improved; the best technique for vasovasostomy appears to be the microscopic 2-layer unstented procedure; discrepancy in the results between patency and pregnancy indicate other factors are involved and antibodies are probably the major cause affecting pregnancy; and vasovasostomy results should be standardized to allow comparisons between surgeons. The role of sperm antibodies must be included in future prospective reports.

Human Papillomavirus Type 6 in Grade I Transitional Cell Carcinoma of the Urethra

Of 4 patients who underwent cystourethroscopy, biopsy and laser excision of suspected urethral condylomata acuminata 3 had coexistent grade I papillary transitional cell carcinoma of the urethra. Human papillomavirus type 6 messenger ribonucleic acid was demonstrated within biopsy specimens using tritium-labeled single-stranded antisense ribonucleic acid probes. Compared to condylomata the papillary transitional epithelium expressed less viral message, which might be expected in an epithelium that does not show full squamous epithelial or koilocytotic differentiation. Among these patients there was 1 papillary transitional lesion in the bladder that, although histologically similar, did not express human papillomavirus message, suggesting differential susceptibility of epithelium between the bladder and urethra. The finding of active human papillomavirus transcription within the urethral papillary transitional lesions raises the possibility of an active role for the virus in the pathogenesis of these lesions. These findings broaden the spectrum of epithelial types reported to support human papillomaviruses and provides impetus for a wider search for these viruses in other transitional cell neoplasms.

Cyclophosphamide-associated carcinomaof urothelium: Modalities for prevention

The relationship between the cyclophosphamide metabolite acrolein and hemorrhagic cystitis is well documented. Its role in inducing bladder cancer is not clear. There are at least 35 cases of cyclophosphamide-associated bladder cancer in the literature to date. We report 3 additional cases of transitional cell carcinoma of the bladder. Literature assessing the relative risk of bladder cancer associated with cyclophosphamide therapy is reviewed as are methods for decreasing the toxic effects on the urothelium of the metabolite acrolein.

Trauma-induced testicular torsion in children.

Testicular torsion represents an urgent surgical problem, whereas it is usual to treat testicular trauma conservatively initially. Direct trauma to the testis has been suggested and occasionally reported to be associated with torsion of the testis. We herein report three cases of testicular torsion secondary to direct trauma. Review of the mechanism of torsion is included. Torsion must be included in the differential diagnosis of direct testicular trauma and treatment must not be delayed.

Bacillus Calmette-Guerin and Interleukin-2 for Treatment of Superficial Bladder Cancer

A total of 22 patients with bladder cancer received bacillus Calmette-Guerin (BCG) and interleukin-2. Significant bladder tumor remissions were noted in 15 of 17 patients (88%). Of 5 patients with carcinoma in situ 1 was noncompliant and he died of carcinoma in situ. The other 4 patients are in remission. BCG alone was instilled in 22 additional patients with superficial bladder cancer. The remission rates were encouraging. Of the 22 patients 13 (59%) had remission of the bladder tumor. A half dose of BCG (60 mg.) is adequate when given weekly for 6 weeks. Maintenance therapy is important as noted in both of our clinical arms. BCG and interleukin-2 therapy results in a higher remission rate.

Inflammatory communicating hydrocele

Abstract A case of acute scrotal swelling after appendectomy is described. Differential diagnosis of an acute scrotal swelling is reviewed.

Primary non-hodgkin lymphoma of prostate presenting as benign prosttic hyperplasia☆

A case of primary non-Hodgkin lymphoma of the prostatic gland is reported. The patient presented with a classic picture of benign prostatic hyperplasia. Review of the literature disclosed about 300 reported cases. Much controversy and confusion exists in the classification of non-Hodgkin lymphoma. The two current classifications are presented, and management of this condition is reviewed.

Recovery of glomerular and tubular function in autotransplanted dog kidneys preserved by hypothermic storage or machine perfusion. Relation of initial function to long-term function.

Sixteen male dogs had split renal function studies prior to unilateral nephrectomy and autotransplant. Kidneys were preserved for 24 hr by either simple hypothermic storage in Collins C2 solution (SHS) or machine-perfused (MP) on a Waters machine (MOX 100) with plasmanate perfusate. Renal function studies were repeated at 1 hr and at 7, 14, and 28 days, and the statistical relationship between initial and 1-month function was determined for a number of parameters. All MP kidneys functioned immediately, whereas 1/3 of SHS kidneys had delayed function. Recovery was more rapid in MP kidneys and was essentially complete by 14 days, at which time MP kidneys had higher rates of creatinine clearance and sodium reabsorption. However, by one month 3/7 MP kidneys (P = 0.15 compared with SHS) had lower creatinine clearance rates than at 2 weeks, and para-aminohippurate (PAH) clearance and fractional sodium reabsorption were significantly decreased. During the same period SHS kidneys either showed continued improvement or maintained stable function. Thus, by one month there were no differences between the groups in clearances of creatinine and PAH, plasma creatinine and blood urea nitrogen concentrations, or fractional reabsorption of sodium, potassium, and water. For SHS kidneys, the 1-hr creatinine clearance and the absolute rate of sodium reabsorption were strong predictors of the eventual function of the kidneys at one month (r = 0.93 and r = .83, P less than 0.05, respectively). No such correlations were found in MP kidneys (r = less than .01, P greater than 0.9 for both variables). The data show that MP results in significantly better function early after transplant, but this advantage does not persist, and that SHS kidneys early function is a good predictor of long-term recovery, but this is not true for MP kidneys.

Hereditary hemorrhagic telangiectasia of bladder in a child

Abstract A female child with gross painless hematuria and cutaneous telangiectasia was found to have 3 telangiectasic areas in the bladder. This represents a case of Osler-Weber-Rendu disease (hereditary hemorrhagic telangiectasia), a rare occurrence in a child or in the urinary bladder.

Pulmonary embolism from left subclavian vein thrombus following suprapubic prostatectomy

Deep venous thrombosis (DVT) of the axillary and subclavian veins accounts for approximately 1-2 percent of all recorded deep venous thrombosis. Pulmonary embolism from an upper extremity DVT has been reported to vary between 2 percent and 35.7 percent. We report the occurrence of a left subclavian vein DVT with subsequent nonfatal pulmonary embolism in a sixty-two-year-old patient twenty-four hours following suprapubic prostatectomy. A review of the literature is presented, along with pathophysiology, diagnosis, and treatment.