M.G. McLoughlin

Vasovasostomy: A Comparison of Macroscopic and Microscopic Techniques at One Institution

During a 5-year period between 1973 and 1977, 87 patients underwent vasovasostomy to correct postvasectomy sterility. Sixty-one patients had single-layer macroscopic reanastomoses and 26 patients had two-layer microscopic reanastomoses. Patency rates of 90% and 96% and pregnancy rates of 46% and 54% for the macroscopic and microscopic techniques were achieved.

Kinetic analysis of 5α-reductase isoenzymes in benign prostatic hyperplasia (BPH)

Kinetic parameters (KM and Vmax) of the 5 alpha-reductase activities in homogenates of stroma and epithelium, isolated from BPH tissue, were determined using both testosterone and progesterone as substrate. The mean KM values for stromal 5 alpha-reductase, at 67.9 nM and 27.7 nM for testosterone and progesterone respectively, were 3-4-fold higher than the comparable KM estimates for the epithelial enzyme. The KM estimates for the epithelial 5 alpha-reductase showed little variation whereas those measured in the stromal homogenates could be subgrouped at less than 50 nM and greater than 100 nM. The mean Vmax for the stromal 5 alpha-reductase was approximately 235 pmol/30 min/mg protein irrespective of the substrate used; a value 10-fold higher than the Vmax of the epithelial 5 alpha-reductase. Preliminary experiments with inhibitors of 5 alpha-reductase demonstrated that the stromal and epithelial enzymes differed in their relative sensitivity to these compounds. Three major conclusions can be drawn from these results: first, that progesterone is a better substrate for prostatic 5 alpha-reductase than testosterone; second, that BPH tissue has at least two isoenzymes of 5 alpha-reductase--one in the epithelium and one (or more) in the stroma; and third, in hyperplastic prostates, most of the 5 alpha-reductase molecules are located in the stroma.

Microdissection and radiographic studies of the arterial vasculature of the human testes

Conflicting and sparsely detailed reports concerning the arterial vasculature of the testes prompted us to study 51 human cadaveric testicles radiographically in order to document any interarterial communications. Twelve specimens were harvested from the pediatric age group and 39 from adult cadavers. Vascular communication was demonstrated between the testicular, cremasteric, and vasal arteries in all specimens studied. Large-caliber anastomotic channels were demonstrated between the testicular and vasal arteries in 87% of specimens. No discernible differences in these vascular communications were documented among adult, pediatric, and undescended testes.

RADICAL PROSTATECTOMY FOR LOCALIZED PROSTATIC CARCINOMA IN THE RENAL TRANSPLANT PATIENT

Three renal transplant patients had prostatic carcinoma after transurethral prostatectomy at 2 weeks, 2 months and 12 years following transplantation. One patient had stage A1 disease, while 2 had stage A2 prostatic carcinoma. All patients underwent radical retropubic prostatectomy and pelvic lymph node dissection. All patients had residual cancer in the radical prostatectomy specimen but none had nodal or capsular involvement. The surgical technique and rationale for management are discussed.

Disseminated intravascular coagulation in carcinoma of prostate: role of estrogen therapy

Advanced carcinoma of the prostate may present as disseminated intravascular coagulation and its sequelae. It is postulated that the slow release of thromboplastic material from tumor cells eventually overcomes normal homeostatic mechanisms. High-dose intravenous diethylstilbestrol diphosphate successfully reversed this coagulopathy in 2 cases of metastatic carcinoma of the prostate.

Testicular Torsion in the Adult

Testicular torsion in men more than 21 years old seems to be as common as in prepubertal boys, accounting for 26 per cent of our cases. Of these patients 10 per cent were more than 30 years old. A previous similar episode will have occurred in nearly half of the patients and is the only helpful historical data. A negative urinalysis is the rule and, while not diagnostic, testicular torsion should be the presumptive diagnosis. Doppler examination and radionuclide scans are accurate and reliable but in our series these studies added little to the plan of management. Manual detorsion can be accomplished with local anesthesia in approximately 70 per cent of the patients and always should be attempted. Delay in operation beyond 12 hours resulted uniformly in loss of the testicle, primarily by orchiectomy or secondarily by atrophy. While correction of the torsion before 6 to 8 hours does not ensure success the rate of salvage is higher. Scrotal exploration for testicular torsion is simple and has little morbidity. Exploration should be done in any patient with acute unilateral scrotal swelling and a negative urinalysis, regardless of age.

Early Hydronephrosis following Aortic Bifurcation Graft Surgery: A Prospective Study

The true incidence and natural history of ureteral obstruction following reconstructive vascular surgery have not been determined previously. A series of 101 patients undergoing aortofemoral and aortoiliac reconstructive surgery were studied prospectively to determine the frequency of hydronephrosis in the first postoperative year. Serial real-time ultrasound examinations were performed preoperatively as well as at 1 week, 3 months and 1 year postoperatively. Ninety-three patients completed the study, with a total of 181 kidneys at risk. Hydronephrosis of mild to moderate degree developed in 15 kidneys (8 per cent) in 11 patients (12 per cent). All patients were asymptomatic, and the obstruction resolved spontaneously in 10 of 11 patients, including 9 within 3 months of onset. Only a single case persisted at 1 year. This study confirms that the hydronephrosis that occurs within the first year after aortic bifurcation graft surgery is not uncommon but it is rarely of clinical significance in the asymptomatic patient.

Transplantation of Pediatric Cadaver Kidneys Into Adult Recipients

Between July 1987 and July 1993, 762 renal allografts were transplanted into adult recipients at our institution. A total of 83 adults received cadaveric renal transplants from donors aged 5 months to 10 years, while 100 adults who received adult cadaver kidneys during the same period served as a comparison group. Cyclosporine based immunosuppression was used. No difference between the 2 groups was found with respect to recipient age, recipient sex, primary renal disease, HLA matching or the number of recipients with a previous transplant. Actual patient (graft) survivals at 1 and 3 years were 91% (77%) and 86% (68%), respectively, for recipients of pediatric kidneys compared to 99% (92%) and 90% (80%), respectively, for recipients of adult kidneys. Pediatric kidney recipients were more likely to encounter renovascular complications (13% versus 4%, p = 0.023) and more likely to have episodes of acute rejection (p = 0.018). Serum creatinine was equal in the 2 groups at 1 year following transplantation (p = 0.63).

Testicular Pain: An Unusual Presentation of Polyarteritis Nodosa

We report a case in which the initial presentation of polyarteritis nodosa was alternating bilateral orchialgia. The diagnosis was confirmed by testicular biopsy. Testicular biopsy is an uncommonly reported diagnostic procedure despite the high incidence of testicular involvement in polyarteritis nodosa. We emphasize the value of testis biopsy, particularly when biopsy of other sites does not prove the diagnosis in suspect cases.

Transurethral Resection of the Prostate in the Outpatient Setting

Transurethral resection of the bladder neck (8 patients) or prostate (142) was performed in the outpatient setting. Of the patients 5 required hospitalization for post-prostatectomy hemorrhage. This method has proved to be safe and cost-effective in the treatment of patients with outlet obstruction.