Malcolm D. Cosgrove

Male genitourinary abnormalities and maternal diethylstilbestrol.

In view of the risk of vaginal cancer developing in young female subjects exposed in utero to maternally ingested diethylstilbestrol a pilot study was undertaken of male subjects similarly exposed. A healthy questionnaire was mailed to 306 male subjects whose mothers were known to have taken diethylstilbestrol in the early part of their pregnancies and to 231 age and sex-matched controls identified from the same record source. Although there was no increased history of cancer, heart disease or asthma when the groups were compared there was a higher incidence of reported urinary tract symptoms and genital abnormalities in the group exposed to diethylstilbestrol. The presence of these abnormalities was confirmed by physical examination of 15 respondents. Studies in experimental animals also have shown that in certain species maternally ingested stilbestrol may result in abnormalities of the genitaltensive clinical studies be undertaken to determine the level of risk, if any, to which many thousands of young men are subject.

Histologic Appearance of the Intestinal Urinary Conduit

The histology of intestinal urinary conduits (8 ileal and 2 sigmoid) in place for 10 months to 10 years was studied in 10 patients between 20 and 65 years old. It is concluded that the ileum and the large intestine do not undergo adaptive metaplastic transformation. The only changes observed are related to a condition of chronic irritation to which the response is a chronic inflammatory reaction. Structures proving to be the most resistant were the cells of Paneth. The latter were not damaged in appearance and number as compared to normal, even when the conduit was in place for 10 years.

Prostatic Cancer Revisited

Thirty patients with prostatic carcinoma treated for varying lengths of time by radiation or endocrine therapy alone and in combination underwent staging and biospy of the prostate 3 years ago. Survival data for these patients have been correlated with the clinical and histologic findings of 3 years ago. A negative biopsy was associated with a better prognosis than a positive one and clinical rectal examination of the treated prostate was a poor index of cancer control. The group of patients treated with a combination of endocrine and radiation therapy was associated with the highest proportion of negative biopsies.

Renal angiomyolipoma: two varieties

Two cases of symptomatic renal angiomyolipoma are presented, and their distinctive clinical, radiologic, and histologic features are discussed. In the first case the scout film demonstrated radiolucency of the tumor which helped to distinguish it from carcinoma. In the second case, which was associated with tuberous sclerosis, the renal lesion was large and unifocal, and the local lymph nodal involvement with tumor raised the possibility of malignant transformation.

Salmonella Infection and the Genitourinary System

Six cases of severe salmonella genitourinary infection and a case of salmonella septicemia after prostatectomy are reported. The mechanism whereby the urinary tract is involved in salmonellosis is described, as are the different manifestations of genitourinary salmonellosis. Host factors predisposing to the development of genitourinary salmonella infection include other urologic pathology, malignant neoplasms and states of depressed immunity. Recommendations are made with regard to the diagnosis and management of this sometimes lethal condition.

Shunt surgery for priapism review of results

In a review of the literature on shunt operations for priapism, 100 case reports were found. The over-all result in terms of potency is 61 per cent. In general there is little difference in outcome between the cavernosus-saphenous vein and cavernosus-spongiosum shunts. If the former surgical procedure is to be performed, a unilateral operation appears to yield better results than a bilateral one. Various causes of priapism are noted in relation to results of surgery, and the complications of shunt procedures are discussed. Equally good results are noted whether the operation is performed early or relatively late in the disease.

Electromyography in pathologic bladder

Abstract Detrusor electromyography, using a technique previously described, was performed on a group of conscious patients with pathologic bladders. A constant abnormal pattern was seen in patients with lower motor neuron lesions. The electromyographic pattern was different and also abnormal in patients with upper motor neuron lesions. In other patients with various voiding problems, the electromyographic pattern of detrusor activity appeared to correlate with the clinical findings. We recommend that when performing bladder electromyography an additional electrode be used simultaneously to monitor the electromyographic activity in the rectus abdominis muscle.

Papillary adenocarcinoma of prostate.

Papillary adenocarcinomas of the prostate are rare tumors which may arise from the prostatic ducts and the utricle; 2 cases are described. The diagnosis of these tumors is best established by cystourethroscopy and transurethral resection. The more common prostatic acinar adenocarcinoma is frequently associated with these tumors. The histopathologic recognition of papillary adenocarcinoma of the prostate and its differentiation from acinar adenocarcinoma is important since the natural history and response to treatment may be different.

Lymphangiography in Genitourinary Cancer

The rationale for pedal lymphangiography in the management of genitourinary cancer is discussed. The comparative studies between lymphangiography and subsequent histologic section of the nodes in the literature and our own instituiion are reviewed. Itis concluded that while lymphangiography is a safe procedure, it is unlikely to play a major role in the management of cancer of the kidney and penis. If more such studies were performed in cases of prostatic, testicular and bladder malignancies, the diagnostic accuracy might be improved and the lymphangiogram could then help significantly in planning treatment for these patients.

Electromyographic studies of human urinary bladder.

Abstract Electromyographic recordings were performed on 11 conscious healthy patients at the time of cystoscopy. Standard electromyographic equipment and modified ureteral catheters were utilized, and the technique and equipment are described. A reproducible pattern of detrusor electrical activity was noted with the bladder empty at rest, during filling, and on voiding. The possible applications of this technique in clinical urologic practice are alluded to.