P. Jonas

Circumcision in hemophilia: the use of fibrin glue for local hemostasis.

Circumcision can be fatal in hemophilia patients unless they are treated with the missing coagulation factor. We describe 10 severe hemophilia patients in whom circumcision was performed with local fibrin glue instead of infusion of factor concentrate. Of the 10 patients 3 had postoperative bleeding and only 2 of them required infusion of factor VIII concentrate. Fibrin glue is a useful treatment modality for circumcision in patients with bleeding diathesis, and it is safer and cheaper than the infusion of factor concentrate.

Long-term followup of patients less than 30 years old with transitional cell carcinoma of bladder.

A review of our records between 1970 and 1986 identified 22 patients with transitional cell carcinoma of the bladder who were less than 31 years old. Of these patients 7 were less than 20 years old (group 1) and 15 were 20 to 30 years old (group 2). The tumors usually were of low grade and low stage. Patients in group 1 had no recurrences, whereas 6 patients (40 per cent) in group 2 had recurrences. Upstaging occurred in 2 patients with tumor recurrence. It would appear that while transitional cell carcinoma of the bladder in patients less than 20 years old has a more favorable prognosis, in patients 20 to 30 years old the prognosis is poorer and similar to that observed in older patients.

Analysis of the long-term outcome of surgically corrected vesico-ureteric reflux

Authors from Tel‐Aviv reviewed a group of patients who had VUR corrected in childhood, assessing their long‐term outcome. Even when patients were successfully treated during childhood they were still prone to recurrent UTI, renal scarring, hypertension and complications during pregnancy. They suggested that a protocol for long‐term follow‐up was required.

Surgical Correction of Vesicoureteral Reflux in Children with Neurogenic Bladder

The reported success rate for correction of vesicoureteral reflux in the neurogenic bladder has been low. Reflux was corrected in 33 of 37 ureters in 23 selected children with neurogenic bladder-treated by reimplantation. Selection was based on good bladder capacity, little or no trabeculation and the expectation that the bladder would be useful in future management of the patient. Preoperative preparation and surgical technique are emphasized.

Factor XI Deficiency: Detection and Management During Urological Surgery

Hereditary factor XI deficiency may remain undiagnosed until severe bleeding is observed after an operation or trauma. Two such cases were encountered and, therefore, a regular screening test for coagulation disorders among urological patients was initiated. During 2 years (1975 and 1976) 10 additional cases of factor XI deficiency were detected: 5 severe and 5 partial. All patients were Ashkenazic Jews of Eastern European origin. The 5 patients with severe factor XI deficiency underwent an operation without any complications. They were transfused with 5 to 20 ml./kg./day of fresh frozen plasma from the day before the operation until 10 to 14 days postoperatively. Of the 5 patients with partial XI deficiency 4 underwent an operation. In 1 of 3 patients who did not receive transfusions postoperative bleeding was observed. A minimal level of 0.3 U./ml. (30 per cent) factor XI was found necessary to ensure good hemostasis during and after an operation. In view of a recent finding of relatively high gene frequency of factor XI deficiency in Ashkenazic Jews it seems warranted to do a partial thromboplastin time in such patients who need an operation.

Echinococcus of the urinary tract: Radiologic findings

Echinococcal involvement of the urinary tract is extremely rare. We present 11 such cases, 10 with renal and 1 with bladder involvement. Clinical and laboratory findings were nonspecific. Calcification was present in all but 1 case. The excretory urogram and retrograde pyelogram demonstrated parenchymal soft-tissue masses causing pressure on and dilatation of the collecting system. Angiography in 3 cases showed the masses to be avascular. The ultrasound findings of a multicystic lesion with mixed echogenicity were typical of echinococcal cysts, while a CT scan in 1 patient showed a cyst with densely calcified border.The combined findings of these different modalities aid greatly in establishing the correct diagnosis.

Diverticula of the male urethra: a review of 61 cases.

Sixty-one cases of diverticulum of the male urethra were reviewed. This group included 10 patients with congenital and 51 with acquired diverticula. The etiology of the acquired variety, the radiological findings, and the frequency of appearance in both congenital and acquired diverticula of the urethra during a 30-year period are described.

Urinary Infections Following Transurethral Resection of Bladder Tumors—Rate and Source

The incidence of urinary infection and its source after transurethral resection of bladder tumors were investigated. Patients undergoing transurethral prostatectomy constituted the control group. All patients had proved preoperative sterile urine and did not receive any antimicrobial treatment. The incidence of urinary infection following transurethral resection of bladder tumors was 19.4 per cent, with an incidence of positive tumor chip cultures of 3.2 per cent. The incidence of urinary infection after transurethral prostatectomy was 32 per cent, with an incidence of positive prostate chip cultures of 8 per cent. We concluded that the source of urinary infection following transurethral resection of bladder tumors and transurethral prostatectomy in most cases is not from within the tissue but rather from perioperative manipulations.

Prophylactic antimicrobial treatment in transurethral prostatectomy How long should it be instituted

Eighty-one patients with proved preoperative sterile urine and undergoing transurethral resection of the prostate were studied. The patients were divided into 3 groups: group A received sulfamethoxazole-trimethoprim (ST) preoperatively and postoperatively for ten days; group B received ST in 2 divided doses, one pre- and one postoperatively; group C received no prophylaxis. In groups A and B, we found urinary infection in 3.8 per cent of patients compared with 32 per cent in group C. Performing prostatic chip cultures, we found that most urinary infections were unrelated to a prostatic source. When the prostate was infected, 75 per cent had infected urine postoperatively. We believe that prophylactic antimicrobial treatment should be given to all patients undergoing transurethral prostatectomy. However, it seems that immediate perioperative treatment suffices.

Imipramine for the treatment of sterility in patients following retroperitoneal lymph node dissection

Imipramin zur Behandlung der Infertilität bei Männern nach retroperitonealer Lymphknoten‐Entfernung