Riad N. Farah

The urological manifestations of the acquired immunodeficiency syndrome

Between 1984 and March 1987, 120 patients with either the acquired immunodeficiency syndrome or its related complex seen at our hospital were studied retrospectively for urological signs and/or symptoms. Autopsy findings also were reviewed. Of the patients 84 per cent had no complaints referable to the urinary system, 2 per cent had gross hematuria (all with a negative diagnostic evaluation) and 14 per cent had urinary infections. We conclude that only a small percentage of patients with the acquired immunodeficiency syndrome suffer from significant urological manifestations and that a full urological evaluation of such patients generally is not warranted. If the patient presents with gross hematuria excretory urography should be performed if there is no infectious etiology, and cytoscopy should be performed only if the hematuria is life-threatening or prolonged and possibly to confirm significant urographic findings.

Surgical Treatment of Deformity and Coital Difficulty in Healed Traumatic Rupture of the Corpora Cavernosa

AbstractExperience with 2 cases of healed traumatic rupture of the corpora cavernosa has demonstrated success in restoration of function by surgical intervention when previous conservative treatment proved unsuccessful.

An Evaluation of Lymphangiography in Staging Carcinoma of the Prostate

Pedal lymphangiography was done on 38 patients with stages O, A and B carcinoma of the prostate. The lymphangiograms were positive in 19 cases and negative in 19. Of 18 patients who underwent lymphadenectomy (9 with positive and 9 with negative studies) operative findings confirmed the lymphangiogram in 15 (83 per cent). In the 6 patients with osseous metastases and/or enzyme elevation, the lymphangiogram was positive. Furthermore, 13 patients with positive lymphangiograms had negative osseous and enzyme survey, emphasizing that nodal involvement may be the earliest finding in disseminated carcinoma of the prostate. The value of lymphangiography in staging carcinoma of the prostate prior to radical prostatectomy or irradiation seems well established.

Intermediate Term Assessment of the Reliability, Function and Patient Satisfaction with the AMS700 Ultrex Penile Prosthesis

PURPOSE The AMS700 Ultrex penile prosthesis is an example of the design changes that penile prostheses have undergone to improve mechanical reliability. Few studies have reviewed an overall experience with the AMS700 Ultrex prosthesis. We review patient outcomes, surgical complications, and Ultrex cylinder intermediate term mechanical reliability and function. MATERIALS AND METHODS Between March 1990 and November 1994, 145 patients 32 to 79 years old (mean age 58) underwent insertion of an AMS700 Ultrex penile prosthesis. At a followup of 6 to 62 months (mean 42) patients were evaluated with a retrospective clinical record review, and patient and partner questionnaires. RESULTS From the clinical record review of 145 patients our malfunction, reoperation, infection, erosion, major complication and minor complication rates were 8, 13, 2, 3, 13 and 7%, respectively. Patient responses to our questionnaire showed that 85% were satisfied overall, 85% had durable and reliable implant function, 86% had a sustained level of satisfaction with the implant and 83% remained satisfied after a revision for malfunction. Overall, partner satisfaction with the implant was 76%, and 42% reported maintenance of a good or improved nonsexual relationship after prosthesis implantation. CONCLUSIONS Our data demonstrate the intermediate term mechanical reliability and function of the AMS700 Ultrex penile prosthesis, and high patient and partner satisfaction with this implant.

Treatment of superficial bladder cancer with intravesical chemotherapy

Proper care of patients with superficial bladder cancer requires the assessment of multiple factors, including an understanding of the natural history of this disease, accurate clinical staging, and the expected efficacy of each drug. The pharmacology of intravesical mytomycin C is discussed in detail, as many of this drugs pharmacological principles are applicable to all intravesical chemotherapeutic agents, including doxorubicin, thiotepa, bacillus Calmette-Guérin, epirubicin, and ethoglucid. The bladder wall, bladder cavity, chemical properties of intravesical chemotherapeutic agents, and tumor considerations are discussed. Suggestions based on pharmacological studies are presented to optimize the efficacy of intravesical chemotherapy.

Eosinophilic Cystitis: An Uncommon Form of Cystitis

Since 1959, 39 cases of eosinophilic cystitis have been reported in the literature. Eosinophilic cystitis is a rare form of allergic cystitis in patients who usually have a strong allergic history. It mimics other forms of intractable cystitis, such as interstitial cystitis, tuberculosis and bladder neoplasms. It is caused by various antigens that form immune complexes at the bladder level and stimulate eosinophilic infiltration. Food allergens, medications, topical agents and parasites have been implicated. The diagnosis is made by excluding all other forms of cystitis.

Management of penile gunshot wounds

The management of 10 cases of penile gunshot wounds treated at Henry Ford Hospital from 1982 to 1986 is reviewed. All patients were assaulted by low velocity weapons (handguns). Eight patients had associated injuries, predominantly to the genital region (thigh, pubis, and scrotum). There were 5 urethral injuries; 4 were treated with primary repair, the remaining patient underwent delayed repair, complicated by severe urethral strictures requiring reoperation. Blood at the urethral meatus was suggestive of urethral injury but microscopic hematuria was not. Five penile injuries did not involve the urethra and were treated by debridement and primary wound closure with no immediate or delayed complications. In dealing with these injuries we recommend a high index of suspicion for urethral and regional organ injury and primary urethral closure if at all possible.

Bilateral orchiectomy for carcinoma of prostate Response of serum testosterone and clinical Response to subsequent estrogen therapy

Forty-five patients with symptomatic Stage D carcinoma of the prostate were treated with bilateral orchiectomy. Serum testosterone levels were obtained before orchiectomy, seven days after and a six-month intervals. With relapse after orchiectomy remission patients were treated with diethylstilbesterol (DES) 1 mg. daily. After bilateral complete orchiectomy 40 patients had serum testosterone levels in the anorchic range (21.5 to 39.7 ng./dl) while 5 had testosterone levels between 117 and 187 ng./dl. The mean remission response after orchiectomy was 9.1 months (three to twenty-four months) in the anorchic group and 9.4 months in the imcomplete anorchic group. Mean relapse response to estrogen therapy in the anorchic group was four months (one to six months). While in the incomplete anorchic group mean relapse response to estrogen therapy was 20.8 months (one to sixty). Serum testosterone levels in the imcomplete group decreased with estrogen therapy while those in the anorchic group were stable with estrogen therapy. Our findings suggest that bilateral complete orchiectomy does not always provide serum testosterone levels in the anorchic range. Subsequently these patients show an improved mean response to oral estrogen therapy.

Primary Urethral Neoplasms: Review of 30 Cases

The recent literature shows our findings on primary urethral neoplasms to be consistent with others, although we did not show an increased incidence of these neoplasms in female over male subjects. Similarly, we recommend an operation with or without irradiation, depending on the stage and location of the lesion. The over-all prognosis of urethral neoplasms remains poor. However, the distal urethral lesions in male and female subjects are easier to approach surgically and seem to be diagnosed earlier in the progression of this disease than the more proximally advanced tumors. These early staged and distal neoplasms greatly improve the changes of long survival. The delay in diagnosis gives this neoplasm its poor prognosis. In men the prognosis probably could be improved by more aggressive evaluation of stricture disease, especially when the need for dilation becomes frequent. In women we believe that the caruncle should be biopsied if it shows signs of progression or remains symptomatic (pain, bleeding and so forth). If a 1 to 2-month course of antimicrobials does not resolve this lesion we recommend biopsy. A relationship between tumor and a diverticulum has been noted in the literature, as in 1 of our cases of adenocarcinoma in a female patient. Whether this relationship could be explained on the basis of recurrent infection and stasis remains theoretical. In conclusion, early diagnosis, accurate staging and aggressive treatments are the means for cure of this disease.

Penis tourniquet syndrome and penile amputation

Abstract Penis tourniquet syndrome and amputation caused by strands of hair is reported. Successful repair of penile amputation for whatever cause has been rarely reported in the literature. All physicians should be cognizant of the existence of this type of trauma in pediatric patients and immediate attempts made to remove the encircling hair strands. If amputation of the penis has occurred, an attempt should be made to reconstruct the distal phallic shaft and urethra to obtain a viable complete phallus.