Sumner Marshall

Infertility in male pesticide workers.

A number of cases of infertility were discovered among men working in a California pesticide factory. The suspected cause was exposure to the chemical 1,2-dibromo-3-chloropropane (D.B.C.P.). The major effects, seen in 14 of 25 non-vasectomised men, were azoospermia or oligospermia and raised serum-levels of follicle-stimulating hormone and luteinising hormone. No other major abnormalities were detected, and testosterone levels were normal. Although a quantitative estimation of exposure could not be obtained, the observed effects appeared to be related to duration of exposure to D.B.C.P.

Varicocele in childhood and adolescence: implication in adulthood infertility?

Thirty boys eight to eighteen years of age had a clearly palpable left varicocele. The presenting complaint usually was either an asymptomatic scrotal mass or a scrotal ache after physical exercise. In 77 per cent of the patients the left testis was smaller than its male. All but one of the 17 boys between ages eight and fifteen had a smaller left testis. When the varicocele is symptomatic, presents as a prominent mass, or where growth of the left testicle lags behind that of its mate, surgical correction of the varicocele is recommended.

Treatment of Prostatic Bleeding: Suppression of Angiogenesis by Androgen Deprivation

Bleeding of prostatic origin is usually caused by the friable hypervascularity of the aging prostate. Suppression of angiogenesis can be achieved through any hormonal manipulation that causes androgen deprivation. We present 4 cases of severe recurrent hematuria treated successfully by this approach.

Intermittent Catheterization Rather than Urinary Diversion in Children with Meningomyelocele

Fifteen girls more than 4 years old and with neuromuscular defects of meningomyelocele are maintaining adequate urinary continence through the use of intraurethral catheterization done by themselves or their parents. Urinary diversion has been necessary in only 1 child. The indwelling catheter has allowed heavily trabeculated bladders to become smooth enough for an antirflux operation to be successful, although the period of followup is only 2 years. Upper tract deterioration has not been observed and urine has been maintained sterile without the help of medication 50 per cent of the time when catheterizations have been done on a routine 3-hour schedule. For this method to be sucessful and replace conduit deversion, parents, child, nurse and physician must be a well-knit team. With the hope that a reliable artificial urinary sphincter will eventually provide contience for some children, one is further justified in pursuing urinary continence by use of the catheter, instead of resorting early to permanent conduit conversion.

Potential problems with testicular prostheses.

In a survey of members of the Western Section of the American Urological Association who had testicular prostheses inserted within the preceding ten years, the responses indicated that the overall complication rate for this procedure is low. Generally, the scrotal cavity distends easily to a size adequate to accommodate the prosthesis. However, in cases of delayed secondary scrotal surgery, or when a previous inflammatory process has existed in the scrotum, the limited scrotal distensibility may lead to further complications.

Bladder rupture following formalin therapy for hemorrhage secondary to cyclophosphamide therapy

Abstract Cyclophosphamide therapy is often followed by bladder hemorrhage. Instillation of a formalin solution has been used to control the bleeding. A complication of this therapy is presented herein.

A Conservative Approach to Testicular Tumors in Children: 12 Cases and Their Management

During a 34-year period 12 children were seen with testicular tumors. Of 8 benign tumors 7 were treated by orchiectomy and 1 by local excision only. The 4 malignant tumors were managed by orchiectomy and 1 boy also received adjunctive chemotherapy. All patients are alive and have had no recurrent tumors after 1 1/2 to 34 years of followup. Because testicular tumors usually are less aggressive in prepubertal children, the chance of cure by orchiectomy alone in this age group is good. However, the potential of these tumors for metastases makes it imperative that they be observed closely.

Normal growth with renal insufficiency owing to posterior urethral valves : value of long-term diversion : a twenty-year follow-up

Twenty-five patients with posterior urethral valves have been monitored for 10-29 years (mean 18 years). Eight underwent diversion because of impaired renal function (creatinine greater than 0.8 mg/dl) accompanied by unimproved upper tract form and function after valve ablation. In the nondiverted group, 6 patients (35%) progressed to renal failure; in the diverted group 5 patients (63%) did so (p = 0.30). Of 13 patients whose lowest serum creatinine in the first year after valve ablation was greater than 0.8 mg/dl, 9 (69%) went on to renal failure (p = 0.02); in the remaining 12 patients, only 2 (17%) did so (p = 0.008). The mean age for renal failure was 13 years for both groups. The Tanner scale rating (mean percent height) for all patients at 10 years was 61% for the diverted group and 35% for those without diversion (p = 0.004). When the patients treated after the age of 1 year (n = 7) were excluded from the calculation, the rating remained different (54% diversion, 26% no diversion; p = 0.012). We conclude that the boy born with urethral valves and serious upper tract damage is at risk for renal failure, especially during the teen years. An undefined relationship appears to exist between urinary obstruction and growth. In our study, the boys who underwent diversion continued to grow along a normal Tanner height curve.

Urethral diverticula in young girls

Five cases of urethral diverticulum in young girls are herein presented. None of these children had associated local infections, unlike what is generally the case in adult women with a similar lesion. Three girls experienced spontaneous regression of the diverticulum. Therefore, unless the diverticulum causes clinical problems, postponement of surgical intervention is advised.

Ureterovesicoplasty: selection of patients, incidence and avoidance of complications. A review of 3,527 cases.

The procedure of ureteral reimplantation has certainly come of age. The incidence of complications can be kept low by careful selection of patients for operation along clear and definite guide lines, by close attention to detail in the surgical procedures and by rigorous followup care. When surgical intervention is deemed advisable the expected cure rate should be more than 94%. While complications do occur resultant damage to the upper urinary tracts should be minimized by its prompt recognition and by institution of appropriate therapy.