Terrence R. Malloy

Expansion without Significant Rigidity During Nocturnal Penile Tumescence Testing: A Potential Source of Misinterpretation

AbstractOf 134 patients who underwent nocturnal penile tumescence evaluation 23 were found to have significant penile expansion without rigidity sufficient to effect vaginal penetration. An assessment of rigidity as well as expansion is necessary for proper interpretation of the study. Although the nocturnal penile tumescence categories of normal expansion-rigidity and insignificant expansion are relatively clear-cut, and indicate psychogenic and biogenic impotence, respectively, there still exists a number of patients who are not in either of these categories and in whom further delineation is necessary.

Carcinoma of penis treated with neodymium yag laser

Sixteen men with squamous cell carcinoma of the penis were treated primarily with the Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser. Five patients had TIS, 9 had T1 tumors, and 2 had T2 carcinoma. All patients had refused traditional therapy of partial penectomy and gave informed consent as to the investigational nature of the Nd:YAG laser photoradiation therapy. Circumcisions and deep tissue biopsies were performed on all patients prior to tumoricidal neodymium photoradiation treatment. The patients were followed from twelve to thirty-six months. At follow-up, 5 patients with TIS had no evidence of recurrent cancer. Of the 9 patients with T1 squamous cell carcinoma of the penis, 6 (67%) were tumor-free at a mean follow-up of twenty-six months. The 2 men with T2 carcinoma of the penis had reduction of the tumor mass but were not cured. The obvious advantage of the Nd:YAG laser in treating carcinoma of the penis is preservation of the penis eliminating disfiguring amputation.

The Effects of Bethanechol Chloride on Urodynamic Parameters in Normal Women and in Women with Significant Residual Urine Volumes

A 5 mg. subcutaneous dose of bethanechol chloride was given to 12 women with residual urine volumes equal to or greater than 20 per cent of bladder capacity but no evidence of neurologic disease, or anatomic or functional outlet obstruction and to 27 normal women wtih approximately the same mean age. The cystometric and some profilometric parameters did change, indicating that the drug was pharmacologically active. No improvement in voiding function was noted, as judged by residual urine volume and flow rate measurements. These results raise significant questions regarding the contemporary use of this drug, especially in the currently recommended oral dosages.

Renal preservation utilizing neodymium: Yag laser

Six patients with malignancies in a solitary kidney were treated with conservative renal parenchymal-sparing surgery utilizing the Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser. Three patients had transitional cell carcinoma in an upper pole calyx of a solitary kidney. The transitional cell carcinoma was treated definitively by the Nd:YAG laser through a nephroscope prior to partial nephrectomy. The 3 patients have been followed up for twenty-eight, eighteen, and six months, respectively. None of the patients has shown evidence of recurrent cancer on follow-up retrograde ureterograms or on urine cytology obtained from the renal pelves. Three patients with renal cell carcinoma in a solitary kidney had the tumor surgically excised utilizing the Nd:YAG laser in conjunction with standard surgical techniques. All the patients were elderly with compromised renal vasculature that prevented bench surgery with autotransplantation or occlusion of the renal artery. At sixteen, fourteen, and three months, respectively, there is no evidence of recurrent cancer on CAT scans obtained on these patients.

Human papillomavirus associated with bladder cancer

Recently published data have suggested a link between active human papillomavirus (HPV) infection and the development of bladder cancer. This study was undertaken to test for HPV genomic material in the tumors of patients without evidence of ongoing viral infection. Twenty-three consecutive patients with clinical evidence of intravesical neoplasia and no history of HPV infection or clinical evidence of intercurrent disease, underwent cystopanendoscopy and biopsy as part of the routine evaluation and treatment of their tumor. Routine pathologic evaluation and southern blot analysis of biopsy material were done to establish the presence or absence of HPV DNA in the bladder tumors. Twenty-one tumors were identified by routine histology: 20 were low-to-moderate grade transitional cell carcinomas; 1 was found to be squamous cell carcinoma; 1 patient had moderate dysplasia; and 1 patient had evidence of inflammation. Four of the 20 transitional cell tumors (20%) were found to contain HPV DNA. In addition, the patients with dysplasia and cystitis were also shown to have HPV genomic material in their biopsy specimens. Viral types 6/11, 16/18, and 31/33 were found. The 20 percent incidence of HPV genomic material in bladder tumors from patients without clinical evidence of viral infection is in keeping with the observations of other investigators. We present the implication of these findings within the context of our current understanding of viral oncogenesis in the urinary bladder.

Erectile dysfunction following minimally invasive treatments for prostate cancer.

OBJECTIVESnCryosurgical ablation of the prostate (CSAP) and interstitial radiotherapy (IR) are relatively new procedures intended to be less invasive than radical prostatectomy for the treatment of prostate cancer. Despite absence of long-term or intermediate data of efficacy, many patients choose one of these therapies because they presume their potency will be maintained. We report our experience with CSAP, IR, and post-procedure erectile dysfunction.nnnMETHODSnGlobal sexual assessments were made in 12 months after therapy in 28 CSAP patients, and at 18 months in 37 IR patients. Each patient was contacted by telephone following his procedure. The patients were asked several questions regarding their sexual function both preoperatively and postoperatively. The questionnaire was administered only to the patient.nnnRESULTSnTwenty-eight of 36 patients who underwent CSAP responded to the questionnaire (78%). Twenty patients were potent preoperatively (71%). The mean age of the potent group was 69 years (range 54 to 82). Following therapy, 2 of these patients (10%) reported potency at 12 months. Thirty-seven of 42 patients who underwent IR responded to the questionnaire (88%). Twenty-seven were potent preoperatively (73%). The mean age of the potent group was 70 years (range 56 to 83). The mean follow-up was 18 months (range 5 to 36). Following therapy, 15 patients reported potency (55%). All of the patients who reported potency felt that the quality of their erections had decreased following radiation.nnnCONCLUSIONSnOur short-term results with IR and CSAP suggest a significant adverse effect on erectile function. Our results suggest that enhanced preservation of potency should not be used as an enticement in the promotion of IR or CSAP.

Scrotal and Penile Lymphedema: Surgical Considerations and Management

From 1971 to 1981, 6 patients with scrotal and penile lymphedema were treated with total excision of the scrotal and penile skin. Split thickness skin grafts were used to cover the penis and form a neoscrotum. Of the patients 2 men had primary idiopathic lymphedema, while 4 had secondary lymphedema resulting from foreign body injections or trauma with subsequent chronic infection. Surgical considerations using split thickness skin grafts versus posterior lateral scrotal skin flaps are compared.

Carbon dioxide laser therapy of subclinical condyloma found by magnified penile surface scanning

The etiology and treatment of condyloma caused by the human papilloma virus (HPV) and the association of HPV with cervical dysplasia and/or carcinoma is a major issue in current gynecologic literature. This study examined results of carbon dioxide (CO2) laser treatment of 127 high-risk males with biopsy-proved subclinical HPV infections found by magnified penile surface scanning (MPSS). At a mean follow-up of four months a 66 per cent recurrence rate of microscopic condyloma was encountered. A discussion of the causes of such a high recurrence rate is given, with conclusions on this and prior condyloma treatment series.

Failure of the bethanechol supersensitivity test to predict improved voiding after subcutaneous bethanechol administration.

Subcutaneous administration of 5 mg. bethanechol chloride did not change significantly either flow rates or percentage residual urine in 11 patients with a positive bethanechol supersensitivity test. Therefore, a positive response to this test cannot be used to predict improved voiding function after subcutaneous or oral administration of the drug. Studies that purport to show a long-term rather than a short-term facilitory effect of this agent on voiding must satisfy rigid criteria, which include totally excluding a change in any other factor affecting the lower urinary tract.

Urological Applications of Human Papillomavirus Typing Using Deoxyribonucleic Acid Probes for the Diagnosis and Treatment of Genital Condyloma

The use of deoxyribonucleic acid probes to examine the type of the human papillomavirus genome found in penile lesions is described at a technical level and in a clinical application. At least 40 different types of human papillomavirus have been identified and these types vary not only in their deoxyribonucleic acid base sequences but also in their clinical manifestations. Although deoxyribonucleic acid probes currently have a role only in a research setting, this study delineates the possible role of this technology in a clinical setting to detect subclinical intraurethral human papillomavirus. The results have widespread implications regarding the treatment of condyloma and the associated cervical dysplasia. In this series 25 grossly visible lesions were typed and 85 per cent contained human papillomavirus types 6 and 11. In contrast, microscopic lesions identified in the male partners of women with cervical dysplasia were shown to contain human papillomavirus types 16, 18 or 31 in 60 per cent of the cases. In addition, urethral brushings were obtained and were positive for human papillomavirus in 50 per cent of the cases despite normal urethroscopy. Human papillomavirus types 16, 18 or 31 accounted for 70 per cent of the positive urethral brushings.