Walter L. Gerber

Scrotal malignancies: The University of Iowa experience and a review of the literature

Cancer of the scrotum is of special interest, despite its relative infrequency, because of its surprising virulence and also by virtue of its historical importance. This was the first known occupational cancer and showed the need for research involving potential environmental carcinogens. No one individual has sufficient experience to randomize patients to different methods of treatment, and the disease is becoming even less common. Therefore, recommendations are often based on compilations from the literature, many reports being fifty to one hundred fifty years old. This report reviews the clinical features of scrotal malignancies and the forty-five-year experience with this disease at the University of Iowa.

Infertility, chemical exposure, and farming in Iowa: Absence of an association

An increased incidence of infertility and abnormal semen analysis has been described in men and experimental animals exposed to agricultural chemicals. These reports led us to review the records of 382 consecutive new male patients who had semen analyses performed at the University of Iowa Hospitals and Clinics. No significant differences in the incidence of abnormalities in either the physical examination or the semen analysis were discovered with respect to occupation or possible exposure to chemical agents.

Xanthogranulomatous pyelonephritis masquerading as occult malignancy

Xanthogranulomatous pyelonephritis (XGP) can present with weight loss, anemia, leukemoid reaction, and generalized debility; there may be no signs or symptoms referable to the urinary tract. Confusion between XGP and renal adenocarcinoma is well recognized, but other malignancies can also be simulated. Case histories of patients with proved XGP whose clinical presentations suggested occult malignancies are recorded. Proteus urinary tract infection, calculi, and a nonvisualizing kidney on intravenous pyelogram should suggest the correct diagnosis. The pathology, bacteriology, diagnosis, and treatment are reviewed.

Percutaneous Nephrostomy with Immediate Dilation

Percutaneous nephrostomy may serve as an alternative to an open operation for urinary diversion. Difficulties with poor drainage and premature catheter dislodgement have prompted the development of a technique for dilation of the needle tract and placement of a large, self-retaining catheter at the time of the initial puncture.

Semen Abnormalities in Artificial Insemination Donor Candidates

We screened 43 healthy adult male medical students as potential anonymous donors for the artificial insemination program at our university. Of the candidates 10 had varicoceles (5 bilaterally). Over-all, 34 men (79 per cent) had inadequate semen analyses by 1 or more criteria. Of the men with varicoceles 80 per cent also had abnormal findings. Three abnormalities were discovered most frequently in the semen of men with a normal physical examination and 5 deficiencies were found in those with a varicocele. Problems with semen quality were more common than those of sperm numbers.

Failure of the Double-Curved Ureteral Stent

Ureteral obstruction no longer requires routine open surgical diversion. With the advent of percutaneous nephrostomy techniques indwelling ureteral stents, the armamentarium exists to provide drainage by nonoperative means. This has been beneficial to many patients but especially to those who are poor risks or who have terminal illnesses and need treatment for relatively brief periods. Herein we report 2 cases of failure of the double-curved polyethylene ureteral catheter to drain effectively, leading to nephrostomy, and a case in which removal of a stent disrupted a repaired ureteropelvic junction, leading to additional surgery. Three patients also are discussed who had severe dysuria and irritation from the stents.

Catheter guide for neonates

Catheterization of a male neonate or infant is not a procedure to be undertaken lightly, since infection and/or stricture may result from the trauma. In some situations in which the passage of a urethral catheter is necessary, prior distortion of the normal anatomy may make instrumentation difficult. Attempts to employ the stylet from ureteral catheters as a stylet have failed because it lacks sufficient strength. However, a catheter guide can be fashioned which can be used with either a small balloon catheter or feeding tube. The only rlequirement is a radiographic spring wire (e.g., by Cook, Inc., Bloomington, Indiana; Type THSF) The “front” end or tip of this wire is usually sofl: and flexible so as to prevent injury during its passage. While this can impart some degree of rigidity to the catheter, it cannot maintain a curve. The stiff “back” end can be bent easily with a hemostat to any desired curve (Fig. 1). As with .any catheter guide, there must be lubrication not only of the outside of the catheter but also of the guide to ensure easy withdrawal. A small hemostat should clamp the open end of the catheter and the stent to avoid shifting of the tube on the wire during passage. Extreme care must be utilized since the urethra of the neonate is so small and the wire adds rigidity to the tube. The 0.035 inch size has the advantage that it can pass through the lumen of a 6-F whistletip ureteral catheter should the need arise, as in the placement of semipermanent indwelling stents. FIGURE 1. S-F pediatric feeding tube with tire bent to form a “CoudB” tip. Greater or lesser degrees of curve are easily attainable. The spring wire guide is visible through the transparent tube.