Warren H. Chapman

Immunological Studies on Urinary Bladder Tumors of Rats and Mice

Human neoplasms derived from the same tissue have been previously shown to have tumor associated antigens characterizing that tissue type. Evidence is now presented for the existence of analogous antigens common to both rat bladder papillomas and carcinomas, and for antigens common to mouse bladder carcinomas. Rats immunized with syngeneic urinary bladder papillomas, then challenged with a methylcholanthrene pellet inserted into the bladder, develop (4 to 6 months later) fewer primary bladder tumors than rats immunized with normal bladder tissue.

Bladder Volume Determination Using a Dedicated, Portable Ultrasound Scanner

Urethral catheterization, the standard method for measurement of bladder volume, is associated with patient discomfort plus the risks of urethral trauma and urinary tract infection. A portable ultrasound instrument that automatically determines bladder volume was used for 164 determinations and the digital readout correlated with the catheterized volume (r2 equals 0.79). This instrument is a noninvasive alternative to urethral catheterization for the determination of bladder volume in most patients.

Tumor Cell Implantation Following Neodymium-YAG Bladder Injury: A Comparison to Electrocautery Injury

Recent clinical experience using the neodymium-YAG laser for the ablation of superficial bladder carcinoma seems to indicate a decreased local and second-site recurrence rate when compared to standard electrosurgical methods. Altered tumor cell implantation has been suggested as a mechanism explaining this phenomenon. The purpose of this study was to compare the effects of laser ablation and standard electrosurgical resection on tumor implantation. Each of three requisite steps in tumor cell implantation was assayed in an animal model system. The number of viable tumor cells liberated during ablation of a standardized lesion was 620% greater in the electrosurgically resected group compared to the laser irradiated group. No difference was observed in the qualitative or quantitative patterns of cellular adherence to a fulguration bladder injury compared to a laser bladder injury. The number of cells adhering to an injury site was shown to increase as a function of the cell concentration to which it was exposed. There was no difference between groups in occurrence of tumor at the injury site following exposure to an equal number of tumor cells. This study has demonstrated marked differences between electroresection and laser ablation in terms of the number of viable cells released during the course of tumor removal. This data, together with the absence of injury site differences, suggests it may play a role in the clinically observed differences in tumor recurrence rates.

Randomized Clinical Trial of an Absorbable Stent for Vasectomy Reversal

PURPOSE More successful methods of vasectomy reversal would benefit those undergoing this treatment and might also increase the popularity of vasectomy. We conducted a randomized, prospective clinical trial of vasectomy reversal methods, comparing a new absorbable stent with 2-layer reattachment. MATERIALS AND METHODS We studied 116 men seeking vasectomy reversal between November 1990 and March 1994. Data were analyzed primarily by intention to treat. RESULTS Patients in the stent (64 cases) and no stent (52) randomized groups were similar in age distribution, age of spouses, years since vasectomy, proportion who had undergone prior vasectomy reversal and proportion who had previously achieved pregnancy. Operation time was more than 19 minutes shorter in the stent randomized group (p = 0.006). Fewer patients in the stent than the no stent group had patent vasovasostomies (81.0 versus 89.6%, respectively, p = 0.2) postoperatively. Fewer stent randomized patients had motile sperm (76.2 versus 81.3%, respectively, p = 0.5) and normal total motile sperm counts (49.2 versus 52.1%, respectively, p = 0.8) than did those without a stent. Conception occurred in 22 and 51% of all couples in the stent and no stent groups. The relative risk of conception among those in the stent group was 0.42 (95% confidence interval 0.24 to 0.71, p = 0.002). A Mantel-Cox log-rank test comparing pregnancies in each group according to the number of postoperative months revealed that the no stent group achieved more earlier pregnancies (p = 0.003). CONCLUSIONS The 2-layer microscopic vasovasostomy results in greater pregnancy rates than vasovasostomy using the absorbable stent.

Repair of a traumatically amputated penis with return of erectile function.

Repair of the amputated penis may be successful using macroscopic and microscopic surgical realignments. However, to date, no one has reported return of erectile function documented by nocturnal penile tumescence. We report a case of traumatically amputated penis with microscopic repair and return of erectile function documented by nocturnal penile tumescence. In addition, the current literature regarding microscopic versus nonmicroscopic repair is reviewed.

Ileocecal Bladder Augmentation in Myelodysplasia

We discuss 14 children and adolescents with myelodysplasia who underwent bladder augmentation with the ileocecal segment. The bowel was not detubularized nor was the ileocecal valve intussuscepted. Urodynamic evaluation was performed before and after the procedure in 13 patients with a followup of 1 to 8 years. Postoperative capacity and compliance were normal but cecal contractions occurred in 8 patients despite adequate doses of anticholinergics. Reflux was demonstrated at capacity with a cecal contraction in 4 patients but upper tract dilatation and infection were not clinical problems. Three patients required reoperation for complications owing to ureteroileal stenosis and/or urinary tract calculi. Although the clinical results were satisfactory, detubularized segments of bowel with intussuscepted afferent loop valves to prevent reflux may resolve these problems in the future.

Severe Prostatic Calcification after Radiation Therapy for Cancer

Severe symptomatic prostatic calcification was seen in 3 patients who had carcinoma of the prostate treated initially with transurethral resection, followed in 2 to 4 weeks by definitive radiation therapy. This complication is probably preventable if an interval of 6 weeks is allowed between transurethral resection of the prostate and radiation therapy.

Bladder function in children with meningomyelocele: comparison of cine-fluoroscopy and urodynamics.

We have assessed 60 children on an outpatient basis with cine-fluoroscopy combined with urodynamics. Bladder and rectal pressure together with sphincter electromyography were measured during bladder filling under fluoroscopy, which was followed by measurement of rectal pressure and sphincter electromyography during voiding under fluoroscopy. Comparison of the x-ray studies and urodynamics showed that the cystogram alone was not a reliable indicator of ray studies and urodynamics showed that the cystogram along was not a reliable indicator of detrusor function. The sphincter electromyogram during voiding must be interpreted in the face of intra-abdominal pressure changes owing to straining or Credés maneuver. Residual urine estimations and the appearance of the bladder outflow on fluoroscopy were better parameters of outflow obstruction than sphincter electromyography.

Stomal Obstruction of Ileal Conduits in Children: A Urodynamic Study

In an attempt to diagnose stomal obstruction before radiological evidence is present, urodynamic perfusion studies were done on 40 children with ileal conduit diversion. Residual urine, capacity, resting pressure and mean emptying pressure were recorded after perfusion of the conduit with normal saline at 10 ml. per minute. Emptying pressure appeared to be the most sensitive parameter of obstruction. Residual urine may be normal in early obstruction and may be increased in the presence of normal emptying pressures in atonic conduits.

Studies of polyglycolic acid hollow self-retaining vasal stent in vasovasostomy * †

A simple method of vasovasostomy using a unique hollow, biflanged, hydrolyzable, self-retaining intraluminal stent made of polyglycolic acid (PGA) was evaluated in rat and dog animal models. The stented vasovasostomy was compared with a modified two-layer technique in a randomized prospective trial in rats. Twenty of 22 vasovasostomies using the 0.8890 mm and 0.9398 mm stents were patent, whereas only 4 of 22 vasovasostomies using a modified two-layer anastomosis without a stent were patent (P less than 0.01). Eight dogs underwent implantation of the absorbable vasovasostomy stent on one side and two-layer vasovasostomy on the other. Scanning electron microscopy showed superior re-epithelialization and closer return to normal morphology in the stented vasovasostomies than with the conventional two-layer technique.