Zvi Braf

Demonstration of antispermatozoal antibodies in varicocele-related infertility with an enzyme-linked immunosorbent assay (ELISA)

To assess the existence of a possible immunologic factor in varicocele-associated infertility, we searched for antispermatozoal antibodies in serum, seminal plasma, and bound to spermatozoa in 32 infertile men with varicocele and 22 infertile patients without palpable varicocele, with the use of an enzyme-linked immunosorbent assay. In addition, we performed morphologic and microbiologic analyses of the semen and urethral smears for isolation of Chlamydia trachomatis. Twenty-nine men from the varicocele group (90.6%) demonstrated antispermatozoal antibodies, compared with only 9 men (40.9%) in the control group. The antibodies in both groups, when present, were mainly serum and seminal plasma immunoglobulins IgA and IgM. A significant quantitative difference between the varicocele and control groups was also observed for serum IgA, seminal plasma IgA and IgM, and sperm-bound IgG, IgA, and IgM. Oligozoospermia and asthenozoospermia were significantly more prevalent in the varicocele men. An asymptomatic genital tract infection with C. trachomatis, Ureaplasma urealyticum, and Escherichia coli was traced in 40.6% of the varicocele men and in 45.5% of the control group. No interaction could be demonstrated between the infection and antispermatozoal antibody formation. These data suggest that an immunologic factor may play a role in varicocele-associated infertility; however, its impact on reproduction has yet to be assessed.

Ineffectiveness of phenoxybenzamine in treatment of benign prostatic hypertrophy A controlled study

Abstract Twenty-eight patients with benign prostatic hypertrophy were observed in a controlled study to determine the effectiveness of low-dose phenoxybenzamine. No statistically significant benefit on flow rate, residual urine, or urethral profile pressure was shown. It is concluded that phenoxybenzamine in low doses is ineffective in reducing the physical obstruction of the enlarged prostate gland.

T Lymphocyte Subsets and Function in the Peripheral Blood of Patients with Urological Cancer

The phenotypic distribution and immune reactivity of T lymphocyte subpopulations from peripheral blood of 50 patients with urological cancer were determined. Included were 36 patients with bladder transitional cell carcinoma, 7 patients with renal cell carcinoma and 7 patients with prostatic carcinoma. Thirty-eight age-matched patients with benign urological disease served as controls. A depression in immune competence was found in the group of male patients with infiltrating bladder cancer. In more than 50% of the patients with infiltrating bladder carcinoma, the T helper (CD4) subset was reduced with a concomitant inversion in the CD4/CD8 ratio and impairment in the T cell function as determined by the ability to proliferate upon phytohemagglutinin and concanavalin stimulation. Patients with superficial bladder carcinoma, as well as those with renal cell carcinoma had an immune profile similar to that of the control group. The group of patients with prostatic carcinoma had higher mean CD4/CD8 ratios than the control group, resulting from decreased suppressor/cytotoxic cells. Our results have indicated that the characterization of T cell subset and lymphocyte activity correlated well with the histopathologic state of patients with bladder carcinoma. Thus, the determination of the CD4/CD8 ratio may prove a valuable method for monitoring patients with bladder carcinoma, in addition to serial urine cytology, random urothelial biopsies and flow cytometry.

Changes in prostate-specific markers under chronic gonadotrophin-releasing hormone analogue treatment of stage D prostatic cancer

Nineteen patients with newly diagnosed advanced prostatic carcinoma were treated with daily inhalations of a gonadotrophin‐releasing hormone (GnRH) analogue (buserelin acetate, Hoechst 766, Frankfurt, FRG), for up to 3 years. Successful long‐term suppression of luteinizing hormone (LH) and testosterone was observed without any escape of testosterone. Ten patients were considered nonresponders, whereas nine were defined as responders (had either stabilized or regressed). Serum prostate‐specific markers, prostatic acid phosphatase (PAP) and prostate‐specific antigen (PSA), were monitored at fixed time intervals throughout treatment in these patients. Simultaneous determinations of both markers was made under treatment in 147 samples. The results suggest a high correlation between the disease state and the level of the markers (P < 0.0001), as well as a very high correlation between serum concentrations of the markers themselves (correlation coefficient = 0.6). Thus, the authors could not point clearly towards a superiority of any marker when monitoring response to GnRH analogue treatment. Contrary to current belief, the pretreatment values of both markers were of no prognostic value with regard to response or survival.

Acute urinary retention in herpes genitalis infection. Urodynamic evaluation.

Acute urinary retention in herpes genitalis infection is reported to be infrequent. We report 4 cases of acute urinary retention caused by neurologic complication of herpes infection. The urodynamic finding and follow-up results are presented.

The role of increased prolactin levels under gnrh analogue treatment in advanced prostatic carcinoma

The role of prolactin in the progress of prostatic carcinoma still is obscure. It is known to modulate testosterone metabolism and may have a prognostic value in determining disease progression. Prolonged treatment with a GnRH analogue has been introduced recently as a therapeutic alternative to surgical castration in advanced prostatic carcinoma. It has been reported that prolactin levels remain unchanged or even decrease in GnRH analogue treatment. By contrast, in this series of 15 prostatic carcinoma patients treated with GnRH analogue, a significant rise was demonstrated in clinical responders as well as nonresponders. In the latter group, prolactin rise was more pronounced. These results suggest that frequent prolactin determinations might be of prognostic value in determining early disease progression under GnRH analogue treatment.

Computerized Tomography in Xanthogranulomatous Pyelonephritis

Computerized tomography offers the means to recognize changes in the kidney associated with xanthogranulomatous pyelonephritis. The preoperative extent of the inflammatory process, reaction of adjacent parenchymal structures, and extension to the muscles and abdominal wall are identifiable on computerized tomography. The presence of obstructing renal stones, thickening of the perirenal fascia and inability of the kidney to handle intravenously injected contrast medium can be assessed with computerized tomography. Low density renal areas measured on computerized tomography may indicate lipid infiltration of the kidney or incorporation of the fat of the renal bed into the tumefactive mass.

Late appearance of perineal implantation of prostatic carcinoma after Perineal needle biopsy

A case is reported of a patient with carcinoma of the prostate and perineal tumor implant five years after perineal needle biopsy. This is the second case of the rare complication in which the implant appeared years after the biopsy. He was treated with wide excision of the tumor.

Relationship between subjective complaints and urinary flow

Two hundred six patients were examined with urine flowmetry and residual urine measurements to determine if a relationship exists between pathologic urine flowmetry determinations and specific subjective patient complaints. A statistical correlation exists in men with the complaint of frequency and in women with the complaint of frequency and incontinence. Possible explanation for these findings is discussed.

Nephrogenic adenoma: Benign proliferative lesion of urothelium

Three new cases of a rare benign proliferative lesion of the urothelium (nephrogenic adenoma) are hereby added to the existent 58 reported cases. All 3 lesions occurred in the bladder. Two of the 3 cases presented with a history of surgical interventions on the bladder, and the third patient had a history of chronic cystitis and pyelonephritis, and was on chronic dialysis. Diagnosis was made on histologic examination of cystoscopic biopsy of the lesions. Transurethral resection and/or fulguration was the treatment of choice. There was no recurrence of the lesions on follow-up cystoscopic examination.