Rhodamine-123: therapy for hormone refractory prostate cancer, a phase I clinical trial.

Rhodamine-123, a lipophilic, cationic, rhodocyanine dye, has been reported to have carcinoma selective toxicity in vitro and in vivo. This phase I clinical trial established the safety and pharmacokinetics of Rhodamine-123 administered to men with hormone refractory prostate cancer. A single dose toxicity study of Rhodamine-123 determined the maximum tolerated dose. A multiple dose toxicity study assessed the safety of Rhodamine-123 at the maximum tolerated dose level. Transient and variable toxicities noted following Rhodamine-123 infusion resolved within 6 hours following infusion. Pharmacokinetic analyses of sera showed no accumulation of drug with repeated monthly administrations. Drug retention was confirmed in prostatic tissue following Rhodamine-123 administration. PSA doubling times lengthened variably suggesting drug efficacy but the data were not statistically significant. The maximum tolerated dose of Rhodamine-123 is 96 mg/m2. The drug can be safely administered at monthly intervals without detectable drug accumulation in serum. Rhodamine-123 is retained by prostatic tumor tissue.

Management of ureteral obstruction secondary to pelvic malignancies.

PURPOSE: To assess the efficacy of urinary diversion (internal v external) in the management of ureteral obstruction secondary to pelvic malignancies and the patients' quality of life after diversion. PATIENTS AND METHODS: Thirty-seven patients presented with malignant ureteral obstruction secondary to primary neoplasms of the pelvis or metastatic disease of the pelvis and retroperitoneum and underwent urinary diversion. Patients were categorized into two groups according to the success (Group I) or failure (Group II) of internal stent drainage. Successful drainage was defined according to either radiologic study or the serum creatinine concentration in the case of a solitary kidney. "Useful life" was defined as satisfying four criteria: (1) little or no pain; (2) no complications; (3) ability to return home for at least 2 months; and (4) full mental capacity. RESULTS: Of the total patient population, 58% ultimately failed internal diversion. Nearly all (92%) of the cervical cancer patients required external drainage. Complications were seen in 10% of the stented patients and 13% of the patients with a percutaneous nephrostomy tube, but no procedure-related deaths occurred. Useful life was achieved by 84% of all patients. CONCLUSION: Antegrade drainage should be considered initially in patients who are likely to fail internal drainage (i.e., those with cervical cancer). The majority of these patients have a reasonably good quality of life, and intervention is most often warranted.

Modified one-layer, nonstented, microsurgical vasovasostomy.

An estimated 750,000 to 1,000,000 vasectomies are done per year in the United States. For a variety of reasons, many of these patients may eventually present for vasectomy reversal. Here at the Kaiser- Permanente Los Angeles Medical Center, we have developed a modified one-layer, nonstented, microsurgical vasovasostomy which we have been using routinely for vasectomy reversals since 1984. The technique is easy to learn and can be employed with a high degree of success.

Diuretic radionuclide urography: functional assessment following pyeloplasty.

The radiographic appearance of the hydronephrotic upper urinary tract due to congenital ureteropelvic junction obstruction may not return to normal even though the obstruction is relieved by surgical repair. We present a case of ureteropelvic junction obstruction in which the success of the repair was demonstrated dramatically only by diuretic radionuclide urography.

Vasectomy and vasovasostomy have no effect on seminal plasma zinc concentrations.

Mean zinc concentrations were determined for human seminal plasma obtained from 110 nonvasectomized men (139 micrograms. per ml.), 43 recently vasectomized men (144 micrograms. per ml.), 25 long-term vasectomized men (139 micrograms. per ml.) and 25 men who had undergone vasovasostomy (129 micrograms. per ml.). The results indicate that there is no significant short-term or long-term effect of these surgical procedures on prostatic secretory function as measured by seminal plasma zinc concentration.

PIP: Zinc levels in seminal plasma were compared in vasectomized men 3-6 wks after surgery, men before and after vasovasostomy, and men consulting for infertility. Semen denatured with perchloric acid, frozen, thawed, and centrifuged, was analyzed by atomic absorption spectroscopy. There were no differences in mean zinc concentrations: 110 infertility patients averaged 139 mcg/ml; 43 vasectomized men averaged 144; 25 vasectomized 2 to 19 yrs ago averaged 139; these men after vasovasostomy averaged 129 mcg/ml. There was no correlation between zinc content in seminal plasma and sperm count. The results indicate that there is no significant effect of vasectomy or of vasovasostomy on secretory function of the prostate.

Erosion of inflatable penile prosthesis reservoir into bladder and bowel.

We report 2 cases of a rare complication associated with the inflatable penile prosthesis, that is erosion of the reservoir into the sigmoid colon and bladder.

Initiation of erection and semen release by rectal probe electrostimulation (RPE).

Instrumentation and methodology are described for rectal probe electrostimulation (RPE) in human males to elicit erection and allow semen collection. This system virtually eliminates shock hazard; the simultaneous monitoring of current, voltage and impedance ensures reliability and repeatability. It was tested with 8 neurologically intact subjects, and 12 paraplegic patients with lesions between T4 and L2. Platinum electrodes delivered current (density never exceeding 0.37 mA per mm. at the electrode) at frequencies of 60 Hz, 20 Hz, and 0.25 Hz. Erection was elicited repeatably in only 1 of the intact subjects, and no seminal emissions or ejaculations occurred. Discomfort prevented current delivery beyond levels even 50 per cent of those safely acceptable. Six of 10 paraplegic patients (2 others had penile implants) developed erections with 20 Hz; the other 2 frequencies were much less effective. The extent of RPE-induced penile tumescence varied directly with electrode surface area and applied current intensity. Discomfort was minimal. Retrograde seminal emission in 5 of the 12 paraplegics was verified by post-stimulation recovery of sperm via voiding or bladder irrigation via catheter. Although motility was very low, 4 of 8 recovered bladder-urine/seminal fluid specimens indicated sperm counts and morphology consonant with use in artificial insemination. Thus, RPE, if combined with techniques to allow antegrade semen collection, may be a useful technique for spinal cord-injured men who, as part of their sexual rehabilitation, are interested in siring children.