Aspergillosis of prostate.

We report a rare case of primary prostatic aspergillosis in a well-controlled diabetic man who presented to our clinic in acute urinary retention. His management and the literature are reviewed.

Experience with schistosomiasis in renal transplantation.

Schistosomiasis involving the urinary tract has only occasionally been reported in North American literature and rarely from American hospital experience. Chronic infection may result in numerous abnormalities of the urinary tract which may interfere with the function of a transplanted kidney. Our institution has performed a number of renal transplants in patients who are from countries where schistosomiasis is endemic. Six patients in our group had evidence of schistosomal disease during their pretransplant evaluation and were appropriately treated. None of these patients had postoperative complications attributable to the schistosomal disease. We recommend that all patients who are from areas where urinary schistosomiasis is endemic undergo a cystoscopic examination and bladder biopsies in addition to the routine pretransplant urologic evaluation.

High- and low-risk prostate cancer treated with 3D CT-guided brachytherapy: 1-to 5-year follow-up.

PURPOSE: To provide a preliminary report of 301 patients treated for prostate carcinoma with three-dimensional CT-guided transischiorectal stereotactic brachytherapy using either iodine-125 or palladium-103 seeds as monotherapy. PATIENTS AND METHODS: Patients with clinical stage T1, T(2ab), or T(3ab) disease with prostate volumes 23 to 180 cm3 and serum prostate specific antigen (PSA) concentrations of 0.9 to 143 ng/mL had seeds placed 10 mm apart under CT guidance. No androgen blockade was used postoperatively, but 47% of the patients had hormonal therapy preoperatively. RESULTS: At 12 to 63 months (median 26 months) of follow-up, PSA concentrations had decreased to <2 ng/mL in 90% of the patients and to <1 ng/mL in 83%. Four patients underwent transurethral resection or incision at least 12 months after implantation; none became incontinent. Three patients had rectal ulceration that lasted for several months. CONCLUSIONS: Computed tomography-guided transischiorectal brachytherapy allows accurate placement of radionuclide seeds in prostate glands of all sizes. The early results, as judged by serum PSA, are encouraging.

Comparison of Minnesota antilymphocyte globulin and OKT3 for induction of immunosuppression in renal transplant patients.

From May 1977 to April 1988, 88 patients receiving cadaveric kidney transplants were selected to receive Orthoclone (OKT3; 5 mg intravenous bolus) (n = 28) or Minnesota antilymphocyte globulin (MAG; 20 mg/kg/day) (n = 60) as the induction phase of a quadruple immunosuppressive protocol. The duration of treatment ranged from 5-16 days for OKT3 (mean, eight days) and 7-14 days for MAG (mean, nine days), as dictated by the post-operative recovery of renal function. All patients were followed for at least four months (maximum 16 months, mean 10 months). Of the 28 patients receiving OKT3, six (21%) had rejection episodes which wre reversed and did not reoccur. Two patients developed OKT3 antibody. Only one graft was lost to rejection. Of the 60 patients receiving MAG, 30 (50%) experienced a first rejection episode within the follow-up period; 15 of these had repeat rejections. Three allografts were subsequently lost in the MAG group. Renal function was significantly better in the OKT3 group. While both OKT3 and MAG were associated with excellent patient (98%) and graft (92%) survival, OKT3 was easier to administer with fewer rejection episodes. We conclude that OKT3 is superior to MAG as perioperative cytoreductive therapy following cadaveric kidney transplantation.

Changes in the corpora cavernosa of impotent diabetics: comparing histological with clinical findings.

In our study, the histological findings showed significant pathological fibrosis affecting the penile arteries and erectile tissue, but no direct damage to the penile nerve fibers. Forty percent of our patients with clinical evidence of penile neuropathies showed no histological evidence to support a neurogenic mechanism of their impotence. In addition, to the consistent vascular lesion found in 90 percent of impotent diabetics in our study, a fibroproliferation of the erectile tissue was predominantly found as well. Our histopathological study seemed to correlate with our previous clinical finding. Does this confirmation of the vascular etiology as a primary cause of impotence in diabetics have practical application? The answer must be "yes". If new diagnostic developments contribute to making an earlier diagnosis of this disease, then more conservative or aggressive treatment of the impotent diabetic will become a reality.

Clinical significance of ultrastructural findings in the corpora cavernosa of normal and impotent men.

Corpora cavernosa of 5 normal and 11 impotent living men were studied by electron microscopy. Of the smooth muscle cells 42.3% from corporeal tissues of impotent men showed a pronounced thickening of the basal lamina, a paucity of dense bodies and contractile filaments, minimal or no glycogen and fewer vesicles on the cell surface, whereas only 5.4% of the smooth muscle cells from normal men showed similar alterations. These differences were statistically significant (p less than 0.003). The percentage of altered smooth muscle cells in corporeal tissues of impotent men was proportional to the severity of symptoms and clinical findings. Morphometric analysis revealed no significant differences in the relative proportions of the major components of corporeal tissue (smooth muscle cells, extracellular matrix, vascular lumina and endothelial cells). These findings suggest the need for early detection of corporeal tissue degeneration by preoperative biopsy to assist in better selection of candidates for a penile vascular operation. They also may contribute to the development of new therapeutic modalities for erectile dysfunction.

Acquired megalourethra: an uncommon complication of the transverse preputial island flap urethroplasty.

We describe 4 patients with significant dilatation of the entire neourethra following transverse preputial island flap urethroplasty. Two patients presented after repair of chordee without hypospadias, which was corrected by interposition with a pedicle graft. The problem arises about 6 months after the repair and is manifested by ballooning of the urethra during urination and postvoid dribbling. We have labeled this entity acquired megalourethra and the repair is similar to that for congenital megalourethra.

Quadruple immunosuppression: comparison of OKT3 and Minnesota antilymphocyte globulin.

From May 1977 to June 1988, 110 patients receiving cadaveric kidney transplants were selected to receive Orthoclone (OKT3; Ortho Pharmaceutical Corporation, Raritan, NJ; 5 mg intravenous bolus) (n = 43) or Minnesota antilymphocyte globulin (MAG; 20 mg/kg/day) (n = 67) as the induction phase of a quadruple immunosuppressive protocol. The duration of treatment ranged from 5 to 16 days for OKT3 (mean, 8 days) and 7 to 14 days for MAG (mean, 9 days) as dictated by the postoperative recovery of renal function. All patients were followed-up for at least 3 months (maximum, 18 months; mean, 10 months). Of the 43 patients receiving OKT3, 11 (26%) had rejection episodes that were reversed and did not reoccur. Two patients had episodes that could not be reversed, resulting in graft loss. Of the 67 patients receiving MAG, 38 (57%) experienced a first rejection episode within the follow-up period; 16 of these had repeat rejections. Renal function was significantly better in the OKT3 group. Although both OKT3 and MAG were associated with excellent patient (98%) and graft (92%) survival, OKT3 was easier to administer with fewer rejection episodes. It was concluded that OKT3 is superior to MAG as perioperative cytoreductive therapy following cadaveric kidney transplantation.

Diagnosis and management of the urologic complications of renal transplantation.

669 patients who received a renal transplant from January 1988 to December 1993 at a single institution were evaluated for urologic complications. Urologic complications were assessed and categorized by organ involvement: kidney, ureter, bladder, lymphatic, calculus and complicated urinary tract infection. Complications were also classified as "early" if they occurred within 14 d after transplant and those diagnosed after this period were called "late." The management of all complications is presented. There were a total of 98 urologic complications identified in 669 patients, of which 51 were complicated urinary tract infections. The other 47 complications were divided among renal (8), ureteral (19), bladder (3), lymphatic (10) and calculi (7). Preventive measures, such as technical management of ureteral reimplantation, periodic renal scan or ultrasound examinations, and long-term urinary antibiotic prophylaxis could further reduce the incidence of urologic complications. The result should be further improvement in transplant patient and graft survival.