Comparison of spontaneous and experimentally induced canine prostatic hyperplasia.

Spontaneous prostatic hyperplasia in the beagle appears to progress with age from a glandular to a cystic histological appearance. Prostatic hyperplasia can be induced in young beagles with intact testes by treatment for 4 mo with either dihydrotestosterone or 5 alpha-androstane-3 alpha, 17 beta-diol, alone, or with either of these steroids in combination with 17 beta-estradiol. In contrast, the induction of prostatic hyperplasia in young castrated beagles, in which the gland had been allowed to involute for 1 mo, requires the administration of both 17 beta-estradiol and either 5 alpha-androstane-3 alpha, 17 beta-diol or dihydrotestosterone. Testosterone and 17 beta-estradiol, either singly or in combination, did not produce the hyperplastic condition in intact or castrated beagles. The experimentally induced prostatic hyperplasia is identical in pathology to the glandular hyperplasia that occurs naturally in the aging dog with intact testes. However, cystic hyperplasia was not produced by any of the treatments tested in young animals.

Case study: sex reassignment in a teenage girl.

The etiology of gender identity is explored through the case history of a teenager with intersex raised without stigmatization as a girl but who declared himself male at age 14 years. Psychological ramifications of such complex medical anomalies as ambiguous genitalia demand a role for child psychiatry.

Psychosexual dysfunction in males with genital anomalies: late adolescence, Tanner stages IV to VI.

OBJECTIVE: To assess psychosexual function in adolescent males with genital anomalies. METHOD: Fourteen consecutive males with bladder exstrophy-epispadias, 14 to 19 years old, Tanner stages IV to VI, were assessed along with their parents, using a developmental questionnaire, Hollingshead socioeconomic status rating, Child Behavior Checklist, Youth Self-Report, semistructured psychiatric interview, detailed sexual history, and 5 written, open-ended questions. RESULTS: All subjects showed psychosexual dysfunction in terms of genital satisfaction and genital touching; only 2 had ever undressed in front of anyone; only 2 had ever masturbated and only after age 16; 8 had few friends and only 5 considered any girls as friends; all expressed heterosexuality but only 4 had dated, 1 at age 17 and 2 after age 18; only the two 19-year-olds had experienced sexual intercourse, at the age of 19. All had an anxiety disorder. Half had experienced a major depressive disorder. CONCLUSIONS: Psychosexual dysfunction and anxiety were universal and chronic in these males with genital anomalies, leading to social and sexual developmental impairment. Half had a mood disorder. Implications for adulthood as well as for children with other genital anomalies are unclear but deserve further study. Males with genital anomalies should be evaluated for psychosexual developmental impairment.

Assignment of sex in neonates with ambiguous genitalia.

Sex assignment in the newborn with ambiguous genitalia has been based on the adequacy of the phallus in the male, potential fertility in the female, and cosmetic appearance of the reconstructed genitalia. Recent data from both the neurosciences and from clinical research, however, casts doubt on the validity of such criteria for clinical decision making. Current knowledge suggests a need to shift away from the current clinical approach and to incorporate these new data into decisions based on a broader understanding of the etiology of gender identity. Recognition of the primacy of psychosocial and psychosexual developmental outcomes for children with ambiguous genitalia is lending direction to longitudinal outcomes research. New approaches to sex assignment have been suggested, and the paradigm for sex assignment in the newborn period is in transition.

Vesicoureteral reflux and ureteropelvic junction obstruction: late occurrence of ureteropelvic obstruction after successful ureteroneocystostomy.

Ureteropelvic junction obstruction occurred in 2 patients after successful correction of vesicoureteral reflux. The correction of vesicoureteral reflux does not always allow complete resolution of pelvioureteral tortuosity, kinking and periureteritis. In cases with a severe degree of these changes the possibility of ureteropelvic junction obstruction occurring either early or late after ureteroneocystostomy should be considered when unsatisfactory renal function is noted during followup.

The embryologic origin of the caput epididymidis in the rat.

The ACI rat with its known incidence of ipsilateral agenesis of the kidney and ductus deferens provides an excellent mammalian model for the study of the embryologic origin or the caput epididymidis. Because a portion of the caput epididymidis remains in these affected animals, it seems to be derived from the mesonephric tubules rather than the mesonephric duct in the rat. Histochemical assays also support the common origin of both the ductuli efferentes and caput epididymidis from the mesonephric tubules.

Long-term survival after hormonal therapy for stage D prostatic cancer.

Hormonal therapy occasionally produces long-term survival of men with metastatic carcinoma of the prostate. To identify which patients will benefit for long intervals a retrospective analysis was done on 56 men with stage D carcinoma of the prostate treated between 1963 and 1968. Of this group 5 patients lived longer than 10 years. We were unable to identify clinical or pathologic characteristics that would have indicated which patients would have done well.

The outcome of patients with classic bladder exstrophy in adult life.

PURPOSE: We determined the outcome of 20 older adult bladder exstrophy patients regarding urinary continence, sexual function, fertility and psychosocial integration. MATERIALS AND METHODS: A total of 16 men and 4 women completed an anonymous questionnaire and the charts were reviewed for medical history. RESULTS: Of 9 patients who void spontaneously 6 are dry for 4 hours and 3 for 2 hours. Among the remaining 11 patients 5 are dry on clean intermittent catheterization, 3 who had undergone uterosigmoidostomy are dry for more than 4 hours and 3 had an incontinent stoma. Four men and 2 women are married, including 2 men and 1 women who had a total of 7 children. Ten of 16 men (63%) reported that they ejaculate a few cubic centimeters in volume, 3 ejaculate only a few drops and 3 have no ejaculation (2 of whom underwent cystectomy). Semen analyzed in 4 patients (3 with azoospermia and 1 with oligospermia) and average volume of ejaculate was 0.4 cc (range 0.2 to 1). All women reported regular and normal menstrual periods. A total of 15 patients experienced normal erections that were described as satisfactory by 8 and not satisfactory by 6 due to a small penis, with dorsal chordee in 1. Of the 16 men 12 (75%) experienced satisfactory orgasms while 10 had participated in sexual intercourse with complete partner satisfaction in 9. Half of the men and all women describe intimate relationships as serious and longterm. Of the 20 patients 15 (75%) achieved a high level of education. CONCLUSIONS: Bladder exstrophy patients generally achieve good results but the fertility of most men is in doubt.

Cloacal exstrophy--improving the quality of life: the Johns Hopkins experience.

PURPOSE: Exstrophy of the cloaca is a multisystem anomaly involving the gastrointestinal, nervous, musculoskeletal and genitourinary tracts which should be managed with a multidisciplinary approach. Improvement in management has led to survival for the majority of infants, and the focus has shifted to improvement in quality of life. The experience with management of cloacal exstrophy at a large center is evaluated. MATERIALS AND METHODS: Demographic data as well as functional results of management of the multiple anomalies in 37 patients with cloacal exstrophy were evaluated. Surgical reconstruction was aimed at providing the best functional and cosmetic results. RESULTS: Average patient age at review was 13.6 years. Most patients (32 of 37) had undergone an initial attempt at bladder closure from birth to greater than 24 months of age. Colostomy was performed when possible and if initial ileostomy was performed, the bowel was augmented later with the hindgut segment. When the hindgut segment was not used for bowel reconstruction, it was preserved for bladder augmentation or genital reconstruction. While urinary continence was achievable in many children, it was usually after augmentation and/or continent diversion. CONCLUSIONS: Improvements in perinatal management have increased survival in cloacal exstrophy. Therefore, the focus of reconstruction has shifted to reduction in the numbers of incontinent stomas, assistance with ambulation and improved cosmesis. All of these goals are achievable using a multidisciplinary approach to the management of this complex anomaly.