Long-term effects of testicular cancer on sexual functioning in married couples.

Long-term sequelae of testicular cancer have not been reported from the perspective of patient and spouse. As part of a larger study, both members of 34 married couples were interviewed individually, almost 4 years after treatment ended. Spouse and patient responses were compared for concordance (agreement) regarding psychosexual functioning and fertility issues. Wives perceived fewer long-term problems than husbands and were extremely supportive throughout their husbands' illnesses. At interview, whereas 23.5% of patients still felt less attractive as a result of treatment, no spouses shared this perception. Patients were more likely to report decreased, and wives increased sexual satisfaction compared to before cancer. However, both patients and spouses were more likely to report decreased frequency of intercourse than increased. In other areas as well, concordance was generally high. Few couples reported that infertility would pose a problem, but 53% were parents; men who banked sperm were less likely to already have children.

Steroid hormone receptor characterization of several histologic variants of a rat prostatic adenocarcinoma.

Several histologic variants of the transplantable R-3327 prostatic adenocarcinoma carried in male Copenhagen rats have been characterized and the histologic types have been correlated with steroid hormone receptor content. One type is clearly an adenocarcinoma; this tumor is hormonally responsive and contains substantial amounts of both androgen and estrogen receptors. In contrast, another histologic type, a fibrosarcoma, is hormonally nonresponsive and does not contain either receptor. A third histologic variant is classified as a carcinosarcoma and contains histological elements of both adenocarcinoma and fibrosarcoma and is also hormonally responsive. This tumor contains lower receptor levels than the adenocarcinomas but more than the fibrosarcomas. The androgen receptor appears to be identical in the different histologic forms of the tumor: the sedimentation coefficient is 7.8S and the dissociatiln constant for methyltrienolone is 4 x 10(-9) M. Similarly, the estrogen receptor from the different histologic forms of the tumor has a sedimentation coefficient of 8.3S and the dissociation constant for estradiol is 7 x 10(-10) M. These findings clearly distinguish the cytosol binding macromolecules from plasma binding proteins, and classify them as steroid hormone receptors. Further, rat serum was devoid of androgen and estrogen binding in the 8S region. Normal prostate tissue from Copenhagen rats contained low levels of an androgen receptor, but no estrogen receptor. It is possible that during growth and/or passage of the R-3327 tumor, the hormonally responsive adenocarcinoma cells do not survive and there is a gradual emergence of the nonresponsive fibrosarcoma. If, as we suspect, the receptors are found in the epithelial cells and not the stromal cells, there clearly should be considerable variation of receptor content in the different intermediary histologic forms of the tumor.

Salmonella infection and the genitourinary system.

Six cases of severe salmonella genitourinary infection and a case of salmonella septicemia after prostatectomy are reported. The mechanism whereby the urinary tract is involved in salmonellosis is described, as are the different manifestations of genitourinary salmonellosis. Host factors predisposing to the development of genitourinary salmonella infection include other urologic pathology, malignant neoplasms and states of depressed immunity. Recommendations are made with regard to the diagnosis and management of this sometimes lethal condition.

Further observations of the detrusor electromyogram.

Using sophisticated recording equipment and two fine copper wire electrodes introduced through the cystoscope into the bladder muscle of conscious patients at cystoscopy, reproducible electromyographic recordings were obtained from the normal and the neuropathic bladders of a group of patients. By means of simultaneous recording of the electromyographic activity of the rectus abdominis muscle in these patients, it was found that, in general, the variations in electromyographic activity of the normal bladder with filling and voiding are quite independent of abdominal muscle activity. The upper motor neuron bladders by a way of contrast showed continuing electrical activity even at rest and this activity increases with abdominal contraction. Lower motor neuron bladders remain electrically silent at all times including during abdominal muscle contraction. This suggests that the bladder electrodes do not record muscle activity from the abdomen or elsewhere and confirms the validity of the detrusor EMG.

Papillary adenocarcinoma of prostate.

Papillary adenocarcinomas of the prostate are rare tumors which may arise from the prostatic ducts and the utricle; 2 cases are described. The diagnosis of these tumors is best established by cystourethroscopy and transurethral resection. The more common prostatic acinar adenocarcinoma is frequently associated with these tumors. The histopathologic recognition of papillary adenocarcinoma of the prostate and its differentiation from acinar adenocarcinoma is important since the natural history and response to treatment may be different.

Electromyographic evaluation of human detrusor muscle activity in relation to abdominal muscle activity.

Simultaneous electromyographic (EMG) recordings from the bladder detrusor muscle and the inferior rectus abdominis muscle were made in six normal subjects, in four patients with lower motor neuron bladder disease and in two patients with an upper motor neuron type of bladder lesion. Results of the study demonstrate that the bladder electrodes do not record remote muscle activity from the abdominal muscles so that any increased detrusor electrical activity with abdominal contraction must have some other explanation such as a possible abdominal-detrusor reflex or the production of increased intra-abdominal pressure from abdominal contraction. The study also demonstrates that the detrusor EMG is of value in studying the physiology of the bladder in humans, is a safe and simple technique and is of value particularly in assessing neurogenic bladder disorders.

Twenty-eight-day courses of antibiotics for urinary tract infection.

A prospective double-blind study was performed in which 30 adult patients with recurrent urinary tract infections due to Escherichia coli, and Proteus mirabilis organisms were treated by twenty-eight-day courses of either ampicillin, 500 mg. four times a day, or trimethoprim-sulphamethoxazole, 2 tablets twice a day. In terms of freedom from infection fifty-six days after the cessation of treatment in both complicated and uncomplicated infections, trimethoprim-sulphamethoxazole yielded results superior to those of ampicillin. In comparing the results of this study with those of a similar study in which the same agents were given for ten-day courses it appears that only in the complicated infection is there an advantage in giving a prolonged course of trimethoprim-sulphamethoxazole. This study did not generate any evidence to support the extension of ampicillin therapy for urinary tract infection beyond ten days.

Prostatic cancer revisited.

Thirty patients with prostatic carcinoma treated for varying lengths of time by radiation or endocrine therapy alone and in combination underwent staging and biospy of the prostate 3 years ago. Survival data for these patients have been correlated with the clinical and histologic findings of 3 years ago. A negative biopsy was associated with a better prognosis than a positive one and clinical rectal examination of the treated prostate was a poor index of cancer control. The group of patients treated with a combination of endocrine and radiation therapy was associated with the highest proportion of negative biopsies.

Histologic appearance of the intestinal urinary conduit.

The histology of intestinal urinary conduits (8 ileal and 2 sigmoid) in place for 10 months to 10 years was studied in 10 patients between 20 and 65 years old. It is concluded that the ileum and the large intestine do not undergo adaptive metaplastic transformation. The only changes observed are related to a condition of chronic irritation to which the response is a chronic inflammatory reaction. Structures proving to be the most resistant were the cells of Paneth. The latter were not damaged in appearance and number as compared to normal, even when the conduit was in place for 10 years.

Renal angiomyolipoma: two varieties.

Two cases of symptomatic renal angiomyolipoma are presented, and their distinctive clinical, radiologic, and histologic features are discussed. In the first case the scout film demonstrated radiolucency of the tumor which helped to distinguish it from carcinoma. In the second case, which was associated with tuberous sclerosis, the renal lesion was large and unifocal, and the local lymph nodal involvement with tumor raised the possibility of malignant transformation.

Lymphangiography in genitourinary cancer.

The rationale for pedal lymphangiography in the management of genitourinary cancer is discussed. The comparative studies between lymphangiography and subsequent histologic section of the nodes in the literature and our own instituiion are reviewed. Itis concluded that while lymphangiography is a safe procedure, it is unlikely to play a major role in the management of cancer of the kidney and penis. If more such studies were performed in cases of prostatic, testicular and bladder malignancies, the diagnostic accuracy might be improved and the lymphangiogram could then help significantly in planning treatment for these patients.