Maxillofacial osteosarcoma successfully treated with surgery and adjuvant chemotherapy in a child.

Maxillofacial osteosarcoma constitutes a minor percentage of all the head and neck tumors. We describe a 10 year-old girl presenting with swelling and pain in left maxillary region and diagnosed as low grade osteosarcoma. The patient was operated and given a chemotherapy protocol consisted of Cisplatin and Doxorubicin. After six courses of chemotherapy the patient was in complete remission and she is well with no evidence of disease for five years. Since high local recurrence rates have been reported in craniofacial osteoarcoma and we know the deleterious side effects of radiation therapy in children, we believe that best management strategy for osteosarcomas in maxillofacial region in children is radical surgical excision and postoperative chemotherapy (Fig. 3, Ref. 11).

Prostatic urethral leukoplakia with prostatic abscess.

We present a case of prostatic abscess and coexistent leukoplakia of the urethra in a 51-year-old man. He had been suffering from diabetes mellitus for 10 years and following cessation of high fewer, transurethral electrovaporesection was performed.

Effect of glycemia status on endocrinological parameters of impotent and infertile patients.

OBJECTIVE: To identify the effects of glycemia status on hormone levels, we evaluated the effects of hypo and hyperglycemia on endocrinological parameters of patients with erectile dysfunction, infertility, varicocele and compared the results with control subjects. MATERIALS AND METHODS: Twenty patients with erectile dysfunction, 20 infertile patients with oligo-azoospermia, 20 patients with normozoospermic left varicocele and 15 healthy control subjects constitute our study population. Plasma follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T) and prolactin (PRL) levels were measured both in patients in hypoglycemia and hyperglycemia status. Statistical analysis were done by Wilcoxon test. RESULTS: All endocrinological parameters did not show any statistically significant difference between the hypoglycemia and hyperglycemia status. Also, no abnormalities in the endocrinological parameters were observed. CONCLUSION: We showed that the glycemia status of the patient (either hypo or hyperglycemia) did not effect the results of endocrine profile. Also, endocrine evaluation is unnecessary in impotence and infertility.

Collecting duct carcinoma.

Collecting duct carcinoma of the kidney is a rare variant of renal cell carcinoma. Hematuria is the most common presenting symptom. This tubulopapillary tumor arises from or differentiates forward to medullary collecting tubules. It is typically centered on the medulla of the kidney and extends into the cortex with a desmoplastic reaction. There are few reports documenting the clinical presentation and long-term prognosis. We describe a case of this uncommon tumor with clinical, histological and immunohistochemical features and review the literature.

Randomized study of transurethral resection of the prostate and combined transurethral resection and vaporization of the prostate as a therapeutic alternative in men with benign prostatic hyperplasia.

BACKGROUND AND PURPOSE: In recent years, various minimally invasive alternatives to transurethral resection have become available for treatment of benign prostatic hyperplasia (BPH). Transurethral electrovaporization has become popular, with reported improvements in subjective and objectives measures, but a high rate of postoperative irritative symptoms and lack of tissue for histologic examination are the two most commonly reported disadvantages of this procedure. To decrease the postoperative irritative symptoms while minimizing intraoperative and postoperative bleeding and also to obtain tissue samples, we have combined the techniques of vaporization, which was termed "vapor-cut." The aim of this randomized study was to compare the efficacy and safety of vapor-cut with those of the gold standard, transurethral resection. PATIENTS AND METHODS: A series of 100 consecutive men (mean age 63.5 +/- 3.4 years) with moderate to severe symptoms of prostatism were randomized to receive transurethral resection of the prostate (TURP) or vapor-cut since November 1997. Adverse events during the procedure, including serial changes in both serum hematocrit and sodium and postoperative irritative symptoms, were recorded after removal of the urethral catheter. Preoperative and postoperative symptom scores and maximum flow rates (Qmax) were obtained from all patients. The volume of the prostate was measured preoperatively and postoperatively using transrectal ultrasonography. The mean follow-up of the patients was 6.7 months (range 6-10 months). RESULTS: The mean operative times for the vapor-cut group and the TURP group were 48.2 minutes and 42.7 minutes, respectively (P > 0.05). In the TURP group and the vapor-cut group, the International Prostate Symptom Score (I-PSS) decreased from 21.6 to 5.0 (P < 0.01) and from 19.4 to 4.0 (P < 0.01), respectively, at 6 months. The Qmax increased from 9.2 +/- 2.6 mL/sec to 24.6 +/- 3.4 mL/sec (P < 0.01) in the TURP group and from 7.9 +/- 2.1 mL/sec to 26.7 +/- 3.7 mL/sec (P < 0.01) in the vapor-cut group. The mean reductions in the weight of the prostate were 49.8% in the TURP group (P < 0.05) and 53.6% in the vapor-cut group (P < 0.05). Both catheterization time and hospital stay were significantly shorter for the vapor-cut group (P < 0.05). The decreases in the mean serum sodium concentration were statistically insignificant in both groups. However, the decrease in the mean hematocrit was statistically significant in the TURP group but not in the vapor-cut group. No patient in either group had the transurethral resection syndrome or required blood transfusion. After removal of the urethral catheter, irritative voiding symptoms, usually associated with frequency, were greater in those patients treated with TURP than in those having vapor-cut. None of the patients demonstrated sphincteric incontinence, bladder neck contracture, or urethral stricture. CONCLUSION: From our preliminary experience, vapor-cut seems to give results comparable to those of TURP. Because there is almost no bleeding during vapor-cut, the procedure is performed under excellent visibility, which permits more rapid and effective resection.

Immunologic aspect of testicular torsion: detection of antisperm antibodies in contralateral testicle.

OBJECTIVE: To evaluate the immunologic etiology in unilateral testicular torsion, an experimental study in rats was carried out. MATERIALS AND METHODS: 75 adult Wistar rats included in the study program were divided into six different groups according to a torsion-detorsion procedure. Torsion degree was kept constant for all animals (720 degrees ). Anti-rat immunoglobulin G (IgG) antibodies against spermatozoa antigens were identified in contralateral testicular tissue after 1 month following detorsion and/or orchiectomy of the twisted testicle. RESULTS: We revealed antibody formation in animals subjected to unilateral torsion for 12 and 24 h, which then followed by detorsion of the testicle. IgG was identified especially on basal membrane of the tubules. CONCLUSIONS: As the controversy on the exact mechanism of testicular damage in unilateral torsion still continues, our findings showed that a possible immunological etiology may play an important role in this respect.

Histopathological and functional effects of radiation therapy in obstructive uropathy.

Leukocyte influx into the cortex and medulla of the kidney is seen following acute ureteral obstruction. To investigate the macrophage influx and alterations in glomerular filtration rate (GFR) and to evaluate the effects of early radiation therapy on these parameters, we evaluated 20 rabbits in four groups. In the first group preoperative technetium-99m scanning preceding bilateral ureteral complete obstruction was performed. All rabbits received whole body irradiation of 1316 rads. Then the bilateral ureteral obstruction was released after 24 hours. Two hours after releasing, the last scanning was performed. The kidneys were immediately removed and histopathological examination was done. In the second group, all procedures except radiotherapy were done. The third group underwent sham laparotomy to assess the effects of surgical trauma on renal functions. The fourth group of rabbits was considered as control. We have observed an apparent macrophage influx into the cortex and medulla of the kidney following bilateral ureteral obstruction (p=0.000). However, irradiation reduced the infiltration significantly (p=0.000). Also in cases who received radiotherapy GFR was preserved to a significantly higher degree (p=0.000). We concluded that irradiation following acute ureteral obstruction has protective effects on renal function through abolition of the infiltrating cells.

Penile implants in erectile impotence. The importance of clinical experience on outcome.

PURPOSE: We assessed maximum patient and partner acceptance and satisfaction by informed preoperative prosthesis selection. MATERIALS AND METHODS: Six months to 5 years after penile prosthesis implantation, 71 men and partners were interviewed personally. Evaluation was focused on delineating not only the etiologic factors but also factors most likely to affect prosthesis recommendation and contribute to prognosis. RESULTS: Overall, 94% of the patients and 95% of the partners were satisfied, and 90% of these believed that they had equal erections to previously without the implant, and 81% reported an improvement in nonsexual relations with their partners after the device was implanted. 83 and 17% of the patients said they had increased or had no change in sexual desire, respectively. No one had a decrease in sexual desire. 86% of all the patients believed that their orgasm was improved. 89% of the patients were completely satisfied with the fit of their clothes after prosthesis implantation. 93% of the patients reported good to excellent emotional adjustment to the prosthesis and the prosthesis produced a positive change in self-esteem in 94% of all the patients. CONCLUSIONS: A detailed assessment of patient-partner expectations is essential in order to be able to predict more accurately which patients will be best suited to the implant and which may need either concurrent counseling or preimplant education. A team was formed in which urologists and psychologists worked together, provided comprehensive information on several personality variables of interest in treatment planning and postoperative satisfaction. Our results clearly demonstrate that not only patient preference but also clinical data are important factors in enhancing patient and partner satisfaction.

Effect of transurethral electrovaporization of the prostate on serum prostate specific antigen concentration.

OBJECTIVE: To assess the effect of transurethral electrovaporization of the prostate (TUVP) on serum prostate specific antigen (PSA) concentration. PATIENTS AND METHODS: Twenty-five men (mean age 61.7 years) with symptoms of prostatism underwent TUVP. Serum PSA levels were determined before any prostatic manipulation, and again at 1 and 24 h after TUVP. In the first 6 weeks after TUVP, serum PSA was measured every week. Prostatic size was measured by transrectal ultrasonography before and again at 6 weeks after TUVP. RESULTS: The mean serum PSA concentration was significantly higher at 1 and 24 h after TUVP (P<0.001) than before. The PSA level returned to less than the value before TUVP at 2, 3 and 4 weeks afterwards in eight (32%), 13 (52%) and 20 (80%) patients, respectively; five (20%) patients reached the baseline value 6 weeks after TUVP. The mean reduction in prostatic volume 6 weeks after TUVP was 42% and the reduction in tissue volume was significantly correlated with the decrease in serum PSA concentration at 6 weeks (P<0.05). CONCLUSION: TUVP increases serum PSA levels, the transient elevation persisting for up to 6 weeks but then declining to a stable, low PSA concentration. Therefore, it is important to wait at least 6 weeks to obtain an accurate and meaningful serum PSA level after TUVP.

Combined transurethal resection and vaporization of the prostate using newly designed electrode: a promising treatment alternative for benign prostatic hyperplasia.

BACKGROUND AND OBJECTIVE: Postoperative irritative symptoms and lack of tissue samples for histologic examination are the two main disadvantages of transurethral electrovaporization of the prostate. To decrease the postoperative irritative symptoms while minimizing intraoperative and postoperative bleeding and also to obtain tissue samples, we have combined the techniques of transurethral resection and vaporization, a procedure we have termed Vapor-cut, by using the Wolf Wing gold-plated electrode. PATIENTS AND METHODS: Forty-eight patients with symptomatic benign prostatic hyperplasia (BPH) were enrolled in the study. Adverse events during the procedure, including serial changes in both serum hematocrit and sodium, and postoperative irritative symptoms were recorded after removal of the urethral catheter. Preoperative and postoperative symptom scores and maximum flow rates (Qmax) were obtained in each patient. The volume of the prostate was measured preoperatively and postoperatively using transrectal ultrasonography. RESULTS: During the procedure, there was minimal bleeding, and serum sodium and hematocrit levels were not changed significantly. The mean operative time was 49.3 minutes. The catheterization time and hospital stay were 48 and 60 hours, respectively. Only five patients (10%) reported transient and intermittent postoperative hematuria lasting for 1 week. After removal of the urethral catheter, four patients (8%) had irritative voiding symptoms. No patients experienced postoperative urinary retention or required subsequent catheterization. At 3-month follow-up, the improvement in the mean Qmax was 114%, and the decrease in the symptom score was 72%. The average reduction in the weight of the prostate was 55%. CONCLUSION: Vapor-cut of the prostate appears to be a safe, effective alternative to the standard loop resection and vaporization. It has the advantages of minimal blood loss, excellent operative visibility, decreased postoperative irritative symptoms, and availability of tissue samples with short catheterization and hospitalization times.

Comparative study of long-term stone recurrence after extracorporeal shock wave lithotripsy and open stone surgery for kidney stones.

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) has become the treatment of choice for most calculi of upper urinary tract and the need for open stone surgery (OSS) have considerably reduced. However, stone recurrence is often encountered as a long-term problem requiring re-treatment. METHODS: In the present retrospective study, the recurrence rates of ESWL and OSS were compared in the treatment of kidney calculi. During the 1 year period of the present study, 43 patients were treated by OSS and 400 underwent ESWL (the Dornier MPL 9000 lithotriptor). The recurrence of stone was defined as reappearance of the stone on plain abdominal radiography during the follow-up period. RESULTS: Complete removal of all stone fragments was achieved in 51.2% of patients (n = 22) treated with OSS. In the ESWL group, the stone free rate was 56.7% (n = 237). The recurrence rate was 31.8% within a mean of 40 months (range 32-48 months) in the OSS group, whereas this figure was 13.9%, with a mean period of 46 months (range 42-48 months) in the ESWL group (P < 0.05). The mean periods of recurrence in ESWL and OSS groups were 20 (range 6-42 months) and 11 months (range 8-44 months), respectively (P < 0.05). However, the mean stone burdens of both groups were different (2.9 +/- 0.8 vs 1.4 +/- 1.1 cm). For comparable stone burdens, the recurrence rate was similar. In the ESWL group, stones in the lower calyx, multiple stones and larger stones showed a higher recurrence rate. The recurrence after OSS was also influenced by stone burden. CONCLUSIONS: The results of the present study demonstrate that stone burden may be the primary risk factor for stone recurrence after ESWL and OSS.

A prospective randomized study of transurethral resection of the prostate and transurethral vaporization of the prostate as a therapeutic alternative in the management of men with BPH.

OBJECTIVE: The common goals of new surgical treatment for benign prostatic hyperplasia (BPH) are to improve subjective and objective symptoms, to decrease the risk of postoperative complications and short hospitalization. Transurethral electrovaporization of the prostate (TUVP) is a new, minimally invasive and a promising alternative to standard transurethral resection of the prostate (TURP) in the treatment of BPH. The aim of this study is to compare the efficacy and safety of these two treatment alternatives. METHODS: A prospective randomized trial of 60 patients with symptomatic BPH was performed. Preoperative and postoperative International Prostate Symptom Score (IPSS), maximum flow rates (Qmax) and complications were recorded in each patient. The volume of the prostate was measured preoperatively and postoperatively using transrectal ultrasound. RESULTS: Of the 30 patients who underwent TURP, mean hospital stay was 4.5 days. The Foley catheter was removed on postoperative day 4 following surgery. IPSS decreased from 21.6 to 5.2, Qmax increased from 9.2 to 19.2 ml/s at 3 months. Mean prostatic volume at 3 months decreased from 51.7 to 26.2 g, a 49.3% reduction. Of 30 patients undergoing TUVP, mean hospital stay was 2.5 days and the catheter was removed within 2 days following surgery. Postoperative urinary retention did not occur in any patient. IPSS decreased from 19.4 to 4.1 and Qmax increased from 7.9 to 17.7 ml/s at 3 months. Mean prostatic volume decreased from 48.9 to 27.8 g, a 43.1% reduction at 3 months. In the TUVP group, none of the patients required blood transfusions or developed clinical transurethral resection syndrome. There were no major complications. Sphincteric incontinence, urethral strictures or bladder neck contractures were not recorded. At 3 months postoperatively, 13 patients in the TURP group and 7 patients in the TUVP group had retrograde ejaculation. CONCLUSION: Our initial experience of TUVP suggests advantages over conventional TURP through reduced blood loss and shorter hospital stay. It appears to be an effective treatment for BPH; however, long-term results should be evaluated.

Testicular effects of vasectomy in rats: an ultrastructural and immunohistochemical study.

OBJECTIVES: The correlation between infertility and morphofunctional alterations following vasal occlusion is not clearly understood. Although a correlation has been found between the expression of a high titer of antisperm antibodies and the status of infertility, the relationship between the immunoglobulin (Ig) depositions in the testis and ultrastructural alterations of the peritubular structures has not been clearly established. The objective of this study is to explain the etiopathogenesis of diffuse and focal testicular lesions caused by vasal obstruction. METHODS: Unilateral vasectomy was performed on adult male rats. Ultrastructural changes of testicular tissues and immunostaining affinity of peritubular structures with anti-actin, anti-vimentin, anti-laminin, and anti-immunoglobulin G (anti-IgG) antibodies were analyzed. RESULTS: In an ultrastructural study, vasectomized animals presented abundant collagen fibril accumulation in the peritubular area. In testis with intense IgG antibodies, staining revealed weak immunostaining of peritubular myoid cells with anti-actin antibodies, but intense immunostaining with anti-vimentin antibodies. The tubules of rats with no IgG deposition on peritubular structures revealed intense immunostaining with anti-actin antibodies but scant immunostaining with anti-vimentin antibodies. Anti-laminin deposits decreased severely in most of the tubules demonstrating intense IgG deposition. CONCLUSIONS: Our findings suggest that spermatogenesis deteriorates more severely in testes with dense IgG deposition. The sclerosis of the lamina propria in cases with vasal occlusion is secondary to alterations in the peritubular myoid cells. With the progressive changes that occur in the peritubular myoid cells or differentiation of the peritubular myoid cells that acquire active cell characteristics, collagen accumulation adjacent to these cells increases markedly. The alterations of the peritubular myoid cells reported here may be caused by alterations in basement membrane structures.

Analysis of the relationship between histologic alterations and the generation of reactive oxygen species in vasectomized rat testes.

OBJECTIVES: To evaluate the effects of vasal obstruction on testicular structure, to determine if tissue and/or cell damage can cause significant reactive oxygen species (ROS) generation, and to correlate the histologic alterations to the measured levels of ROS products. METHODS: To evaluate the effects of ROS generation in vasectomized testes, unilateral vasectomy was performed on 17 rats and tissue samples were examined by light microscopy. The histologic alterations were correlated to the measured tissue malondialdehyde levels by thiobarbituric acid analysis as an indicator of the ROS-induced tissue damage. RESULTS: Unilateral vasectomy significantly affected the weights of the ipsilateral testes, but not the contralateral testes. No significant changes were noted in plasma estradiol, follicle-stimulating hormone, luteinizing hormone, and testosterone levels. The mean values of malondialdehyde were found to be significantly higher in vasectomized rats than in control rats (0.025 +/- 0.008 versus 0.018 +/- 0.007 nmol/mg protein) (P < 0.01). The malondialdehyde level was a mean of 28% lower in the contralateral testes tissue as compared to that found in ipsilateral testes (P < 0.01). Malondialdehyde output from vasectomized rats had a parallel correlation to tissue destruction. CONCLUSIONS: Our results indicate that overproduction of ROS may be involved in vasectomy-induced testicular damage.

The role of cigarette smoking in prostatic enlargement.

OBJECTIVE: To investigate the association between cigarette smoking and sex hormone concentrations in men with benign prostatic hyperplasia (BPH) and thus provide some understanding of the underlying mechanism of the effects of cigarette smoking on prostatic enlargement. PATIENTS AND METHODS: The association between cigarette smoking and prostatic volume was investigated in 68 men with BPH (mean age 59 years, range 52-74) by assessing changes in serum levels of oestradiol, testosterone, dihydroepiandrosterone (DHEA) and dihydroepiandrosterone sulphate (DHEA-S). Possible enzymatic mechanisms in the prostate gland that might be affected by cigarette smoking were assessed. RESULTS: The mean prostate volume was greater in non-smokers than smokers. Current cigarette smokers had significantly higher mean serum oestradiol levels than did the non-smokers (33.8 and 26.7 pg/mL, respectively, P < 0.01). Cigarette smoking was inversely but not significantly related to testosterone level. These differences persisted after adjusting for body mass index. There was no significant difference in serum DHEA and DHEA-S levels between smokers and non-smokers. There was a weak correlation between the degree of prostatic enlargement, the presence of obstructive symptoms and urinary flow rates. CONCLUSION: These results indicate that cigarette smoking may affect the size of the enlarging prostate, but through indirect effects of smoking on factors provoking the development of BPH.

In vitro drug sensitivity testing of human testicular germ cell tumours with cytostatic drugs and interferon alpha-2b.

In spite of the significant advances in the chemotherapy of germ cell neoplasms, some patients do not achieve disease-free status and ultimately die from their diseases. Therefore, it is reasonable to select the best chemotherapeutic agents in these patients by in vitro drug sensitivity assay (IVDSA) in order to apply the most effective agent in case of resistance to primary chemotherapy. Fresh operative cells from 12 testicular germ cell tumours (TGCT) were cultured in vitro. Sensitivity of the tumour cells to interferon-alpha (IFN-alpha), cisplatin, mitomycin C, vinblastine, doxorubicin, etoposide, bleomycin, vincristine (VCR) were tested by a colorimetric assay using MTT. A preexposure viability over 75% was essential for IVDSA. Sensitivity was determined by a more than 50 +/- 2 SD% reduction from the control absorbance. All eight drugs in their high concentrations exhibited cell proliferation inhibition in 83.3 +/- 100% of TGCT. But in low concentrations efficacy of IFN and VCR were found to be lower than the others (33.3% and 58.3%, respectively). The results indicated that although TGCT are highly sensitive to various agents IVDSA may help to identify the effective agents which might be necessary for second line chemotherapy in a small percentage of patients.

Testicular torsion: evaluation of contralateral testicular histology.

Infertility may occur in patients with unilateral testicular torsion whose contralateral testis is intact. Depending on this observation, the physicians have begun to examine the contralateral testis. In the present prospective study we aimed to examine the histopathologic alterations occurring in the contralateral testicle with time. Sixty adult male albino rats were included in the programme, and following experimental torsion the histopathologic findings, especially those in the contralateral testis, were evaluated after 4-12 weeks. Long-term and high degree torsion of the testicle led to varying degrees of deterioration in the germinal epithelium and interstitial cells of the contralateral testicle. Histopathologic alterations were reversed in 12 weeks. Tubular diameter and testicular volume also decreased in accordance with the histopathologic alteration. In our opinion, orchiectomy following torsion of one testicle will limit potential histopathologic alterations in the contralateral testicle.

Determination of in vitro drug sensitivity to a panel of cystostatic drugs and interferon alpha-2b in patients with renal cell carcinoma.

Fresh operative cells from 27 renal cell carcinomas (RCC) were cultured in vitro for the determination of in vitro drug sensitivity. Two samples were not culturable. Incubation was carried out in triplicate in the presence and absence of various concentrations of chemotherapeutic agents. Sensitivity of the tumour cells to interferon-alpha (IFN-alpha), cisplatin (CDDP), mitomycin C (MMC), vinblastine (VBL), doxorubicin (DOX), etoposide (ETOP), bleomycin (BLM), vincristine (VCR) were tested by a colorimetric assay using MTT. A preexposure viability over 75% was essential for in vitro drug sensitivity assay (IVDSA). Sensitivity was determined by a more than 50 +/- 2 SD% reduction from the control absorbance. All eight drugs in their low concentrations exhibited cell proliferation inhibition in 0-12% of RCCs. On the other hand, IFN-alpha in its higher concentration (60 IU/ml) was effective in 88% of RCCs. After IFN, CDDP was found to be the second most effective drug in its higher concentration (36% efficacy). The results indicate that IFN appears to be the most effective in vitro agent in our 25 RCCs and the clinical trials either as a monotherapy or multiple combinations of various agents should include IFNs for the treatment of RCC.

Glycosaminoglycan content of Ca-oxalate stone matrix. Effect of this factor on stone fragility.

To evaluate the fragility of Ca-oxalate monohydrate stones in terms of high energy shock wave effectivity, we measured the glycosaminoglycan (GAG) content of the organic stone matrix of 35 patients who had undergone extracorporeal shock wave lithotripsy (ESWL) treatment for renal pelvic stones. The patients were classified into 3 different groups with respect to the rate of stone disintegration. While group I consisted of patients in whom only one ESWL session was needed to complete disintegration, in group II there were patients requiring 3 or more sessions for complete stone disintegration. On the other hand, patients in whom no sign of disintegration was observed despite 3 ESWL sessions constituted group III. Following this procedure, comparative evaluation of the GAG content of the stone matrix per dry stone weight in each group revealed a statistically significant difference between the first 2 and the 3rd group (p < 0.05). Our results indicated that as the GAG content of the stone matrix decreased, the efficiency of the shock waves on stone disintegration also prominently decreased, disintegration being impossible in some cases. On the other hand, the stones which were found to have higher amounts of GAGs in the organic matrix tended to be more fragile and were easily disintegrated with shock waves. In our study group the chemical composition of Ca-oxalate monohydrate stones, e.g. the matrix GAG content, seemed to be important with regard to the disintegrative effect of high energy shock waves.

Color Doppler imaging in the diagnosis of the acute scrotum.

OBJECTIVES: To determine the value of color Doppler imaging (CDI) in the diagnosis of acute scrotum. MATERIALS AND METHODS: We evaluated 102 consecutive patients referred to our institution with scrotal pain. All patients were evaluated by physical examination, ultrasound with stethoscopic Doppler followed by CDI. Radionuclide scanning was performed only in 14 patients. Patients with a diagnosis of testicular torsion by CDI underwent surgical exploration. Patients with CDI diagnosis of epididymorchitis were treated with intravenous antibodies and underwent repeat CDI evaluation after treatment. RESULTS: Of the 102 patients evaluated ages 11-44, CDI diagnosed 18 patients with testicular torsion and 78 patients with epididymorchitis. Cases of testicular torsion were found to have absent flow on CDI. CDI findings of normal or increased flow were present in all patients with epididymorchitis. All cases of torsion were confirmed on surgical exploration, 11 patients underwent orchidopexy and 7 patients underwent orchiectomy. No cases of testicular atrophy were encountered on long-term follow-up in patients with epididymorchitis. Diagnoses in the remaining patients were testicular tumor 1, testicular abscess 2, scrotal hematoma 2 and incarcerated hernia 1. CDI was found to be 100% sensitive and 100% specific in the diagnosis of the acute scrotum. CONCLUSION: We found CDI to be more accurate and reliable than physical examination in conjunction with gray-scale ultrasound and Doppler stethoscopic examination in the differential diagnosis of the acute scrotum. CDI is practical and can be performed in a rapid manner. CDI should become an integral part of the urologist's armamentarium in the differential diagnosis of the acute scrotum.