The effect of verapamil in reducing the severity of acute tubular necrosis in canine renal autotransplants.

Calcium channel blockade has been shown to prevent warm renal ischemic damage. The ability of verapamil to decrease the severity of acute tubular necrosis (ATN) after 24-hr cold storage and autotransplantation was studied in a randomized paired study of 12 dogs. Experimental animals pretreated with intraarterial verapamil and flushing of the harvested kidney with cold intracellular solution containing verapamil demonstrated significantly (P less than .05) greater renal function preservation over their matched controls. A subsequent nonpaired study of 6 dogs treated only with flushing of the harvested kidney with perfusate containing verapamil demonstrated no significant preservation advantage over controls. We conclude that verapamil, administered prior to the ischemic event, can enhance the protective effect of hypothermia and decrease the severity of ATN in ischemically injured kidneys.

Carcinoma of deep male urethra.

Carcinoma of the deep male urethra is a rare disease. Conservative measures yielding dismal outcomes were standard until 1957, with the report of an 80 per cent five-year survival rate after radical surgery. To assess the value of this surgery, we reviewed all cases of carcinoma of the deep male urethra managed at UCLA Medical Center and its affiliated hospitals between 1952 and 1980. Of the patients managed with radical surgery, 1 died of a myocardial infarction between staged surgical procedures, and 5 died of their disease between twelve and fifty-two months postoperatively (mean survival, 26 months). There were 2 long-term disease-free survivors, yielding a survival rate of 25 per cent. We have also compiled the results of all major series dealing with deep urethral carcinoma published subsequent to the 1957 report. This review of the literature supports the concept that radical extirpative surgery is mandatory in the management of carcinoma of the deep male urethra.

Spontaneous rupture of ureter.

A patient with spontaneous ureteral rupture in the absence of obstruction or calculus disease is presented. In addition to ureteral rupture this patient also had a penile squamous cell carcinoma and infected inguinal lymph nodes. A review of the literature discloses that all reported cases with spontaneous rupture of the ureter had an underlying process leading to that rupture. It is considered, therefore, that rupture of the ureter should be designated as "traumatic" or "nontraumatic." The term "spontaneous," implying a primary event, is a misnomer. No such case has been reported occurring in an otherwise healthy individual.

Urethral gap in complete disruption of membranous urethra.

In patients with complete disruption of the membranous urethra treated initially with placement of a suprapubic cystostomy, delayed synchronous retrograde and voiding cystourethrograms failed to demonstrate accurately the distance between the two urethral ends. Radiographic exposure obtained during synchronous instrumentation of the anterior and posterior urethra in the anesthetized patient was the most precise method of defining the extent of the urethral gap. Any surgical decision should be based on this type of investigation. In most cases of pelvic crush injuries, the severed membranous urethra probably remains attached in close proximity to the distal segment, thus directing the redescent of the prostate and bladder base in the presence of a contracting pelvic hematoma.

Luteinizing hormone and follicle-stimulating hormone responses to intransal gonadotropin-releasing hormone.

For determination of the dose-response relationships of plasma luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to the intranasal administration of gonadotropin-releasing hormone (GnRH), normal adult men were administered doses of 100, 200, 400, and 800 micrograms of GnRH on separate days, and plasma LH and FSH were measured before and after nasal insufflation of GnRH. Plasma LH was increased after a minimum dose of 200 micrograms GnRH. Median peak plasma LH levels occurred 30 minutes after intranasal GnRH and followed a log-dose relationship. When compared with intravenous GnRH, the biopotency of intranasal GnRH at the 200-, 400-, and 800-microgram doses was 1.1%, 2.3%, and 6.2%, respectively. Plasma FSH levels rose significantly only after the highest (800-micrograms) intranasal GnRH dose. From these data, we conclude that in eugonadal adult men the minimal effective dose of intranasal GnRH to elicit a significant pituitary (LH) response is 200 micrograms and that the relative efficacy of intranasal GnRH increases with the dose. In spite of the apparently low biopotency for intranasal GnRH, this route of administration may be considered as an alternative to the parenteral mode of GnRH delivery, and the lower biopotency can be partly overcome by increasing the dose.

Impaired testosterone biosynthesis in cryptorchidism.

In an attempt to determine whether the production and synthesis of testosterone (T) by the testis is impaired by the cryptorchid state, the ability of the cryptorchid rat testis to form T was assessed at various time periods into adulthood after the surgical induction of cryptorchidism in the newborn period. The intratesticular T content of the descended testis rose from 0.3 ng/testis at 14 days of age to 71.2 ng/testis at adulthood (day 56); whereas in the cryptorchid testis, the values were 0.4 ng/testis and 2.0 ng/testis, respectively, at the same ages (P less than 0.001). For determination of the site of inhibition of T biosynthesis in the cryptorchid testis, the enzymatic activities (17 alpha-hydroxylase, 17,20-desmolase, and 17 beta-hydroxysteroid dehydrogenase) in the delta 4T biosynthetic pathway were measured. All these enzyme activities in the cryptorchid testis were inhibited at 56 days of age by about 80% when compared with the descended testis (P less than 0.01). These data suggest that cryptorchidism exerts a deleterious effect on the ability of the Leydig cells to synthesize T and may in part explain the abnormal morphology and resultant infertility seen in patients with cryptorchidism.

Corporectomy for intractable sickle-associated priapism.

Priapism is a complication of sickle cell disease, and for those with severe prolonged attacks, it is serious, often resulting in permanent sexual impairment. Treatment is frustrating, and psychological consequences may be profound. A 20-year-old sickle cell patient with intractable priapism associated with intense pain and penile gigantism underwent multiple but unsuccessful medical and surgical treatment regimens. Finally, corpora cavernosa corporectomy was performed. The pathologic findings of extensive vascular thrombosis and stromal fibrosis underscore the irreversibility of this process and explain the inevitable impotence. Pain and sexual impairment were associated with serious psychological difficulties and suicide attempts. Counseling and close follow-up have improved his outlook considerably. He has been pain-free for 1 year, and future management includes consideration of placement of a penile prosthesis.

Silicate urolithiasis.

Urinary tract silicate calculi are rare. Occurrence is limited strictly to patients who ingest magnesium trisilicate antacids. We report a case of a renal silicate calculus and review the subject of silicate stones.

Fracture of semirigid penile prosthesis: a rare complication.

We report 3 cases of fractured semirigid Small-Carrion and Finney penile prostheses. All prostheses had been in place and functional for at least 2 years before fracture. We may begin to see more complications associated with material failure.

Association between abdominal wall defects and cryptorchidism.

To determine whether intra-abdominal pressure may have a role in the process of testicular descent in man, we reviewed retrospectively the records of all male infants who presented during a 10-year period with severe abdominal wall defects, such as gastroschisis (28), omphalocele (29) and umbilical hernia (53), and calculated the incidence of cryptorchidism in these patients. The incidence of cryptorchidism at birth and at 1 year after birth was 18 and 15 per cent, respectively, in patients with gastroschisis, 52 and 33 per cent, respectively, in those with omphalocele, and 6 and 6 per cent, respectively, in those with umbilical hernia. For all 3 disorders the incidence of cryptorchidism was higher than in documented historical controls. From these data we conclude that in male infants there is an association between these 3 abdominal wall defects and cryptorchidism. The demonstration that intra-abdominal pressure is lowered significantly by these abdominal wall defects would suggest a possible role for intra-abdominal pressure in the process of testicular descent in man.