Are consecutive nightly recordings required for valid evaluation of sleep-associated erections?

We questioned the need for more than one RigiScan recording for accurate assessment of sleep-associated penile erections and determine the necessity of consecutive nightly recordings for valid evaluation of sleep-associated erections. Men complaining of erectile dysfunction (ED) and referred to RigiScan evaluation for the first time participated. Recordings were performed at the patient's home during two consecutive nights, and data on test time, number of erections, erection duration, minimal and maximal base and tip tumescence and rigidity were retrieved for both nights. Normal erectile function was defined with the recording of at least one erection (70 out of 100% tip rigidity lasting for at least 10 min during either night). The main outcome measures were RigiScan recordings. Group 1 consisted of 29 men (mean age 42.4+/-13.8 years, range 22-71) who had normal erections, all during the first night. Group 2 consisted of 26 men (mean age 48.6+/-13.5 years, range 25-70) who failed to fulfill both criteria for normal erection. In Group 2, only the values for penile base rigidity and erection duration were normal during the first night: the parameters of maximal base tumescence, tip rigidity, number of effective erections and duration of effective erections that were impaired during the first night were significantly worse (P<0.01) during the second night. The required information for the diagnosis of psychogenic ED was obtained during the first night in >50% of the participants. Men with normal erections during the first night can be spared the inconvenience and cost of re-testing. Consecutive night recording should be reserved for patients whose recorded data during the first night did not fulfill the criteria for normal erection.

Acute urinary retention in herpes genitalis infection. Urodynamic evaluation.

Acute urinary retention in herpes genitalis infection is reported to be infrequent. We report 4 cases of acute urinary retention caused by neurologic complication of herpes infection. The urodynamic finding and follow-up results are presented.

Does preoperative nephrostomy increase the incidence of wound infection after nephrectomy?

OBJECTIVES: To determine whether patients with nephrostomy after simple nephrectomy more often had postoperative wound complication than did matched patients without nephrostomy. METHODS: The hospital records of patients who underwent retroperitoneal simple nephrectomy were evaluated, and the following data were retrieved: age, indication for nephrectomy and nephrostomy insertion, medical history, urine culture, antibiotic regimen, time elapsed from nephrostomy insertion to nephrectomy, surgical technique, type of complication, time elapsed from surgery to complication, treatment, and outcome of complications. RESULTS: Thirty-one patients (mean age 57.9 years, +/-SE 3.0) were evaluated. Seven (31.8%) of the 22 patients without nephrostomy (group 1 ) had wound infection compared with 7 (77.7%) of the 9 patients with nephrostomy (group 2) (P <0.05). All 9 group 2 patients had infected urine compared with 11 of the 22 in group 1 (P <0.05). Complications were apparent within a median time of 1 month (+/-SD 0.9) from surgery in group 2, whereas the median time to complication was 4.5 months (+/-SD 3.7, P <0.05) in group 1. Two patients in group 2 died of wound infection and sepsis. Both groups were similarly matched for age, indication for nephrostomy and nephrectomy, perioperative and operative techniques, and histologic findings of the removed kidneys. All patients received antibiotic agents at the time of surgery. CONCLUSIONS: Patients with nephrostomy inserted because of pyonephrosis or to relieve obstruction who underwent simple nephrectomy because of unrecoverable renal damage had earlier and more frequent wound infections than patients who underwent the identical procedure without nephrostomy. UROLOGY

Effect of radiation combined with hyperthermia on human prostatic carcinoma cell lines in culture.

The effect of radiation combined with heat on three human prostatic carcinoma cell lines growing in vitro was investigated. Cells were exposed to different radiation doses followed by heat treatment at 43 degrees C for one hour. Heat treatment, given ten minutes after radiation, significantly enhanced the radiation response of all the cell lines studied. The combined effect of radiation and heat produced greater cytotoxicity than predicted from the additive effects of the two individual treatment modalities alone. These results indicate that a combined treatment regimen of radiation plus hyperthermia (43 degrees, 1 hr) might be an important tool in maintaining a better local control of prostatic cancer.

Nephrogenic adenoma: benign proliferative lesion of urothelium.

Three new cases of a rare benign proliferative lesion of the urothelium (nephrogenic adenoma) are hereby added to the existent 58 reported cases. All 3 lesions occurred in the bladder. Two of the 3 cases presented with a history of surgical interventions on the bladder, and the third patient had a history of chronic cystitis and pyelonephritis, and was on chronic dialysis. Diagnosis was made on histologic examination of cystoscopic biopsy of the lesions. Transurethral resection and/or fulguration was the treatment of choice. There was no recurrence of the lesions on follow-up cystoscopic examination.

Erectile dysfunction following Nd-YAG visual laser-assisted prostatectomy (VLAP).

We investigated if side fire Nd-YAG visual laser prostatectomy (VLAP) causes erectile dysfunction (ED) in patients who were sexually active prior to the procedure. The 36 study patients gave a detailed medical/sexual history: physical examination included bulbo-cavernous reflex (BCR) on rectal examination and routine blood tests. Lasing time, power of the applied laser beam (in watts), coagulation site and energy intensity were recorded. Patients with new onset ED during the one year study period underwent pudendal nerve conduction (PNC), color duplex Doppler ultrasonography, and NPT/RigiScan testing. In 6 out of 36 (16.7%) patients reporting significant post-operative ED, there was a tendency towards higher energy applied and longer lasing time but no correlation between prostate size or the site of energy application. Patients reported loss of night and/or morning erections (n = 5), retrograde ejaculations (n = 2), loss of ejaculate (n = 2), and decreased sensation of orgasm (n = 3). Three had abnormal PNC, duplex Doppler showed abnormal blood supply in four, and all six had abnormal NPT/RigiScan. We believe this is the first demonstration that VLAP may be associated with a high rate of ED and that the lasing time and intensity of applied laser energy may play a role in this outcome.

Transcatheter renal artery embolization in the treatment of infected cutaneous ureterostomy.

Palliative renal ablation by means of transcatheter embolization is described. A patient with left cutaneous ureterostomy suffered from urosepsis. The left kidney was embolized using isobutyl-2-cyanoacrylate and Lipiodol in order to stop infected urine excretion. Complete recovery was achieved.

Per urethra insertion of a through-and-through safety guide wire using a dual-lumen ureteral catheter during percutaneous nephrolithotripsy.

BACKGROUND: The second ("safety") of two guide wires is commonly inserted antegradely in percutaneous nephrolithotripsy (PCNL). We describe the retrograde insertion of a through-and-through safety guide wire during PCNL. METHODS: After inserting a percutaneous nephrostomy 1 day earlier, a guide wire was introduced through the nephrostomy tube to the bladder and pulled out through the urethral meatus via a cystoscope and grasper. The tube was removed, leaving the wire positioned from the flank to the meatus. A dual-lumen catheter was introduced retrogradely through the urethra over the wire, up to the nephrostomy incision. The safety guide wire was introduced retrogradely through the catheter's other port. RESULTS: This procedure succeeded in 9 of 10 patients: the exception was very obese and the catheter was too short to reach the incision in the flank. CONCLUSION: Using a dual-lumen catheter allows quick and simple retrograde insertion of a safety guide wire during PCNL.

Epididymo-orchitis: a retrospective study of 121 patients.

One hundred twenty-one patients with acute epididymitis or epididymo-orchitis were evaluated retrospectively according to their clinical symptoms, duration of symptoms, physical examination, and laboratory studies. The patients younger than 30 years of age usually showed less severity of symptoms than the patients older than 50 years of age. The latter often demonstrated evidence of outflow obstruction. Eighty-two percent of patients with demonstrated urographic abnormalities had lower tract abnormalities, mainly secondary to outflow obstruction. All of these patients were older than 50 years of age. An intravenous pyelogram is indicated only in patients over 50 years of age and in young adults with positive bacteriologic urine culture.

[I125 prostate brachytherapy--short-term results of the first 150 patients in Israel].

UNLABELLED: Prostate cancer is the most common malignancy among adult men. The treatment of locally confined prostate cancer is either surgical or radiation therapy. In the last decade or so a renewed method has gained popularity among patients and physicians, the use of implantable I125 seeds into the prostate--named brachytherapy. METHOD: We describe our first 150 cases treated with I125 brachytherapy with a follow-up after 3-24 months, median of 15 months. Twenty patients had a combination of external beam radiation and brachytherapy. RESULTS: Nadir PSA values of < 0.5 ng/ml were noted in 89%. This is accepted as evidence of cure. In 6 men elevation of PSA was noted and interpreted as a recurrence of disease. Associated morbidity was mild to moderate focusing on lower urinary tract symptoms, for about 3 months. IPSS values, measuring urinary symptoms after 3 months, resembled baseline levels. Impotence developed in 1/3 of men as a result of treatment. This was assessed using a self-completed IIEF questionnaire. No major complications (WHO grade III-IV) were noted in either urinary system or lower gastro-intestinal tract. IN CONCLUSION: We describe initial experience with Brachytherapy for the treatment of prostate cancer in Israel. Our results compare favourably with those published in American literature and profess moderate impact on quality of life as well as transient effects on lower urinary tract symptoms, and a minimal impotence rate (1/3) developing as a result of treatment. These results compare favourably with morbidity rates cited for radical surgery or external beam radiotherapy.

Use of automatic insulin injector for intracorporeal injection in erectile dysfunction.

Intracorporeal injection of vasoactive drugs for the treatment of impotence may be problematic in patients with limited dexterity or psychogenic inhibitions of self-injection. Already in common use for diabetic patients is an easy-to-use automatic injector device, with rapid and simple loading and operating. This economical and handy gadget is adapted to accept standard disposable syringes. We have found it useful also for painless self-injection of intracorporeal vasoactive drugs for the treatment of erectile dysfunction.

Method for securing a single-lumen urethral catheter in the female.

When a single-lumen urethral catheter (catheter coudé) is applied for bladder catheterization in the female, secure fixation of such a catheter may present a problem. A simple method for fixation of a single-lumen urethral catheter in the female is described.

The effect of hyperthermia on human prostatic carcinoma cell lines: evaluation in vitro.

The effect of hyperthermia on established human prostate carcinoma cell lines (PC-3, DU-145) and related sublines (1-LN, 125-1L) was investigated in vitro. Cells were exposed to heat treatment at 43C or 37C for varying time intervals, (one hr or two hrs) and cell survival was evaluated by the colony formation assay and by measurement of cellular growth rate. While one hr exposure at 43C did show a mean inhibition of colony formation, ranging from 29 to 41%, a statistically significant increase in inhibition rate (p less than 0.001) was observed at two hr exposure, ranging from 57 to 92%. This study is a report of the cytotoxic effect of hyperthermia on established human prostatic tumor cell lines. These in vitro results indicate that hyperthermia may become a potentially useful form of adjunctive therapy for local control of prostatic cancer. However, the temperature and exposure time may have an important impact on cell kill when this new modality for cancer treatment is proposed for a clinical trial.

Elevated urinary fibronectin levels after transurethral resection of bladder tumour: a possible role in patients failing therapy with bacillus Calmette-Guérin.

OBJECTIVE: To investigate fibronectin levels in urine samples from patients with noninvasive transitional cell carcinoma (TCC) of the bladder immediately and for 4 weeks after transurethral resection of bladder tumour (TURBT), to determine whether soluble fibronectin within the bladder, which blocks the attachment of bacillus Calmette-Guérin (BCG), might lower the efficacy of BCG therapy over this period. PATIENTS AND METHODS: Urinary fibronectin was measured using an enzyme-linked immunosorbent assay in 25 patients with superficial bladder TCC who underwent TURBT for complete resection. Eight samples were collected for each patient, one before and seven during the 4 weeks after TURBT. RESULTS: High levels of urinary fibronectin were detected in 18 patients (72%) after TURBT. In 16 patients the fibronectin level returned to normal within 2 weeks of surgery. The other two patients showed elevated levels of fibronectin for > 4 weeks. CONCLUSIONS: These results show that urinary fibronectin concentration is significantly increased in most patients after TURBT and this should be considered in patients who receive BCG therapy. Treatment within the first 2 weeks after TURBT may be associated with a high failure rate, as urinary fibronectin levels were increased significantly in about three-quarters of these patients during that period. Indeed, the persistent elevation of fibronectin, occurring in two of the present patients, may be responsible for some of the failures of BCG therapy when it is administered 2-5 weeks after surgery.

Conservative approach in treating acute renal carbuncle.

During the years 1980-82 seven patients with renal carbuncles successfully underwent conservative treatment with antibiotics alone. Early diagnosis was made using excretory urography and nephrotomography, ultrasound and computerized tomography scan. Follow-up studies showed a normal kidney in six of the seven patients. One patient had a clinical remission, but ultrasound follow-up showed a small area in the right kidney with a few low-level echoes, representing focal scarring.

Use of gonadotropin-releasing hormone analogue in advanced prostatic cancer: 3 years clinical experience.

The relative efficacy of the recently introduced gonadotropin-releasing hormone (GnRH) analogues in advanced prostatic cancer, compared with surgical castration, is still debatable. High patient compliance, lack of side effects, and absence of the psychological impact of castration, seem to be the most prominent advantages cited. Our long-term follow-up in a group of 19 prostate cancer patients treated with GnRH analogue also indicated high patient compliance and mild side effects. However, we found a discrepancy between local prostatic regression and general clinical responsiveness, and a poorer therapeutic effect than that obtained with surgical castration. In this group of patients follow-up with either prostatic acid phosphatase or prostatic specific antigen seems promising. We found a high correlation between disease state and prostatic markers. We suggest that GnRH analogues are another addition to the armamentarium for treating advanced prostatic carcinoma, yet are limited in their therapeutic effectiveness.

[Tomodensitometry in the diagnosis of perinephritic phlegmon]. / Apport de la tomodensitométrie dans le diagnostic des phlegmons périnéphrétiques.

Twenty-nine patients with perinephric abscess were treated during the last 15 years. Twenty-seven abscesses were cured by drainage performed as soon as the diagnosis has been made. One patient died from septicemia in spite of the treatment. One patient died because the correct diagnosis was not revealed until the autopsy. Ten patients had a nephrectomy performed on them later on. Staphylococcus and gram negative bacilli were equally isolated. Stones were present in twenty patients. Eleven patients were diabetic. The clinical picture is not always clear, and diagnosis might be difficult. The different radiological signs help to reach a correct and prompt diagnosis. To these classical signs we can add during these last years Gallium-67 radionuclide studies, ultrasound and computerized tomography, each of these having its indication and usefulness.

Cardiac arrhythmias during nonsynchronized extracorporeal shock wave lithotripsy.

PURPOSE: We evaluated the occurrence of cardiac arrhythmias during nonsynchronized extracorporeal shock wave lithotripsy. MATERIALS AND METHODS: A total of 125 nonsynchronized shock wave lithotripsy treatments was performed using a spark plug lithotriptor. RESULTS: Asymptomatic unifocal ventricular premature contractions occurred during 23 treatments (18.4%) and were more frequent during therapy on the right side (p < 0.05). Among patients undergoing multiple sessions only 1 exhibited ventricular premature contractions during treatment. No correlation was demonstrated between ventricular premature contractions and patient age, gender, presence of heart disease, stone size and location within the collecting system (kidney or ureter), presence of a ureteral catheter or nephrostomy tube, mode of anesthesia or number of shock waves. CONCLUSIONS: Nonsynchronized shock wave lithotripsy can be accomplished safely in most patients.

[Kaposi's sarcoma localized on the shaft of the penis]. / Sarcome de Kaposi localisé sur le corps pénien.

The importance of Kaposi's Sarcoma, known for over a century, resides in its relation to AIDS. The localisation on the shaft of the penis is very rare even in the generalised forms, more so when the lesion is primary and localized. The basic lesion appears as a reddish-violet nodule. The authors report a case of a primary Kaposi's Sarcoma in a 58 year-old patient where the tumor appeared as a pedunculated 2 X 2 cm lesion with a necrotic surface. The tumor was excised. A search for internal foci of KS was negative. The complete cure was proven by decreased lymphocyte proliferative responses and defective natural-killer cell activity.

Infected renal cysts: sonographic diagnosis and management.

IRC are rare entities characterized by fever and unilateral flank pain resistant to antibiotic therapy. In our series of nine IRC in eight patients, the predominant sonographic finding was an abnormal echogenic texture of the cyst contents, in contrast to previous reports that stressed the frequency of wall thickening as a sign of infection. Sonographically guided cyst aspiration and drainage of eight cysts in seven patients provided diagnostic material and resulted in relief of symptoms. Although the cause of IRC is uncertain, these entities may be more common than previously suspected.