Per os pubis (POP) urethropexy.

This series of 24 female patients with stress urinary incontinence managed surgically by a pubis-pubovaginal fascia fixation demonstrates success comparable or superior to other techniques. Several advantages in carefully selected patients are noted.

Renal cell carcinoma in cadaver donor kidney.

A cadaver kidney, reported to contain a "simple cyst," was received from another institution. Frozen section biopsy prior to transplant showed renal cell carcinoma. The contralateral kidney already had been transplanted at the other medical facility.

"Acute scrotum" in Henoch-Schönlein syndrome.

Two patients with Henoch-Schönlein syndrome presented with clinical pictures mimicking testicular torsion. No evidence of testicular torsion was found. A review of the literature revealed that testis torsion is very rarely associated with testicular involvement in Henoch-Schönlein syndrome, and hence only rarely is surgical exploration required.

Renal actinomycosis.

Renal actinomycosis is an endogenous systemic fungal disease with rare renal involvement. Diagnosis, pathogenesis, and therapy are discussed.

Nonpsychotic genital self-mutilation.

The case of a sixty-four-year-old man who progressively created a penoscrotal hypospadias on himself is presented. Although genital self-mutilation is normally considered symptomatic of deep psychotic disturbance, the details and evaluation of this case would classify it as nonpsychotic, though unusual behavior.

Monitoring of suspected infertile men with varicocele by the sperm penetration assay.

Although varicocele remains the most frequently diagnosed cause of male infertility, and improvement in semen quality is associated with repair of varicocele, improvement in spermatozoal fertilizing capacity has not been conclusively demonstrated. The sperm penetration assay was employed to monitor prospectively surgical (n = 59) and nonsurgical (n = 40) groups of men with varicocele. There were no significant increases in the average count, motility, morphologic features, or sperm penetration assay results for either group. Varicocele surgery enhanced assayable egg penetration rates in 14 of the 59 patients (23.7%), whereas the nonsurgical group had 10% spontaneous improvement. Of those in the surgery group who showed assayable fertility enhancement and were attempting conception, pregnancies were achieved in 70% (7 of 10 patients). Of patients in the nonsurgical group who improved in the assay, no pregnancies were obtained.

Variability in the human-hamster in vitro assay for fertility evaluation.

Sources of variability in the zona-free hamster egg penetration assay were evaluated. Internal consistency in the assay was examined in replicate experiments using sperm from 23 donors. The average difference in the percentage of fertilization between the replicates was 3.9%. Optimal preincubation conditions and insemination time were examined and shown to be 0.5 to 1.0 X 10(7) sperm/ml and 2 to 3 hours. Abstinence time was found to be a variable, and a critical abstinence of more than 12 hours was required. Prolonged exposure to seminal plasma (i.e., more than 30 minutes) produced a reduction in the fertilization test results. If the variables studied here are consistently controlled, then changes in the assay results greater than the experimental error should reflect true changes in the semen sample.

Sperm morphology assessment as an indicator of human fertilizing capacity.

Semen samples from 95 men were examined by routine semen analysis and specific histologic staining for sperm morphology. The men were classified into fertile and infertile groups on the basis of clinical evaluation and in vitro testing, using the zona-free hamster egg penetration assay. Thirty men were designated as fertile, as they had fathered children and their sperm showed penetration of greater than 20% of the zona-free hamster eggs with the in vitro fertilization test. Subjects classified as infertile were men from infertile couples whose wives showed no evidence of infertility and whose in vitro fertilization ability was 10% or less. The semen analysis parameters of the fertile and infertile groups were significantly different. Fertile men had mean values of 108 X 10(6) sperm/ml, 61% motile, 64% normal forms (sperm with oval morphology), and 69% penetration in vitro. The mean values for infertile men were significantly lower: 42 X 10(6) sperm/ml, 45% motile, 32% normal forms, and 3.2% penetration in vitro. The importance of the morphology parameter was revealed by comparison of the percentage of penetration with count, motility, and morphology. Penetration correlated best with morphology (r = 0.730) as compared with motility (r = 0.451) and count (r = 0.605). The distribution of abnormalities in the infertile group revealed 81.6% with abnormal morphology (less than 50%), 53.8% with abnormal motility (less than 50%), and 38.5% with abnormal count (less than 20 million/ml). As a single parameter, decreased number of normal forms appears to be a good indicator for clinical infertility if in vitro fertilization testing is not available.

Comparison of the penetration ability of human spermatozoa into bovine cervical mucus and zona-free hamster eggs.

In vitro bovine cervical mucus (BCM) penetration tests, sperm penetration assays (SPA) using zona-free hamster eggs, and routine semen analyses were performed on a total of 136 freshly collected semen samples from men who were seen at an infertility clinic. The correlations between bovine cervical mucus penetration and other semen parameters were the percent motile spermatozoa (r = 0.48), progressive motility grade (r = 0.44), sperm count (X 10(6)/ml) (r = 0.47), the percent normal morphology (r = 0.32) and the percent eggs penetrated (r = 0.46) (P less than 0.0001 for each correlation coefficient). When known fertile (n = 32) and infertile (n = 18) groups were tested, positive mucus penetration was associated 75% correctly and positive egg penetration was associated 90% correctly to clinical status. The mucus test had no false-negative results and the SPA had no false-positive results in these groups. It appears, then, that the mucus test and sperm penetration assay, although contributing different elements of data to an infertility evaluation, are both useful adjuncts to a semen analysis.

Prostate cancer screening at an equal access tertiary care center: its impact 10 years after the introduction of PSA.

INTRODUCTION AND OBJECTIVES: Dwight D. Eisenhower Army Medical Center has been involved in Prostate Cancer Awareness Week (PCAW) screening during the period 1995-2000. The purpose of this study is to review the results of screening in a self-selected population of military beneficiaries at our institution. MATERIALS AND METHODS: Screening involving a brief urologic history, digital rectal examination (DRE) and serum prostatic specific antigen (PSA) measurement was offered to our screening population. Patients with an elevated PSA (>4.0 ng/ml) and/or a suspicious DRE were considered for transrectal ultrasonography with prostate needle biopsy (TRUS/PNB). Patient health records were reviewed retrospectively and analyzed to determine patient demographic characteristics, PSA distribution, DRE results and cancer detection rates. RESULTS: A total of 455 screening visits were performed from 1995 to 2000, of which 426 visits were included for analysis. Mean age of the study population was 57.4 y (40-83). Seventy-one percent of the patients reported prior PSA screening visits. Forty-four patients met indications for biopsy. A total of 30 TRUS/PNB were performed demonstrating presence of cancer in three patients for an overall cancer detection rate of 0.7%. CONCLUSIONS: Our study shows that the overall prostate cancer detection rate at our institution is lower than detection rates previously reported in the literature. Potential reasons for this finding may include that the subjects participating in PCAW screening tended to be younger than in other series and that a majority of them had already undergone prior screening. These findings suggest the need to modify prostate cancer screening recommendations and to improve prostate cancer screening efficacy.

Complete embedding and close step-sectioning of radical prostatectomy specimens both increase detection of extra-prostatic extension, and correlate with increased disease-free survival by stage of prostate cancer patients.

The objectives of this work were to evaluate the efficacy of controlled close step-sectioned and whole-mounted radical prostatectomy specimen processing in prediction of clinical outcome as compared to the traditional processing techniques. Two-hundred and forty nine radical prostatectomy (RP) specimens were whole-mounted and close step-sectioned at caliper-measured 2.2-2.3 mm intervals. A group of 682 radical prostatectomy specimens were partially sampled as control. The RPs were performed during 1993-1999 with a mean follow-up of 29.3 months, pretreatment PSA of 0.1-40, and biopsy Gleason sums of 5-8. Disease-free survival based on biochemical or clinical recurrence and secondary intervention were computed using a Kaplan-Meier analysis. There were no significant differences in age at diagnosis, age at surgery, PSA at diagnosis, or biopsy Gleason between the two groups (P<0.05). Compared with the non-close step-sectioned group, the close step-sectioned group showed higher detection rates of extra-prostatic extension (215 (34.1%) vs, 128 (55.4%), P<0.01), and seminal vesicle invasion (50 (7.6%) vs 35 (14.7%), P<0.01). The close step-sectioned group correlated with greater 3-y disease-free survival in organ-confined (P<0.01) and specimen-confined (P<0.01) cases, over the non-uniform group. The close step-sectioned group showed significantly higher disease-free survival for cases with seminal vesicle invasion (P=0.046). No significant difference in disease-free survival was found for the positive margin group (P=0.39) between the close step-sectioned and non-uniform groups. The close step-sectioned technique correlates with increased disease-free survival rates for organ and specimen confined cases, possibly due to higher detection rates of extra-prostatic extension and seminal vesicle invasion. Close step-sectioning provides better assurance of organ-confined disease, resulting in enhanced prediction of outcome by pathological (TNM) stage.