Review of current practice to establish success after vasectomy.

BACKGROUND: This study aimed to examine the criteria used by surgeons in a district general hospital to confirm success following vasectomy, to establish the proportion of men undergoing vasectomy in whom the procedure was unsuccessful according to those criteria, and to evaluate their subsequent management. METHODS: All 15 surgeons performing vasectomy indicated that they required two consecutive azoospermic postvasectomy semen specimens before they advised couples that the vasectomy was successful. Results of postvasectomy semen analysis (PVSA) for all 240 primary vasectomies performed over a 12-month interval were analysed. Minimum follow-up was 30 (range 30-42; median 37) months. RESULTS: At follow-up 72 men (30 per cent) had not returned postvasectomy samples that fulfilled the criteria, including 18 who were azoospermic on the first PVSA 3 months after vasectomy but who failed to produce a second specimen. In 24 men (10 per cent) who failed to comply with the PVSA protocol, there was no documentation of any further action being taken. No pregnancies were reported in the partners of the study group during this interval and only one patient underwent repeat vasectomy. CONCLUSION: The results suggest that the strict requirement of two consecutive azoospermic postvasectomy semen specimens may be unjustified, leads to a high level of non-compliance and causes unnecessary delay in confirming success of the procedure.

Human papillomavirus and bladder cancer.

Bladder cancer remains an important cause of oncological morbidity and mortality in women. Known etiological agents include smoking and exposure to certain industrial chemical compounds, though the origin of the majority of cases remains unknown. Human papillomavirus infection is also common in women and has been closely linked to the development of carcinoma of the cervix. It has been suggested that infection with HPV may also be an important factor in the subsequent development of bladder cancer. A number of studies using various techniques of molecular biology have looked at the relationship between HPV infection and bladder cancer. Although the results are somewhat conflicting, the overall picture would suggest little involvement of HPV in the evolution of bladder cancer, except possibly in a small group of patients who are immunocompromised.

The aetiological significance of human papillomavirus in bladder cancer.

OBJECTIVE: To determine the prevalence of human papillomavirus (HPV) DNA types 6, 11 and 16 in histological sections of human bladder cancer. MATERIALS AND METHODS: Fifty-five formalin-fixed, paraffin-embedded bladder tumour specimens were analysed for the presence of HPV infection using Southern blotting DNA hybridization and radiolabelled probes for HPV DNA types 6/11 and 16. RESULTS: Despite the detection of HPV DNA type 6, 11 and 16 in positive control samples and the successful detection of HPV DNA in anogenital cancer using the same technique, no HPV DNA was found in any of the bladder tumour specimens examined. CONCLUSIONS: Using a technique with proven efficacy in the detection of HPV DNA from histological specimens, no HPV DNA was present in any of the bladder tumours examined. This finding is in agreement with most recently published studies suggesting that HPV has no significant role in the development of human bladder cancer.

Bladder and erectile dysfunction before and after rectal surgery for cancer.

OBJECTIVE: To establish the incidence of bladder and erectile dysfunction after rectal surgery for cancer. PATIENTS AND METHODS: Twenty patients (16 men and four women, median age 66 years, range 36-78) with carcinoma of the rectum were prospectively studied immediately before and 4 months after operation by clinical assessment, uroflowmetry and video-cystometrography. All patients were catheterized routinely at the time of surgery. Those experiencing voiding difficulties after catheter removal were managed by intermittent self-catheterization or an indwelling urethral catheter. RESULTS: Before surgery, only six patients had completely normal bladder function and 13 of the 16 men were at least partially potent. Eight of the 19 patients who eventually had surgery developed identifiable bladder dysfunction, of whom three had urodynamic evidence of complete bladder denervation. Three men who were potent before became impotent after surgery. CONCLUSIONS: Bladder and erectile dysfunction are recognized complications of radical rectal surgery, although there is significant variation in the reported risk; much of this variability is related to the retrospective nature of most previous studies. This study demonstrates the importance of prospective urodynamic evaluation and confirms that the small but significant risk of permanent bladder dysfunction is likely to be related to pelvic nerve injury at the time of surgery.

Liposarcoma of the esophagus.

Liposarcoma is one of the most common soft tissue sarcomas found in adults, yet it rarely develops in the alimentary tract. This report describes the pathological features and management of a liposarcoma of the esophagus.