Significance of asymptomatic bacteriuria in neurogenic bladder disease.

Whether or not to treat bacteriuria (greater than or equal to 100,000 col/cc) in the asymptomatic patient has long been controversial. Fifty-two patients with uncomplicated neurogenic bladder disease secondary to spinal cord injury and bacteriuria were followed throughout their hospitalization. Antibiotics were reserved only for symptomatic patients. Our results indicate the value of no treatment for chronic bacteriuria as an alternative to chronic suppressive therapy.

Evaluation and treatment of priapism.

We herein review the last 29 patients with priapism treated at our hospitals with respect to the physiology and pathophysiology of erection and priapism, respectively, and present a rational approach to the management of priapism. Emphasis is given to the corpus cavernosum to corpus spongiosum shunt with a vascular anastomosis technique.

Urachal carcinoma: diagnosis by computerized axial tomography.

A case of mucin-producing adenocarcinoma of the urachus is reported. Preoperative diagnosis was established by computerized axial tomography. The embryology, histogenesis, signs, symptoms, diagnostic criteria and treatment are discussed.

Renal angiomyolipoma; polycystic kidney, and renal cell carcinoma in patient with tuberous sclerosis.

A patient with tuberous sclerosis presented with renal failure secondary to bilateral angiomyolipoma. The angiomyolipoma was associated with polycystic disease and a foci of renal cell carcinoma. This unusual combination has not been reported previously, although each entity has been described separately in tuberous sclerosis.

Pathologic vascularity of renal angiomyolipoma: cast corrosion and angiographic study.

Angiomyolipomas of the kidney at times have been preoperatively identified by the interlobar or interlobular artery eneurysms in the early vascular phase of renal arteriograms. A case report is presented in which a plastic cast corrosion technique was used postnephrectomy to demonstrate the presence of aneurysms identified angiographically prior to surgery. Portions of a cast corrosion model of a hypernephroma are also exhibited to compare and contrast pathologic vascular features of both types of tumors.

Guanethidine sulfate in the prevention of autonomic hyperreflexia.

Autonomic hyperreflexia constitutes the only medical emergency seen in spinal cord injury patients. Uncontrolled hypertension and bradycardia can result in seizures and death. The acute treatment of the syndrome has ranged from medical ganglionic blockers to topical anesthetic agents to surgical procedures. The oral use of 10 mg. guanethidine sulfate 3 times daily successfully prevented the major symptoms of the syndrome in 200 spinal cord injury patients with lesions above T5. Toxicity has been mild and the drug is recommended until the patients are voiding and are capable of self-care.

Hemangioma of scrotum, perineum, and buttocks.

A case of cavernous hemangioma of the scrotum with involvement of the perineum and buttock is presented and discussed.

External sphincterotomy at the 12 o'clock position.

Transurethral resection of the external sphincter was done at the 12 o'clock position 61 times in 60 men. There was a 2.8 per cent incidence of postoperative impotence and a 75 per cent cure of vesicoureteral reflux but there was only a 65 per cent success rate of decreasing post-voiding residual urine after 6 months. The techniques and applications of the procedure are discussed.

Phenoxybenzamine and sweating in the spinal cord injury patient.

There were 10 patients with cervical spinal cord lesions and hyperhidrosis treated with the alpha-adrenergic blocking agent, phenoxybenzamine. Five of the 7 patients completing the study experienced marked diminution or elimination of the profuse sweating pattern.

Unusual complications of transvesical ureteral reimplantation.

Four of 8 cases that represent unusual and infrequent complications of the transvesicle Politano-Leadbetter ureteral reimplantation technique are reported. Approximately 90 per cent of ureteral reimplantations for vesicoureteral reflux may be done satisfactorily as a transvesical procedure but combining it with an extravesical approach of the ureter when necessary or indicated will serve to correct any conceivable congenital, acquired or iatrogenic lesion of the lower ureteral segment. The extravesical approach should be used if there is any difficulty in performing the procedure transvesically or if the patient has undergone previous attempts at antireflux operation. Obstructive complications may occur in either the early or late postoperative period. When discovered, surgical correction is usually indicated. We strongly advocate strict adherence to the surgical technique involved and meticulous postoperative followup of these patients.

Small-Carrion penile prosthesis. New implant for management of impotence.

The etiology of impotence and a review of various techniques in treatment are discussed. A perineal surgical approach with a new type of paired sponge-filled silicone prostheses is described. The prostheses are inserted into previously dilated corpora cavernosa. Of the initial 31 patients, excellent results were obtained 27, and a good result in 1. Of the 3 patients with initial serious complications, adequate functional results were attained in 2. The distinct advantages and potential complications using the Small-Carrion penile prosthesis and surgical technique are discussed.