Ureteral segment replacement using a circumferential small-intestinal submucosa xenogenic graft.

We wished to determine whether small-intestinal submucosa (SIS) will epithelialize when used as a ureteral replacement material. An 11-mm segment of native ureter was excised from eight New Zealand White rabbits and replaced with an 11-mm porcine SIS graft, which was circumferentially wrapped around a ureteral stent. The SIS ureteral grafts were harvested at 11 days or 35 days postimplantation and examined grossly and by standard light microscopy techniques. Partial epithelialization with the ingrowth of urothelium, smooth muscle cells, and blood vessels was observed in the grafts harvested at 11 days postimplantation. The SIS ureteral grafts examined at 35 days postimplantation showed additional restructuring of the smooth muscle cell layer and more organized epithelialization in comparison to the SIS graft examined at 11 days. After 35 days of regenerative healing, elements of all three layers of the native ureter were observed within the collagen matrix of the SIS graft. No significant complications were observed, but all subjects (8/8) demonstrated mild intra-abdominal adhesions. Mild collecting system dilatations were observed in 4/4 (100%) of the animals harvested at 35 days and in 0/4 (0%) of the animals harvested at 11 days. We have this demonstrated in this preliminary study that SIS xenografts will epithelialize when used as a ureteral replacement material. The repair mechanism of these ureteral grafts occurred through a regenerative healing process rather than by scar formation. With further studies, this material may prove to be a useful treatment option in patients with ureteral injuries.

Early-phase adaptations of traditional-speed vs. superslow resistance training on strength and aerobic capacity in sedentary individuals.

We performed a randomized exercise training study to assess the effects of traditional Nautilus-style (TR) or superslow (SS) strength training on muscular strength, body composition, aerobic capacity, and cardiovascular endurance. Subjects were 14 healthy, sedentary women, 19-45 years of age (mean +/- SD age, 32.7 +/- 8.9 years), randomized to either the SS or TR training protocols and trained 3 times per week for 10 weeks. Measurements were taken both before and after training, which included a maximal incremental exercise test on a cycle ergometer, body composition, and 1 repetition maximum (1RM) tests on 8 Nautilus machines. Both groups increased their strength significantly on all 8 exercises, whereas the TR group increased significantly more than the SS group on bench press (34% vs. 11%), torso arm (anterior lateral pull-down) (27% vs. 12%), leg press (33% vs. 7%), leg extension (56% vs. 24%), and leg curl (40% vs. 15%). Thus, the TR group's improvement in total exercise weight lifted was significantly greater than that of the SS group after testing (39% vs. 15%). Exercise duration on the cycle ergometer and work rate significantly improved for both groups, but there was no group-by-training interaction. No significant differences were found for body composition or additional aerobic variables measured. Both strength training protocols produced a significant improvement in strength during a 10-week training period, but the TR protocol produced better gains in the absence of changes in percentage of body fat, body mass index, lean body mass, and body weight. In addition, strength training alone did not improve Vo2max, yet short-term endurance increased.

The overactive bladder in multiple sclerosis.

Multiple sclerosis is a common neurologic disorder that often affects the genitourinary system. One of the most common symptoms of multiple sclerosis is the hyperactive bladder. These patients will have symptoms that may affect their lifestyle, such as urinary incontinence, urgency, and frequency. They may also suffer from debilitating urinary tract symptoms, such as frequent or recurrent urinary tract infections and also on occasion, damage to the upper urinary tract. Fortunately, the neurogenic bladder dysfunction associated with multiple sclerosis can be treated with a reasonable chance of success. With proper treatment, related symptoms may be brought under control, allowing the physician to concentrate on the more debilitating aspects of this disease.

Transurethral microwave hyperthermia in the treatment of chronic nonbacterial prostatitis.

Chronic nonbacterial prostatitis is an ill-understood and difficult-to-diagnose disease. Symptoms of chronic nonbacterial prostatitis are similar to those of chronic prostatitis and include low back pain, frequency, dysuria, perineal discomfort, and painful ejaculation. In view of uncertainty about etiology, treatment of chronic nonbacterial prostatitis remains speculative. Most treatment is aimed at relieving symptoms and not at curing the disease. Because of the troublesome nature of chronic nonbacterial prostatitis and the poor results obtained from traditional treatment methods, a new modality of transurethral microwave hyperthermia was investigated. Six patients were treated from January 1994 through June 1995 by use of transurethral microwave hyperthermia. These men were treated four times during a 2-week period. Their average symptom score decrease was 74.9% and was associated with minimal morbidity. Based on this result, it is concluded that transurethral microwave hyperthermia is a safe and effective treatment modality for chronic nonbacterial prostatitis.

Metastatic Sertoli cell carcinoma of the testis.

Metastatic Sertoli cell tumor is a very rare and deadly disease accounting for approximately 1% of all testicular carcinomas. With fewer than 30 cases reported in the literature, there has not been a uniform treatment regimen with good results. Retroperitoneal lymph node dissection, chemotherapy, and radiation therapy in combination appear to offer the best outcome. This report describes the occurrence of this rare tumor in a 38-year-old man 2 years after left orchiectomy.

Acute cholecystitis or metastatic renal cell carcinoma? a diagnostic dilemma.

Renal cell carcinoma is known to metastasize to many different organ systems. Lung and bone are clearly the most common sites of metastasis, but the symptoms at presentation may simulate those of other diseases of the organ system involved. The patient with metastatic renal cell carcinoma described here had symptoms of acute cholecystitis.

Use of predeposited autologous blood plus intraoperative autotransfusion compared with use of predeposited autologous blood alone in radical retropubic prostatectomy.

The efficacy of combining preoperative autologous blood donation with the intraoperative use of an autotransfuser during radical retropubic prostatectomy was examined by retrospective analysis of the charts of 27 patients who underwent this procedure between February 1989 and August 1992. An intraoperative autotransfuser was combined with 2 units of predonated autologous blood in 14 patients (group 1), with 4 (29%) of the 14 requiring homologous blood. In group 2, 5 (62%) of 8 patients required homologous blood. For the remaining 5 patients (group 3), no autologous blood was available, so all received homologous blood transfusion. Preliminary data suggest that ideally, patients scheduled for radical prostatectomy should attempt to store at least 2 units of autologous blood and have an autotransfuser available during surgery.

Twenty-year experience with the Mentor bladder pacemaker.

Twenty years after placement of a Mentor bladder pacemaker, a 38-year-old woman with spina bifida cystica still has controlled detrusor contraction and complete bladder emptying. The varied treatment modalities for this difficult group of patients has included electronic bladder stimulation. Although no longer commonly used, electronic bladder stimulation has shown long-term efficiency in this patient.

Transitional cell carcinoma of the distal portion of ureter protruding into the sigmoid conduit six years after cystoprostatectomy.

Bladder tumors develop after the diagnosis of upper urinary tract carcinoma in approximately 20% of cases, whereas the incidence of upper urinary tract tumor after the diagnosis of bladder cancer is low, approximately 2%. In a 64-year-old man who had undergone cystoprostatectomy treatment of bladder carcinoma 6 years previously, with the sigmoid conduit used for supravesicle diversion, a transitional cell carcinoma that developed in the conduit was not revealed with intravenous pyelography at regular follow-up intervals. The patient had only hematuria. After an obstructed left kidney, left ureteral stricture, and a filling defect in the conduit were observed radiologically and biopsy revealed a transitional cell carcinoma at the ureterosigmoid junction, the patient underwent left nephroureterectomy, partial resection of a third of the sigmoid conduit, and right ureteral reimplantation. The occurrence of upper urinary tract carcinoma after treatment of bladder cancer should be considered even in light of intravenous pyelography that shows no abnormality; and when such carcinomas occur in this situation, disease involving the conduit should be ruled out.

Flow cytometric determination of ploidy in prostatic adenocarcinoma and its relation to clinical outcome.

Flow cytometry was used to measure the DNA content in paraffin-embedded archival specimens of prostatic adenocarcinoma. The specimens were from 49 patients who were found to have adenocarcinoma of the prostate at the time of transurethral resection of the prostate for bladder outlet obstruction. At initial presentation, 34 of these patients had clinically localized disease and 15 had metastatic disease. The authors studied the relationship of DNA ploidy to clinical stage, histologic grade, disease progression, and duration of survival. Their results indicate that regardless of the clinical stage at presentation, the mean time to disease progression is longer in a patient with a DNA diploid tumor when compared with that in a patient with a DNA aneuploid tumor (18.1 months vs 6.5 months, respectively). Additionally, mean time of survival was longer in a patient with a diploid tumor than in a patient with an aneuploid tumor (31.6 months vs 9.6 months, respectively).

Epilation of hair-bearing urethral grafts using the neodymium:YAG surgical laser.

Nonhair-bearing skin should be used when grafting is necessary during urethroplasty for stricture or hypospadias repair. Occasionally, this is not possible or hair-bearing skin is used inadvertently. Traditionally, electrocoagulation has been the method used for epilation when intraluminal hair has become a problem, such as interfering with flow, as a focus for recurrent urinary tract infection or acting as a nidus for calculus formation. Electrocautery also is performed during grafting in an attempt to prevent the growth of hair when hair-bearing skin is used. Unfortunately, due to lack of penetration the hair follicles are not destroyed and the epilating procedure fails or is only partially successful. The neodymium:YAG surgical laser can photocoagulate tissue to a depth up to 5.0 mm, and thus, has the ability to destroy hair follicles. We report 4 cases presenting with clinical problems directly related to hair-bearing urethral grafts successfully treated by neodymium:YAG laser epilation.

Early detection of stage A prostate carcinoma: combined use of prostate-specific antigen and transrectal ultrasonography.

We prospectively studied 103 men who had normal results on digital prostate examinations but had bladder outlet obstruction secondary to prostatic hypertrophy and needed transurethral prostatectomy. All men underwent a preoperative transrectal ultrasonographic examination of the prostate and prostate-specific antigen (PSA) level determination. A total of 30 cancers were ultimately detected, 22 (73%) of which were detected preoperatively by either an abnormal ultrasonogram or elevated PSA levels (or both). Eight of these men were spared transurethral prostatectomy and had definitive treatment based on transrectal biopsy and appropriate staging evaluation. For PSA and ultrasonography combined, the sensitivities and negative predictive values for cancer (92% and 94%, respectively) were superior to the specificities and positive predictive values (71% and 64%, respectively). The combined use of both studies is recommended to rule out cancer in candidates for prostatectomy but not to routinely screen the general male population older than 40 years.

Testicular metastasis from adenocarcinoma of the prostate.

Reported are two cases of prostate cancer metastatic to the testicle. Both patients underwent bilateral orchiectomies for treatment of symptomatic metastatic prostate cancer. Testicular metastasis was found incidentally in one patient and was suspected in the other. This site of spread is rare. The clinical significance and prognosis are discussed and the pertinent literature reviewed.

Incomplete rectal obstruction secondary to adenocarcinoma of the prostate.

Ureteral and bladder outlet obstruction are well-known sequelae of adenocarcinoma of the prostate. Contiguous extension of prostate cancer locally to involve the rectum is an uncommon phenomenon. It has been suggested that this is because Denonvillier's fascia is an effective barrier to posterior extension of malignant prostatic neoplasms. Herein, we report a case of this unusual association as well as a review of the literature.

Laser surgery for the treatment of squamous cell carcinoma of the penis.

We describe our experience with six cases of squamous cell carcinoma of the penis treated with the carbon dioxide and neodymium yttrium aluminum garnet (Nd:YAG) lasers. One patient had carcinoma in situ. One patient had a T1 tumor. Two patients had T2 disease and two patients had T3 carcinoma of the penis when seen. The patients were followed up from 13 to 64 months. The patients with carcinoma in situ and T1 carcinoma of the penis were tumor-free at a mean follow-up of 45 months. One patient with T2 carcinoma apparently had a complete response to surgery; however, he was seen 56 months after the initial laser treatment with a new invasive penile tumor located at a different site that failed to respond to laser treatment and required a penectomy. Another man with T2 carcinoma as well as the two men with T3 carcinoma failed to respond to laser treatment and required a penectomy. It appears that laser surgery offers the potential for cure in patients with carcinoma of the penis with superficial involvement.

Priapism associated with intranasal cocaine abuse.

Cocaine abuse has escalated to epidemic proportions in the United States. In addition to the social and economic problems associated with the recreational use of this agent, a variety of medical complications have been reported. The occurrence of priapism with intranasal use has not been documented previously. We report a case of priapism secondary to intranasal cocaine abuse and describe the possible neurochemical etiology for this phenomenon.

Epilation of hair-bearing urethral grafts utilizing the neodymium:YAG surgical laser.

Non-hair-bearing skin should be utilized when grafting is necessary in carrying out urethroplasty for stricture or hypospadius repair. Occasionally this is not possible, or hair-bearing skin is used inadvertently. Traditionally electrocoagulation has been the method used for epilation when intraluminal hair has become a problem, such as interfering with flow, being foci for recurring urinary tract infection, or acting as a nidus for calculus formation. Electrocautery is also used at the time of grafting in an attempt to prevent the growth of hair when hair-bearing skin is utilized. Unfortunately, because of lack of penetration, the hair follicles are not destroyed and the epilating procedure fails or is only partially successful. The neodymium: YAG (Nd:YAG) surgical laser can photocoagulate tissue to a depth up to 5.0 mm and thus has the ability to destroy hair follicles. We report three cases presenting with clinical problems directly related to hair-bearing urethral grafts successfully treated by Nd:YAG epilation.

Massive hemorrhage secondary to metastatic testicular carcinoma.

Massive bleeding secondary to metastatic foci of testicular carcinoma is a rare finding. Two cases of metastatic testicular carcinoma in which massive intraabdominal and gastrointestinal hemorrhage occurred are reported. The first patient, who had metastasis to the duodenum and stomach, first underwent surgery because of the concern that chemotherapy might result in rapid tumor necrosis and bowel perforation. The bleeding was controlled, postoperative chemotherapy was administered, and the patient was alive 15 months after chemotherapy. In the second case, in which metastasis was to the liver and lungs, aggressive chemotherapy was begun because of the patient's poor pulmonary status. Three days later, the patient began to hemorrhage. Operative and massive resuscitative measures failed, and the patient died shortly after surgery.

Metastasis of prostate gland adenocarcinoma to penile and scrotal cutaneous tissues.

The metastatic sites of adenocarcinoma of the prostate are well documented. Bone metastasis is the most frequently encountered site. Skin metastasis is rarely reported. Its presence, however, is associated with a poor prognosis. The possible cause of cutaneous spread is discussed in the case report. The possible role that external-beam radiotherapy may play in this setting is also analyzed.