ABSTRACT
Ureteric fibroepithelial polyp is a rare disease; it is of mesodermal origin and exhibits benign characteristics. Hydronephrosis occurs in rare cases, and it is generally accepted that it may result in an obstruction without causing alterations of renal function. In many cases it is difficult to differentiate from transitional cell carcinomas. Nowadays, endoscopic evaluation is the means of treatment and management. In our case study we report a patient with a long fibroepithelial polyp of the distal ureter prolapsing into the bladder in a periodic pattern. Cystoscopy revealed that movement of the polyp was moving forward and backward in the right ureteric orifice. Cold-cut biopsy established the diagnosis. The patient underwent ureteroscopic excision and remains asymptomatic a year later.
Subject(s)
Polyps/complications , Ureteral Diseases/etiology , Ureteral Neoplasms/complications , Aged , Female , Humans , Polyps/pathology , Prolapse , Ureteral Neoplasms/pathology , Urinary BladderABSTRACT
PURPOSE: Penile vibratory stimulation is the treatment of first choice for anejaculation in men with spinal cord injury. Nonresponders to penile vibratory stimulation are usually referred for electroejaculation or surgical sperm retrieval. Compared to penile vibratory stimulation these methods are invasive and usually yield lower total motile sperm, potentially limiting options for assisted reproductive technologies. To avoid these less than ideal options a simple method to salvage penile vibratory stimulation failures would be of benefit to spinal cord injured patients. We investigated the recovery rate when 2 vibrators were used to salvage ejaculatory failures to 1 vibrator in men with spinal cord injury. MATERIALS AND METHODS: A retrospective chart review was performed in 297 spinal cord injured men who underwent a total of 965 trials of penile vibratory stimulation at our center between 1991 and 2006. Only trials with high amplitude vibrators were examined. All men underwent 2 or more penile vibratory stimulation trials using 1 vibrator applied to the dorsum or frenulum of the glans penis. Men failing to ejaculate with 1 vibrator received 1 or more trials in which the glans penis was then sandwiched between 2 vibrators. RESULTS: Of all men 49% and 57% of those whose level of injury was T10 or above responded to penile vibratory stimulation with 1 vibrator. Of failures with 1 vibrator 22% responded to penile vibratory stimulation with 2 vibrators. CONCLUSIONS: Application of 2 vibrators salvaged ejaculatory failures to 1 vibrator during penile vibratory stimulation procedures in men with spinal cord injury. This simple penile vibratory stimulation sandwich method is recommended before referring patients for electroejaculation or surgical sperm retrieval.
Subject(s)
Ejaculation , Physical Stimulation/instrumentation , Spinal Cord Injuries/physiopathology , Adolescent , Adult , Equipment Design , Humans , Male , Middle Aged , Penis , Retrospective StudiesABSTRACT
OBJECTIVE: To determine current use of penile vibratory stimulation (PVS), electroejaculation (EEJ), and intrauterine insemination (IUI) in treatment of infertility in men with spinal cord injury (SCI). DESIGN: Prospective survey, retrospective chart review, and literature review. SETTING: Major university medical center. PATIENT(S): Male SCI patients and female partners. INTERVENTION(S): A survey administered to professionals determined current treatment methods for infertility in couples with SCI male partners. MAIN OUTCOME MEASURE(S): Sperm retrieval methods, ejaculation success rates, total motile sperm (TMS), IUI application, and IUI outcomes. RESULT(S): Twenty-eight percent of surveyed professionals do not retrieve sperm from ejaculates of SCI patients, relying instead on retrieval from reproductive tissues. Reasons for not offering PVS or EEJ were lack of familiarity, training, or equipment. Thirty-four percent do not offer IUI to these couples. Chart review showed that semen could be retrieved by PVS or EEJ in 95% of patients. Fifty-three percent and 43% of trials had TMS >5 and >10 x 10(6), respectively. Of survey respondents performing IUI, 42% lacked enough data to estimate pregnancy rates (PRs) in these couples. Literature review showed IUI PRs between 9% and 18% per cycle and 30% and 60% per couple. CONCLUSION(S): Based on ejaculation success rates, TMS yields, and IUI outcomes, the methods of PVS, EEJ, and IUI warrant consideration in centers not currently offering these options for couples with SCI male partners.
Subject(s)
Infertility/epidemiology , Infertility/therapy , Practice Patterns, Physicians'/statistics & numerical data , Practice Patterns, Physicians'/trends , Reproductive Techniques, Assisted/statistics & numerical data , Spinal Cord Injuries/epidemiology , Spinal Cord Injuries/rehabilitation , Comorbidity , Health Care Surveys , Humans , Male , United StatesABSTRACT
Most men with spinal cord injury are anejaculatory. To retrieve their semen for insemination, the procedure of penile vibratory stimulation is recommended over electroejaculation. Some men with spinal cord injury, however, cannot ejaculate with penile vibratory stimulation. We present 2 cases in which a simple, over-the-counter abdominal muscle stimulator rescued failures to penile vibratory stimulation. Use of this safe, easy, and inexpensive method may prevent some patients from undergoing more expensive, more invasive sperm retrieval methods such as electroejaculation or surgical sperm retrieval from the testis or epididymis.
