ABSTRACT
A 32-year-old man with decreased ejaculatory volume was found to have acquired hypogonadotropic hypogonadism. Initial evaluation demonstrated castrate levels of testosterone with low serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. Semen analysis revealed a volume of 0.35 cc and severe oligospermia. Administration of gonadotropin-releasing hormone (GnRH) did not effect an increase in LH or FSH, indicating a pituitary defect. Magnetic resonance imaging revealed a partially empty sella turcica. Treatment with human chorionic gonadotropin (hCG) alone resulted in normalization of testosterone levels, sperm concentration, and semen volume, as well as the successful conception and delivery of a healthy baby girl. The findings from this case demonstrate the importance of considering low serum testosterone levels in the evaluation of low semen volume, as well as the role of hCG alone as an infertility treatment for acquired hypogonadotropic hypogonadism.
Subject(s)
Hypogonadism/complications , Hypogonadism/diagnosis , Infertility, Male/etiology , Oligospermia/etiology , Adult , Chorionic Gonadotropin/administration & dosage , Ejaculation , Follicle Stimulating Hormone/blood , Humans , Infertility, Male/drug therapy , Luteinizing Hormone/blood , Magnetic Resonance Imaging , Male , Sella Turcica/pathology , Semen , Testosterone/bloodABSTRACT
Free patch grafts of bladder mucosa and underlying lamina propria have been used to cover large defects in canine bladder walls. Both autografts and allografts were successfully transferred. Sex chromatin studies showed the final urothelial covering was from the recipient and not the donor bladder.
Subject(s)
Urinary Bladder/surgery , Animals , Dogs , Female , Graft Survival , Male , Mucous Membrane/analysis , Mucous Membrane/transplantation , Sex Chromatin/analysis , Transplantation, Autologous , Transplantation, HomologousABSTRACT
Three to 4 cm-diameter, circular-shaped full thickness sections of the anterior wall of canine bladders were resected. Free grafts of bladder mucosa were lifted from the muscular wall and sewn back as a patch onto the original defect. Fusion of the graft and normal urothelium occurred, and at eight weeks a dense fibrotic external layer and normal urothelium was observed. No diverticuli occurred. A successful closure of recurrent multiple vesicovaginal fistulas in a woman using mucosa alone is reported.
Subject(s)
Mucous Membrane/transplantation , Urinary Bladder/surgery , Vesicovaginal Fistula/surgery , Adult , Animals , Dogs , Female , Humans , Hysterectomy/adverse effects , Methods , Recurrence , Vesicovaginal Fistula/etiologyABSTRACT
Free bladder mucosal grafts were evaluated as material for ureteral substitution. Surgical replacement of the ureter with free bladder mucosa in dogs demonstrates the feasibility of this technique. Graft patency with preservation of urothelial lining and regeneration of smooth muscle was observed. Physical properties observed during the experiment indicate a good potential for long term preservation of the graft material.
Subject(s)
Ureter/surgery , Urinary Bladder/transplantation , Animals , Dogs , Female , Mucous Membrane/transplantation , Postoperative Complications , Sutures , Tissue PreservationABSTRACT
A technique for the repair of severe hypospadias is described. The essential features include: chordee release and cosmetic repair of the previously tethered penis; the construction of a new urethra using bladder mucosa in a subcutaneous tunnel; and an oblique anastomosis of the graft and true urethra as deep within the shaft of the penis as possible. One stricture has developed utilizing this technique. The remainder of the children appear to have obtained a good result. Meatal stenosis requiring dilatation remains a minor problem. The use of bladder mucosal grafts in cases in which previous repairs have failed or when adequate foreskin for urethral reconstruction is lacking is feasible and has been successfully performed in adults. The combination of a chordee release and bladder mucosal inlay graft as a single-stage procedure in a small child had not yet been attempted.
Subject(s)
Hypospadias/surgery , Surgical Flaps , Urinary Bladder/surgery , Child , Humans , Male , Methods , Mucous Membrane/transplantationABSTRACT
The unusual complication of neuromuscular blockade secondary to neomycin absorption is described. The syndrome characterized by acute muscle flaccidity, diaphragmatic breathing, and central nervous system depression presents a potentially fatal situation. Appropriate treatment of this complication includes respiratory assistance and calcium gluconate administration (IV). A review of the pediatric literature reveals 12 previous cases, of which 2 were secondary to urologic procedures.
Subject(s)
Neomycin/adverse effects , Neuromuscular Junction/drug effects , Calcium Gluconate/therapeutic use , Child, Preschool , Humans , Male , Neomycin/administration & dosage , Respiratory Insufficiency/etiologyABSTRACT
A total of 930 cases of open prostatectomies done at Lenox Hill Hospital from 1965 to 1974 are reviewed. The Pilcher bag technique utilized in 830 cases is compared with 100 cases of suprapublic prostatectomy with suturing of the bladder neck. Operating time, intra- and postoperative blood transfusions, hospital stay, and complications are compared. Operative time and intra- and postoperative blood loss are significantly less with the Pilcher bag technique.
Subject(s)
Prostatectomy/methods , Evaluation Studies as Topic , Hemorrhage/etiology , Humans , Intraoperative Complications , Length of Stay , Male , Postoperative Complications , Prostatectomy/adverse effects , Prostatectomy/mortality , Time FactorsABSTRACT
The experience with ureterovesical reimplantation in 491 children is presented. A success rate of 92% using the Paquin technique is reported. The ineffectiveness of ureteral reimplantation in the face of massive hydronephrosis and thick-walled contracted bladder is stressed.
Subject(s)
Replantation , Ureter/surgery , Urinary Bladder/surgery , Female , Follow-Up Studies , Humans , Hydronephrosis/complications , Male , Urinary Bladder/pathology , Urinary Bladder Diseases/complications , Urinary Bladder Diseases/pathologyABSTRACT
A retrospective analysis of 242 families revealed that the incidence of reflux among siblings of children with reflux was 2.2 per cent. In a prospective study of 24 families, 8 of 50 siblings (16 per cent) had reflux. Although the incidence of reflux in the prospective study is surprisingly high infections was absent in all affected siblings in whom cultures were obtained and in only 2 siblings (4 per cent) was surgical correction necessary.
Subject(s)
Vesico-Ureteral Reflux/genetics , Adolescent , Age Factors , Child , Child, Preschool , Female , Humans , Male , Prospective Studies , Radiography , Retrospective Studies , Sex Factors , Vesico-Ureteral Reflux/diagnostic imagingSubject(s)
Ureteral Obstruction/therapy , Humans , Infant, Newborn , Male , Methods , Ureter/surgery , Ureteral Obstruction/diagnostic imaging , Ureteral Obstruction/surgery , Urinary Bladder/diagnostic imaging , Urinary Catheterization , Urinary Fistula/surgery , Urination Disorders/surgery , UrographyABSTRACT
The bilateral absence of testes is described in one of two otherwise healthy and well-developed 12-year-old identical twin boys. The twins' father has only one palpable testis. The occurrence of complete anorchia in only one of otherwise identical twins constitutes relevant new data for considering the etiology of this rare condition and in assaying the role of the testis in growth and development between birth and puberty.
