Effect of insulin-like growth factor-1 on apoptosis of rat testicular germ cells induced by testicular torsion.

OBJECTIVE: To investigate the possible protective role of insulin-like growth factor-1 (IGF-1, reported to have a protective effect in experimental models of hypoxic ischaemia), and the involvement of apoptotic cell death in a model of torsion/detorsion of the rat testis. MATERIALS AND METHODS: Adult male Wistar rats were divided into five groups of five rats each. Group 1 underwent a sham operation as a control; in group 2 the testis was twisted and in group 3 then untwisted; in group 4 IGF-1 was injected subcutaneously just before bilateral torsion, and then the right testis removed after 4 h and the left after 24 h; in group 5, IGF-1 was injected immediately after bilateral detorsion and then the testes removed as in group 4. Both testicles were examined histologically, with apoptosis detected using the in situ DNA fragmentation (TUNEL) system, with combined enzymology and immunohistochemistry techniques. RESULTS: In groups 2 (torsion) and 3 (detorsion), light microscopy of the testis showed some degenerative changes in the germ cells. Compared to group 1, apoptosis was more significant in group 3 than in the other groups. Group 4 (torsion/IGF-1) had a similar number of apoptotic germ cells as in group 2 (torsion) after 24 h, but fewer than the same group after 4 h. In group 5 (detorsion/IGF-1), apoptosis was reduced by IGF-1 significantly more than in group 3 (P < 0.05). Apoptosis was significantly less in spermatids in group 5 than in group 3 (P < 0.05). CONCLUSIONS: IGF-1 seems to lower the levels of germ cell apoptosis, which may be important for protecting the testes from torsion/detorsion injury. Further clinical studies are needed to evaluate this protective effect in testicular torsion/detorsion.

Meningioma presenting with only urinary symptoms which is diagnosed by magnetic resonance imaging followed by urodynamic study.

Neurological tumour processes when involving bladder organs or innervations may give rise to urological symptoms. Depending on the organ or nerve tract affected, and emptying capacity of the bladder, the clinical signs manifested may be extremely varied, simulating different pathological entities that may lead to unnecessary treatment.

Solitary calcaneal metastasis in superficial bladder carcinoma.

We report a case of a solitary calcaneal metastasis in a patient with superficial bladder carcinoma. The patient underwent transurethral tumor resection twice because of local recurrence. Both histologic examinations revealed a grade 2 PT1 superficial transitional cell carcinoma of the bladder. The metastasis was detected four months after the initial cystoscopy, due to severe leg pain. The lesion was curetted and filled with bone cement. A year later, a below knee amputation was performed because of local recurrence. This case deserves special attention, for two reasons. First, metastatic carcinoma to the bones of the foot is very rare. Although bony metastasis by transitional cell carcinoma of the bladder can be seen, presenting as a symptomatic solitary lesion after superficial bladder carcinoma is extremely unusual. Second, failure to control bladder tumours by local means might be an indication for an early cystectomy, even in tumours with no evidence of muscle invasion, in order to prevent distant metastasis.

Priapism induced by chlorpromazine.

Priapism is a pathologically prolonged and painful penile erection, usually unassociated with sexual desire or intercourse. Causes include certain oral medications, although the mechanism for drug-induced priapism is unknown. We describe two cases of priapism attributed to chlorpromazine who have presented within the past two years.

Should we get routine urothelial biopsies in every stone surgery?

Physical traumas have been implicated as intrinsic risk factors for the progression of urothelial tumours. In stone disease, histologic changes of the urothelium have a wide spectrum. We want to show the importance of biopsies for identification of these changes. In this study, we investigated the histologic changes of the urothelium in stone patients. There were 16 squamous metaplasia, 14 pyelitis follicularis, 5 pyelitis or ureteritis cystica, 4 polypoid pyelitis or ureteritis, 2 encrusted pyelitis in 43 stone patients, and 5 calcium, 2 long-standing struvite and 2 mixed calculi histories were found in 9 of 14 upper urothelial tumour patients. According to our results, it is important to identify the histologic changes of the upper urothelium during stone surgery for possible neoplastic progression in the future. If any suspicious finding is demonstrated, the patients should be enrolled in a follow-up programme or should be transferred to tumour treatment programme. Therefore, we propose to take biopsies of the urothelium in every stone surgery.

Penile strangulation injuries.

Penile tourniquet injury is probably not a rare entity. Various objects can cause penile strangulation, which may lead to severe injury. Three penile strangulation injuries are presented, one due to thread and two to hair. There were urethral fistulas in two cases. All patients were circumcised and had enuresis nocturna. They were treated successfully. In enuretic patients, it should be kept in mind that there may be a strangulation that can cause penile edema or ulceration and even a urethral fistula.

Electroejaculation using standard nerve stimulation equipment and Teflon-coated needles.

We attempted transperineal needle electroejaculation using a Digistim nerve stimulator and Teflon-coated needles in 12 anejaculatory men. We obtained semen in 11 men. Five of the 12 men also underwent electroejaculation using a transrectal probe. Comparable semen parameters were obtained by transrectal probe and transperineal needles.