Electroejaculation and assisted reproductive techniques for anejaculatory infertility.

OBJECTIVE: To report our experience with electroejaculation combined with intrauterine inseminations (IUI) and other assisted reproductive technologies. METHODS: Anejaculatory men desirous of fertility were evaluated in our Assisted Reproductive Program. Between March 1991 and December 1994, 26 men (age 24-48) underwent a total of 84 electroejaculations. Causes of anejaculation included spinal cord injury (n = 23) and retroperitoneal lymph node dissection (n = 3). Female partners were super-ovulated to improve the pregnancy rate. The success in sperm retrieval and pregnancy rates were determined, and the quality of electroejaculates was evaluated. RESULTS: Seventy-seven of 84 (92%) electroejaculations were successful, defined by retrieval of more than 10 x 10(6) total and more than 10(6) motile spermatozoa. Mean sperm count was 65 million/mL (range 0-569), but mean motility was only 16% (range 0-66). Mean normal morphology was 27% (range 0-71). Ten couples attempted conception. Fifty cycles of IUIs were performed, resulting in four normal term infants and one spontaneous abortion (pregnancy rate 10% per IUI). One patient failed to conceive with eight cycles of IUIs but became pregnant with in vitro fertilization-embryo transfer with micromanipulation using electroejaculates; she delivered a set of healthy twins. Two couples elected donor sperm insemination after failing to conceive by IUI with electroejaculates; both became pregnant. CONCLUSION: Electroejaculation offers an encouraging pregnancy opportunity for anejaculatory men who otherwise are considered infertile. Marked asthenospermia is observed in electroejaculates, the etiology of which remains obscure. Further studies to elucidate the cause may improve pregnancy rates.

Assisted fertility using electroejaculation in men with spinal cord injury--a review of literature.

OBJECTIVE: To review the effectiveness of rectal probe electroejaculation in terms of pregnancy in treatment of anejaculatory males due to spinal cord injury. The characteristics of electroejaculates also are examined. DATA IDENTIFICATION: All English language studies reporting pregnancies as a result of electroejaculation from men with spinal cord injury and related publications on electroejaculation were identified through MEDLINE search and manual scanning of recent relevant journals. RESULTS: Electroejaculation has become an accepted mode of semen procurement in anejaculatory individuals, with a success rate of approximately 60% to 90% varying among different centers. In general these electroejaculates exhibit high sperm counts but low motility and poor sperm function. Retrograde ejaculation is also common. Pregnancies using electroejaculates have been documented since 1975 in the form of case reports and small series. Assisted reproductive technology recently has been used in conjunction with electroejaculation. Although results are encouraging, pregnancy rates, however, cannot be accurately estimated because of the lack of large series in the literature. CONCLUSIONS: An increasing number of spinal cord-injured patients desiring fertility can achieve pregnancy through combined use of electroejaculation and assisted reproductive techniques. Larger series are needed to establish an accurate pregnancy rate. Elucidation by further studies on etiology of sperm dysfunction of these individuals may improve their prognosis.

Urological aspects of hemicorporectomy.

The indications for hemicorporectomy are few. However, with improvements in surgical techniques, anaesthesia and post-operative surgical care, hemicorporectomy may again become a reasonable treatment for certain patients with malignancies of the pelvis. A 2-stage procedure is described which consists of an initial staging celiotomy with urinary and faecal diversions. A non-refluxing colon conduit is the preferred form of urinary diversion. The hemicorporectomy is performed approximately 2 weeks later. No complications were encountered in the post-operative period. Our experience and a review of the literature suggest that hemicorporectomy is a reasonable salvage procedure for certain patients with pelvic malignancies.

[Continent urinary diversion with the Florida pouch]. / Dérivation urinaire continente à l'aide de la poche de Floride.

Continent urinary diversion (Florida Pouch) has been performed on 151 patients. The surgical technique utilizes a detubularized extended right colon segment, a doubly-plicated segment of ileum and a non-tunneled uretero-intestinal anastomosis. Mortality rate was 1.3%. Early and late complication rates have been minimal. 2.8% were incontinent. No radiographic renal damage has been noted and electrolyte abnormalities have not been a problem. The procedure is highly recommended to those surgeons performing continent urinary diversions.

Complications of the non-refluxing colon conduit.

The non-refluxing colon conduit has been offered as a superior alternative to the ileal conduit for long-term supravesical urinary diversion. The main advantage would seem to be that the upper tracts can be protected by the formation of a ureterocolic anastomosis without reflux, thereby preventing the deterioration associated with ileal conduits, which is presumably secondary to reflux and ascending infection. Although a colon operation is potentially more hazardous than a small bowel operation the short-term complication rates are not significantly different. We report 2 cases of stenosis of the ureterocolic anastomosis to emphasize that this serious complication continues to be a potential problem with any procedure of this type. With long-term followup its present incidence in 8 to 10 per cent of the patients may exceed the incidence of conduits with reflux. In our 2 cases severe stenosis of the ureter within the tunnel was encountered at reoperation. Techniques that may help prevent stenosis include preservation of periureteral adventitia, careful formation and closure of the submucosal tunnel, forming an anastomosis free of tension and tapering the ureters, when necessary, adequately but not excessively. Correction of this complication may require lysis of surrounding adhesions, a ureterocolic anastomosis with reflux, transureteroureterostomy, transureteropyelostomy, replacement of the ureter with small bowel or nephroureterectomy.

Properties of human epithelioid cells established in vitro by a herpesvirus [IBRV(HMC)] isolated from cytomegalovirus-transformed human cells.

Infectious bovine rhinotracheitis virus [IBRV(HMC)], a double-enveloped herpesvirus, was isolated from human embryo lung fibroblasts transformed by cytomegalovirus (CMV). This agent was identified as an IBRV strain that was antigenically related to human CMV. Inoculation of a primary human kidney cancer cell culture with IBRV(HMC) resulted in persistent infection and subsequent establishment of a cell line [IBRV(HMC)HKC-1]. Virus-related nuclear, cytoplasmic, and cell membrane antigens were detected in these cells in early in vitro passages by anticomplement and indirect immunofluorescence tests. Infectious virus was rescued from one of the cell sublines after temperature-shock treatment at passage 26. Karyotypic analysis confirmed the human origin of the cells. Control uninfected kidney cancer cells survived only six in vitro passages. The established cells grew to more than 100 in vitro passages 1 year after initiation of the experiments and induced an epithelioid cancer of variable morphology that infiltrated nerves and muscles when inoculated sc into athymic nude mice.

Establishment and characterization of a new human urinary bladder carcinoma cell line (PS-1).

An epithelioid cell line (PS-1) has been established from a transitional cell cancer derived from human urinary bladder. Subcutaneous injection of the epithelioid cells into weanling athymic nude mice induced solid tumors histologically similar to the original tumor. A cell line was also established from a tumor induced in the athymic nude mouse (PS-1, T-1). Both cell lines exhibited essentially identical growth characteristics and formed a monolayer growth of epithelioid cells in culture. Electron microscopic studies confirmed epithelioid morphology. No fibroblastoid elements were observed. Chromosomal analysis revealed heteroploidy with persistent marker chromosomes; all cells contained a Y chromosome. The presence of tumor-specific antigen(s) in PS-1 cells was suggested by microcytotoxicity assays with peripheral allogeneic lymphocytes from other transitional cancer cell patients. Sera of urinary bladder cancer patients reacted with nuclear antigens of the established cells.

Recognition of virally transformed cells by lymphocytes from patients with prostatic cancer.

Data presented describe the first assay using human peripheral blood lymphocytes (PBL) against two unique virally transformed cell lines in vitro. Human cells transformed by a cytomegalovirus (CMV-Mj) isolated from normal human prostate tissue were used as target cells in microcytoxicity assays with lymphocytes from 100 patients. Three target cell types were used: control human embryonic lung cells (HEL), transformed HEL cells (CMV-Mj-HEL-2), and transformed HEL cells retrieved from tumors induced in athymic nude mice (CMV-Mj-HEL-2, T-1) by injection of CMV-Mj-HEL-2 cells. PBL preparations from 84% of all patients tested significantly killed CMV-Mj-HEL-2, T-1 cells. However, only PBL from patients with prostatic carcinoma were cytotoxic for CMV-Mj-HEL-2 cells significantly more often than for control HEL. The implications of this approach are discussed.

Immune response of prostatic cancer patients to cytomegalovirus-infected and -transformed human cells.

The indirect immunofluorescent test was used to determine the prevalence of humoral immunity to cytomegalovirus (CMV)-induced antigens in prostatic cancer patients as compared to age-matched controls. Significantly more prostatic cancer patients demonstrated high CMV-antibody titers than did the benign prostatic hyperplasia and nonurogenital cancer groups; however, no significant difference in reactivity was found between paients with prostatic cancer and transitional cell carcinoma of the urinary bladder. When screened against CMV-transformed human cell lines, the reactivity of the sera followed the rate of expression of CMV-related antigens of cell lines used in these tests.

Altered in vitro adrenergic responses of dog detrusor msucle after chronic bladder outlet obstruction.

Muscle strips from the bladder body and dome of normal and control dogs usually demonstrate a relaxing (beta-adrenergic) response to norepinephrine. After bladder outlet obstruction was caused by urethral constriction, all body muscle strips from 7 of 12 dogs (58 per cent) demonstrated contractile (alpha-adrenergic) responses to norepinephrine. Bladder base muscle strips continued to show alpha-adrenergic responses. Desensitization or decreased beta-adrenergic receptor activity may play a part in causing the low compliance and detrusor instability seen in patients with bladder outlet obstruction.

The effects of castration on adrenal testosterone secretion in men with prostatic carcinoma.

Selective adrenal vein catheterization was done on intact and castrated men with prostatic carcinoma. Adrenal to peripheral venous testosterone gradients were observed in all patients, indicating adrenal production of this hormone. No compensatory adrenal production of testosterone was noted during a 17-month period after orchiectomy. The data suggest that the human adrenal in castrates produces testosterone, which may explain why adrenal ablation can offer palliation in some patients with prostatic carcinoma.

Lymphocyte reactivity against virally transformed cells in patients with urologic cancer.

Lymphocytes from patients with urologic cancer were tested in microcytotoxicity assays against human cells transformed by cytomegalovirus. Human lymphocytes were significantly cytotoxic against the transformed cell line when compared to a normal human control cell line. Patients with prostatic carcinoma demonstrated greater target cell reduction than those with benign prostatic hyperplasia.

Evidence for the association of cytomegalovirus with carcinoma of the prostate.

A human genital isolate of cytomegalovirus is shown to have transformed human embryonic lung cells in vitro. These cells produce tumors when injected into athymic nude mice. Two cell lines derived from tissue from human prostatic carcinoma have survived more than 20 passages in vitro and demonstrate cytomegalovirus-specific membrane antigen. Significant humoral antibody titers against cytomegalovirus have been demonstrated. Cell-mediated lymphocytotoxicity against these transformed cells has been demonstrated in patients with urinary tract tumors. This evidence indicates that an association between cytomegalovirus and human prostatic cancer may be more than coincidental.

Perinatal asphyxia and renal failure in neonatal patients.

Herein we discuss oliguria and azotemia in neonatal patients associated with perinatal complications, including difficult labor and delivery, and respiratory asphyxia. Renal failure in these patients is accompanied by proteinuria, microscopic hematuria and red blood cell casts, and it generally resolves in 7 to 10 days. Umbilical aortography can be helpful in determining the presence of normal kidneys in these patients.

The role of intermittent catheterization in the management of children with myelomeningocele.

Of 114 patients with myelomeningocele 44 (40 per cent) have no significant urologic disability. Intermittent catheterization has been used in 51 children and was helpful in 13 (26 per cent). Cystometrograms and urethral pressure profiles have been useful as predictive parameters. Causes of intermittent catheterization failures are discussed.

Cytomegalovirus and cancer of the prostate: in vitro transformation of human cells.

Urogenital tissue specimens were maintained in culture for 2 years. Epithelioid growth was enhanced with use of collagenase digestion rather than trypsinization. Twenty of 34 prostate cancer cell cultures survived more than ten in vitro passages, during which time four of 20 demonstrated epithelioid morphology. One epithelioid line (T-157) survived 32 in vitro passages. The cells demonstrated lack of contact inhibition in culture, were slightly positive in acid phosphatase tests, and reacted positively with cytomegalovirus (CMV)-immune sera in indirect immunofluorescence (IF) tests. These cells, which were proven to be of human male origin, failed to yield infectious virus and could be re-isolated from a nodule induced by the cells when injected sc into weanling athymic nude mice. The serum of the patient from which the tumor cells were derived demonstrated high CMV antibody titers and reacted with the virus-specific membrane and intracellular antigens of CMV-transformed human cells in IF tests. A CMV strain isolated from one of the normal prostate cell cultures established an in vitro long-term persistent infection of human embryo lung cells which resulted in the development of two transformed cell lines. The transformed cells possessed CMV antigenic markers and induced non-differentiated tumors when transplanted into athymic nude mice. The results constitute further evidence of the transforming capacity of CMV, and suggest that the virus may be oncogenic in its natural (human) host.

In vitro culture of human prostatic tissue.

A procedure is described which yields a significant percentage of long-term mixed cell cultures of human prostatic tissue. Attempts were made to suppress the proliferation of stromal fibroblasts and to characterize the cultured cells as those of prostatic origin. The problems associated with establishing epithelial cell lines are discussed.