Fibroblast growth factor-7 regulates stratification of the bladder urothelium.

PURPOSE: The cellular and molecular mechanisms that regulate the organization of bladder urothelium into basal, intermediate and superficial cell layers remain poorly understood. We tested the hypothesis that fibroblast growth factor (FGF)-7 is essential for generating a multilayered stratified bladder epithelium. MATERIALS AND METHODS: The morphological and molecular characteristics of bladder urothelium in age and sex matched FGF-7 +/+ wild-type and -/- null mice were evaluated. In addition, the effect of exogenous FGF-7 on the growth and differentiation of primary murine urothelial cells was assessed. RESULTS: Morphometric analyses demonstrate that FGF-7 null urothelium is markedly thinned compared with wild-type urothelium. Electron microscopy revealed that null urothelium lacks the intermediate cell layers and molecular marker analyses confirmed this observation. In vitro cell culture experiments indicated that FGF-7 regulates urothelial cell growth, differentiation and stratification. Primary urothelial cultures maintained without FGF-7 ceased to divide and expressed proteins characteristic of terminally differentiated umbrella cells. In contrast, cultures maintained with exogenous FGF-7 contained proliferating epithelial cells with protein expression patterns consistent with those of intermediate cells in addition to terminally differentiated, post-mitotic umbrella cells. Importantly, isolated urothelial cells maintained with exogenous FGF-7 formed a multilayered epithelium in vitro. CONCLUSIONS: Collectively these data indicate that FGF-7 is essential for normal bladder urothelial stratification, specifically the formation of the intermediate cell layers. Fibroblast growth factor-7 stimulates urothelial proliferation and delays the differentiation of these cells into post-mitotic umbrella cells.

Massive hematuria due to right renal artery mycotic pseudoaneurysm in a patient with subacute bacterial endocarditis.

A 40-year-old woman with recently diagnosed bacterial endocarditis was admitted to the hospital with gross hematuria and anemia. Computed tomography revealed a large right upper pole renal artery pseudoaneurysm, a wedge-shaped hypoperfused region of the left kidney, and a splenic abscess. Radiographic embolization of the right renal artery was performed to stabilize the bleeding. The splenic abscess was drained. Subsequent right nephrectomy and splenectomy were performed for persistent leukocytosis. This unusual presentation of a septic embolus and its management are discussed.

Histologic effects of testicular sperm extraction on the testicle in men with nonobstructive azoospermia.

OBJECTIVES: Testicular sperm extraction (TESE) is a therapeutic technique that has revolutionized the treatment of severe male infertility presenting as nonobstructive azoospermia. However, the procedure is not without side effects, involving at least a transient effect on spermatogenesis. The purpose of this study was to demonstrate the histologic effects of TESE on the testicle. METHODS: Testicular biopsy specimens were analyzed from 7 patients with nonobstructive azoospermia who each underwent two consecutive TESE procedures. We evaluated two biopsies at the same site on the testicle so that we could examine the histologic effects of the first TESE procedure with the second biopsy specimen. First, a quantitative evaluation of seminiferous tubular volume was performed with a 121-point grid over multiple fields of the testicular specimen slides. The second step of the analysis involved a comparison of the number of germ cells per tubule in each set of specimens. Both Student's t test and Wilcoxon matched pairs tests were used for analysis. RESULTS: In the first set of TESE specimens, tubules comprised 33,158 of 63,525 grid points, or 52.2% of the specimen area. This decreased to 28,637 points, or 45.1%, in the second set of specimens. This decrease in seminiferous tubular volume and corresponding increase in interstitial tissue was statistically significant (P <0.00042). Our data also showed a 5.5% decrease in the number of germ cells per 91 tubules in each data set (from 3222 to 2887, P = 0.25), which suggests a trend toward a lower number of germ cells per tubule. CONCLUSIONS: These findings support our clinical observation that TESE causes a decrease in seminiferous tubular volume within the testicular parenchyma adjacent to the biopsy site. This reflects a potentially adverse local effect of TESE on the testis that may have important clinical consequences for men with nonobstructive azoospermia.

Acquired hypogonadotropic hypogonadism presenting as decreased seminal volume.

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.

Urethrocutaneous fistula due to a retained ring of condom.

Hidden foreign bodies have been described as a rare cause of both strangulation of the glans penis and urethrocutaneous fistula. We present the case of a 30-year-old man who developed a urethrocutaneous fistula and penile shaft necrosis after a condom broke during intercourse. Neither the patient nor several physicians could identify the retained ring of condom, which had been buried under newly epithelialized skin. He underwent removal of the foreign body under general anesthesia, followed 5 months later by a formal urethrocutaneous fistula repair.