Patient-reported erectile dysfunction: a cross-validation study.

Previous work highlighting a significant correspondence between patient-reported sex history information and physiological indices of erectile functioning was cross-validated. The matched sample comprised of 46 older male veterans presenting with erectile dysfunction, with many experiencing chronic physical illnesses. All subjects underwent a comprehensive medical and psychological evaluation, followed by 2 consecutive nights of in-hospital Rigiscan diagnostic monitoring, to evaluate penile rigidity, tumescence, and duration of erectile episodes. Stringent criteria were employed to control for confounding of Rigiscan results, with elimination from the study for affective, thought, or sleep disorders. Results from the multiple regression analyses showed that patient reports of AM erections and erectile quality accounted for significant proportions of the variance in the Rigiscan criterion measures, with 3 of the 4 R2 values falling within the Herzberg criterion for cross-validation. Results confirm the diagnostic significance of patient self-report for the population of older, chronically ill men who present with impaired erectile functioning.

Acute renal failure due to rhabdomyolysis associated with the extreme lithotomy position.

A patient who developed acute renal failure secondary to rhabdomyolysis associated with the use of the extreme lithotomy position for 6 hours during radical perineal prostatectomy is described. It appears that muscle ischemia due to compression of the lumbar and pelvic muscles resulted in muscle injury. Intense muscle uptake of technetium 99m methylene diphosphonate assisted in localizing the muscles involved and ascertaining the extent of the injury. Review of the literature disclosed seven other patients with a similar association. All patients complained of muscle pain shortly after recovery from anesthesia. Early recognition and aggressive treatment with intravenous fluids may prevent the development of acute renal failure.

Gangrene of the penis after implantation of penile prosthesis: case reports, treatment recommendations and review of the literature.

We report 3 cases of gangrene of the penis seen at our institution after penile prosthesis implantation. All 3 patients had insulin-dependent diabetes mellitus. Amputation was required in 2 patients. Aggressive debridement in conjunction with hyperbaric oxygen prevented amputation in the third patient.

The predictive significance of patient-reported sexual functioning in RigiScan sleep evaluations.

We evaluated the relevance of patient reported sex history information in predicting erectile functioning as measured by the RigiScan monitor. A total of 46 male veterans who presented with erectile dysfunction completed an extensive medical and psychological evaluation including a sexual history, and then underwent 2 consecutive nights of inhospital RigiScan sleep evaluation performed under supervision. Multivariate analyses indicated a significant relationship among patient reported sex history information, and RigiScan measurements of tip and base duration, and rigidity. The sex history item with the greatest predictive power was the question regarding early morning erections. The results of this study highlight the importance of patient reported information, and the significance of obtaining a detailed sex history in the evaluation of older, primarily chronically ill patients who present with erectile dysfunction.

Patient-reported sexual symptomatology in predicting functional and insufficient erectile capacity.

We evaluated the clinical utility of patient-reported erectile functioning information in discriminating Rigiscan-determined functional (greater than or equal to 70% penile tip and base rigidity and greater than or equal to 10 minutes' duration) from insufficient (less than 40% penile tip and base rigidity and less than or equal to 6 minutes' duration) erectile capacity, in a population of chronically ill men presenting with erectile dysfunction. Forty-three male veterans completed an extensive medical and psychologic evaluation, including a detailed assessment of sexual functioning, and then underwent two consecutive nights of supervised in-hospital Rigiscan sleep evaluations. Results of discriminant function analysis indicated that patient reports of morning erections and ejaculatory ability accurately predicted group membership for functional (96.7%) and insufficient (100%) categories. Careful attention to patient self-report is suggested for the urologist's initial appraisal of erectile dysfunction in populations of older, chronically ill men.

Decreased incidence of urinary tract infections in patients with spinal cord injury: effect of methenamine.

This study was designed to determine the effect of methenamine on the frequency of urinary tract infections (UTI) in hospitalized patients after spinal cord injury. The study included 56 patients with neurogenic bladder dysfunction treated with intermittent catheterization. A group of 34 patients was treated with methenamine, 1g twice daily; the other group of 22 patients was the control group receiving no antimicrobial therapy. On a weekly basis urine samples from all patients were obtained for urinalysis and culture. A total of 500 urine samples were analyzed. The patients treated with methenamine had 23.4% positive urine cultures which was significantly lower than 57.5% in the untreated control group (p less than 0.001). Our data suggest that methenamine therapy is an effective prevention of UTI in paralyzed patients with neurogenic bladder dysfunction during the rehabilitation in hospital.

Tetany induced on separate occasions by administration of potassium and magnesium in a patient with hungry-bone syndrome.

The case is described of a 68-year-old man whose therapy induced tetany during each of two consecutive hospital admissions. On each occasion the patient had marked hypocalcemia and hypomagnesemia, presumably as a result of the hungry-bone syndrome associated with diffuse prostatic osteoblastic metastases. During the February 1991 admission, marked hypokalemia was the principal initial concern. It seems likely that the tetany associated with the administration of KCl, without sufficient calcium, resulted from attenuation of the protection against hypocalcemia-enhanced neuromuscular excitability conferred by coexisting hypokalemia. The admission in March 1991 was prompted by the finding (without symptoms) of very low levels of both serum Mg and serum Ca. Tetany occurred during the infusion of MgSO4, without calcium. An acute decrement in plasma ionized Ca resulting from complexing of Ca with sulfate ions together with augmented urinary excretion of Ca were likely pathogenic factors.

Malignant vesical tumors following spinal cord injury.

We present 11 male patients with spinal cord injury and neurogenic bladder disease in whom malignant vesical tumors developed. The incidence of these tumors in our spinal cord injury unit was 2.3 per cent. We investigated retrospectively the clinical, endoscopic and radiographic diagnoses, and analyzed the treatment. The most common presenting symptoms were recurrent urinary infections, hematuria and stone disease. Two patients presented with abdominal symptomatology (a large abdominopelvic mass and peritonitis). Endoscopic evaluation was nonspecific in 8 patients (72 per cent). Squamous cell carcinoma was present in 9 patients (81 per cent). One patient had pure transitional cell carcinoma, and 1 had mixed squamous and transitional cell cancer. Cytology was of no value in these patients. The presence of local invasion and bulky disease suggests that ultrasonography or computerized tomography of the abdomen and pelvis should be included during followup. Radical cystoprostatectomy with pelvic lymphadenectomy is the recommended therapy for localized disease. The presence of active or recurrent urethral disease in 55 per cent of the patients indicated that urethrectomy also should be performed.

Osteomyelitis of the symphysis pubis: a separate disease from osteitis pubis. Report of three cases and review of the literature.

We reviewed the case of three of our own patients who had osteomyelitis of the symphysis pubis, as well as those of twenty-five patients described in the literature. The early symptoms of osteomyelitis of the symphysis mimic those of osteitis pubis. Osteomyelitis almost invariably is preceded by urological or gynecological surgery (often when a technical complication has occurred), and does not respond to shortterm antibiotic treatment. Characteristic radiographic findings develop. Osteomyelitis of the symphysis pubis should be treated by debridement and curettage, together with long-term treatment with an appropriately high dose of antibiotics.

Bladder calcification in the prune-belly syndrome.

Calcification of the bladder wall is described in two neonates with the prune-belly syndrome. The radiological and pathological findings are discussed and four additional cases are reviewed.

Sonographic evaluation of Peyronie disease.

In this case report we illustrate and discuss the use of high frequency, superficial organ, real-time ultrasound scanning in the evaluation of patients with Peyronie disease.

Testicular infiltrate in childhood acute lymphocytic leukemia. The need for biopsy in suspected relapse.

The testicle is a prime initial target for infiltration during relapse in male children with acute lymphocytic leukemia. Herein wer report our experience with management of this entity in 8 childre. It is stressed that a biopsy is essential to the diagnosis. The differential diagnosis is usually straightforward. One is admonished not to make presumptive diagnosis by palpation. Orchiectomy is unwarranted. The treatment of choice is testicular radiation with 2,000 rads in ten fractions in a twelve-day course plus reinsstitution of high-dose adjunctive chemotherapy in those children off chemotherapy, or reinduction therapy for children who relapse while still on chemotherapy. Prognosis of male children who undergo a bout of testicular infiltration is guarded.

True hermaphroditism: a rational appraoch to diagnosis and treatment.

Eight previously unreported cases of true hermaphroditism are presented, and their basic characteristics are described and discussed with regard to diagnosis and management. Two basic groups are identified: those diagnosed prior to establishment of gender role and those diagnosed at a later date. The latter group should benefit from therapy designed to enhance and maintain their sex of rearing, while the former group should be reconstructed according to functional considerations first and fertility considerations second. Diagnostic criteria are evaluated, and the value of the exploratory laparotomy is stressed.

Prostatic needle examination: current clinical concepts.

A survey of urologic training programs was undertaken to determine the clinical usage of needle biopsy technics in evaluating prostatic disease. The most popular procedure was transperineal (57%), performed on an inpatient basis (62%). Transrectal biopsy was slightly less popular (43%), with 100% of the surveyed institutions using prebiopsy antibiotic coverage versus only 24% with the transperineal technic. An average of 3.25 cores per biopsy procedure were obtained. Various advantages and disadvantages of each procedure including the use of anesthesia and analgesia are discussed and future direction is proposed.

Localization of aldosterone-producing adenoma by computed tomography.

Abdominal computed tomography (CT) was performed on nine patients with primary aldosteronism in an attempt to evaluate the utility of this noninvasive procedure in localizing aldosterone-producing adenomas. Confirmation of the diagnosis of primary aldosteronism was made by demonstrating elevated urinary aldosterone excretion, low PRA, and failure of plasma aldosterone to fall after acute saline load. Each patient had diagnostic lateralizing adrenal venous sampling and adrenal venography before unilateral adrenalectomy. The CT scan correctly predicted unilateral adenoma in the four patients whose tumors measured the largest in diameter at surgery. Bilateral tumors measuring 0.8 and 1.2 cm on scan (at or below the resolution capabilities of our scanner) were falsely predicted in two patients. The CT scan failed to identify an adrenal abnormality in three patients whose tumors measured 0.9, 1.0, and 1.0 cm in greatest diameter. It is concluded that at its current state of precision, the CT scan is of diagnostic utility in primary aldosteronism when a large adenoma is present. In our patients, the adrenal venogram and CT scan were equally accurate. The sampling of adrenal venous blood for aldosterone and cortisol remains the gold standard for localization of unilateral adenoma.

Desaturation of eicosa-11,14-dienoic acid in human testes.

The metabolism of [1-14C]eicosa-11,14-dienoic acid was investigated in human testes using whole tissue minces and microsomal preparations. Both types of preparations catalyzed the desaturation of the labeled diene to eicosa-8,11,14-trienoic as well as eicosa-5,11,14-trienoic acid. The reported results, therefore, indicate that human testicular tissue, as well as rat testicular tissue (reported previously), is capable of utilizing eicosa-11,14-dienoic acid as a precursor of arachidonic acid. Since it is known that there is no delta 8 desaturase activity in rat liver and brain, these studies support the concept that there is a tissue variation in this enzymatic pathway.