Fertility potential: a comparison of intra-abdominal and intracanalicular testes by age groups in children.

We compared a group of intra-abdominal (IA) with intracanalicular (IC) testes of the same age in order to see if there were differences in the fertility potential of the testes in these two locations. We also wished to determine at what age, if any, differences became apparent. Semithin (1 microm thick) sections of 54 IA and 103 IC testes between the ages of 3 months and 5 years were evaluated and the spermatic index (SI) calculated for each. The two groups were compared using mathematical models to describe the relationship between age and SI. Models of both IA and IC testes show a sharp decline in the SI during the first 1.8 years of life and remain near zero thereafter. The models are statistically indistinguishable, suggesting there is no detectable difference in the fertility potential of IA and IC testes up to 5 years. The SI appears to reach a critically low value in both groups between 8 and 9 months of age, suggesting that surgical intervention would be appropriate before this time.

Bilateral fibroepithelial polyps of ureter in a child.

Presented here is the first case of bilateral ureteral polyps in a patient under eighteen years of age, with vivid colored intraoperative photographs. The importance of careful identification of the base of the polyp to reduce operative morbidity and the necessity of ureteral reanastomosis rather than simple excision of the polyp in children is emphasized.

Iodine 125 interstitial irradiation for localized prostate cancer.

We present the technique, complications, and 5-year results of transperineal percutaneous template permanent interstitial iodine 125 endocurietherapy of localized prostate cancer in 85 treated patients. The 5-year outcome appears similar to that of external beam radiation therapy or radical surgery, but the iatrogenic mortality, morbidity, treatment time, and hospitalization are significantly reduced.

Retreatment of recurrent pelvic tumors with iodine-125.

We describe our experience with successful retreatment of common pelvic tumors including recurrent cervical and endometrial cancer, colorectal cancer, and soft tissue sarcomas. Two different permanent interstitial 125iodine (125I) endocurietherapy (ECT) techniques were employed. The first technique, percutaneous transperineal template 125I ECT, was used in the retreatment of recurrent tumors located within the true pelvis. The second technique, implantation of 125I in Vicryl carrier following celiotomy, was used for retreatment of recurrent tumors located outside the true pelvis within the false pelvis.

Chitosan: effects on wound healing in urogenital tissue: preliminary report.

We conducted a survey of the effect of chitosan on wounds of the genitourinary system in dogs. Wounds were made in the kidney, ureter and penile foreskin. Chitosan caused no adverse effects on urogenital wound healing. A decrease in fibrosis was seen in the wounds treated with chitosan in all tissues studied. These observations suggest that the morbidity of urogenital surgery may be decreased by treating the wounds with chitosan.

The role of percutaneous nephrostomy in the management of obstructing candidiasis of the urinary tract in infants.

We report on 5 neonates with obstructive urinary tract candidiasis in whom percutaneous nephrostomy had a major role in management. The advantages of percutaneous nephrostomy in this setting include prompt drainage of the obstructed renal pelvis or ureter, direct access to obtain specimens from the renal pelvis to confirm the diagnosis, direct irrigation of the fungus balls with amphotericin B and an access route for fragmentation of fungus balls by guide wire manipulation. In 3 cases percutaneous placement of the nephrostomy tube was successful in obtaining and maintaining access to the renal pelvis, while in 2 surgical intervention was required because of problems maintaining placement of the percutaneous catheters. Percutaneous nephrostomy with antegrade amphotericin B irrigation, coupled with systemic antifungal therapy, is the mainstay of treatment. The usefulness of ultrasonography in the early diagnosis of renal candidiasis also is emphasized.

Transperineal 125iodine endocurietherapy of prostate cancer.

We present the improved implant technique, intraoperative and postoperative complications, local control, and survival of 67 patients with cancer of the prostate treated by means of percutaneous transperineal template permanent 125iodine interstitial endocurietherapy (ECT). This ECT technique is a simple, easily learned, accurate and rapid procedure that can be performed without subjecting the patient to celiotomy. The use of vicryl carriers for permanent 125iodine implantation of the prostate with the percutaneous transperineal template technique prevents seed loss and permits implantation of patients after transurethral resection of the prostate (TURP).

In vitro comparison of the properties of polydioxanone, polyglycolic acid and catgut sutures in sterile and infected urine.

The effect of immersion in sterile urine, infected urine and plasma on the breaking strength and stiffness of polydioxanone (PDS), polyglycolic acid (PGA) and chromic catgut was studied. Tests were done under closely controlled conditions with immersion periods varying from zero to ten days. The breaking strength and stiffness of the three suture materials was not significantly changed by immersion in plasma for periods up to ten days. In sterile urine, PDS lost all of its strength after three days of immersion while PGA lost 64% of its initial breaking strength after ten days. Catgut maintained its strength over the ten day study period. In E. coli-infected urine, PDS lost all of its strength in six days while PGA lost 71% and catgut 8% after ten days. In proteus-infected urine, PDS and PGA lost all their breaking strength after one day of immersion while catgut lost 5.8% of its initial strength after 10 days. Corresponding decreases in stiffness were also observed.

Transabdominal ultrasound versus excretory urography in preoperative evaluation of patients with prostatism.

Transabdominal ultrasound is superior to excretory urography when radiographic imaging of the urinary tract is indicated in patients with prostatism. We studied 53 patients with excretory urography and ultrasonography before prostatectomy. Patients with a history of microscopic or macroscopic hematuria, urolithiasis, renal failure or upper urinary tract anomalies were excluded from our study. Ultrasonography proved to be more accurate in defining prostatic size and configuration. Bladder wall thickness also was quantified more clearly with ultrasonography. We found 17 renal masses incidentally with excretory urography, although ultrasound was essential and superior to excretory urography in defining these masses in each case. We recommend that ultrasonography be used in lieu of excretory urography when imaging of the urinary tract is indicated before prostatectomy.

Simple, accurate, safe, and cost-effective percutaneous transperineal template technique for permanent 125iodine interstitial brachytherapy of prostate cancer.

We present the technique, intraoperative and postoperative complications of percutaneous transperineal template permanent 125iodine interstitial brachytherapy of prostate cancer. The percutaneous transperineal template permanent iodine interstitial brachytherapy under "C-arm" fluoroscopic guidance is a simple, easily-learned, accurate and rapid procedure which can be performed without subjecting the patient to celiotomy. We have treated 58 patients by the transperineal percutaneous permanent interstitial brachytherapy. 33 of 58 patients also had a staging celiotomy just prior to the brachytherapy. In the group of 22 patients undergoing brachytherapy without celiotomy and without adjuvant external-beam pelvic radiotherapy, there were no major complications. Blood transfusions were not required by any patients who underwent percutaneous transperineal permanent iodine interstitial brachytherapy without celiotomy.

Balloon dilation of upper ureteral strictures in primates.

We report the successful creation of ureteral strictures in primates and their successful management by balloon dilation 3 months later without ureteral stenting. This experimental work confirms the sporadic clinical reports of the effectiveness of balloon dilation in the management of ureteral strictures and suggests that ureteral stenting is not necessary for a successful result.

Intussusception technique for use in duplicated system.

Removing a ureter by intussuscepting it into the bladder has been described previously; but so far use of this technique was thought to be contraindicated in the presence of a duplicated system. We have modified this technique so that intussusception can now be used in a duplicated system as well. Two cases are presented.

Fluoroscopy guided transperineal percutaneous permanent 125iodine implantation of prostate cancer.

The transperineal percutaneous template permanent iodine interstitial brachytherapy under "C-arm" fluoroscopic guidance is a simple, easily-learned, accurate and rapid procedure which can be performed without subjecting the patient to celiotomy. We have treated 58 patients by the transperineal percutaneous permanent interstitial brachytherapy. The use of transperineal percutaneous technique with C-arm fluoroscopic guidance improves the symmetry and dosimetry of the implant. This results in reduction of the incidence of chronic radiation-induced complications. In the group of 22 patients who underwent brachytherapy without celiotomy and lymphadenectomy and without adjuvant external-beam radiotherapy, there were no major complications.

Pitfalls in using human chorionic gonadotropin stimulation test to diagnose anorchia.

Previous studies have concluded that surgical exploration is unnecessary in genetic male subjects with nonpalpable tests who fail to respond to human chorionic gonadotropin. Lack of response suggested absent testicular tissue. We report on 2 patients thought to have anorchia because of lack of response to human chorionic gonadotropin stimulation. Testes were found in both patients. Genetic and phenotypic male subjects with nonpalpable testes who fail to have increased testosterone after human chorionic gonadotropin stimulation should undergo laparoscopy. If testicular structures are present at laparoscopy surgical exploration is indicated. Unresponsiveness to human chorionic gonadotropin may be evidence of nonexistent or dysfunctional Leydig cells rather than evidence of complete absence of testicular tissue.

The absence of premalignant changes in the cryptorchid testis before adulthood.

Previous investigators have reported that premalignant changes in the form of abnormal germ cells can be detected in the cryptorchid and infertile adult testis. These cells are characterized by a thin rim of pale-staining cytoplasm, a large hyperchromatic nucleus and prominent nucleoli. We studied 113 biopsies from 102 patients to determine if these abnormal germ cells occur in the nonadult cryptorchid testis. The patients ranged in age from 3 months to 16 years. Evaluation of testicular tissue by light microscopy disclosed histological alterations in the undescended testis, which were those commonly ascribed to the undescended testis. However, none of the changes could be interpreted as premalignant. The abnormal germ cells described by other investigators were not found in any of these specimens.

"C" arm guidance in interstitial brachytherapy of pelvic malignancies.

Since 1979 more than 50 transperineal interstitial implants, both removable and permanent, have been performed at the University of Nebraska Medical Center. The "C" arm of the mobile image-intensifier television unit Siemens Mobile 2 was used to guide the placement of the needles and was found to be useful in achieving accurate implantation.