Use of vacuum tumescence device for impotence secondary to venous leakage.

The causes and treatment of venogenic impotence are still controversial. From September 1989 to April 1991, 317 men complaining of impotence were evaluated in our Erectile Dysfunction Clinic. Seventy patients were suspected of having venous leakage, and all men had dynamic cavernosography performed. Forty-seven of these 70 men (67%) had venous leakage, and a vacuum tumescence device was recommended as initial treatment for all of them. A questionnaire was later mailed to all 47 patients. A response to the questionnaire was obtained from 45 men (96%). Twenty-nine patients had purchased a vacuum tumescence device (Osbon ErecAid). A satisfactory result was obtained in 20 patients (69%) with venous leakage. Since the use of the vacuum tumescence device is relatively safe and noninvasive, and the results are as good as or better than venous ligation, we recommend its use as the initial treatment of venogenic impotence until a consistently reliable treatment for this condition is found.

Relationship of prostatic acid phosphatase localization in human prostate by a monoclonal antibody with the Gleason grading system.

Prostatic acid phosphatase (PAP) was localized in human prostate with a monoclonal antibody prepared against PAP isoenzyme II to determine patterns of its expression in normal, hyperplastic (BPH), and cancerous glands. The monoclonal antibody reacted with both isoenzymes II and IV in immunoblot studies. Formalin-fixed, paraffin-embedded tissue was used from patients who had not been treated with hormones or chemotherapy. In normal glands and BPH, there was marked variation in the intensity of PAP staining in morphologically otherwise similar epithelial cells. There was similar heterogeneity of staining in the adenocarcinomas. Rough quantification of the intensity patterns in the clinical groups indicated a slight shift to more intense staining in BPH and well-differentiated carcinomas but a progressive decline in the PAP staining in the moderately and poorly differentiated tumors. This decrease in intracellular staining with decreasing differentiation is not inconsistent with the clinical observation that serum levels of acid phosphatase generally increase with higher grade and disseminated tumors, since the enzyme is simply more accessible to the circulatory system in those cases. The same decrease may explain the few disseminated tumors that are not associated with elevated serum levels.

Analysis of fixation effects on immunohistochemical localization of prostatic specific antigen in human prostate.

We studied human prostatic specific antigen (PSA) localization in human prostate to investigate the possibility that the previously reported variations in the intensity of antigen staining were due to fixation and embedding methods. We have evaluated the effects of physical and several chemical fixatives on prostate samples obtained immediately after prostatectomies and radical cystectomies. Our analysis of fixation effects and immunohistochemical staining of polyclonal antibody to PSA indicates that the formalin fixation and paraffin embedding methods used previously did provide optimum localization of the antigen and the variations in the intensity of PSA staining could not be attributed to the methodology. Although PSA staining was relatively uniform in the lower grade neoplastic tumors, the higher grade, moderately to poorly differentiated tumors showed intense-through-weak PSA localization or no PSA staining suggesting that PSA staining intensity was not uniformly related to tumor differentiation.

Reconsideration of orchiectomy in the treatment of advanced prostatic carcinoma.

The results of a large randomized prospective clinical trial conducted by the Veterans Administration Co-operative Urological Research Group (VACURG) in 1968 are updated and reevaluated. In this study, placebo, diethylstilbestrol (DES, 5 mg/day), orchiectomy plus placebo, and orchiectomy plus DES were compared in patients whose conditions were initially diagnosed as stage III and IV carcinoma of the prostate. Results showed that orchiectomy alone or in combination with estrogen did not improve overall survival rates in stage III and IV carcinoma of the prostate. In the two treatment groups receiving estrogen, however, there were fewer deaths due to cancer of the prostate, but this effect tended to be offset by an increased number of deaths due to cardiovascular causes. Deaths from other causes showed no particular pattern with respect to treatment. These studies showed that estrogen is more effective than orchiectomy in preventing deaths from cancer and that the addition of orchiectomy to estrogen does not offer any clear-cut advantage over estrogen therapy alone. If cancer symptoms necessitate treatment, initial therapy with estrogen is preferred. Orchiectomy should be reserved for those circumstances in which a patient is not reliable, cannot tolerate estrogens, or has severe cardiovascular disease.

Freeze-fracture observations on the membranes and junctions in human prostatic carcinoma and benign prostatic hypertrophy.

In human prostatic carcinomatous acini, the columnar cells possessed a loosely organized meshwork of ridges and grooves and many isolated, short, and disorganized strands of tight junctions, unlike those of benign prostatic hypertrophy (BPH), where the tight junctional ridges and grooves were numerous and compact. Desmosomes were more irregular in size, shape and distribution in cancerous cells than in BPH. Our observation indicated that the junctional complexes were altered and defective in cancerous cells and probably facilitated migration of some acinar cells into the stroma. In addition, we have also shown that the membranes including the intramembranous particles of Golgi complexes, mitochondria, secretory granules and vacuoles, lipofuscin granules and nuclei, were essentially similar in cancerous and BPH columar cells.

Etiology of postobstructive diuresis: ouabain-sensitive adenosine triphosphatase deficit and elevated solute excretion in the postobstructed dog kidney.

A selective deficit in ouabain-sensitive adenosine triphosphatase has been shown in unilaterally obstructed dog kidneys; the deficit correlates inversely with Na+ and K+ excretion following relief of obstruction. It is postulated that the enzymatic defect may play a role in the etiology of postobstructive diuresis.

Prophylactic antibiotics in transurethral prostatectomy.

In a prospective randomized study involving 90 uninfected patients undergoing transurethral prostatectomy it was found that routine postoperative use of prophylactic cephalosporins had no beneficial effect on the incidence of fever, hospital stay or major complications. Patients receiving cephalosporins had a significantly lower incidence of postoperative bacteriuria immediately after catheter removal and 1 month postoperatively.

Disseminated intravascular coagulation in the urologic patient.

Gram-negative septicemia and metastatic prostatic cancer are frequent causes of disseminated intravascular coagulation. The clinical manifestations of this condition as well as the laboratory data vary considerably, depending on the patient's compensatory mechanisms in relation to the magnitude and duration of the thromboplastin or endotoxin release. Treatment centers primarily on correcting the underlying disorder. Secondly, deficient clotting factors and platelets should be replaced in the appropriate patient. Heparinization is often unnecessary. The use of drugs that inhibit the protective fibrinolytic mechanism is contraindicated in disseminated intravascular coagulation.

Correlation of pre-treatment serum 17-hydroxycorticosteroid values with survival in patients with prostatic cancer.

Total 17-OHCS values were determined before and after treatment in 715 patients with all stages of prostatic cancer. The pre-treatment 17-OHCS level was an important variable in predicting survival and appeared to be a better prognostic indicator of death in the first year than the patient's age, treatment or stage of disease. Generally, the higher the initial value of serum 17-OHCS the greater the probability of death in the first year of treatment. There was no preponderance of one type of death over another when patients with initial high and low values were compared.

The Veterans' Administration Cooperative Urological Research Group studies of carcinoma of the prostate: a review.

The Veterans' Administration Cooperative Urological Research Group has conducted three consecutive randomized clinical trials of various treatments for all stages of prostatic carcinoma. Thus far, a total of 3774 patients have been entered into these three main studies. The first study showed that early endocrine treatment of patients with advanced prostatic cancer did not increase overall survival when compared to initial treatment with placebo alone. Diethylstilbestrol, when given in a dose of 5.0 mg/day, was associated with an increased incidence of cardiovascular deaths. In the second study, diethylstilbestrol given in a dose of 1.0 mg/day has been as effective as the 5.0-mg dose in controlling the prostatic carcinoma but has been associated with a lower incidence of cardiovascular deaths. Patients are still being entered into the third study and it is too early to report the findings in detail.