Forensic urology: a practical vision.

Urologists enjoying the protection of the law owe a duty to participate in the legal system as expert witnesses. Forensic education has been neglected by clinical educators. Qualification of experts includes forensic as well as clinical competence. The forensic urologist must know legal concepts and language; the powers, duties, and role of courtroom experts. The expert witness' role is to factually enlighten the judges, not to persuade them. Practical measures to remedy the current state of affairs are described from over a decade of experience. These practical measures should be supplemented by the formal development of a subspecialty of Forensic Urology sponsored by our colleges and professional societies.

Formative years of the Urodynamics Society: reminiscences.

This paper traces the roots and foundations of the Urodynamics Society as a scientific urologic research society back to the postwar information explosion of the 1950s and 1960s. It describes the then-separate islands of science and urologic practice which gradually became amalgamated through interdisciplinary and crossprofessional collaborations and networks, aided by generous government subsidies and wise university policies.

Chlamydia psittaci. An uncommon cause of community-acquired pneumonia.

Chlamydia psittaci is an uncommon cause of community-acquired pneumonia. Fewer than 200 cases of psittacosis are reported annually to the Centers for Disease Control and Prevention; however, many cases are believed to be unreported. Unrecognized cases not properly treated may result in significant morbidity and possibly have a fatal outcome. We describe a 42-year-old man with multilobar pneumonia and respiratory compromise secondary to infection with C psittaci. The patient also exhibited hepatic involvement and mild anemia as a result of systemic infection. Appropriate antibiotic therapy and respiratory support resulted in a good clinical outcome. The diagnosis of psittacosis requires serologic verification. All confirmed cases should be reported to local and state health departments and may require further investigation by the Centers for Disease Control and Prevention.

Testicular torsion: pitfalls of color Doppler sonography.

Only 25% of boys with acute scrotal swelling have testicular torsion. A noninvasive test that reliably distinguishes torsed testes from all other acute scrotal conditions would benefit patients presenting with pain and swelling of the scrotum. Recent reports suggest that color Doppler ultrasound may be the long-awaited test that clearly differentiates testes with compromised blood flow from all other conditions. However, we report on 2 patients with positive blood flow on color Doppler ultrasonography who subsequently were found at surgery to have testicular torsion. Inability to distinguish normal testes and normal epididymis on physical examination is still the best indicator to proceed with surgical exploration in pediatric patients with acute scrotal swelling.

Thanatology: a new clinical specialty to help confront death.

The complexities, widespread ramifications and uncertainties surrounding decisions dealing with the process of dying call for a specialty of clinical thanatology. The need for such a specialty grows out of medical technological progress, which has permitted the prolongation of life without parallel guidelines for its termination. The further functions and roles of a thanatologist would evolve with the passage of time.

Medicolegal aspects of testicular torsion.

Testicular torsion is a surgical emergency which requires prompt exploration, detorsion, and bilateral orchiopexy. The authors present information helping to explain why testicular torsion often leads to lawsuits for physicians.

Can a urologic nurse contribute to management of secondary impotence in an office setting?

A practicing urologist with a properly trained nurse can form a dual (male, female) sex therapy team. We have found that such a team will improve sexual history-taking from both partners, provide a more holistic approach to patient management, help avoid certain misdiagnoses, and improve case selection for penile surgery. A nurse can assist with the workup, preoperative and postoperative care, counseling, and if so trained, the actual surgery.

Practical measures to reduce medical expert witness bias.

To minimize bias by the testifying clinician, particularly in professional liability cases, six practical measures should be used: 1. testify for both the plaintiff and the defense in different cases; 2. assess the merits of the case separately from agreeing to testify; 3. insist on reviewing all the records thoroughly; 4. develop a solid medical posture for each case; 5. review the case in a balanced, critical manner; and, 6. articulate carefully the standard of care in his words before expressing it in deposition or at trial. The expert must stay within his role and duty as "expert witness" to remain effective.

Discounting surgical benefits. Enucleation versus resection of the prostate.

This manuscript introduces and demonstrates a modification of the popular cost-effectiveness methodology. Because arbitrarily selected discount rates for future health effects can radically change the cost-effect ratio, the determinants of the ratio--differences in the present values of effects and costs-are examined for a wide range of discount rates. Treatment selection then follows directly from explicit judgments about expected patient longevity and appropriate combinations of cost and effect discount rates. The decision to select resection or enucleation of a benign prostatic hypertrophy is developed with data from a small number of clinical patients from Washington University.

Carcinosarcoma of the prostate: report of a case with ultrastructural observations.

A carcinosarcoma of the prostate was examined by light and electron microscopy. The epithelial component was comprised of adenosquamous carcinoma. The stromal component demonstrated osseous and cartilaginous differentiation, and appeared mesenchymal by fine structure analysis. Despite aggressive therapy the patient died with disseminated disease 5 months after diagnosis.