Double-blind randomized comparison of single-dose ciprofloxacin versus intravenous cefazolin in patients undergoing outpatient endourologic surgery.

OBJECTIVES: To compare the efficacy of single-dose oral ciprofloxacin with intravenous cefazolin as a prophylactic agent in patients undergoing outpatient endourologic surgery. METHODS: One hundred patients were enrolled in a double-blind, randomized study to receive either ciprofloxacin (500 mg) or cefazolin (1 g) before surgery. A postoperative clinical evaluation and urine cultures were performed 5 to 10 days after surgery. Patients undergoing ureteral stent insertion or exchange, ureteroscopy, bladder biopsy, retrograde pyelography, collagen injection, and internal urethrotomy were included. RESULTS: Postoperative urinary tract infection occurred in 7 (9.1%) of 77 patients, including 3 (8.1%) of 37 and 4 (10.0%) of 40 of those who received ciprofloxacin and cefazolin, respectively (P = 0.77). There were no episodes of sepsis, and no patient with infection required hospitalization. The total cost associated with the administration of prophylactic antibiotics in the study population was $3657 less in those 50 patients who received ciprofloxacin than in the 50 patients who received cefazolin. CONCLUSIONS: A single oral dose of ciprofloxacin in patients undergoing outpatient endourologic surgery was equally effective as cefazolin in preventing postoperative urinary tract infection, but was associated with markedly lower overall costs.

DNA organization in patients with a history of cryptorchidism.

OBJECTIVES: Cryptorchidism is associated with infertility, even in those patients with unilateral undescended testes. The mechanism for this infertility is not understood. We demonstrated recently that in mice, a stable nuclear matrix, a structural component of the nucleus that organizes DNA, is necessary for proper embryogenesis. We tested the hypothesis that spermatozoa from cryptorchid patients had unstable nuclear matrices. METHODS: Semen samples from 7 patients with a history of undescended testes and decreased fertility were tested for sperm nuclear matrix stability using our halo assay. RESULTS: All 7 patients were found to have unstable nuclear matrices, as compared with controls. CONCLUSIONS: This preliminary study suggests that one factor in the decreased fertility of cryptorchid patients may be unstable sperm nuclear matrices.

Technique of Hautmann ileal neobladder with chimney modification: interim results in 50 patients.

PURPOSE: We report our 4-year experience with the chimney modification of the Hautmann ileal neobladder. This modification involves use of an 8 to 12 cm. tubularized isoperistaltic ileal chimney for the ureterointestinal anastomosis. MATERIALS AND METHODS: Between April 1995 and March 1998, 50 men and women with invasive bladder cancer underwent radical cystectomy and creation of a Hautmann neobladder with chimney modification. Complications were assessed, divided as early and late, and subdivided as those related or unrelated to the neobladder. Continence was evaluated using a detailed patient questionnaire. RESULTS: There were no intraoperative deaths. Early complications in 11 of the 50 patients were neobladder related in 5 (10%) and unrelated to the neobladder in 6 (12%). The early reoperation rate was 6%. Late postoperative complications in 10 patients (20%) were neobladder related in 8 (16%) and unrelated to the neobladder in 2 (4%). After 1 year 93% and 86% of patients achieved good day and nighttime continence, respectively. In 2 patients (4%) clean intermittent catheterization is performed and 1 required placement of an artificial urinary sphincter. Ureterointestinal anastomotic strictures were detected in 6 of 100 ureteral units (6%), including 2 with failed initial endoscopic management. Open surgical revision of the ureterointestinal anastomotic site was easier due to the anterior position of the ureters, and identification and mobilization of the isoperistaltic limb. CONCLUSIONS: Our experience with the chimney modification of the Hautmann neobladder compares favorably to other forms of orthotopic urinary diversion in regard to ureteral stenosis, early and late postoperative complications, urinary continence and simplification of the ureterointestinal anastomosis.

Phytotherapeutic agents in the treatment of lower urinary tract symptoms: a demographic analysis of awareness and use at the University of Chicago.

OBJECTIVES: To assess awareness and use of phytotherapeutic agents in treating lower urinary tract symptoms (LUTS). METHODS: A survey was conducted of 1280 patients presenting to the University of Chicago Hospitals urology clinic. The questions pertained to age, race, educational level, and use of prescription and nonprescription medications for urinary symptoms. RESULTS: Of 1264 patients filling out the surveys correctly, the 51 to 60-year-old age range demonstrated the greatest percentage of use of these agents. Whites were nearly twice as likely as their African American counterparts to use medicinal botanicals. Men with college or graduate school degrees were 1.5 times as likely to use medicinal botanicals in treating LUTS. More than 50% of men using phytotherapeutic drugs were also taking prescription medications for the urinary symptoms. CONCLUSIONS: There is significant use of phytotherapeutic agents in men with LUTS, although there is variability in their use between patient groups. American physicians need some understanding of these agents to best advise and treat their patients.

Duplicated seminal vesicle.

We report a case of complete, unilateral seminal vesicle duplication without concomitant reproductive duct or renal anomalies encountered during radical retropubic prostatectomy. We also discuss the possible embryologic origin of this anomaly and the clinical implications.