Routine pouchograms are not necessary after continent urinary diversion.

OBJECTIVES: Pouchograms are routinely performed before catheter removal after continent urinary diversion at our institution. Our aim was to determine the necessity of pouchograms based on a review of our experience. METHODS: A retrospective review of patient records and radiographic studies was done for patients undergoing radical cystectomy and continent urinary diversions between 1991 and 2001. RESULTS: Seventy-two patients underwent continent urinary diversion (orthotopic, n = 59; cutaneous, n = 13) during the study period. All underwent pouchogram postoperatively (median 22 days; range 20 to 27). Six patients (8.3%) had a demonstrable radiographic leak; in 5 of the 6 patients, the urine leak was suspected on clinical grounds. Three patients (4.7%) developed urosepsis after pouchogram. CONCLUSIONS: Our findings indicate that routine pouchograms before pouch activation after continent urinary diversion may not be necessary.

Anatomic variants associated with newborn circumcision complications.

OBJECTIVE: Circumcision is one of the commonly performed procedures on males in the United States, Canada, Australia, and the United Kingdom. The association of minor anatomic variations of the newborn genitalia in patients with minor circumcision complications has not been previously examined. In this study, we looked for an association between subtle genital anatomic variations and newborn circumcision complications. MATERIALS AND METHODS: Over an 18-month period, children presenting for circumcision revision were examined for minor variations in genital anatomy. Children referred for other urological problems during the same period comprised the control group. The same physician evaluated all of the children. RESULTS: During this period, 68 children were evaluated for possible circumcision complications. A confirmed complication was present in 57 infants. Patients with a minor circumcision complication were found to have a 9-fold higher incidence of a prominent suprapubic fat pad, penoscrotal webbing, or being a premature infant as compared to the control group. CONCLUSIONS: Subtle anatomic variations may be associated with a higher incidence of circumcision complications. Physicians performing newborn circumcisions should thoroughly examine the genitalia for these anatomic variations prior to the procedure in order to reduce potential complications.

Novel assay for determining DNA organization in human spermatozoa: implications for male factor infertility.

OBJECTIVES: To present a novel assay for determining DNA organization in fertile human spermatozoa and establish morphometric parameters for these samples. The three-dimensional organization of DNA within a cell nucleus is intimately related to cellular function. For example, it has recently been demonstrated that normal sperm DNA organization may be necessary for successful in vitro fertilization in the mouse. METHODS: Semen from 12 fertile volunteers was tested for sperm DNA organization using our nuclear matrix stability assay. Sperm DNA then underwent computerized digital image analysis and standards of normal were established. RESULTS: Sperm DNA organization was constant in all samples tested. Normal parameters established included mean nuclear matrix diameter (9.17 +/- 1.59 microm), mean DNA halo diameter (20.56 +/- 2.53 microm), mean halo area (66.88 +/- 7.92 microm(2)), and mean nuclear matrix area (32.98 +/- 4.3 microm(2)). CONCLUSIONS: This assay may be used to determine DNA organization in a semen sample. Defining sperm DNA organization may be important clinically, because normal DNA organization is necessary for normal cellular function.

Urodynamics in a patient with Werdnig-Hoffman disease.

Werdnig-Hoffman Disease (WHD) is a rare type of spinal muscular atrophy which causes progressive deterioration of the lower motor neurons of the spinal cord and the brainstem. To our knowledge we report the first case of neurogenic bladder documented on urodynamic studies of a patient with WHD.

Carcinoma of the Bladder: Predictors.

The natural history of carcinoma of the bladder is unpredictable. In some patients, invasive (potentially lethal) carcinomas represent their initial clinical presentation, whereas in others, a protracted clinical course characterized by multiple recurrent tumors is witnessed. This latter population of patients is the most vexing to the urologist. The prediction of the patient's "state of risk" from the tumor has historically been based on clinical pathologic staging employing grade and stage. Predictive clinical evidence for the development of invasive (potentially lethal) carcinoma has been gleaned from observations of the rapidity and pattern of tumor recurrence (single vs. multiple), tumor characteristics (grade, shape, and presence of lymphatic or venous invasion) and the presence of carcinoma in situ at preselected endoscopically normal biopsy sites. Currently available "objective" predictors such as blood group isoantigen deletion from bladder urothelium of patients with invasive bladder carcinoma are provocative. Presently, this technique cannot pinpoint when tumor invasion will occur in a particular patient. However, the application of this methodology in a prospective study (including examination of preselected endoscopically normal mucosal biopsies) is well as resected tumor tissue may prove valuable. At the ultrastructure level as studied with the electron microscope and immunofluorescent probes, alterations in the plasma membrane have been defined that are associated with malignant transformation and abnormal growth patterns (potentially predictive of tumor invasion). Certain Of these techniques appropriately applied to a population at high risk may ultimately assist the surgeon in timing extirpative surgery.