Analysis and management of chronic testicular pain.

A total of 45 patients was seen in consultation between May 1980 and April 1989 for chronic unilateral or bilateral orchialgia, defined as intermittent or constant testicular pain 3 months or longer in duration that significantly interferes with the daily activities of the patient so as to prompt him to seek medical attention. We analyzed 34 patients available for followup in terms of socioeconomic parameters, etiology and duration of pain, associated urological symptomatology, specific treatment and results of therapy. Of the patients 31 underwent surgical treatment after failing medical management (24 orchiectomies, 10 epididymectomies, 5 orchiopexies and 1 hydrocelectomy). Of 10 patients who underwent epididymectomy 9 underwent subsequent orchiectomy as definitive treatment. Of 15 patients who underwent inguinal orchiectomy 11 (73%) reported complete relief of pain, while 4 had partial relief. Of the 9 patients who underwent scrotal orchiectomy 5 (55%) reported complete relief of pain, 3 had partial relief and 1 denied improvement. On the basis of these results we recommend inguinal orchiectomy as the procedure of choice for the management of chronic testicular pain when conservative measures are unsuccessful.

Treatment of renal cell carcinoma with renal infarction, delayed nephrectomy, medroxyprogesterone, and xenogeneic immune RNA.

The authors have used xenogeneic immune ribonucleic acid (RNA) in the treatment of patients with renal cell carcinoma. This has been used in conjunction with renal artery embolization, delayed nephrectomy, and progestational therapy, using immune RNA derived from sheep cell lymphocytes immunized with patient's tumor. Four of 5 patients with Stage I disease had extremely large primary tumors. This group is alive with no evidence of disease at twelve to twenty-four months. There are no Stage II tumors in this group. One patient with Stage III tumor is alive at twenty-two months without evidence of disease. Three patients with metastases are stable at five to twenty-two months. Two patients have progressive disease at three and six months. This treatment has not been effective in patients with massive tumor burden. The results in the other groups are encouraging.

Urethral strictures following transurethral prostatectomy: review of 2,223 resections.

There were 2,223 consecutive transurethral prostatectomies reviewed in regard to the incidence and possible etiology of postoperative urethral strictures. Possible etiologies were evaluated and a mode of stricture formation was postulated. Factors considered to be important were 1) initial calibration of the urethra to determine anatomical adequacy prior to instrumentation, 2) gentle urethral dilatation, 3) the use of perineal urethrostomy in patients with strictures noted at the time of initial endoscopy and 4) the size of the urethral catheter used postoperatively.

A second look at injection of vesical neck contractures with triamcinolone.

Adjuvant therapy for vesical neck contractures with triamcinolone injection has given good results with long-term followup but similar results have been obtained with transurethral resection alone in our current re-evaluation. Herein we review 220 consecutive vesical neck contractures treated by the aforementioned modalities.