Chlamydia trachomatis epididymitis diagnosed by fluorescent monoclonal antibody.

Two cases are described of atypical presentation of epididymitis requiring surgical exploration to rule out the presence of testicular tumor. In each case epididymal biopsy confirmed the diagnosis of epididymitis, and the causative organism, Chlamydia trachomatis was identified by fluorescent monoclonal antibody technique.

Increased residual urine in patients with bladder neuropathy secondary to suprasacral spinal cord lesions.

Multichannel urodynamic studies were done on 30 patients with incomplete bladder emptying secondary to suprasacral spinal cord lesions. In 11 patients fluoroscopy was done simultaneously. A single most important factor accounting for the increased residual urine was present in 21 cases: inadequate detrusor contraction in 10, sphincter dyssynergia in 6 and bladder neck obstruction in 5. A combination of 2 of these factors was present in 3 patients. Although the initial residual urine volume was high in 6 patients voiding during the urodynamic study was efficient and no residual urine was demonstrated at that time. Urethral pressure profiles were variable, depending on whether a spastic external sphincter contraction was present during the procedure. It is concluded that bladder pressure and sphincter electromyographic measurement during voiding, combined with fluoroscopy, are ideal methods to identify the factors responsible for incomplete emptying in problem cases. The urethral pressure profile is of limited value in the initial assessment of these patients.

True prostatic tissue in 46,XX female with adrenogenital syndrome.

A case is presented of a seventeen-year-old phenotypic male with empty scrotum, hormonal studies consistent with adrenogenital syndrome, a 46,XX karyotype, and a normal prostate on rectal examination. Histochemical evidence of the true nature of the prostatic tissue is presented, and the developmental aspects of the case are discussed.

Intermittent bladder emptying via urethral catheterization or suprapubic cystocath: a comparison study.

A prospective study was undertaken to compare patients with recent spinal cord injuries undergoing bladder training by conventional intermittent urethral catheterization with a similar group treated with the Cystocath. Our present information suggest there are no differences with respect to episodes of bacteriuria encountered or for time spent by the catheter team for each procedure. Paraplegics tended to reach balanced bladder status more easily without surgery while quadriplegics did not. The bladder training program was shorter on the average for the Cystocath group. Further investigation is necessary to determine whether this is significant. Problems encountered were minimal and fewer than reported in the literature. We find no reason not to employ the Cystocath in bladder training programs in spinal cord injured patients.

Anal sphincter stretch: a technique to overcome detrusor-sphincter dyssynergia.

Intermittent catheterization has become a well-accepted method of management of the neurogenic bladder following spinal cord injury. Frequently, the presence of detrusor-sphincter dyssynergia interferes with the attainment of acceptable residual urine volumes in patients with upper-motor-neuron bladders. We have recently reported success in overcoming the problems of dyssynergia in some patients utilizing a technique called anal sphincter stretch in which relaxation of the external anal and urethral sphincters is produced by sustained distention of the anal sphincter. This has lessened the need for other measures that usually produce incontinence and has met with good patient acceptance. An update on the results of using this technique is presented. Although we have previously encountered quadriplegics who might have benefited from sphincter stretch, the lack of hand intrinsic muscle function required for the patient to perform it independently has precluded its use. We herein present a device that circumvents inadequate hand function, and which has enabled four C-7 quadriplegics to achieve satisfactory bladder emptying.

Sphincter stretch: a new technique resulting in continence and complete voiding in paraplegics.

A technique is described to facilitate voiding in the paraplegic, whereby external sphincter spasm is eliminated as a source of obstruction. Digital stretch on the anal sphincter combined with the Valsalva maneuver has resulted in satisfactory bladder emptying in 16 paraplegic patients. The technique has been found unsatisfactory in patients with contracted bladders or with incomplete lesions of the spinal cord.

Chlamydial infection of the male baboon urethra.

Two adult male baboons (Papio cynocephalus) were infected by urethral catheter with a Type D strain of Chlamydia trachomatis isolated from a male patient with nongonococcal urethritis. Chlamydial organisms were shed from the urethra for about 90 days and serum antibody developed. Intraurethral re-inoculation of homologous and heterologous (Type I) strains of Chalmydia, 4 and 11 months later, resulted in relatively shorter periods of infection of less than 15 days. The antibody titres and type-specific patterns were not substantially influenced by re-infection.

Transurethral sphincterotomy: relationship of site of incision to postoperative potency and delayed hemorrhage.

A series of 33 cases of transurethral sphincterotomy is reviewed, comparing the incidence of postoperative complications between incisions at the 3 and 9 o'clock and those at the 1 and 11 o'clock positions. Postoperative impotence and delayed hemorrhage were more frequently encountered following incisions at the 3 and 9 o'clock positions. It is recommended that patients be warned of the possibility of loss of erections following sphincterotomy and that the 1 and 11 o'clock positions be adopted routinely for this procedure.

Ureteral response to partial obstruction. Smooth muscle hyperplasia and connective tissue proliferation.

A technique for producing a reversible form of partial ureteral obstruction in the experimental animal has been described. The response of the rabbit ureteral muscularis to partial obstruction was characterized by hypertrophy of the smooth muscle cells within the first 3 days followed by hyperplasia of the leiomyocytes which appeared to continue as long as the obstruction was present. Deposition of connective tissue was noted between the smooth muscle cells after 2 weeks of partial obstruction increasing to a marked extent by 8 weeks.

Smooth muscle regeneration in the ureter. Electron microscopic and autoradiographic observations.

The cellular events taking place during reconstitution of the rabbit ureteral wall following resection of a portion of its circumference were studied utilizing electron microscopy and autoradiography. It was shown that hyperplasia takes place in the smooth muscle of the ureteral remnant during the first 2 postoperative weeks and that spindle-shaped cells possessing the ultrastructural characteristics of myoblasts migrate from the edges of the remnant into the defect, resulting in regeneration of the muscularis within 5 to 6 weeks of the time of injury.