Management of bladder stones: should transurethral prostatic resection be performed in combination with cystolitholapaxy?

We report our institutional experience and review the literature in the management of bladder stones, with particular attention to combined cystolitholapaxy and transurethral prostatectomy. Vesical calculi are associated with obstructing prostatic hypertrophy two thirds of the time. Combined cystolitholapaxy and transurethral resection of the prostate have significant morbidity.

Reconstructive surgery for vasculogenic impotence.

A multidisciplinary approach was used to diagnose 12 patients with vasculogenic impotence. Deep dorsal vein ligation was performed in 8 men to treat venous incompetence. Venous arterialization according to the technique of Virag was used in 4 men to treat arterial inflow insufficiency. A 75 per cent success rate was noted for the correction of venous incompetence. With an average followup of 1 year, excellent success was achieved in re-establishing corporeal blood flow with the technique of venous arterialization plus creation of a venocorporeal shunt.

Primary mesonephric carcinoma of the female urethra.

We report the sixth case of mesonephric carcinoma of the female urethra, which is a rare urethral tumor arising from embryonal remnants of the wolffian or mesonephric duct. The 5 cases previously reported are reviewed. Despite the over-all high stage and entire urethral location of these tumors at presentation, their innate biological malignant potential appears to be much less than the usual variants of urethral cancer. Radical surgical procedures appear to offer an excellent prognosis with a 5-year survival rate without evidence of recurrent disease approaching 80 per cent.

A simple stain for differentiating semen constituents.

Extensive use of Sedi-stain in an outpatient infertility office has demonstrated that this commercially available urinary sediment preparation is a valuable and practical stain in semen analysis. The stain is inexpensive, has a long shelf life, is easy to apply, and produces immediate and reproducible results. The accuracy of Sedi-stain has compared favorably to other staining compounds used. It should prove to be an asset to the office investigation of male infertility.

Modern urodynamic evaluations in the urologist's office.

Patients with voiding disturbances comprise 20 per cent of the yearly outpatient visits to urologists. Of this number 25 per cent have significant neurogenic bladder dysfunction. The theoretical basis and experimental demonstration of urodynamics have been established and reported by multiple investigators during the last 15 years. Recent advances in clinical applications of fast-flow gas cystometry have led to the development of complete, portable urodynamic units that can be used conveniently in the urologist's office and are capable of simultaneously recording parameters of detrusor, urethral and skeletal muscle phincter function. This equipment is simple, efficient, economical and can be operated by well trained paramedical personnel, with minimal immediate direction required by a physician. With recent recognition by many third party carriers this equipment may amortize itself rapidly but, more importantly, it may serve to identify neurological diseases of the bladder that are undetected by other conventional methods of investigation. During the last 9 months 213 patients have undergone urodynamic evaluation at our outpatient urology clinic. These patients were categorized according to type and incidence of voiding disturbance and the number of neurogenic bladders diagnosed within each group was compiled and discussed. Several of the more interesting and unusual clinical examples are presented to familiarize the urologist with the interpretative aspects of this study.

Solitary crossed renal ectopia and its associated congenital anomalies.

Solitary crossed renal ectopia is one of the rarest congenital renal anomalies, with only 21 previously reported cases. It is often accompanied by multisystem congenital anomalies, mainly skeletal and genital in type. The twenty-second such case of this rare congenital anomaly is reported in association with a severe congenital scoliosis of the lumbosacral spine. The embryogenesis and the significance of its associated congenital anomalies are discussed.