[Experience of a double Malecot polyurethane intraurethral catheter in patients with dysuria].

We reviewed our experience of using double Malecot polyurethane intraurethral catheters (IUC). Ten patients with dysuria were treated between April 1991 and April 1993. Seven patients with benign prostatic hypertrophy (BPH) were judged as in a high risk group for operation. The three other patients had neurogenic bladder (two had underactive bladder and 1 had overactive bladder). Under local anesthesia, 150 ml of 0.1% Povidone iodine solution was infused into the bladder through a Nelaton catheter. Under guidance by ultrasonography, an IUC was placed into the bladder neck and posterior urethra using the specially designed introduction set. An long-term follow up of the BPH patients, two IUCs were removed for operation and one was exchanged for an indwelling catheter because of deterioration in general condition. In the neurogenic bladder patients, all IUC were removed because of the increase of residual urine, formation of a pseudourethra, or dislocation into the bladder. Side effects were observed in 6 patients such as, urethral bleeding and stone formation in the stent. Erosion and bleeding tendency in the urethral mucosa were shown in the prolonged duration cases. We conclude that a urethral stent is an effective devise for a high risk patient with benign prostatic hypertrophy but we must keep each patient under strict observation for complications during IUC placement.

[Studies of transrectal prostatic ultrasonography on patients with male infertility].

The diagnostic significance of transrectal prostatic ultrasonography for chronic prostatitis and varicocele was evaluated in 380 male infertility patients. Of 20 patients with pyospermia, thought to be mainly caused by chronic prostatitis, 10.0 percent showed heterogeneous echo pattern of the prostate, while 25.0 percent showed capsular irregularity. Since 285 patients with non-infected semen showed similar sonographic findings, it is concluded that prostatic ultrasonography has little value in the diagnosis of chronic prostatitis in infertile patients. Enlarged periprostatic echo-free zone, thought to coincide with the dilatation of the Santrini's plexus, was found in 42.9 and 42.7 percent of patients with chronic prostatitis and varicocele, respectively, in contrast to 34.0 percent of patients without either diseases. Twelve percent of patients with varicocele showed highly enlarged echo-free zone, which was significantly more frequent compared to 5.0 percent in normal patients. Moreover, follow up of 4 patients with varicocele pre- and post-operatively found 2 of them to show a great improvement in the enlargement of the zone. These results suggest that varicocele may cause the dilation of the Santrini's plexus through a venous anastomosis in some patients and transrectal ultrasonography may be a useful tool in detecting small varicoceles in such patients.

[Clinical studies on methicillin-resistant Staphylococcus aureus (MRSA) infections].

We experienced 20 cases of methicillin-resistant Staphylococcus aureus (MRSA) infection from April 1991 to September 1992. Of them, 9 showed substantial morbidity and their clinical courses are herein reported. The clinical presentations of these cases were wound infection and enterocolitis. Although in 8 cases MRSA was eradicated in 14 to 160 days by effective antibiotics administration, one had a fatal outcome. All strains isolated showed similar drug-sensitivity pattern suggesting hospital infection. Sensitivity to vancomycin and arbekacin, however, remained high and these drugs were effective clinically. It should be stressed that treatment strategy of MRSA infection should consist of isolation of patients with MRSA from other patients, use of disposable equipment and products, and serious and continuing concerns of medical personal on communicability of MRSA.

[Strangulation of the penis by a metallic ring].

An 81-year-old male patient visited our hospital on November 13, 1992 for the treatment of penile edema that had been caused by a metallic ring which he placed for fun 4 days prior to the visit. He had placed the metallic ring on the base of the penis and subsequent penile edema made it impossible to remove the ring. He had no problem with urination. The ring was successfully removed with a metal-cutting tool. But 3 days later, infected penile ulceration occurred at the base of the penis and the necrotic tissue was resected. It took 25 days for the wound to heal. It is stressed that penile strangulation is a serious injury and prompt removal is necessary.

Experimental testicular ischaemia: time course of the effect on rat spermatogenesis.

Protection of the spermatogenic cells against anticancer drugs can be performed by temporarily interrupting testicular blood flow during drug administration. In our study we investigated the effect of ischaemia on spermatogenesis, using mature male Sprague-Dawley rats. Eight and 16 weeks after a 1 h period of left testicular ischaemia, left testicular weights significantly decreased compared with the controls (both, p < 0.05). The decreased testicular weights returned to almost normal values at 24 weeks. Sperm counts in the left cauda epididymis were significantly reduced 8, 16 and 24 weeks after ischaemia (p < 0.01, p < 0.01 and p < 0.05, respectively). Sperm motility also decreased 8 and 16 weeks after the procedure (both, p < 0.01). These parameters returned to normal at 48 weeks. The diameter of seminiferous tubules in the left testis was diminished 8 and 16 weeks after testicular ischaemia, and increased tubular wall thickness on the left side was demonstrated 8 weeks after ischaemia (each, p < 0.05). No changes in the parameters at any interval after ischaemia were observed in the right testis. The serum levels of LH, FSH and testosterone showed no alteration throughout the experiment. The present study reveals that testicular damage induced by ischaemia up to 1 h is completely reversible and no contralateral orchiopathy is produced by this procedure.