Pelvic floor electrical stimulation for the treatment of urge and mixed urinary incontinence in women.

OBJECTIVES: To determine the efficacy of daily or every-other-day electrical stimulation in treating detrusor instability (urge) or urge plus genuine stress (mixed) urinary incontinence in women. METHODS: A multicenter, prospective, nonrandomized study enrolled subjects with urge and mixed urinary incontinence assigned to daily or every-other-day treatments (15 minutes twice daily) using pelvic floor stimulation. Outcome measures assessed were (1) leakage episodes, nocturnal episodes, voiding frequency, total voids, and pad count, and (2) patient subjective assessment and quality of life. RESULTS: Seventy-two subjects were enrolled. Sixty-eight subjects completed the 20-week protocol: 33 treated daily and 35 treated every other day. The entire study group (n = 68) experienced a significant decrease in total leaks (P < 0.001), nocturnal episodes (P = 0.001), pad count (P = 0.002), and total voids (P = 0.003) and on visual analog scales. Sixty-nine percent (n = 46) of subjects with urge or mixed incontinence were cured or improved by at least 50%, with 28% (n = 19) being cured. There were no significant differences between daily and every-other-day users. Nonresponse was correlated with number of previous therapies (P < 0.001) and number of vaginal deliveries (P = 0.007). Overall, subjects were 93% compliant with device use, and 72% (n = 47) were satisfied with the therapy. CONCLUSIONS: Twenty weeks of pelvic floor electrical stimulation therapy is effective in treating urge and mixed urinary incontinence, regardless of daily or every-other-day treatments.

Evaluation of erectile dysfunction by dynamic infusion cavernosometry and cavernosography (DICC). Multi-institutional study.

In a cooperative, private practice, multi-institutional impotence study, dynamic infusion cavernosometry and cavernosography (DICC) was performed on 743 patients to make an accurate diagnosis and/or identify candidates for penile revascularization. Maximum equilibrium intracorporeal pressure achieved following papaverine and phentolamine injection (Phase I) averaged 29.42 +/- 0.76 mm Hg, approximately one third of normal erection pressure. Corporeal pressure fall from 150 mm Hg over thirty seconds (cavernosometry) averaged 82.38 +/- 1.33 mm Hg (Phase II). The gradient between systolic and cavernosal artery pressure averaged 42.84 +/- 1.12 mm Hg on the right and 43.33 +/- 1.13 mm Hg on the left (Phase III). Cavernosography at 90 mm Hg erection pressure was performed in Phase IV. Of the 124 patients from one center who were reviewed in greater detail, pure cavernosal artery insufficiency (CAI) was found in 25 (20.2%), corporeal veno-occlusive dysfunction (CVOD) in 26 (21.0%), and 73 patients (58.9%) demonstrated combined CAI and CVOD. Diabetics (n = 69) achieved lower equilibrium intracorporeal pressures than nondiabetics, had similar CVOD, and worse CAI. Smokers (n = 365) and patients with Peyronie's disease (n = 32) had erectile dysfunction similar to those without these conditions. Patients impotent after trauma (n = 124) were younger, achieved higher intracorporeal pressures, and showed better corporeal veno-occlusive function than those without trauma. Complications of DICC were minimal and infrequent. After DICC, 169 patients underwent internal pudendal arteriography, 105 had arterial bypass surgery with or without penile venous ligation procedures, and 45 had venous surgery alone. Dynamic infusion cavernosometry and cavernosography is a useful erectile function study to evaluate impotence and can be performed easily in a private practice setting.

The role of vaginal immunoglobulin A in girls with recurrent urinary tract infections.

Vaginal immunoglobulin A in girls with recurrent urinary tract infections was significantly lower when compared to an age-matched group of controls who had never experienced bacteriuria. The possible role of deficiencies in vaginal secretory immunoglobulin A leading to recurrent urinary tract infection in this age group is discussed.

Interference of human spermatozoal motility by trichomonas vaginalis.

Human spermatozoa were exposed to concentrations of live Trichomonas vaginalis varying from 10(4) to 10(7) organisms per ml. A striking decrease in spermatozoal motility ensued. The possible role of trichomoniasis in human reproductive failure is considered.

PIP: Trichomonas vaginalis is a flagellated parasite often found as an occult resident of the genital tract of sexually active women. A pure culture of T. vaginalis was isolated from urine and maintained at 37 degrees C by in vitro passage in Diamond's broth. Fresh semen specimens were incubated in .2 ml of serial dilutions of T. vaginalis culture. Spermatozoal motility was observed immediately on mixing and again after 2, 4, and 6 hours of incubation. Marked lessening of spermatozoal activity was observed but no agglutination. The motion of T. vaginalis continued normally. In control samples containing saline or Diamond's broth, only minor retardation of spermatozoal activity was noted during 6 hours of incubation. Filtered Diamond's broth, which prior to filtration had supported a dense concentration of protozoa, when added to equal volumes of fresh human ejaculate caused a similar retardation of spermatozoal activity. It was speculated that some metabolic metabolites of T. vaginalis decrease spermatozoal activity. T. vaginalis should be included among other factors that lead to infertility. In subfertile couples eradication of T. vaginalis may enhance fertility.

Embryonal carcinoma of the testis in elderly men.

A rare case of pure embryonal carcinoma of the testis in a black man in the tenth decade of life is presented, as well as a review of the literature on germ cell testicular tumors in men 60 years old or more. It is noteworthy that nearly 9 per cent of testicular tumors occur in this age group and a third of these tumors are of germ cell origin.

Interference of human spermatozoal motility and spermatozoal agglutination by Candida albicans.

Human spermatozoa were exposed to concentrations of 10(2) to 10(7) organisms per ml. Candida albicans. A subsequent striking decrease in spermatozoal motility and significant agglutination were observed. The possible role of mycotic genital tract infections in human infertility is considered.

PIP: Candida albicans, isolated from a urine culture, was grown in beef heart infusion containing penicillin and streptomycin. Several 10-fold dilutions were made in physiological saline. Semen ejaculations were obtained from 8 volunteers. Drops of a suspension of semen in various dilutions of Candida albicans culture, or in culture media alone, were immediately observed microscopically for spermicidal motility and agglutination. After 2 and 4 hours of incubation, observations were repeated. On immediate examination spermatozoal motility was observed to decrease as the concentration of Candida albicans was increased. In control samples spermatozoal activity remained normal. The pH of all samples remained between 7-8. Spermatozoal agglutination was not noted immediately but after 2 and 4 hours of incubation clumping was obvious. Infertility may follow as a result of mycotic vaginitis, particularly with a marginal state of fertility. In evaluation of couples for infertility, the presence of clinical or subclinical genital tract infection with these organisms should be considered. Antimycotic treatment may be a simple solution for a seemingly complex problem.

Mesotheliomas of spermatic cord.

Mesotheliomas of the spermatic cord are exceedingly rare and scarcely mentioned in the urologic literature. An additional case of spermatic cord mesothelioma is presented and the literature reviewed.

Bladder epithelial neoplasms metastatic to glans penis.

A rare case of bladder tumor metastatic to the glans penis is presented. It is the fifth such case in the literature. Clinical aspects and review of the literature are presented.

Urinary retention and hydronephrosis in a child caused by contact dermatitis of external genitalia.

Contact dermatitis of the external genitalia is added to the list of entities that can cause urinary retention with hydroureteronephrosis in a child. The urinary tract returned to normal following successful treatment of the acute penile edema with topical and systemic steroids.