Experience with penile fractures in Egypt: long-term results of immediate surgical repair.

We present our experience in the management of 14 patients with fracture of the penis. The time between the injury and hospital arrival ranged from 2 to 12 hours. All the patients were managed by emergency surgical repair. Surgery consisted of complete evacuation of the hematoma and repair of the tear in the tunica albuginea. Urethral injury associated with penile fracture was not seen in this series. Follow-up time ranged from 12 to 78 months (average, 42.3 +/- 18.3). The results were excellent, with complete early recovery of erectile function. Slight penile curvature during erection was observed in two patients, but this did not affect their sexual activity. Because of these encouraging results and the reported high complication rate of conservative treatment, the need for immediate surgical repair is emphasized.

Fracture of the penis and the result of surgical management.

Twenty-nine patients with fracture of the penis were treated between January 1983 and January 1987. The mean age was 26 years (range 18-61 years) and 25 of them (86.2 per cent) were single. The first four patients were managed conservatively with bad results in three cases. Immediate exploration with repair of the tear of the tunica albuginea was carried out in 25 patients, who all had excellent results with retained potency and only mild pain during early intercourse that disappeared within the first 4 months. Urethral injury in association with fracture of the penis was not seen in this series. In view of the good results we recommend immediate surgical repair in cases of fracture of the penis.

In vitro comparison of the properties of polydioxanone, polyglycolic acid and catgut sutures in sterile and infected urine.

The effect of immersion in sterile urine, infected urine and plasma on the breaking strength and stiffness of polydioxanone (PDS), polyglycolic acid (PGA) and chromic catgut was studied. Tests were done under closely controlled conditions with immersion periods varying from zero to ten days. The breaking strength and stiffness of the three suture materials was not significantly changed by immersion in plasma for periods up to ten days. In sterile urine, PDS lost all of its strength after three days of immersion while PGA lost 64% of its initial breaking strength after ten days. Catgut maintained its strength over the ten day study period. In E. coli-infected urine, PDS lost all of its strength in six days while PGA lost 71% and catgut 8% after ten days. In proteus-infected urine, PDS and PGA lost all their breaking strength after one day of immersion while catgut lost 5.8% of its initial strength after 10 days. Corresponding decreases in stiffness were also observed.

The urological evaluation and management of patients with myelodysplasia.

The urological evaluation and results of management of 183 myelodysplastic patients are presented. Our management protocol stresses upper tract and infection status surveillance during the early childhood years, and a clean intermittent catheterisation programme with pharmacological manipulation of detrusor and sphincter function as the optimal later management. Continence failures are few and are manageable by sphincter prosthetic surgery or bladder augmentation. Urodynamic results are valuable in children with difficult incontinence or poor upper tracts. The intermittent catheterisation programme reduces the incidence of symptomatic urinary infections in these patients, but the incidence of asymptomatic bacteriuria is high. The adverse results of supravesical diversion in myelodysplastic children rarely justify its use.

The predictive value of 2,-4, dinitrochlorobenzene skin testing in patients with bilharzial bladder cancer.

A group of 40 patients with bilharzial bladder cancer underwent quantitative skin testing with dinitrochlorobenzene and purified protein derivative of tuberculin before radical surgery. Correlations were made between various clinical parameters, patient outcome, skin test results and pathologic changes in the resected bladder and draining lymph nodes. Striking associations between dinitrochlorobenzene responses and tumor stage, tumor recurrence and several specific parameters of lymph node stimulation were found, while no correlations were made with the pathologic grade, size or type of tumor, degree of schistosomal infestation or tumor bed inflammation. Purified protein derivative responses showed no correlation with any parameter examined. Patient outcome also showed a good correlation with tumor stage and draining lymph node reaction. These findings indicate that dinitrochlorobenzene skin testing as a presumptive test of cell-mediated immunity may represent a good predictor of clinical outcome in patients with bilharzial bladder cancer, and correlates well with draining lymph node stimulation.