Transactions of the American Association of Genito-Urinary Surgeons最新文献

A simplified surgical technique for a male-to-female transsexual operation has been developed and applied satisfactorily in a series of carefully selected patients. The simplicity of the technique allows relatively brief hospitalization for 1-stage sex conversion, provides satisfactory cosmetic and functional results and has not been accompanied by any untoward complications.

A number of reports have shown that serotonin has a detrimental effect on spermatogenesis and androgen synthesis. Serotonin has 2 mechanisms of action on the testicle: 1) vasoconstrictive changes and 2) direct alterations of testicular metabolism and endocrine activity. The data in animals with the experimental varicocele clearly mimic the human situation. All of the seminal parameters except volume are decreased after creating the varicocele. In many infertile patients with a varicocele serotonin may be the inciting factor that results in subfertile semen parameters. This is corroborated by the presence of elevated serotonin levels in spermatic vein plasma of certain patients with a varicocele. More data comparing the relationship between spermatic vein and peripheral blood serotonin levels in patients with and without a varicocele are needed. This investigation also is being pursued in patients undergoing inguinal operations for lesions other than a varicocele.

A canine model of bilateral chronic partial ureteral obstruction with one side severely obstructed and the other side moderately obstructed was used to determine which kidney should be released initially to facilitate maximum recovery of renal function. The data show a significantly greater return of total renal function (20%) if the more severely injured kidney is released first.

Urinary supersaturation in respect to brushite or calcium oxalate represents the main pathogenic factor in stone formation. Of the patients with calcium oxalate stones 30 to 40% present with hypercalciuria. Herein we determine and compare the effects and side effects in the treatment of hypercalciuria with sodium cellulose phosphate or Campanyl, a potassium versus calcium ion exchanger, and thiazides alone or in combination with an ion exchanger.

Cis-platinum as single agent therapy was investigated in 8 patients with stage D transitional cell carcinoma of the bladder. Dramatic responses were obtained in some patients and the quality of life was improved for as long as 8 months but no cures were obtained. Also noted was an occasional marked loss of renal function as measured by creatinine clearance despite a carefully managed protocol to avert this known side effect of cis-platinum (nephrotoxicity). No auditory problems were noted in these 8 patients.

Nine patients with a variety of surface transitional cell neoplastic lesions received topical mitomycin-C. The results of treatment were encouraging, all patients responding completely or partially. Based on this experience the authors are participating in a study to compare the efficacy of mitomycin-C with that of thio-tepa.

The recognition of secondary causes of hypertension, such as renovascular disease and aldosteronism, can be enhanced by stimulation and suppression of the 2 limbs of the renin angiotensin system. Normal values have been established in unstimulated and stimulated conditions. Saline infusion suppresses plasma aldosterone normally. Patients with proved adenomas do no suppress renin and are outside the well established ranges of normal suppression. Likewise, furosemide will stimulate renin release. Patients with proved aldosteronism are outside the normal ranges of plasma renin activity. These maneuvers also are useful in discriminating renovascular hypertension, particularly when achieving differential renal venous collections under stimulated conditions (after furosemide and tilting). By stressing this system (with furosemide stimulation or saline suppression) one can discriminate better secondary hypertension by the failure to respond normally.