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

We report herein on the destruction by cryosurgery of the Dunning R3327 adenocarcinoma grown in the prostate. Tumors less than 1,000 mm.3 were destroyed by a single freezing procedure within 2 to 4 weeks, whereas tumors greater than 1,000 mm.3 could not be destroyed completely. We also have been able to demonstrate antibody and cellular immune responses to antigens on the R3327 cells. Species, organ and tumor specific antigens were identified by xenogeneic antiserum produced in the rabbit, while major and minor antigens were identified by alloantisera produced in the rat. Tumor antigens were characterized by a variety of in vitro and in vivo immune responses. In addition to the rabbit xenoantisera used in cytotoxicity assays, mixed lymphocyte tumor interaction produced a demonstrable in vitro immune response, lymphocytes from rats immunized with tumor cells were cytotoxic to radiolabeled tumor cells in culture, rats immunized with tumor cells in adjuvant demonstrated protection against subsequent challenge and immunological stimulation of lymph nodes draining the site of tumor cell inoculation was demonstrated by an increase in lymphocyte trapping. Clearing, the R3327 tumor system in the rat is suitable for immunological studies of prostatic cancer.

Orchialgia is a term that can only lead to confusion with regard to symptoms and etiology of the symptoms. It implies testicular discomfort or testicular pain that is intrascrotal. Testicular pain per se probably is appreciated in the lower abdomen and internal ring and not in the testicular body. Therefore, true orchialgia, namely testicular pain of unknown etiology, would be more appropriately described as lower abdominal pain (in the absence of any inflammatory ailments), which is worsened by testicular pressure or palpation. Treatment of the patient with orchialgia has been a difficult and often unrewarding clinical situation. Return to gainful activity without significant use of analgesics is the desired goal. Microsurgical testicular denervation has been used in 2 patients in an effort to achieve this goal without sacrifice of the testes.

The clinical and endocrinological features of 15 male subjects with small but normally formed external genitalia are reviewed. Nine of these patients had a simple microphallus alone, while the other 6 patients exhibited associated central nervous system defects. The endocrine data obtained from both groups were the same and were consistent with defective hypothalamic function. Parenteral testosterone seems to be the present treatment of choice but we believe it should be started early in life to take advantage of the greater hyperplastic response of the young.

Experience with 54 operations for the membranous-prostatic urethral stricture is presented. There were 7 operations performed through pubectomy exposure, 6 Badenoch operations, 31 exteriorization 2-stage operations using a perineal-scrotal flap for the first state and 10, 1-stage transperineal end-to-end anastomoses after scar tissue had been excised. The technique for the transperineal approach is presented. Presently, a 1-stage end-to-end anastomosis of the bulbomembranous urethra to the prostatic urethra through a perineal approach is preferred. Exteriorization urethroplasty using the perineal-scrotal flap is recommended when an end-to-end anastomosis is not feasible, either because of a long stricture or severe scar secondary to previous operative failures. The pubectomy approach is seldom needed but the Waterhouse pubectomy procedure is recommended as a possibility in patients who cannot be placed in the exaggerated lithotomy position.

Two ureteral sheaths and the vesical musculature combine to form a watertight ureterovesical junction but the precise anatomy and function of each component are still somewhat contentious. The morphology was studied in postmortem specimens of children with and without paraureteral diverticula and urethral obstruction, and function by deductive reasoning from radiographic and surgical observations in living children. Waldeyer's fascia (the superficial sheath) of the ureter was found to seal the potential space between the tunnel wall and the ureter, and deficiencies were associated with hiatal hernias. The deep sheath provided anchorage of the ureter to the trigone and through the attachments of the superficial sheath to the bladder wall. Both sheaths and the tunnel muscles could be identified clearly and dissected precisely at operations involving the ureterovesical junction to facilitate the surgical procedures.

Early cases of renal autotransplantation have resulted in 2 postoperative deaths in high risk patients, 1 nephrectomy with cure of high blood pressure, 1 cure of hypertension, 3 greatly reduced hypertensions and 2 highly successful bridgings for ureteral avulsions. Anticipated improvements in selection, especially for patients with hypertension, may widen applications in institutions in which homotransplantation is familiar.

Semen analyses from 9 male patients with bladder exstrophy revealed a high incidence of infertility (7 cases). Possible causes and measures that might help to preserve the fertility potential are suggested.

Six women with urethral diverticulitis and a history of having had previous operations for diverticula were subjected to transurethral diverticulotomy with a knife electrode. Each patient had multiple diverticula, some compartmented, located in the mid or most proximal segments of the urethra. All patients have been releived of the symptoms and infection during the postoperative period, varying from 1 1/2 to 7 years.