1. health and fitness
2. disease
3. cancer

Volume 144
July 1990
Number 1
The Journal of
UROLOGY
Official Journal of the American Urological Association, Inc.
Founded In 1917 By Hugh Hampton Young
Annual Meeting, American Urological Association, Inc., New Orleans, Louisiana, May 13-17,1990
T H E JOURNAL OF U R O L O G Y
V o l . 144, December
Printed in U.S.A.
Copyright (£, 1990 by A m e r i c a n Urological Association, Inc.
CONTENTS
N U M B E R 1, J U L Y
CLINICAL UROLOGY
Review Article
Prognostic Assessment i n Nonseminomatous Testicular Cancer: Implications for Therapy.
and R. J . Krane
P. J . Hesketh
1
Original Articles
Renal F u n c t i o n Immediately After Piezoelectric Extracorporeal L i t h o t r i p s y . M. P. Daniel and J . R. Burns
(Editorial Comments by G. M . Preminger and D. M . Newman)
Absence of Persisting Parenchymal Damage After Extracorporeal Shock Wave L i t h o t r i p s y as Judged by
Excretion of Renal Tubular Enzymes. G. S. Karlin, D. Schulsinger, Μ. Urivetsky and A. D. Smith . . . .
Extracorporeal Shock Wave Lithotripsy of Kidney Stones Does N o t Induce T r a n s i e n t Bacteremia. Prospec­
tive Study. H. Westh, F. Knudsen, A.-M. Hedengran, M. Weischer, P. Mogensen, J . T. Andersen and
The Copenhagen Extracorporeal Shock Wave Lithotripsy Study Group
Treatment of Staghorn Calculi by Fiberoptic Transurethral Nephrolithotripsy. Y. Aso, N. Ohta, M. Nakano,
Y. Ohtawara, A. Tajima and K. Kawabe
Outcome of Renal Transplantation i n Patients W i t h Functioning Graft for 20 Years or More. S. A. Slauis,
A. C. Nouick, D. R. Steinmuller, S. B. Streem, W. E. Braun, R. A. Straffon, B. Mastroianni and D.
Graneto
Squamous Cell Carcinoma of Renal Pelvis: Nuclear Deoxyribonucleic A c i d Ploidy Studied by Flow Cytome­
t r y . 0. Natiu, Η. Z. Winkler, Η. M. Reiman, J r . and Μ. M. Lieber ( E d i t o r i a l Comments by R. W. deVere
W h i t e and M . S. Soloway)
Functional Classification of Conduits for Continent Diversion. F. Hinman, J r
Fate of Remaining Bladder Following Supravesical Diversion. Ε. B. Eigner and F. S. Freiha
Nondelayed Transvaginal Repair of High L y i n g Vesicovaginal Fistula. Y. Wang and H. R. Hadley
Recurrent Interstitial Cystitis Following Cystoplasty: Fact or Fiction? J . P. MacDermott,
G. L . Charpied, H.
Tesluk and A. R. Stone
Treatment of Radiation or Cyclophosphamide-Induced Hemorrhagic Cystitis Using Conjugated Estro­
gen. Υ. K. Liu, J . I . Harty, G. S. Steinbock, Η. A. Holt, J r . , D. Η. Goldstein and Μ. Amin
Urothelial Cancer i n W h i t e and Japanese Patients i n Hawaii: Pathology.
G. N. Stemmermann,
C. N.
Yoshizawa, Α. Μ. Y. Nomura and L . N. Kolonel
New 180 kDa. Urine Protein Marker Associated W i t h Bladder Cancer. Η. Ε. Ζ hau, R. J . Babaian and S . - J .
Hong (Editorial Comment by M . J . Droller)
Effects of Local Bacillus Calmette-Guerin Therapy in Patients W i t h Bladder Carcinoma on Immunocompe­
t e n t Cells of Bladder W a l l . A. Bohle, J . Gerdes, A. J . Ulmer, A. G. Hofstetter and H.-D. Flad
Elevations of Cytokines I n t e r l e u k i n - l . Interleukin-2 and Tumor Necrosis Factor i n U r i n e of Patients After
Intravesical Bacillus Calmette-Guerin Therapy. A. Bohle, Ch. Nowc, A. J . Ulmer, J . Musehold, J .
Gerdes, A. G. Hofstetter and H.-D. Flad
Randomized Prospective Comparison of Oral Versus Intravesical and Percutaneous Bacillus CalmetteGuerin for Superficial Bladder Cancer. D. L . Lamm, J . L DeHauen, J . Shriver, R. Crispen, D. Grau and
M. F. Sarosdy
Comparison of Different Schedules of Cytostatic Intravesical Instillations i n Patients W i t h Superficial Blad­
der Carcinoma: Final Evaluation of Prospective Multicenter Study W i t h 419 Patients. H. Huland, G.
Klöppel, I . Feddersen, U. Otto, W. Brachmann, Η. Hubmann, J . Kaufmann,
W. Knipper, F. LantziusBeninga and E. Huland (Editorial Comments by M . S. Soloway and H . W . H e r r )
Indications for Urethrectomy i n Era of Continent Urinary Diversion. A. K. Levinson, D. E. Johnson and K.
I . Wishnow
Prostatomembranous
Urethral Disruptions: Management by Suprapubic Cystostomy and Delayed
Urethroplasty. D. A. Husmann, W. Τ Wilson, Τ. B. Boone and T. D. Allen ( E d i t o r i a l Comments by R.
P. M y e r s , J . Barry and F. F. Marshall)
Treating Erectile Dysfunction W i t h External Vacuum Devices: Impact U p o n Sexual, Psychological and M a r ­
ital Functioning. L. A. Turner, S. E. Althof, S. B. Levine, Τ R. Tobias, E. D. Kursh, D. Bodner and Μ. I .
Resnick
Endoscopic Balloon Dilation of Prostate: Early Experience. S. L . Goldenberg, R. A. Perez-Marrero,
L . M.
Lee and L . Emerson (Editorial Comments by D. L . McCullough and J . B. Dowd)
Resection M a r g i n Status i n Radical Retropubic Prostatectomy Specimens: Relationship to Type of Opera­
t i o n , T u m o r Size, Tumor Grade and Local Tumor Extension. E. C. Jones
Further Study of Oxalate Bioavailability i n Foods. L . J . Brinkley, J . Gregory and C. Y. C. Pak
Absence of Effect of Allopurinol on Oxalate Excretion by Stone Patients on Random and Controlled
Diets. M. Urivetzky, S. Braverman, J . A. Motola and A. D. Smith
Strategies for Asymptomatic Microscopic Hematuria: Prospective Study of 1,034 Patients. S. Murakami, T.
Igarashi, S. Hara and J . Shimazaki
iii
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15
17
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27
31
34
37
41
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iv
CONTENTS
Urologists At Work
Decoy Catheter.
N. S. Schomer
102
and J . L . Möhler
Urological Neurology and Urodynamics
U r i n a r y Dysfunction i n Transverse M y e l i t i s . Y. Berger, J . G. Blaivas and L . Oliver
Outcome of Transvaginal Cystourethropexy i n Patients W i t h Anatomical Stress U r i n a r y Incontinence and
Outlet Weakness. J . Ramon, J . A. Mekras and G. D. Webster (Editorial Comments by J . G. Blaivas and
E. J . McGuire)
103
106
Pediatric Articles
Congenital Renal Abnormalities i n Infants W i t h I n Utero Cocaine Exposure. B. J . Rosenstein, J . S. Wheeler
and P. L . Heid
Percutaneous Decompression: Treatment for Respiratory Distress Secondary to Multicystic Dysplastic K i d ney. W. R. Holloway and S. H. Weinstein
Technical Factors Contributing to Successful Kidney Transplantation i n Small Children. J . T. Rosenthal,
R. B. Ettenger, R. M. Ehrlich and R. N. Fine
Low Transurethral Incision of Single System Intravesical Ureteroceles i n Children. M. A. Rich, M. A.
Keating, Η. M. Snyder, III and J . W. Duckett
Urodynamic Consequences of Posterior U r e t h r a l Valves. C. A. Peters, M. Bolkier, S. B. Bauer, W. H.
Hendren, A. H. Colodny, J . Mandell and A. B. Retik
110
113
116
120
122
C a s e Reports
Eosinophilic Ureteritis Associated W ith Eosinophilic Cholangitis. M. L . Platt, V. J . Kiesling, J r . and J . A.
Vaccaro
Appendix Interposition of Ureter. S. Juma and J . C. Nickel
Case of Ureteral Injury Repaired W i t h Appendix.
Y. Komatz and H. Itoh
Impotence Following Childhood Priapism. D. J . Mykulak and Κ I. Glassberg (Editorial Comment by Η. N .
Noe)
Penile Frenulum Neurilemoma: Rare and Unusual Genitourinary Tract Tumor. W. P. Chan, S. S. Chang, A.
H. Huang and C. N. Lin
Effort-Induced Spontaneous Thrombosis of Left Spermatic Vein Presenting Clinically as Left Inguinal Her­
nia. J . S. Isenberg, G. Ozuner, Μ. H. Worth and G. Ferzli
T
INVESTIGATIVE
127
130
132
134
136
138
UROLOGY
T h i s M o n t h in Investigative Urology: Platelet Activating Factor: Mediator of Renal Pathology? D. Felsen
and E. D. Vaughan, J r
Involvement of Platelet Activating Factor and Thromboxane A. in Renal Response to Unilateral Ureteral
Obstruction. D. Felsen, Μ. Η. Loo, D. Ν. Marion and E. D. Vaughan, J r
K - C h a n n e l Openers for Relaxation of Isolated Penile Erectile Tissue From Rabbit. F. Holmquist,
K.-E.
Andersson, M. Fovaeus and H. Hedlund
Androgen Binding A c t i v i t y i n Spongy Tissue of Mammalian Penis. K. Nonomura,
N. Sakakibara, T.
Demura, T. Mori and T. Koyanagi
Augmentation Myoperitoneocystoplasty.
J . L . Weingarten, W. J . Cromie and R. J . Paty
Combined Effects of Shock Waves and Cisplatin Therapy on Rat Prostate Tumors. R. P. Holmes, L . I
Yeaman, W.-J. L i , L . J . Hart, C. A. Wallen, R. D. Woodruff and D. L . McCullough
Photoinactivation of Bladder T u m o r Cells by Methylene Blue: Study of Variety of Tumor and N o r m a l
Cells. D.S. Yu, S.-Y. Chang and C.-P. Ma
M u l t i - D r u g Resistance of Doxorubicin-Resistant Bladder Cancer Cell Line. J . W. Floyd, C.-W. Lin and G.
R. Prout, J r
"
I n V i t r o and I n Vivo A n t i - T u m o r A c t i v i t y of Recombinant Mouse T u m o r Necrosis Factor ( T N F ) i n Mouse
Bladder Tumor ( M B T - 2 ) . R. R. Bahnson and T. L . Ratliff
Bladder Purinergic Receptors. M. R. Ruggieri, Κ. E. Whitmore and R. M. Levin
Investigative Grammar
140
2
141
+
146
152
156
159
164
169
172
176
182
UROLOGICAL SURVEY
Benign and Malignant Neoplasms of Prostate
Imaging
Pediatric Urology
Perioperative Care
Urinary Tract Infection
Book Reviews
News and Announcements
184
186
192
199
201
207
208
C O N T E N T S
V
N U M B E R 2, A U G U S T
CLINICAL UROLOGY
Review Article
Amphotericin Β i n Urological Practice.
G. J . Wise
215
Original Articles
Further Study of Increased M o r t a l i t y Following Transurethral Prostatectomy: Chart-Based Analysis. D. J .
Malenka, N. Roos, E. S. Fisher, D. McLerran, F. S. Whaiey, M. J . Barry, R. Bruskewitz and J . E.
Wennberg (Editorial Comments by C. W h i t e , W . K . Mebust and H . L . Holtgrewe)
Clinical Effects of Prophylactic Dietary Treatment on Renal Stones. M. Iguchi, T. Umekawa, Y. Ishikawa,
Y. Katayama, M. Kodama, M. Takada, Y. Katoh, K. Kataoka, Κ Kohri and T. Kurita
Surgical Treatment for Isolated Dissection of Renal Artery. S. A. Slavis, Ε. E. Hodge, A. C. Novick and T.
Maatman
Evaluation of New Tumor, Nodes and Metastases Classification of Renal Cell Carcinoma. P. Hermanek and
Κ M. Schrott (Editorial Comments by J . B. deKernion and F. F. Marshall)
Enlargement of Regional L y m p h Nodes i n Renal Cell Carcinoma is Often N o t Due to Metastases.
U. E.
Studer, S. Scherz, J . Scheidegger, R. Kraft, R. Sonntag, D. Ackermann and E. J . Zingg
Ureteronephroscopic Endopyelotomy.
R. V. Clayman, J . W. Basler, L . Kavoussi and D. D. Picus (Editorial
Comments by A. D. S m i t h , L . R. K i n g and G. Brannen)
I n Situ Extracorporeal Shock Wave Lithotripsy for Ureteral Calculi. N. R. Netto, J r . , G. C. Lemos and J . F.
A. Claro
Failure of Combined Supratrigonal Cystectomy and Mainz Ileocecocystoplasty i n Intractable Interstitial
Cystitis: Is Histology and Mast Cell Count Reliable Predictor for Outcome of Surgery? Κ. K. Nielsen,
B. Kromann-Andersen,
K. Steven and T. Haid (Editorial Comments by Ε. M . Messing and P. M . Hanno)
Recurrent Superficial Transitional Cell Carcinoma of Bladder: Adjuvant Topical Chemotherapy Versus I m ­
munotherapy. Prospective Randomized T r i a l . J . Flamm, Α. Bucher, W. Höltl and W. Albrecht (Editorial
Comment by D. L . Lamm)
Bacterial Adherence to Urethral Catheters. J . A. Roberts, Ε. N. Fussell and Μ. B. Kaack
Urethrectomy W i t h Preservation of Potency. C. B. Brendler, P. N. Schlegel and P. C. Walsh
Endocrine Evaluation of Adults W i t h M i l d Hypospadias. J . P. Gearhart, P. A. Donohoue, T. R. Brown, P. C.
Walsh and G. D. Berkovitz
Dysfunctional Penile Cholinergic Nerves i n Diabetic Impotent M e n . R. Blanco, I . Saenz de Tejada, I .
Goldstein, R. J . Krane, Η. Η. Wotiz and R. A. Cohen
Corporeal Plication for Surgical Correction of Peyronie's Disease. G. R. Mufti, M. Aitchison, S. P. Bramwell,
P. J . Paterson and R. Scott (Editorial Comments by J . N . Corriere, J r . and C. J . Devine, Jr.)
High Rate of Noncompliance for Post-Vasectomy Semen E x a m i n a t i o n : Medical and Legal Considera­
tions. A. M. Belker, Μ. S. Sexter, S. J . Sweitzer and M. J . Raff
Nerve-Sparing Retroperitoneal Lymphadenectomy W i t h Preservation of Ejaculation. J . P. Donohue, R. S.
Foster, R. G. Rowland, R. Bihrle, J . Jones and G. Geier (Editorial Comment by M . A. S. Jewett)
Nerve-Preserving Bilateral Retroperitoneal Lymphadenectomy: Anatomical Study and Operative Ap­
proach. K. Colleselli, S. Poisel, W. Schachtner and G. Bartsch ( E d i t o r i a l Comments by J . P. Donohue
and J . P. Richie)
Deoxyribonucleic Acid Ploidy and Direct Assay of Prostatic Acid Phosphatase and Prostate Specific Antigen
in Fine Needle Aspiration Biopsies as Diagnostic Methods i n Prostatic Carcinoma. R. Stege, Β. Lundh,
Β. Tribukait, A. Pousette, K. Carlström and M. Hasenson
Nuclear Deoxyribonucleic Acid Ploidy and Serum Prostate Specific A n t i g e n i n Operable Prostatic Adenocarcinoma. 0. Nativ, R. P. Myers, G. M. Farrow, T. M. Therneau, H. Zincke and Μ. M. Lieber (Editorial
Comment by D. F. Paulson)
Prostate Cancer: Post-Irradiation Incontinence. N. Green, D. Treible and H. Wallack
224
229
233
238
243
246
253
255
260
264
270
274
278
281
284
287
293
o
299
303
307
Urologists At Work
Miniccre Needle Biopsy of Kidney Transplants: Safer Sampling M e t h o d . P. Belitsky and R. Gupta
Use of Bubble Wrap as A r m Support for Extracorporeal Shock Wave L i t h o t r i p s y . J . A. Fernandez, E. L .
Shook and C. C. Carson, III
Preparation, Handling and Use of Intravesical Bacillus Calmette-Guerin for Management of Stage Ta, T l ,
Carcinoma I n Situ and Transitional Cell Cancer. S. A. Brosman and D. L . Lamm
Penile Advancement and Lengthening i n Spinal Cord Injury Patients W i t h Retracted Phallus W h o Have
Failed Penile Prosthesis Placement Alone. J . N. Kabalin, J . Rosen and I . Perkash
310
312
313
316
Urological Neurology and Urodynamics
Loop-Loosening Procedure for U r i n a t i o n Difficulties After Stamey Suspension of Vesical Neck. T. Araki,
H. Takamoto, T. Hara, H. Fujimoto, M. Yoshida and Y. Katayama (Editorial Comment by S. Raz)
319
Pediatric Articles
Cystic Dilatations W i t h i n Pelvis i n Patients W i t h Ipsilateral Renal Agenesis or Dysplasia. C.-P. Sheih, CS. Hung, C-F. Wei and C.-Y. Lin
Ureteral Tailoring: Comparison of Wedge Resection W i t h Infolding. T. S. Parrott, J . R. Woodard and J . J .
Wolpert
324
328
vi
C O N T E N T S
Continent Urinary Reservoirs i n Pediatric Urological Practice. M. P. Leonard, J . P. Gearhart and R. D.
Jeffs
Duplicate Bladder Exstrophy: New Variant of Clinical and Embryological Significance. C. A. Sheldon, G. A.
McLorie, A. Khoury and Β. M. Churchill
Fetal Bladder Histology i n Posterior Urethral Valves and Prune Belly Syndrome. S. J . Workman and B. A.
Kogan
Case of Fibrous Hamartoma of Infancy i n Scrotum Including Immunohistochemical Findings. G. Groisman
and H. Kerner
330
334
337
340
C a s e Reports
Eosinophilic Cystitis i n Renal Allograft Recipient. S. A. Horner and J . L . Weingarten
Small Cell Carcinoma of Renal Pelvis: Clinicopathological, Morphological and Immunohistochemical Study
of 2 Cases. H. Essenfeld, J . C. Manivel, P. Benedetto and J . Alhores-Saavedra
B l u n t Trauma of Uterovaginal and Vesical Prolapse W i t h Associated Bladder Rupture. C. G. Miller, P. B.
Marshburn, L . M. Talbert and M. S. Tucker
Tuberculous Cold Abscess of Corpus Cavernosum. D. Yachia, M. Friedman and L . Auslaender
Bilateral Synchronous Testis Tumors of Different Histology i n Patients W i t h Acquired Immunodeficiency
Syndrome Related Complex. C. G. Roehrborn, J . Τ Worrell and E. L . Wiley
Transrectal Prostate Ultrasonography as Diagnostic and Therapeutic A i d for Ejaculatory Duct Obstruc­
t i o n . A. M. Belker and G. 5. Steinbock
Is Evaluation of Right Colon Necessary Prior to Cecocystoplasty? A. Z. Beshai and P. E. Zimmern
342
344
348
351
353
356
359
Special Communication
K U H Notes.
362
G.E. Striker
Letters to Editor
Re: Nonintubated Anderson-Hynes Repair of Ureteropelvic Junction Obstruction i n 60 Patients, by D. H .
Nguyen, H . Aliabadi, C. J . Ercole and R. Gonzalez. R. J . Cherrie
Re: Carcinoma I n Situ of Testis, by Y. Reinberg, J . C. M a n i v e l and E. E. Fraley. K-P. Dieckmann and V.
Loy
364
364
Erratum
Prostate Cancer
364
INVESTIGATIVE UROLOGY
Effect of Various Degrees of Unilateral Spermatic Cord Torsion on Fertility i n Rat. R. M. Heindel, R. E.
Pakyz, L . N. Reinking and M. J . Cosentino
Combined Therapy of Hyperthermia and T u m o r Necrosis Factor for Nude Mice Bearing K K - 4 7 Bladder
Cancer. T. Amano, K. Kumini, K. Nakashima, T. Uchibayashi and H. Hisazumi
Functional Rectal Bladder—Prevention of Hyperchloremic Acidosis Following Vesico-Sigmoidostomy i n
Dogs. K. Miller, U. Matsui and R. Hautmann
Effects of Sclerosant, Ethanolamine, on Venous Drainage System of Dog Penis. J . Τ. K. Tiong, Z. S.
Wisniewski, E. J . Keogh, C. M. Earle, A. G. S. Tulloch, D. J . Lord, J . M. Harvey and J . M. Papadimitriou
Effects of Magnesium Salts i n Preventing Experimental Oxalate Urolithiasis i n Rats. Y. Ogawa, K.
Yamaguchi and M. Morozumi
Bradykinin-Induced Contractions of Canine Prostate and Bladder: Effect of Angiotensin Converting Enzyme
I n h i b i t i o n . C. P. Streidle, M. L . Cohen and B. L . Neubauer
366
370
375
381
385
390
UROLOGICAL SURVEY
Principles of Oncology and Immunology, and Tumors of Bladder, Penis and U r e t h r a
Male Infertility
Sexual Function and Dysfunction
Renal Calculi
Renal Tumors, Retroperitoneum, Ureter, and U r i n a r y Diversion and Reconstruction
Book Reviews
394
400
402
405
407
409
411
N e w Information for A u t h o r s 1 9 9 0
N U M B E R 2, P A R T 2, A U G U S T
Tumors
Flow Cytometric Evaluation of Multicystic Dysplastic Kidneys. W. H. Jung, C. A. Peters, J . Mandell, G. F.
Vawter and A. B. Retik
Necessity of Contralateral Surgical Exploration i n W i l m s T u m o r W i t h Modern Noninvasive Imaging Tech­
nique: Reassessment. A. S. Koo, M. A. Koyle, R. S. Hurwitz, D. Weese, Η. Applebaum, Ε. W. Fonkalsrud
and R. Μ. Ehrlich
Influence of Nephrectomy on G r o w t h of M u r i n e W i l m s Tumor: Study Using Parabiotic Rats. J . C. S.
Trindade, M. C. Rangel, J . H. Ross, Κ Jojima, Ν. Τ Stowe, R. Kay and J . E. Pontes
413
416
418
C O N T E N T S
VÜ
Discussion
422
Myelodysplasia
Effect of Back Closure on Detrusor Function i n Neonates W i t h Myelomeningocele. R. L . Kroovand, W. Bell,
L . J . Hart and Κ Y. Benfield
Occult Spinal Dysraphism: Clinical and Urodynamic Outcome After Division of F i l u m Terminale. A. E.
Khoury, E. B. Hendrick, G. A. McLorie, A. Kulkarni and Β. M. Churchill (Editorial Comment by T . D.
Allen)
Urethral Dilation Improves Bladder Compliance i n Children W i t h Myelomeningocele and H i g h Leak Point
Pressures. D. A. Bloom, J . M. Knechtel and E. J . McGuire
Periurethral and Puboprostatic Sling Repair for Incontinence i n Patients W i t h Myelodysplasia.
J . S. Elder
Effects of Artificial U r i n a r y Sphincter on Prostatic Development and Sexual Function i n Pubertal Boys W i t h
Meningomyelocele. Β. M. Jumper, G. A. McLorie, Β. M. Churchill, A. E. Khoury and A. Toi
Discussion
423
426
430
434
438
443
Augmentation
Bladder Augmentation: Experience W i t h 129 Children and Young Adults. W. H. Hendren and R. B.
Hendren
Seromuscular Enterocystoplasty i n Dogs. J . L . P. Salle, J . C. S. Fraga, A. Lucib, M. Lampertz, G. Jobim, G.
Jobim and A. Putten
Management of Pregnancy After Augmentation Cystoplasty. D. E. Hill and S. A. Kramer
Discussion
445
454
457
460
Research
Augmentation Cystoplasty i n Rats: Development of A n i m a l Model. Z. Guan, G. Ricard, L . Charest-Boule,
K.
Neilson and G. Kiruluta
Long-Term Effects of Prepubertal Testicular Vessel Ligation on Testicular Function i n Rat. J . A. Pascual,
J . Villaneuva-Meyer,
J . L . Rutgers, C. A. E. Lemmi, S. C. Sikka, R. M. Ehrlich, I . Mena and J . Rajfer . .
Association of Type 1 Blood Group Antigens W i t h U r i n a r y Test Infections i n Children W i t h Genitourinary
Structural Abnormalities. J . Sheinfeld, C. Cordon-Cardo,
W. R. Fair, D. D. Wartinger and R.
Rabinowitz
Discussion
461
466
469
474
INorwich-Eaton Lectureship
Pathogenesis of Nonobstructive U r i n a r y T r a c t Infections i n Children.
Discussion
J . A. Roberts
475
480
Stones
Ureteroscopy i n Children. D. E. Hill, J . W. Segura, D. E. Patterson and S. A. Kramer
Endoscopic Manipulation of Ureteral Calculi i n Children by Rigid Operative Ureterorenoscopy. P. Caione,
M. De Gennaro, N. Capozza, A. Zaccara, C. Appetito, A. Lais, M. Gallucci and F. di Silverio
Percutaneous Balloon D i l a t i o n of Ureteral Strictures After Failed Surgical Repair i n Children. H. Aliabadi,
Y. Reinberg and R. Gonzalez
Lithostar Extracorporeal Shock Wave Lithotripsy i n Children. E. Abara, P. A. Merguerian, G. A. McLorie,
Κ Ε. Psihramis, Μ. A. S. Jewett and Β. M. Churchill
Discussion
481
484
486
489
492
Testis
Flow Cytometric Analysis of Undescended Testes i n Children. K. S. Ring, K. A. Burbige, M. C. Benson, F.
Karp and T. W. Hensle
Effect of Experimental Varicocele on Testis of Adolescent Rats. H. Choi, K. S. Kim and Κ Μ. Kim
Significance of Intraoperative Venographic Patterns on Postoperative Recurrence and Surgical Incision
Placement of Pediatric Varicoceles. B. Gill, S. J . Kogan, J . Maldonado, E. Reda and S. B. Levitt
Microvascular Autotransplantation of Intra-Abdominal Testis. C. B. Harrison, G. W. Kaplan, H. C. Scherz,
Μ. G. Packer and J . Jones
Efficacy of Orchiopexy by Patient Age 1 Year for Cryptorchidism. S. J . Kogan, S. Tennenbaum, Β. Gill, Ε.
Reda and S. Β. Levitt
Diagnostic Pneumoperitoneum for Detection of Clinically Occult Contralateral Hernia i n Children. C. B.
Harrison, G. W. Kaplan, H. C. Scherz and M. G. Packer
Discussion
494
499
502
506
508
510
512
iPediatric Urology Medal
Dr. Jack Lapides: Clinician, Teacher, Investigator and Innovator.
B. A. Kogan
514
Hypospadias
Caudal Epidural Anesthesia Reduces Blood Loss D u r i n g Hypospadias Repair. J . B. Gunter, J . E. Forestner
and C. B. Manley
Single Stage Hypospadias Reconstruction W i t h o u t Fistula. E. J . Kass and D. Bolong
Sleeve Advancement Distal Hypospadias Repair. J . R. Spencer and A. D. Perlmutter
Experience W i t h 81, 1-Stage Hypospadias/Chordee Repairs W i t h Free Graft Urethroplasties. P. E. Rober,
A. D. Perlmutter and C. Reitelman
Discussion
517
520
523
526
530
viii
CONTENTS
Reflux and Urinary Tract Infection
Submucosal Injection of Polyvinyl Alcohol Foam i n Rabbit Bladder. P. A. Merguerian, G. A. McLorie, A. E.
Khoury, P. Thorner and Β. M. Churchill
Endoscopic Correction of Vesicoureteral Reflux: Our Experience W i t h 115 Ureters. A. Farkas, Ε. Z. Moriel
and S. Lupa
High Grade Vesicoureteral Reflux: Analysis of Observational Therapy. G. A. McLorie, P. H. McKenna,
Β. M. Jumper, Β. M. Churchill, R. F. Gilmour and A. E. Khoury
Renal Scarring and Vesicoureteral Reflux i n Children W i t h Myelodysplasia. R. A. Cohen, H. G. Rushton,
A. B. Belman, E. J . Kass, M. Majd and C. Shaer
Discussion
531
534
537
541
545
Exstrophy and Incontinence
Technique for Bladder Neck Reconstruction i n Exstrophy: Cinch. S. A. Koff
Fascia Lata and Early Spica Casting as Adjuncts i n Closure of Bladder Exstrophy. H. C. Scherz, G. W.
Kaplan, D. H. Sutherland and M. G. Packer
Cloacal Exstrophy Reconstruction for U r i n a r y Continence. Μ. E. Mitchell, C. G. Brito and R. C. Rink . . . .
Management of Urinary Incontinence by Bladder Tube U r e t h r a l Lengthening and Submucosal Reimplanta­
tion. T. G. Nill, P. A. Peller and K. A. Kropp
Discussion
546
550
554
559
562
Prenatal and Postnatal Hydronephrosis
Experimental Ureteral Obstruction i n Fetal Opossum. I . Renal Functional Assessment. G. Steinhardt, L .
Salinas-Madrigal,
R. Farber, R. Lynch and G. Vogler
Effect of Protein Intake on Lifelong Changes i n Renal Function of Rats W i t h Solitary Kidney Damaged at
Young Age. A. P. Provoost, Μ. H. De Keijzer and J . C. Molenaar
Evaluation of Fetal Renal Function: Unreliability of Fetal U r i n a r y Electrolytes. J . S. Elder, J . P. O'Grady,
G. Ashmead, J . W. Duckett and E. Philipson
Transitional Hydronephrosis of Newborn and Infant. Y. L . Homsy, F. Saad, I . Laberge, P. Williot and C.
Pison
Postnatal Management of Hydronephrosis Diagnosed by Prenatal Ultrasound. P. G. Ransley, Η. Κ Dhillon,
I . Gordon, P. G. Duffy, M. J . Dillon and Τ. M. Barratt
Importance of Visualizing Ureter Before Performing Pyeloplasty. S. N. Cockrell and W. H. Hendren
Discussion
564
567
574
579
584
588
593
Imaging
Renal Cortical Scintigraphy and Single Proton Emission Computerized Tomography (SPECT) i n Assess­
ment of Renal Defects i n Children. D. B. Joseph, D. W. Young and S. P. Jordon
High Resolution Single Photon Emission Computerized Tomography (SPECT)
Technetium-DimercaptoSuccinic Acid Renal Imaging: State of A r t Technique. M. A. Tarkington, R. D. Fildes, Κ Levin, Η.
Ziessman, Β. Harkness and Μ. D. Gibbons
M o n i t o r i n g Renal Function i n Children W i t h Urological Abnormalities. P. S. Chandhoke, B. A. Kogan, A.
Al-Dahwi, J . DuBois and M. A. Holliday
Discussion
595
99m
N U M B E R 3,
598
601
606
SEPTEMBER
CLINICAL UROLOGY
Review Article
Current Status of T u m o r of Bowel Following Ureterosigmoidostomy.
D. A. Husmann and Η. M. Spence
..
607
Original Articles
Computerized Tomography i n Acute Pyelonephritis: Clinical Correlations. N. Tsugaya, N. Hirao, H.
Sakagami, Y. Iwase, H. Watase, Κ Ohtaguro and H. Washida
Preparative Cytoreductive Surgery i n Patients W i t h Metastatic Renal Cell Carcinoma Treated W i t h Adop­
tive Immunotherapy W i t h Interleukin-2 or Interleukin-2 Plus Lymphokine Activated K i l l e r Cells. C.
N. Robertson, W. M. Linehan, Η. I . Pass, L . G. Gomella, G. P. Haas, A. Berman, M. Merino and S. A.
Rosenberg (Editorial Comments by J . P. Richie and J . B . deKernion)
Effect of Extracorporeal Shock Wave L i t h o t r i p s y on Microbiological Flora of U r i n a r y Calculi. M. L . Stoller
and S . J . Workman
Experience W i t h Dornier H M 4 and M P L 9000 Lithotriptors i n Urinary Stone Treatment. G. G. Tailly . . .
Percutaneous Antegrade Fiberoptic Ureterorenoscopic Treatment of Ureteral Calculi. W. B. C. Berkhoff and
F. Meijer (Editorial Comments by R. V . Clayman and J . L . Huffman)
Endourological Management of Ureteral Strictures. N. R. Netto, J r . , U. Ferreira, G. C. Lemos and J . F. A.
Claro
Low Dose Intravesical Heparin as Prophylaxis Against Recurrent Noninvasive (Stage Ta) Bladder Can­
cer. M. Bitsch, G. G. Hermann, J . P. Andersen and K. Steven
Quantitative Immunocytology i n Management of Patients W i t h Superficial Bladder Carcinoma. I . Marker to
Identify Patients W h o Do N o t Require Prophylaxis. E. Huland, H. Huland and A. W. Schneider (Edi­
torial Comments by M . J . Droller and R. Oyasu)
Role of Radical Cystectomy i n Management of High Grade Superficial Bladder Cancer (PA, P I , PIS and
611
614
619
622
628
631
635
637
C O N T E N T S
IX
P2). S. B. Malkowicz, P. Nichols, G. Lieskovsky, S. D. Boyd, J . Huffman and D. G. Skinner (Editorial
Comments by Β. L y t t o n and W. R. Fair)
Deoxyribonucleic Acid Flow Cytometry i n Predicting Response to Radical Radiotherapy of Bladder Can­
cer. H. Wijkström and B. Tribukait (Editorial Comments by M . J . Droller and M . C. Benson)
Long-Term Followup of Patients Treated W i t h 1 or 2, 6-Week Courses of Intravesical Bacillus CalmetteGuerin: Analysis of Possible Predictors of Response Free of Tumor. D. E. Coplen, M. D. Marcus, J . A.
Myers, T. L . Ratliff and W. J . Catalona
Randomized Controlled Study of Intravesical a-2b-Interferon i n Carcinoma I n Situ of Bladder. R. W.
Glashan
Usefulness and L i m i t a t i o n s of Methotrexate, Vinblastine, Doxorubicin and Cisplatin for Treatment of A d vanced Urothelial Cancer. M. Igawa, T. Ohkuchi, Τ Ueki, M. Ueda, K. Okada and T. Usui (Editorial
Comments by Μ. B. Garnick and W . R. Fair)
Urethral Recurrence Following Radical Cystectomy.
S. W. Hardeman and M. S. Soloway (Editorial Com­
ment by J . E. Montie)
Voiding Dysfunction Following Cystourethropexy: Its Evaluation and Management. G. D. Webster and Κ J .
Kreder
Post-Prostatectomy U r i n a r y Incontinence: Response to Behavioral T r a i n i n g . J . P. Meaglia, A. C. Joseph,
M. Chang and J . D. Schmidt
Impotence Following Delayed Repair of Prostatomembranous Urethral D i s r u p t i o n . C. B. Dhabuwala, S.
Hamid, D. M . Katsikas and J . M. Pierce, J r . (Editorial Comment by G. D . Webster)
Penile Vein Ligation for Corporeal Incompetence: Evaluation of S h o r t - T e r m and Long-Term Results. B.
Rossman, M. Mieza and A. Melman (Editorial Comments by I . Goldstein and J . Rajfer)
Concentration of Ofloxacin and Ciprofloxacin i n H u m a n Semen Following Single Oral Dose. S. A. Berger,
H. Yavetz, G. Paz, A. Gorea and Z. Homonnai
Modern Radiotherapy Results W i t h B u l k y Stages I I and I I I Seminoma.
S. R. Smalley, J . D. Earle, R. G.
Evans and R. L . Richardson (Editorial Comments by Ε. E. Fraley and J . P. Richie)
Efficacy of Norfloxacin i n Treatment of Chronic Bacterial Prostatitis Refractory to T r i m e t h o p r i m - S u l ­
famethoxazole and/or Carbenicillin. A. J . Schaeffer and F. S. Darras
Transurethral Incision of Bladder Neck and Prostate. P. G. Katz, A. Greenstein, J . E. Ratliff, S. Marks and
J . Guice (Editorial Comments by W. K . Mebust and A. Orandi)
Visual Disturbances, Serum Glycine Levels and Transurethral Resection of Prostate. A. R. Mizutani, J .
Parker, J . Katz and J . Schmidt
Prognosis of Patients W i t h Stage D l Prostate Carcinoma Following Radical Prostatectomy W i t h and W i t h ­
out Early Endocrine Therapy. J . B. deKernion, H. Neuwirth, A. Stein, F. Dorey, A. Stenzl, J . Hannah
and B. Blyth (Editorial Comment by R. P. Gibbons)
I o d i n e Reimplantation for Locally Progressive Prostatic Carcinoma. Κ. E. Wallner, D. Nori, M. J . Morse,
P. C. Sogani, W. F. Whitmore and Z. Fuks
Use of Transrectal Ultrasound i n Detection and Evaluation of Local Pelvic Recurrences After Radical
Urological Pelvic Operation. R. O. Parra, R. M. Wolf and R. P. Huben (Editorial Comments by Η. M .
Pollack and Μ. I . Resnick)
Experiences i n Treatment of Chyluria i n Taiwan. L . - B . Tan, C.-P. Chiang, C.-H. Huang, Y.-H. Chou and CJ . Wang
641
646
652
658
662
666
670
674
677
679
683
685
690
694
697
700
125
704
707
710
Urologists At Work
Corporeal Perforation or Undersized Prosthesis? Role of Corpus Cavernosum Endoscopy.
P. E. Zimmern (Editorial Comment by D. K . Montague)
D. L . Weese and
714
Pediatric Articles
Improved Results of Vascular Reconstruction i n Pediatric and Young A d u l t Patients W i t h Renovascular
Hypertension. A. Martinez, A. C. Novick, R. Cunningham and M. Goormastic
Comparison of 2 Protocols for Living-Related Renal Transplantation i n Children: Donor-Specific Transfu­
sions Versus Cyclosporine.
M. R. Leone, S. R. Alexander, T. Melvin, J . Striegel, Κ Reller, D. J . Norman
and J . M. Barry
Exstrophy of Testis. C. F. Heyns
Testicular Sparing Surgery for Prepubertal Teratoma of Testis: Clinical and Pathological Study. H. G.
Rushton, A. B. Belman, I . Sesterhenn, K. Patterson and F. Κ Mostofi
717
721
724
726
C a s e Reports
Adrenal Adenoma W i t h Excess Secretion of Corticosterone and 18-Hydroxycorticosterone.
M. Morioka, Y.
Sen, K. Inoue and Y. Fujita
Alveolar Echinococcosis W i t h Involvement of Ureter and Testis. W. L . Strohmaier, K.-H. Bichler, D. M.
Wilbert and Η Μ. Seitz
Resection of Nonrenal Retroperitoneal Tumors W i t h Large Vena Caval T h r o m b i Using Cardiopulmonary
Bypass and Hypothermic Circulatory Arrest. K. W. Angermeier, J . H. Ross, A. C. Novick, J . E. Pontes
and D. M. Cosgrove
Rupture of Ileal Neobladder Due to Urethral Obstruction by Mucous Plug. G. Haupt, J . Pannek,
H.-J.
Knopf, H. Shulze and Th. Senge
Neurofibromatosis: Bladder Involvement W i t h Malignant Degeneration. C. A. Hülse
Adenocarcinoma of Prostate Discovered i n 2 Young Patients Following T o t a l Prostatovesiculectomy for
Refractory Prostatitis. Β. E. Davis and J . W. Weigel
Radiation-Induced Prostatic Sarcoma. J . M. Scully, J . M. Uno, Μ. Mclntyre and S. Mosely
731
733
735
740
742
744
746
χ
C O N T E N T S
Letters to Editor
Re: Approaches to Superior Calix: Renal Displacement Technique and Review of Options, by G. S. K a r l i n
and A. D. Smith. Κ. Η Barth
Re: Deoxyribonucleic Acid Content and Medroxyprogesterone Acetate Treatment i n Metastatic Renal Cell
Carcinoma, by B. Ljungberg, R. Tomic and G. Roos. H. Neuwirth, B. Blyth, A, W. S. Richie, D. M.
Taube and J . B. deKernion
Re: Impact of Endourology on Diagnosis and Management of Upper U r i n a r y T r a c t Urothelial Cancer, by M .
L . Blute, J . W. Segura, D. E. Patterson, R. C. Benson, Jr. and H . Zincke. J . A. Martinez-Piherio
Re: Complications of Whole Bladder Dihematoporphyrin Ether Photodynamic Therapy, by J . I . H a r t y , M .
A m i n , Τ. J . Wieman, Μ. T . Tseng, D. Ackerman and W . Broghamer. B. P. Shumaker, U. 0. Nseyo, S.
Lundahl and D. C. Merrill
Re: Risk of Distant Metastases After Transurethral Resection of Prostate Versus Needle Biopsy i n Patients
W i t h Localized Prostate Cancer, by R. B. Meacham, P. T . Scardino, G. S. Hoffman, J . D . Easley, J . H .
Wilbanks and C. E. Carlton, Jr. G. E. Hanks
749
749
750
750
751
INVESTIGATIVE UROLOGY
T h i s M o n t h i n Investigative Urology: M u l t i d r u g Resistance i n Genitourinary Malignancy. G. H. Weiss and
W. M. Linehan
Mechanisms and Modulation of M u l t i d r u g Resistance i n P r i m a r y H u m a n Renal Cell Carcinoma. G. H.
Mickisch, Κ. Roehrich, J . Koessig, S. Forster, R. Κ Tschada and P. M. Aiken
Differences i n Expression of Oligosaccharide Determinants by Phenotypically D i s t i n c t Sublines of D u n n i n g
3327 Rat Prostate Cancer. P. D. Abel, C. S. Foster, S. Tebbutt and G. Williams
Ontogeny of Bladder Function i n Rabbit. M. A. Keating, J . W. Duckett, Η. M. Snyder, A. J . Wein, L . Potter
and R. M. Levin
Effects of New Bisphosphonate ( A H B u B P ) on Osteolysis Induced by H u m a n Prostate Cancer Cells i n Nude
Mice. R. Nemoto, S. Sato, Y. Nishijima, I . Miyakawa, Κ Koiso and M. Harada
Agonist-Induced Contraction and Accumulation of Inositol Phosphates i n Guinea-Pig Detrusor: Evidence
T h a t Muscarinic and Purinergic Receptors Raise Intracellular Calcium by Different Mechanisms. J .
W. Iacouou, S. J . Hill and A. T. Birmingham
Bacterial Epididymitis i n Rat: Model for Assessing Impact of Acute I n f l a m m a t i o n on Epididymal A n t i b i o t i c
Penetration. W. A. See, T. 0. Taylor, L . A. Mack, T. A. Tartaglione, Κ E. Opheim and R. E. Berger...
I n Vivo Effects of H i g h Energy Shock Waves on Urological Tumors: Evaluation of Treatment M o d a l ­
ities. G. Ο. N. Oosterhof, G. A. H. J . Smits, A. E. de Ruyter, J . A. Schalken and F. M. J . Debruyne . . . .
Effect of Venous Incompetence and Arterial Insufficiency on Erectile Function: A n i m a l Model. S. R.
Aboseif, U. Wetterauer, J . Breza, F. Benard, R. Bosch, C. G. Stief, Τ F. Lue and Ε. Tanagho
Hemodynamics of Pelvic Nerve Induced Erection i n Canine Model. I . Pressure and Flow. Y. Vardi and M.
B. Siroky
Mechanisms of Human Bladder T u m o r Invasion: Role of Protease Cathespin B. R. E. Weiss, B. C.-S. Liu,
T. Ahlering, L . Dubeau and M. J . Droller
754
755
760
766
770
775
780
785
790
794
798
UROLOGICAL SURVEY
Diagnostic Urology and Testis Cancer
Adrenal, Hypertension, Renal Physiology and Renal Failure
Kidney Transplantation and Renovascular Hypertension
Voiding Function and Dysfunction, and Female Urology
Book Reviews
806
811
815
819
823
824
N e w s and Announcements
N U M B E R 4, O C T O B E R
CLINICAL UROLOGY
Review Article
Bladder Mucosa i n Urethral Reconstruction.
827
M. A. Keating, P. C. Cartwright and J . W. Duckett
Special Article
Urology: 1990 Perspectives.
835
J . H. McGovern
Original Articles
Technique of Left Adrenalectomy for Autotransplantation to Caudate Nucleus i n Parkinson's Disease. E.
Skinner, S. D. Boyd and M. L . J . Apuzzo (Editorial Comments by A. C. Novick and P. C. Peters)
O n Necessity of Adrenal E x t i r p a t i o n Combined W i t h Radical Nephrectomy. P. Winter, W.-D. Miersch,
Vogel and N. Jaeger (Editorial Comments by B . L y t t o n and F. F. Marshall)
Selection Criteria for Evaluation of L i v i n g Related Renal Donors. R. A. Riehle, J r . , R. Steckler, Ε.
Naslund, R. Riggio, J . Cheigh and W. Stubenbord
Familial Renal Cell Carcinoma: Hereditary or Coincidental? Α. Κ Leuinson, D. E. Johnson, L . C. Strong,
Pathak, V. Huff and G. F. Saunders
C.
838
J.
842
B.
845
S.
849
C O N T E N T S
XI
Progression and Survival After Renal-Conserving Surgery for Renal Cell Carcinoma: Experience i n 104
Patients and Extended Followup. W. R. Morgan and H. Zincke (Editorial Comments by A. C. Novick
and J . B . deKernion)
Prognostic Factors i n Patients W i t h Primary Transitional Cell Carcinoma of Upper U r i n a r y Tract. R. A.
Badalament, R. V. O'Toole, P. Kenworthy, D. C. Young, S. Keyhani-Rofagha, J . Simon, J . F. Perez and J .
R. Drago
Continent Colonic U r i n a r y Reservoir: Florida Pouch. J . L . Lockhart, J . M. Pow-Sang, L . Persky, P. Kahn,
Μ. Helal and E. Sanford
Interstitial Cystitis: Bladder Mucosa Lymphocyte Immunophenotyping and Peripheral Blood Flow Cytome­
t r y Analysis. D. S. Harrington, M. Fall and S. L . Johansson
Small Urothelial Carcinoma: Diagnosis and Treatment by Cold Forceps Biopsy. G. Bianchi, P. Novelli, P.
Beltrami, M. Bonzanini and G. Mobilio (Editorial Comments by H . W . H e r r and Τ. H . Stanisic)
Growth Factors of Transitional Cell Carcinomas of Bladder Defined by Monoclonal Antibody K I - 6 7 . K.
Okamura, Κ Miyake, T. Koshikawa and J . Asai
Characterization of Squamous Cell Bladder Tumors by Flow Cytometric Deoxyribonucleic Acid Analysis:
Report of 100 Cases. A. A. Shaaban, B. Tribukait, A.-F. A. El-Bedeiwy and M. A. Ghoneim
Prediction of L y m p h Node Metastases i n Bladder Carcinoma W i t h Deoxyribonucleic Acid Flow Cytome­
t r y . A. A. Shaaban, B. Tribukait, A.-F. A. El-Bedeiwy and M. A. Ghoneim
Diagnostic Value of Radioisotope Erection Penogram for Vasculogenic Impotence. S. C. Kim, Κ Β. Kim and
C. H. Oh (Editorial Comment by T . F. Lue)
Penile Blood Flow Changes i n Flaccid and Erect State i n Potent Young M e n Measured by Duplex Scan­
ning. B. C. Meilinger and E. D. Vaughan, J r
Papaverine-Induced Penile Blood Flow Acceleration i n Impotent M e n Measured by Duplex Scanning. B. C.
Meilinger, J . J . Fried and E. D. Vaughan, J r
Cigarettes, Alcohol and Marijuana are Related to Pyospermia i n Infertile M e n . C. E. Close, P. L . Roberts
and R. E. Berger
Preliminary Evaluation of Color Doppler Imaging for Investigation of Intrascrotal Pathology. J . N. Krieger,
Κ Wang and L . Mack
Use of al-Blocker,
YM617, i n Treatment of Benign Prostatic Hypertrophy. Κ Kawabe, A. Ueno, Y.
Takimoto, Y. Aso, H. Kato and YM617 Clinical Study Group (Editorial Comments by A. J . W e i n and H .
Lepor)
Local Microwave Hyperthermia of Benign Prostatic Hyperplasia. W. L . Strohmaier, K.-H. Bichler, S. H.
Flüchter and D. M. Wilbert
Internal Urethrotomy of Prostatic Urethra or Transurethral Resection i n Benign Prostatic Hyperplasia. C.
A. L . DAncona, N. R. Netto, J r . , A. M. Card and O. Ikari
Prostate Specific Antigen and Local Recurrence After Radical Prostatectomy. D. J . Lightner, P. H. Lange,
P. K. Reddy and L . Moore (Editorial Comments by P. C. Walsh and T . A. Stamey)
Effect of Radiation Therapy After Radical Prostatectomy i n Patients W i t h Elevated Prostate Specific A n t i gen Levels. P. H. Lange, D. J . Lightner, Ε. Medini, P. Κ Reddy and R. L . Vessella (Editorial Comments
by P. C. Walsh and T . A. Stamey)
Influence of Different Types of Antiandrogens on Luteinizing Hormone-Releasing Hormone Analogue-In­
duced Testosterone Surge i n Patients W i t h Metastatic Carcinoma of Prostate. H. Schulze and Τ Senge
852
859
864
868
872
875
879
884
888
894
897
900
904
908
913
918
921
927
934
Urologists At Work
Subepididymal Orchiectomy: Acceptable Alternative.
942
J . F. Glenn
Urological Neurology and Urodynamics
Reduction i n H u m a n Bladder W a l l Compliance Following Decentralization. J . G. Sislow and Μ. E. Mayo
(Editorial Comment by E. J . McGuire)
New Technique for Assessing Efferent Innervation of H u m a n Striated U r e t h r a l Sphincter. /. Eardley, K.
Nagendran, R. S. Kirby and C. J . Fowler
945
948
Pediatric Articles
Nuclear Morphometry as Predictor of Response to Therapy i n W i l m s T u m o r : Preliminary Report. A. W.
Partin, A. C. Walsh, J . I . Epstein, B. G. Leventhal and J . P. Gearhart
Augmentation Cystoplasty Complicated by Postoperative Ventriculoperitoneal Shunt Infection. Κ J .
Kreder, G. D. Webster and W. J . Oakes (Editorial Comment by T . D . Allen)
Clinicopathological
952
955
Conference
Rapidly Progressive Bilateral Ureteral Obstruction.
Brendler
P. N. Schlegel, J . I . Epstein,
Ε. Κ Fishman
and C. B.
957
C a s e Reports
Intrarenal Opacity Resisting Extracorporeal Shock Wave Lithotripsy. H. Vandeursen and L . Baert
Massive Intratubular Hemorrhage W i t h Herniations I n t o Renal Veins. A. Billis, P. C. R. Palma, A. Prando
and A. A. Gouvea
Percutaneous Nephrectomy i n Nonfunctioning Kidneys: Preliminary Report. O. Ikari, N. R. Netto, J r . , P.
C. R. Palma and C. A. L . DAncona
Portal Venous Drainage for Cadaveric Renal Transplantation. J . T. Rosenthal and R. K. Loo
Ureteral Stump Transitional Cell Carcinoma i n Patient W i t h Recurrent Superficial Bladder Cancer: A r g u ­
ment for Complete Nephroureterectomy i n Selected Patients. L . W. Klee, Μ. C. Adams and R. S. Foster
961
963
966
969
972
xii
C O N T E N T S
Endoscopic Extraction of Eroded Marlex Mesh i n Kock Pouch. L . S. Baskin and M. L . Stoller
Eosinophilic Cystitis Presenting as Invasive Bladder Cancer: Comments on Pathogenesis and Manage­
ment. A. Thijssen and R. G. Gerridzen
Adenocarcinoma Development i n Trigone 34 Years After Trigonocolonic U r i n a r y Diversion for Exstrophy of
Bladder. P. B. Mortensen, K. E. J . Jensen and K. Nielsen
Skin Necrosis Caused by Use of Negative Pressure Device for Erectile Impotence.
W. Meinhardt, R. F.
Kropman, Α. A. B. Lycklama a Nijeholt and J . Zwartendijk
Pyoderma Gangrenosum Presenting as Fournier's Gangrene. L . S. Baskin, C. Dixon, M. L . Stoller and P. R.
Carroll
Traumatic Rupture of Corpus Cavernosum: Evaluation and Management.
M. Cendron, K. E. Whitmore, V.
Carpiniello, S. J . Kurzweil, P. M. Hanno, Η. Μ. Snyder and J . W. Duckett
Artificial Spermatocele Persisting for 14 Years. W. Ludvik (Editorial Comments by A. M . Belker and L . S.
Ross)
Testicular Tumor Presenting W i t h Torsion of Testicle. J . M. Perez (Editorial Comment by J . W .
McRoberts)
Spontaneous Breakage of Self-Retaining Intraprostatic Stent. D. Yachia
INVESTIGATIVE
974
977
980
983
984
987
992
995
997
UROLOGY
Laser Assisted Urethral Closure i n Rat: Comparison of C 0 and Neodymium-YAG Laser Technique.
R. A.
Bürger, C.-D. Gerharz, H. Bunn, U. H. Engelmann and R. Hohenfellner
Dipyridamole-Cisplatin Potentiation: Enhanced I n Vivo Cytotoxicity i n Xenograft Models of H u m a n T e s t i cular and Bladder Cancers. Τ. E. Keane, G. Rosner, J . T. Donaldson, D. L . Norwood, S. H. Poulton and
P. J . Walther
Characterization of Soluble M a t r i x Proteins i n Selected H u m a n Renal Calculi Using Two-Dimensional Poly­
acrylamide Gel Electrophoresis.
W. T. Jones and Μ. I. Resnick
Endothelium Dependent Relaxation of Human Corpus Cavernosum by B r a d y k i n i n . Y. Kimoto, R. Kessler
and C. E. Constantinou
Testicular Blood Flow i n Peripubertal and Older Rats W i t h Unilateral Experimental Varicocele and Investi­
gation I n t o Mechanism of Bilateral Response to Unilateral Lesion. Τ. T. Turner and T. J . Lopez
Urethral Function After Chronic Cauda Equina Lesions i n Cats. I . Contribution of Mechanical Factors and
Sympathetic Innervation to Proximal Sphincter Dysfunction. H. D. Flood, J . W. Downie and S. A.
Awad
Urethral Function After Chronic Cauda Equina Lesions i n Cats. I I . Role of Autonomically-Innervated
Smooth and Striated Muscle i n Distal Sphincter Dysfunction. H. D. Flood, J . W. Downie and S. A.
Awad
Characterization of Muscarinic Acetylcholine Receptors i n H u m a n Penile Corpus Cavernosum: Studies on
Whole Tissue and Cultured Endothelium. A. M. Traish, M. P. Carson, N. Kim, I . Goldstein and I . Saenz
de Tejada
Nonrefluxing Ileal Ureteral Replacement Using Intussuscepted Ileal Nipple: Laboratory Studies. A. C.
Weinburg, Η. W. Xie, Β. E. Hardy and D. G. Skinner
Structural Changes i n Aging Submucosa: New Morphologic Criteria for Evaluation of Unstable H u m a n
Bladder. B. J . Levy and Τ. N. Wight
Investigative Grammar
2
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1004
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1022
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1036
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1056
UROLOGICAL SURVEY
Benign and Malignant Neoplasms of Prostate
Imaging
Pediatric Urology
Perioperative Care
Urinary Tract Infection
Book Reviews
1058
1060
1065
1071
1075
1080
1081
New Information for Authors 1990
N U M B E R 5,
NOVEMBER
CLINICAL UROLOGY
State of Art Article
Neoadjuvant Chemotherapy i n Invasive Bladder Cancer: Evolving Role of Surgery.
Whitmore, J r . , M. J . Morse, P. C. Sogani, P. Russo, J . Sheinfeld and W. R. Fair
H. W. Herr,
W. F.
1083
Original Articles
Anatomical Relationship Between Renal Venous Arrangement and Kidney Collecting System. F. J . B.
Sampaio and Α. Η. M. Aragäo
1089
Surgical Treatment of Renal Artery Stenosis After Failed Percutaneous T r a n s l u m i n a l Angioplasty. A. G.
Martinez, A. C. Novick and J . M. Hayes
1094
C O N T E N T S
Incidence and Properties of Renal Masses and Asymptomatic Renal Cell Carcinoma Detected by Abdominal
Ultrasonography. A. Tosaka, K. Ohya, Κ Yamada, H. Ohashi, S. Kitahara, H. Sekine, Y. Takehara and
Κ Oka
Magnetic Resonance Imaging for Assessment of Vena Caval Tumor T h r o m b i : Comparative Study W i t h
Venacavography and Computerized Tomography Scanning. D. A. Goldfarb, A. C. Novick, R. Lorig, P. N.
Bretan, J . E. Montie, J . E. Pontes, S. B. Streem and S. W. Siegel (Editorial Comments by J . B.
deKernion and B. L . McClennan)
Extravesical Versus Leadbetter-Politano Ureteroneocystostomy: Comparison of Urological Complications i n
320 Renal Transplants. J . B. Thrasher, D. R. Temple and Ε. K. Spees
Ureterosigmoidostomy: Long-Term Results, Risk of Carcinoma and Etiological Factors for Carcinogen­
esis. Τ Kälble, A. R. Tricker, P. Friedl, R. Waldherr, J . Hoang, G. Staehler and Κ Möhring
Primary Adenocarcinoma of Bladder: Favorable Prognostic Significance of Deoxyribonucleic Acid Diploidy
Measured by Flow Cytometry. J . Song, G. M. Farrow and Μ. M. Lieber
Randomized Phase I I Evaluation of Carboplatin and C H I P i n Advanced Transitional Cell Carcinoma of
Urothelium. D. L . Trump, P. Elson, S. Madajewicz, S. H. Dickman, R. G. Hahn, J . E. Harris, S. E. Vogl
and Eastern Cooperative Oncology Group
Perioperative Methotrexate, Vinblastine, Doxorubicin and Cisplatin ( M - V A C ) for Poor Risk Transitional
Cell Carcinoma: Eastern Cooperative Oncology Group Pilot Study. R. Dreicer, Ε. M. Messing, P. J .
Loehrer and D. L . Trump (Editorial Comments by M . J . Droller, N . J . Vogelzang and A. Yagoda)
Preliminary Results i n Invasive Bladder Cancer W i t h Transurethral Resection, Neoadjuvant Chemotherapy
and Combined Pelvic Irradiation Plus Cisplatin Chemotherapy. G. R. Prout, J r . , W. U. Shipley, D. S.
Kaufman, Ν. M. Heney, P. P. Griffin, A. F. Althausen, Β. Bassil, Β. Ν. Nocks, Ε. C. Parkhurst and Η. Η.
Young, II (Editorial Comments by Μ. A. Bagshaw, D. G. Skinner, M . J . Droller and Μ. B. Garnick) . . .
Local Recurrence and Survival Following Nerve-Sparing Radical Cystoprostatectomy.
C. B. Brendler, G. D.
Steinberg, F. F. Marshall, J . L . Mostwin and P. C. Walsh (Editorial Comments by J . Garnett and G.
Lieskovsky)
Recurrent Urethral Stricture Disease Managed by Clean I n t e r m i t t e n t Self-Catheterization. L . H. Newman,
Ν. N. Stone, J . H. Chircus and H. C. Kramer
Microarchitecture of Intracavernosal Smooth Muscle and Cavernosal Fibrous Skeleton. Α. Μ. B. Goldstein
and Η. Ρadma-Nathan
Arteriographically Determined Occlusive Disease W i t h i n Hypogastric-Cavernous Bed i n Impotent Patients
Following B l u n t Perineal and Pelvic Trauma. F. J . Levine, A. J . Greenfield and I . Goldstein
Patient Acceptance of and Satisfaction W i t h External Negative Pressure Device for Impotence. A. A. Sidi,
E. F. Becher, G. Zhang and J . H. Lewis
Testicular Carcinoma i n Patients Positive and at Risk for H u m a n Immunodeficiency Virus. M. Wilkinson
and P. R. Carroll
Clinical Stage 1 Testicular Cancer: Role of Modified Retroperitoneal Lymphadenectomy. J . P. Richie . . . .
Erythrocyte Polyamine Levels i n H u m a n Prostatic Carcinoma. B. Cipolla, J . - P . Moulinoux, V. Quemener,
R. Havouis, L.-A. Martin, F. Guille and B. Lobel
Relationship of Prostate Specific Antigen Levels and Residual Tumor Volume i n Stage A Prostate Can­
cer. Η. B. Carter, A. W. Partin, J . I . Epstein, D. W. Chan and P. C. Walsh (Editorial Comments by D. F.
Faulson and V/. J . Catalona)
Prostate Specific Antigen After Irradiation for Prostatic Carcinoma. /. Kaplan, B. R. Prestidge, R. S. Cox
and M. A. Bagshaw (Editorial Comments by W . J . Catalona, P. H . Lange and W . U . Shipley)
Prostate Specific Antigen for Assessing Response to Ketoconazole and Prednisone i n Patients W i t h H o r ­
mone Refractory Metastatic Prostate Cancer. G. S. Gerber and G. W. Chodak
Radical Prostatectomy for Clinical Stage T 1 - 2 N 0 M 0 Prostatic Adenocarcinoma: Long-Term Results. D. F.
Paulson, J . W. Moul and P. J . Walther
Urinary Excretion of T a m m - H o r s f a l l Protein i n Women W i t h Recurrent U r i n a r y Tract Infections. H.
Reinhart, Ν. Obedeanu, Τ. Hooton, W. Stamm and J . Sobel
1097
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1105
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1128
1137
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1154
1157
1160
1164
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1172
1177
1180
1185
Urologists At Work
Improved Technique for Creation of Ileal Conduit Stoma. J . K. Burgers, D. M. Quinlan and C. B. Brendler
(Editorial Comments by F. S. Freiha and W . F. W h i t m o r e , Jr.)
New Technique for Ileal Nipple Fixation: Preliminary Report. M. A. Atta (Editorial Comments by R. G.
Rowland and L . R. K i n g )
Enveloping Bladder W i t h Displacement of Flap of Rectus Abdominis Muscle for Treatment of Neurogenic
Bladder. Z. Yu-Hai, S. Qiang and W. Jin-Ming
Mohan's Urethral Valvotome: New Instrument. Μ. K. Abraham
Urethral Plug: New Treatment M o d a l i t y for Genuine U r i n a r y Stress Incontinence i n Women. Κ. K.
Nielsen, B. Kromann-Andersen,
H. Jacobsen, Ε. M. Nielsen, J . Nordling, Η. H. Holm and J . F. Larsen
Uncircumcision: Technique for Plastic Reconstruction of Prepuce After Circumcision. W. E. Goodwin . . . .
1188
1192
1194
1196
1199
1203
Urological Neurology and Urodynamics
Urinary Retention Due to Sacral Myeloradiculitis: Clinical and Neurophysiological Study.
Μ. C. Nogueira and E. Wespes
A. G. Herbaut,
1206
Pediatric Articles
Long-Term U r i n a r y Continence and Renal Function i n Neonates W i t h Posterior Urethral Valves. J . P.
Connor and K. A. Burbige
1209
Management of Posterior Urethral Valves by I n i t i a l Vesicostomy and Delayed Valve Ablation. R. D. Walker
Xiv
C O N T E N T S
and M. Padron
Laparoscopy for Nonpalpable Testis: How to Interpret Endoscopic Findings. L . N. Castilho
Pheochromocytoma i n Pediatric Age Group: Prostate—Unusual Location. G. E. Voges, F. Wippermann, C.
Düber and R. Hohenfellner
Nuclear Morphometry as Prognostic Indicator for Genitourinary Rhabdomyosarcoma: Preliminary Investigation. M. P. Leonard, A. W. Partin, J . I. Epstein, R. D. Jeffs and J . P. Gearhart
1212
1215
1219
1222
C a s e Reports
Embolization of Giant Renal Arterial Aneurysm. A. A. Saltiel, T. A. S. Matalon and S. K. Patel
1227
Massive Hemorrhage From Arterioureteral Fistula Associated W i t h Chronic Renal Transplant Failure. A.
List, J . Collins and M. MacCormick
1229
Cyclophosphamide-Induced Hemorrhagic Pyelitis and Ureteritis Associated W i t h Cystitis i n M a r r o w T r a n s plantation. M. Efros, T. Ahmed and M. Choudhury
1231
De Novo Carcinoma of Lower U r i n a r y Tract i n Renal Allograft Recipients. M. J . Lemmers and J . M. Barry 1233
Polyarteritis Nodosa Masquerading as Primary Testicular Neoplasm: Case Report and Review of Literature. Τ. K. Huisman, W. T. Collins, J r . and G. R. Voulgarakis
1236
B u r k i t t ' s Lymphoma of Testicle: Report of 2 Cases Occurring i n Elderly Patients. M. Root, Τ. Y. Wang, H.
Hescock, M. Parker, P. Hudson and L. Balducci
1239
Retroperitoneal L y m p h Node Dissection i n Malignant Mesothelioma of Tunica Vaginalis Testis. J . J .
Smith, HI, M. J . Mahne, J . Geffin, M. L . Silverman and J . A. Libertino
1242
Letters to the Editor
Re: Adrenal Hemorrhage i n Newborn W i t h Evidence of Bleeding i n Utero, by T . Gotoh, Y. Adachi, 0 .
Nounaka, T . M o r i and T . Koyanagi. Y. Reinberg
1244
Re: Prostatic Specific Antigen: Immunoreactivity i n Urachal Remnants, by R. Golz and G. E. Schubert. H.
D. Flood and E. F. Gaffney
1244
Re: Prostatic Needle Biopsy: Simple Technique for Increasing Accuracy, by S. Marshall. D. W. Bussmann
1244
INVESTIGATIVE UROLOGY
T h i s M o n t h i n Investigative Urology: Production of Lymphokines Following B C G Therapy. A. Morales
Radio-Immunoassay Detection of Interferon-Gamma i n Urine After Intravesical Evans B C G Therapy. S.
Prescott, K. James, T. B. Hargreave, G. D. Chisholm and J . F. Smyth
Synchronized Electrical Stimulation of the Sympathetic and Parasympathetic Innervation of Bladder: Facili­
tation of I n i t i a t i o n of M i c t u r i t i o n i n Dog. R. J . L . H. Bosch, S. R. Aboseif, F. Benard, C. G. Stief, R. A.
Schmidt and E. A. Tanagho
Mechanical Properties of Urethra i n Healthy and Stress Incontinent Females: Dynamic Measurements i n
Resting Urethra. G. Lose and H. Colstrup
Determination of Norepinephrine Levels i n A d u l t H u m a n Prostate. H. Lepor, E. Shapiro, R. R. Bowsher
and D. P. Henry
Influence of Chondroitin Sulfate, Heparin Sulfate, and Citrate on Proteus Mirabilis-Induced Struvite Crys­
tallization I n V i t r o . R. J . C. McLean, J . Downey, L . Clapham and J . C. Nickel
Time-Course of Alterations of Bladder Function Following Acetone-Induced Cystitis. K. Kato, S. Kitada, P.
A. Longhurst, A. J . Wein and R. M. Levin
Effects of Intracavernosal Trazodone Hydrochloride: A n i m a l and H u m a n Studies. K. M. Azadzoi, T.
Payton, R. J . Krane and I . Goldstein
Long-Term Effects of Gastrocystoplasty i n Rats. L . W. Klee, D. M. Hoover, Μ. E. Mitchell and R. C. Rink
Comparison of Antigen Expression on Normal Urothelial Cells i n Tissue Section and Tissue Culture. M.
Liebert, G. Wedemeyer, J . H. C. Chang, J . A. Stein, P. E. McKeever, Τ. E. Carey, A. Flint, Z. Steplewski,
D. J . Buchsbaum, R. L . Wahl and Η. B. Grossman
Guinea Pig Model for Study of Bladder Mast Cell Function: Histamine Release and Smooth Muscle Contrac­
tion. Μ. M. Christensen, I . Keith, P. R. Rhodes, F. M. Graziano, P. 0. Madsen, R. C. Bruskewitz and R.
Saban
1246
1248
1252
1258
1263
1267
1272
1277
1283
1288
1293
UROLOGICAL SURVEY
Principles of Oncology and Immunology, and Tumors of Bladder, Penis and U r e t h r a
Male Infertility
Sexual Function and Dysfunction
Renal Calculi
Renal Tumors, Retroperitoneum, Ureter, and U r i n a r y Diversion and Reconstruction
Book Reviews
News and Announcements
1302
1306
1309
1314
1316
1319
1321
C O N T E N T S
N U M B E R 6,
XV
DECEMBER
CLINICAL UROLOGY
Review Article
Hyperfiltration-Induced Renal Injury i n Normal M a n : M y t h or Reality.
E. D. Vaughan, J r
R. E. Steckler, R. A. Riehle, J r . and
1323
Original Articles
Fatal Sepsis Following Intravesical Bacillus Calmette-Guerin A d m i n i s t r a t i o n for Bladder Cancer. W. H.
Rawls, D. L . Lamm, B. A. Lowe, E. D. Crawford, M. F. Sarosdy, J . E. Montie, Η. B. Grossman and P. T.
Scardino
,
Fatal Disseminated Mycobacterial Infection Following Intravesical Bacillus Calmette-Guerin. R. L .
Deresiewicz, R. M. Stone and J . C. Aster (Editorial Comment by D . L . L a m m )
3-Dimensional Imaging of Pelviocaliceal System by Computerized Tomographic Reconstruction.
C. F.
Heyns and W. F. C. van Gelderen
Triamterene Nephrolithiasis: Renewed A t t e n t i o n is Warranted. M. C. Carr, E. L . Prien, J r . and R. K.
Babayan
Prospective Comparison of Plain Abdominal Radiography W i t h Conventional and Digital Renal Tomogra­
phy i n Assessing Renal Extracorporeal Shock Wave L i t h o t r i p s y Patients. Ε. M. Sacks, L . L . Fajardo, B.
J . Hillman, G. W. Drach, J . A. Gaines, H. R. Claypool, N. J . Clinger, D. J . Fillmore, K. R. Hunt, G. D.
Pond and S. H. Smyth (Editorial Comment by S. A. Loening)
Extracorporeal Shock Wave L i t h o t r i p s y i n Patients W i t h Bleeding Diatheses. S. B. Streem and A. Yost ..
Outcome of Renal Transplantation After U r i n a r y Diversion and Enterocystoplasty: Retrospective, Con­
trolled Study. D. H. Nguyen, Y. Reinberg, R. Gonzalez, D. Fryd and J . S. Najarian
Nephron-Sparing Surgery for Renal Cell Carcinoma W i t h Venous Involvement. K. W. Angermeier, A. C.
Novick, S. B. Streem and J . E. Montie (Editorial Comments by F. F. Marshall and Μ. M . Lieber)
Radiation Exposure D u r i n g Ureteroscopy.
D. H. Bagley and A. Cubler-Goodman
Detubularized Right Colonic Segment as U r i n a r y Reservoir: Evolution of Technique for Continent Diver­
sion. W. Mansson, T. Davidsson and S. Colleen (Editorial Comments by R. G. Rowland and A. I .
Sagalowsky)
Adverse Impact of F i b r i n Clot Inhibitors on Intravesical Bacillus Calmette-Guerin Therapy for Superficial
Bladder Tumors. M. A. Hudson, J . J . Yuan, W. J . Catalona and T. L . Ratliff
Outpatient Flexible Cystoscopy and Fulguration of Recurrent Superficial Bladder Tumors. H. W. Herr
(Editorial Comments by D. L . L a m m and Τ. H . Stanisic)
Primary Malignant Lymphoma of Bladder. D. A. Guthman, R. S. Malek, W. R. Chapman and G. M. Farrow
Salvage Posterior Urethroplasty After Failed I n i t i a l Repair of Pelvic Fracture Membranous Urethral De­
fects. G. D. Webster, J . Ramon and K. J . Kreder
Prostacyclin-to-Thromboxane A2 Ratio i n Arteriogenic Impotence. S. C. Kim, I. G. Choi, C. H. Oh and Y. J .
Cha
Natural History of Peyronie's Disease. Μ. K. Gelbard, F. Dorey and K. James
Ultrasonographic Characteristics of Seminal Vesicles After Ejaculation. A. D. Hernandez, R. L . Urry and J .
A. Smith, J r
Transurethral Microwave Hyperthermia for Benign Prostatic Hyperplasia: Preliminary Clinical and Patho­
logical Results. L . Baert, F. Ameye, P. Willemen, J . Vandenhove, J . Lauweryns, M. Astrahan and Z.
Petrovich
Serum Prostate Specific Antigen Levels D u r i n g Hyperthermia Treatment of Benign Prostatic Hyper­
plasia. A. Lindner, Υ. I . Siegel and D. Korczak
Complications i n Hyperthermia Treatment of Benign Prostatic Hyperplasia. A. Lindner, Υ. I . Siegel, R.
Saranga, D. Korzcak, H. Matzkin and Z. Braf (Editorial Comments by R. C. Bruskewitz and W. K .
Mebust)
Dose T i t r a t i o n Study Evaluating Terazosin, Selective, Once-a-Day a l - B l o c k e r , for Treatment of Symptoma­
tic Benign Prostatic Hyperplasia. H. Lepor, G. Knapp-Maloney
and H. Sunshine (Editorial Comments
by R. C. Bruskewitz, W . K . Mebust and H . W . Schoenberg)
Clinical and Pathological Findings i n Prostates Following Intravesical Bacillus Calmette-Guerin Instilla­
tions. E. Mukamel, M. Konichezky, D. Engelstein, S. Cytron, A. Abramovici and C. Servadio
Madigan Prostatectomy. A. R. Dixon, P. H. Lord and M. R. Madigan (Editorial Comment by V. J . O'Conor,
Jr.)
Prognostic Value of Modal Deoxyribonucleic Acid i n Low Grade, Low Stage Untreated Prostate Cancer. J .
Adolfsson, L . Rönström, P.-Ο. Hedlund, T. Löwhagen, J . Carstensen and B. Tribukait (Editorial Comments by R. W . deVere W h i t e and Μ. M . Lieber)
Evaluation of T u m o r Progression by Repeated Fine Needle Biopsies i n Prostate Adenocarcinoma: Modal
Deoxyribonucleic Acid Value and Cytological Differentiation. J . Adolfsson and B. Tribukait
Flutamide i n Hormone-Resistant Prostatic Cancer. S. D. Fossa, G. Hösbach and E. Paus
Prognostic Significance of Prostate Specific Antigen i n Endocrine Treatment for Prostatic Cancer. Y. Arai,
T. Yoshiki and O. Yoshida
Role of Nerve-Sparing Radical Prostatectomy for Clinical Stage B2 Prostate Cancer. S. W. Bigg, L . R.
Kavoussi and W. J . Catalona
Management of Stage D l Adenocarcinoma of Prostate: Johns Hopkins Experience 1974 to 1987. G. D.
Steinberg, J . I . Epstein, S. Piantadosi and P. C. Walsh
1328
1331
1335
1339
1341
1347
1349
1352
1356
1359
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1393
1399
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1404
1408
1411
1415
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1425
xvi
C O N T E N T S
T o t a l Pelvic Exenteration W i t h Simultaneous Bowel and U r i n a r y Reconstruction.
Sherrod (Editorial Comment by B. L y t t o n )
D. G. Skinner and A.
1433
Urological Neurology and Urodynamics
Value of Leak Pressure and Bladder Compliance i n Urodynamic Evaluation of Meningomyelocele Pa­
tients. G. M. Ghoniem, Μ. B. Roach, V. H. Lewis and E. P. Harmon (Editorial Comment by E. J .
McGuire)
1440
Pediatric Articles
Renal Autotransplantation i n Children: Successful Treatment for Renovascular Hypertension. P. A.
Merguerian, G. A. McLorie, J . W. Balje, A. E. Khoury and Β. M. Churchill
1443
Management of Children W i t h Myelodysplasia: Urological Alternatives. A. G. Klose, C. Κ Sackett and H.-G.
J . Mesrobian (Editorial Comment by E. J . McGuire)
1446
Paratesticular Rhabdomyosarcoma: Results of Therapy i n 18 Cases. B. Blyth, J . Mandell, S. B. Bauer, A. H.
Colodny, Η. E. Grier, H. J . Weinstein, Ν. J . Tarbeil, W. H. Hendren and A. B. Retik (Editorial Comment
by H . W. Herr)
1450
C a s e Reports
Isolated Primary Aldosteronism i n Patient W i t h Adrenal Carcinoma and X Y / X X Y Mosaic Klinefelter's
Syndrome. J . Pascual, F. Liaho, A. Garcia- Villanueva, J . L . Salvador, J . A. Herrero and J . Ortuno . . . .
Renal Scintigraphy i n Diagnosis and Surgical Management of Patient W i t h Caliceal Colic. B. Eisenberg, Ε.
R. Ar ring ton, J . Mouchizadeh and L . J . Gibel
Giant Renal Artery Aneurysm Diagnosed Post Partum. Μ. J . Pliskin, M. L . Dresner, L . H. Hassell, J . R.
Gusz, P. W. Balkin, Κ S. Lerud and A. W. Larson
Recurrent Vesicogluteal Fistula Due to Sequestrum. P. N. Dogra and V. K. Mehta
Nonsteroidal A n t i - I n f l a m m a t o r y Drugs i n Treatment of Eosinophilic Cystitis. D. Motzkin
Reverse Coitus: Mechanism of Urethral Injury i n Male Partner. T. P. Mohapatra and S. Kumar
Transrectal Ultrasonography i n Evaluation of Infertile M a n : Report of 3 Cases. L . Patterson and J . P.
Jarow
Gonadoblastoma i n Anatomically N o r m a l M a n : Case Report and Literature Review. W. Η. H. Chapman, M.
R. Plymyer and M. L . Dresner
Malignant Mesothelioma of Tunica Vaginalis Testis. Ν. Z. Carp, R. 0. Petersen, J . F. Kusiak and R. E.
Greenberg
Sudden Death Due to Disease Flare W i t h Luteinizing Hormone-Releasing Hormone Agonist Therapy for
Carcinoma of Prostate. /. M. Thompson, E. J . Zeidman and F. R. Rodriguez
1454
1457
1459
1462
1464
1467
1469
1472
1475
1479
Letters to Editor
Re: Radiographic Assessment of Renal Trauma: 10-Year Prospective Study of Patient Selection, by S. L .
Mee, J . W . M c A n i n c h , A. L . Robinson, P. S. Auerbach and P. R. Carroll. J . P. S. Fagundes
Ureteral Stenosis in Renal Transplantation. P. Y. Scarlett, A. D. Hibberd and J . H. Wlodarczyk
Re: Review of 8-Year Experience W i t h Modifications of Endoscopic Suspension of Bladder Neck for Female
Stress Urinary Incontinence, by K . R. Loughlin, W . F. W h i t m o r e , I I I , R. F. Gittes and J . P. Richie. C.
C. Winter
Size Considerations for Custom Penile Prostheses. J . N. Krieger, S. L . Roxer and J . A. Ronk
Re: Treatment of Persistent Penile Erection and Priapism Using Terbutaline, by T . R. Shantha, D . P.
Finnerty and A. P. Rodriquez. P. Bondil
Re: Carcinoma I n Situ of Testis, by Y. Reinberg, J . C. M a n i v e l and E. E. Fraley. B. Gondos
Re: Prostatic Infarction Associated W i t h Aortic and Iliac Aneurysm Repair, by P. Feero, J . C. Nickel, P.
Brown and I . Young. T. J . Garvin
Re: Prostate Specific Antigen i n Diagnosis and Treatment of Adenocarcinoma of Prostate. I . Untreated
Patients. I I . Radical Prostatectomy Treated Patients. I I I . Radiation Treated Patients. I V . A n t i - A n drogen Treated Patients, by Stamey and associates. Κ Τ McVary and A. W. Rademaker
1481
1481
1481
1482
1483
1484
1485
1485
INVESTIGATIVE UROLOGY
Suggestions for Consultants
Reversal of Toxic Effects of Cyclosporine on Male Reproduction and Kidney Function of Rats by S i m u l ­
taneous Administration of hCG + F S H . L. Seethalakshmi, C. Flores, D. A. Diamond and M. Menon . .
Kinetics of Cellular Proliferation i n Rat Urinary Bladder Treated W i t h N - B u t y l - N - ( 4 - H y d r o x y b u t y l ) N i t r o samine. H. Tsujihashi, H. Matsuda, S. Uejima, Τ Akiyama and Τ Kurita
Relaxation Mechanisms of Antispasmodics Papaverine and T h i p h e n a m i l on H u m a n Corpus Cavernosum. Y. Kimoto, R. Kessler and C. E. Constaninou
Use of Prostaglandin F2 Alpha for Prophylaxis of Cyclophosphamide Induced Cystitis i n Rats. D. J . Grinberg-Funes, C. Sheldon and M. Weiss
Pressure Threshold for Shock Wave Induced Renal Hemorrhage. R. Mayer, E. Schenk, S. Child, S. Norton,
C. Cox, C. Hartman, C. Co χ and E. Carstensen
Identity of Prostate Specific Antigen and Semen Protein P30 Purified by Rapid Chromatography Tech­
nique. H. C. B. Graves, M. Kamarei and Τ A. Stamey
Comparison of Polyclonal and Monoclonal Immunoassay for PSA: Need for International Antigen Stan­
dard. Η C. B. Graves, N. Wehner and Τ A. Stamey
1488
1489
1493
1497
1500
1505
1510
1516
C O N T E N T S
Seminal Plasma Protein p30: Simplified Purification and Evidence for Identity W i t h Prostate Specific A n t i gen. G. F. Sensabaugh and Ε. T. Blake
Effect of Alpha-2 Agonist on Bladder Function and Cord Histology After Spinal Cord Injury. R. Weiss, J . J .
Tomasula and J . R. Sotolongo, J r
Physiologic and Pathologic Alterations Associated W i t h Ultrasonically Generated Shock Waves. D. E. Hill,
W. S. McDougal, H. Stephens, A. Fogo and M . 0. Koch
Cell Injury Associated Calcium Oxalate Crystalluria. R. L . Hackett, P. N. Sheuock and S. R. Khan
Characterization of 1,4 Dihydropyridine Calcium Channel B i n d i n g Sites i n H u m a n Prostate.
E.
Rosenthal, E. Shapiro and H. Lepor
Contractile Effect of Tachykinins on H u m a n Prostatic Urethra: Involvement of N K - 2 Receptors. M .
Parlani, B. Conte, S. Majmone, C. A. Maggi, P. Rouero and A. Giachetti
Effect of Thiorphan on Response of Guinea-Pig Isolated U r i n a r y Bladder to Exogenous and Endogenous
Tachykinins. C. A. Maggi, M. Astolfi, P. Santicioli, M. Tramontana,
G. Leoncini, P. Geppetti, A.
Giachetti and A. Meli
I n Situ Hybridization of Prostate-Specific Antigen m R N A i n H u m a n Prostate. S.-D. Qiu, C. Y.-F. Young,
D. L . Bilhartz, J . L . Prescott, G. M . Farrow, W.-W. He and D. L . Tindall
XVÜ
1523
1527
1531
1535
1539
1543
1546
1550
UROLOGICAL SURVEY
Diagnostic Urology and Testis Cancer
Adrenal, Hypertension, Renal Physiology and Renal Failure
Kidney Transplantation and Renovascular Hypertension
Voiding Function and Dysfunction, and Female Urology
Penis, Urethra, Trauma and Fistulas
Book Reviews
1558
1561
1565
1571
1575
1576
Subject Index to Abstracts in Volume 144
1578
Information for Authors
1586
Volume Index and Contents
Index, Volume 144
Table of Contents, Volume 144
1587
iii
0022-5347/90/1443-0790S02.00/0
T H E JOURNAL OF UROLOGY
Copyright
1990 by AMERICAN UROLOGICAL ASSOCIATION, INC.
Vol. 144, September
Printed in U.S.A.
T H E E F F E C T O F V E N O U S I N C O M P E T E N C E AND A R T E R I A L
I N S U F F I C I E N C Y ON E R E C T I L E F U N C T I O N : AN A N I M A L M O D E L
S H E R I F R. A B O S E I F , U L R I C H W E T T E R A U E R , J A N B R E Z A , F R A N C O I S B E N A R D , R U U D
C H R I S T I A N G. S T I E F , T O M F . L U E A N D E M I L T A N A G H O *
BOSCH,
From the Department of Urology, University of California School of Medicine, San Francisco, California
ABSTRACT
W e designed a n a n i m a l m o d e l t o e l u c i d a t e t h e effect o f venous leakage a n d a r t e r i a l i n s u f f i c i e n c y
o n erectile f u n c t i o n . I n 10 dogs, electrodes were i m p l a n t e d a r o u n d t h e c a v e r n o u s nerves for
e l e c t r o e r e c t i o n a n d b l o o d f l o w i n t h e i n t e r n a l p u d e n d a l a r t e r y was recorded. V e n o u s leakage was
m i m i c k e d b y i n s e r t i n g needles o f v a r y i n g gauges (30 t o 16G) i n t o t h e c o r p u s c a v e r n o s u m a n d t h e
erectile response t o n e u r o s t i m u l a t i o n was r e c o r d e d before a n d a f t e r t h e c r e a t i o n o f t h e leak. T h e
r e l a t i o n s h i p b e t w e e n t h e size a n d t h e a m o u n t o f t h e v e n o u s leakage, t h e changes i n t h e i n t r a c a v ernous pressure (peak a n d d r o p ) , a n d t h e changes i n t h e peak a n d m a i n t e n a n c e a r t e r i a l b l o o d f l o w
were d o c u m e n t e d .
A r t e r i a l b l o o d f l o w was t h e n r e d u c e d b y 25 a n d 50 per c e n t b y m e a n s o f a screw c l a m p o n t h e
t e r m i n a l a o r t a . T h e erectile response t o n e u r o s t i m u l a t i o n was again d e t e r m i n e d , w i t h t h e same
e l e c t r i c a l p a r a m e t e r s , f i r s t w i t h reduced b l o o d flow alone, t h e n i n c o m b i n a t i o n w i t h leakage o f
v a r y i n g size.
O u r r e s u l t s s h o w e d t h a t m i n o r c a v e r n o u s v e i n leakage i n t h e presence o f n o r m a l a r t e r i a l flow a n d
a h e a l t h y s i n u s o i d a l s y s t e m h a d a m i n i m a l effect o n erectile f u n c t i o n o w i n g t o a c o m p e n s a t o r y
increase i n p e n i l e b l o o d flow. H o w e v e r , w h e n r e d u c t i o n o f a r t e r i a l b l o o d flow was s u p e r i m p o s e d o n
venous leakage, even o f a m i n o r degree, t h e e r e c t i l e response t o n e u r o s t i m u l a t i o n was m a r k e d l y
i m p a i r e d . ( J . UroL, 144: 790-793,
1990))
Many experiments have been devised to elucidate the relative
contribution of the arterial and the venous systems to erectile
capacity. I n this century Lydston and Lowsley and B r a y were
the first to report the venous contribution to impotence, but
later investigators attributed erection solely to increased arterial f l o w . Accordingly, most attention was given to investigation of the arterial system by both noninvasive and invasive
techniques. The controversy regarding the role of the venous
system had its basis i n the conflicting results from the human
penile perfusion studies of Newman and Reiss and the
-xenon wash-out studies of Shirai and associates and Wagner and Uhrenholdt.
Recent studies have clearly demonstrated that penile erection
is the result of three synergistic hemodynamic events: increased
arterial flow, sinusoidal relaxation, and venous outflow restriction.
W i t h the recognition of the importance of both the
arterial and venous systems and the frequency of both arterial
insufficiency and venous incompetence as causes of organic
impotence, we undertook this study to determine the c o n t r i bution of each system i n the hemodynamics of erection and the
effect of impairment of each alone or i n combination on erectile
function i n dogs.
1
2
%4
5,6
7
133
8
9
1 0 - 1 2
MATERIALS AND METHODS
Ten healthy adult mongrel dogs, weighing 20 to 30 kg., were
used i n this study. Dogs were premedicated w i t h acepromazine
(0.1 mg./kg. body weight [B.W.]) and anesthetized w i t h i n t r a venous sodium pentobarbital (30 mg./kg./B.W. w i t h bolus i n jections of 25 to 50 mg./hr. as needed to maintain an adequate
level of anesthesia and spontaneous respiration). Fluid intake
consisted of intravenous infusion of normal saline solution (two
ml./kg. B . W . / h r . ) .
Through a midline incision from the xiphoid process to the
pubic bone, the abdomen was opened and the bladder and
F i G . l . Schematic drawing of experimental set-up.
prostate were exposed. By electrostimulation, the cavernous
nerves were identified along the posterolateral aspect of the
prostate, and bipolar cuff electrodes (Avery Laboratory) were
placed around them to induce erection (fig. 1). The ipsilateral
internal pudendal artery was exposed and an ultrasonic blood
Accepted for publication May 22, 1990.
* Requests for reprints: Department of Urology, U-575, University
of California School of Medicine, San Francisco, California 94143.
790
VENOUS
INCOMPETENCE,
ARTERIAL
INSUFFICIENCY
T A B L E 1. Effect on flow within the internal pudendal artery of leakage
AND ERECTILE
latent periods
produced by needles of varying gauges
791
FUNCTION
Normal blood flow
Arterial Flow
Needle Gauge
Peak*
46.3
46.3
46.6
45.7
47.3
48
48.1
none
30
27
25
22
19
16
Maintenancet
(ml./min.)
22.4
26.2
32.7
33.7
33.6
32.9
33
± 7.3
± 6.6
± 5.9
± 5.5
± 6.6
±6.1
± 6
±
±
±
±
±
±
±
2.5
3.3
7.3
4.4
5.4
1.8
3
All values represent the mean ± S . E . in 10 dogs.
* Change in peak flow with different gauges was not statistically significant,
t Increase in maintenance flow with different gauges was statistically signifi­
cant at 9 5 % by both Student's t test and Fisher P L S D test, ρ = 0.01; F = 2.962.
TABLE
2.
Effect on intracavernous pressure of le akage produced by
needles of varying gauges
Intracavernous Pressure*
Needle
Gauge
Peak
(cm. H 0 )
2
None
30
27
25
22
19
16
139.4
123
112
110
87
63
57.1
Detumescencet
(sec.)
Drop from
Control Peak (%)
± 6.6
± 6.5
± 6.5
±6
± 6
± 7.3
±9.6
83.2
73.8
47
35
32
28
14.6
12.0
20
21.4
37.8
55
59.2
±
±
±
±
±
±
±
19.1
15.2
11.1
11.8
8.4
9.1
2.9
All values represent the mean ± S . E . in 10 dogs.
* A l l control vs different gauges statistically significant at 95% by both t test
and Fisher P L S D . ρ = 0.0001; F = 49.258.
t A l l control vs different gauges statistically significant by both tests, ρ =
0.0001; F = 9.173.
801
60
Ω
ο
40
20
30
27
25
22
19
16
Gauge
FlG.
2. Reduction in duration of detumescence (sec.)
T A B L E 3. Effect of reduced blood flow on intracavernous pressure
Blood
Flow
(ml./min.)
Latent
Period*
(sec.)
Intracavernous
Pressuret
Drop from
Peak
Control Peak
(cm. H 0 )
(%)
Detumescencet
(sec.)
2
Normal
25% reduction
50% reduction
9
6.75
4.5
29.6 ± 2.6 139.4 : 7.7
42.4 ± 3.4
96 : 7.3
56.8 ± 5.3 60.6 : 4.8
31
57
83.25 ± 19.1
45.8 ± 5.8
39.7 ± 7.8
All values represent the mean ± S . E . in 10 dogs.
* Control vs 25, 50% statistically significant by Student's t test and Fisher
P L S D . ρ = 0.0001; F = 20.839.
t Control vs 25, 50% statistically significant by both tests, ρ = 0.0001; F =
54.926.
$ Control vs 25 and 50% not statistically significant.
0
20
40
60
80
stimulation
120
160
Time (sec)
F I G . 3. Effect of reduction of arterial flow on duration of latent
period and peak intracavernous pressure.
flow probe w i t h a 1.5-mm. diameter (Transonic System, Inc.;
Ithaca N.Y.) was placed to record arterial blood flow.
The entire penis was denuded, exposing both corpora caver­
nosa down to the ischial rami. A 21-gauge butterfly needle was
placed i n the corpus cavernosum and connected to a Statham
pressure transducer for intracavernous pressure recording on a
Grass polygraph. Systemic blood pressure was monitored
through a 16-gauge angiocatheter placed i n the femoral artery
and connected to the same polygraph.
For reduction of penile blood flow, the terminal part of the
aorta below the inferior mesenteric artery was dissected circumferentially and a screw clamp (Bel-Art) capable of controlling
flow i n flexible tubing up to 14 m m . (outer diameter) was placed
around it. Once all monitoring and stimulating devices were i n
place, an intravenous bolus of 1000 U sodium heparin was
delivered for anticoagulation w i t h a maintenance dosage of 50
U to ensure t h a t a l l pressure-recording cannulae remained
patent.
Baseline measurements of the arterial blood flow and intra­
cavernous pressure were recorded. Erection was induced by
cavernous nerve stimulation and the following were measured:
peak and maintenance penile blood flow; latency period (time
from the beginning of stimulation u n t i l the maximal intracav­
ernous pressure was attained); rise i n intracavernous pressure;
and the duration of detumescence (time from cessation of
stimulation to return to baseline intracavernous pressure).
Venous leakage study. For creation of cavernous leakage,
needles of different sizes (30 to 16G) were inserted into one
corpus cavernosum. Previous heparinization helped to keep the
needles patent. Electrostimulation of the cavernous nerve was
repeated w i t h each needle w i t h the same stimulation parame­
ters as i n the control study. I n addition, the volume of blood
leaking from the corpus cavernosum during the period of s t i m ­
ulation was measured.
Reduction of arterial blood flow. Penile blood flow was reduced
by 25 and 50 per cent by means of the screw clamp around the
terminal aorta, and neurostimulation was repeated.
Venous leakage and reduction in arterial flow. The erectile
response to neurostimulation was recorded again i n the pres­
ence of both cavernous leakage and reduced penile blood flow
w i t h the same parameters as i n the control study.
Data were analyzed w i t h both Student's t test and analysis
of variance ( A N O V A ) Fisher P L S D test, and values are ex­
pressed as the mean ± S.E.
RESULTS
A n immediate response to cavernous nerve stimulation was
sinusoidal relaxation, evidenced by a slight drop i n the basal
intracavernous pressure and a marked increase i n blood flow
through the internal pudendal artery to a peak of almost six
times the basal flow rate (seven m l . / m i n . ) . The arterial flow
then dropped to a maintenance level of an average of 22.5 m l . /
792
A B O S E I F AND ASSOCIATES
min. and the intracavernous pressure gradually rose to an
average peak of 140 cm. H 0 w i t h an average latency period of
32.8 sec. After stopping the stimulation, the intracavernous
pressure gradually dropped to baseline after an average of 80.6
sec. (detumescence period).
Venous leakage. I n the presence of small venous leakage
(produced by 25 to 30 G needles), the peak arterial flow i n the
internal pudendal artery was not significantly different from
the control value (table 1). However, the maintenance arterial
flow gradually showed a compensatory increase to a peak of
33.7 m l . / m i n . (control = 22.4 m l . / m i n . ) w i t h the 25G leak and
remained at that level w i t h increasing needle gauge. T h i s was
statistically significant at 95% by both Student's t test and the
Fisher P L S D test (p = 0.01, F = 2.962). This compensatory
increase i n the maintenance blood flow was reflected i n the
changes i n intracavernous pressure: leakage created by needles
up to 25G resulted i n only a slight drop i n pressure from 139.4
cm. H 0 to an average peak of about 110 cm. H 0 (21.4 per
cent) (table 2). A t this point, w i t h the maintenance arterial
blood flow at its peak, a further increase i n the size of the leak
resulted i n a steeper drop i n the peak intracavernous pressure
to about 57 cm. H 0 w i t h the 16G needle (60 per cent reduction
from control).
I n addition to the reduction i n the peak intracavernous
pressure, we also noticed a reduction i n the duration of detu­
mescence from 83.2 sec. i n the control study to 14.6 sec. i n the
presence of 16G leakage (fig. 2).
Reduction of arterial flow. When the blood flow i n the aorta
was reduced by 25 per cent (normal nine m l . / m i n . ) , the first
change noticed on cavernous nerve stimulation was a marked
increase i n the latent period to an average of 42.4 sec. (table 3)
and a further prolongation to 56.8 sec. when the blood flow was
reduced to 50 per cent (fig. 3). The effect on the peak intracav­
ernous pressure was directly related to the percentage of reduc­
t i o n i n the arterial blood flow: 96 cm. H 0 at 25 per cent and
60.6 cm. H 0 at 50 per cent. Interestingly, the duration of
2
2
2
2
2
2
T A B L E 4. Effect of combined cavernous leakage and reduced arterial
flow on intracavernous
pressure
Detumescence
(sec.)
Intracavernous Pressure
Needle
Gauge
Drop from
Control
Peak (%)
Peak
(cm./H 0)
2
25%*
30
27
25
22
19
16
69.7
58.8
49.7
43.7
33.5
26
50% t
±
±
±
±
±
±
3.6
5.3
4.5
1.7
4.2
5.4
47.8
38.2
32.0
25
19.4
12
±
±
±
±
±
±
6.8
5.6
6.4
7.6
7.2
4.4
25%
50%
49.7
57.6
64
68
76
80.7
66
77
78
83
90.2
93.3
25%+
40
37.6
34.1
24.5
18.0
10.5
±
±
±
±
±
±
TABLE
Arterial Blood Flow
Needle
Gauge
Normal Flow
25% Reduction
50% Reduction
30
27
25
22
19
16
0.1
0.49
1.2
2.8
5.9
7
0.07
0.3
0.82
1.5
3.2
4.8
3 drops
0.2
0.6
1.1
2.35
3.2
All values represent the mean ± S . E . in 10 dogs.
* I n ml./min.
detumescence was also affected w i t h reduction of the arterial
blood flow alone, from an average of 83.2 sec. to 39.7 sec. w i t h
50 per cent reduction.
Venous leakage and reduction of arterial flow. When venous
leakage was combined w i t h reduction i n arterial blood flow, the
erectile response was markedly impaired (table 4). The effect
on the latent period was similar to that induced by the reduction
of arterial flow alone: i t was prolonged by 43 and 63 per cent
w i t h a 25 and 50 per cent reduction, respectively. The changes
i n the peak intracavernous pressure were dramatic. M i n o r
venous leakage alone (created by a 30G needle) had initially
resulted i n a very slight drop (from 139.4 to 123 cm. H 0 ) ;
however, when a 25 per cent reduction of arterial blood flow
was superimposed, the peak intracavernous pressure dropped
to almost 50 per cent of the control (to 69.7 cm. H 0 ) (fig. 4).
When the blood flow was further reduced to 50 per cent of
normal, the same size leakage almost completely abolished the
erectile response (an average peak of only 47.8 cm. H 0 ) . I n
addition, the shortening of the period of detumescence was also
more pronounced. I n the presence of a 30G leak alone, the
duration had decreased from 83.2 sec. i n the control to 73.8
sec, whereas w i t h a 25 and 50 per cent arterial flow reduction,
it was 40 and 24.8 sec, respectively. T h i s decrease i n the
duration of detumescence was enhanced w i t h increasing leak­
age size u n t i l i t reached 10.5 and 5.5 sec. i n the presence of 16G
leakage and 25 and 50 per cent reduction i n arterial flow.
Volume of venous leakage with normal and reduced blood flow.
I n table 5 are tabulated the average amounts of blood leaking
from the corpus cavernosum during the period of stimulation
in the presence of needles of different gauges and both normal
and reduced blood flow.
2
2
2
50% §
8.9
9.7
7
7.6
3.2
2.7
24.8
19
17.5
15.7
9
5.5
± 5.4
± 3.8
± 3.8
± 3.5
±3.5
± 2.3
All values represent the mean ± S . E . in 10 dogs.
* Control vs 25% reduction statistically significant at 95% by Student's t test
and Fisher P L S D . ρ = 0.0001; F = 54.248.
t Control vs 50% reduction statistically significant at 95% by both tests. F =
61.08, ρ = 0.0001.
X Control vs 25% statistically significant, ρ = 0.0002; F = 6.245.
§ Control vs 50% statistically significant, ρ = 0.000; F = 9.099.
η Normal Wood flow
Λ 251 reduction
ο SO ι reduction
Iniracevernous
Pressure
(cm H 0)
2
FiG. 4. Effect of cavernous leakage and reduction of arterial flow
on peak intracavernous pressure.
5. Venous leakage*
DISCUSSION
The results presented i n this study further confirmed the
role of both the arterial and venous systems i n the hemody­
namics of erection.
When cavernous leakage was created by inserting needles of
different size into the corpus cavernosum, we noticed that the
effect on erection depended not only on the size of the leak but
also on the efficiency of penile arterial blood flow. A l l dogs had
exhibited a good erectile response to control neurostimula­
tion—evidence of healthy sinusoidal smooth muscle. I n these
animals minor venous leakage (30 to 25G) w i t h unimpaired
arterial flow had only a minor effect on the erectile response to
neurostimulation owing to a compensatory increase i n the
maintenance arterial blood flow. However, when the size of the
leakage increased beyond the compensatory capacity of the
arterial flow (22 to 16G), the peak intracavernous pressure
demonstrated a steeper drop to approximately 57 per cent of
the control w i t h the 16G needle. I n contrast to these results (a
noticeable response only to a large leak), a significant decrease
i n the duration of detumescence was seen w i t h even a small
leak. Thus, i n the presence of m i l d to moderate venous leakage,
the increase i n the maintenance flow and the decrease in the
duration of detumescence were the earliest parameters affected.
T h i s is i n agreement w i t h our previous report on patients w i t h
venogenic impotence. I n t h a t study, we found these same
parameters to be the most sensitive on cavernosometry in the
13
V E N O U S I N C O M P E T E N C E , A R T E R I A L I N S U F F I C I E N C Y AND E R E C T I L E F U N C T I O N
diagnosis and quantification of m i l d to moderate venous leak­
age.
This first part of our study might resemble the clinical
situation of venogenic impotence i n young patients w i t h a
normal arterial system. Usually this condition is asymptomatic
unless the leak is very large or arterial insufficiency is super­
imposed, i n which case inability to maintain a prolonged erec­
t i o n is the usual complaint. Similar findings have also been
reported by o t h e r s .
When the arterial blood flow was reduced i n the presence of
normal venous and sinusoidal systems, the decrease i n the
erectile response to neurostimulation was proportional to the
percentage of reduction: the average peak intracavernous pres­
sure dropped by 31 and 63 per cent when the blood flow i n the
aorta was reduced by 25 and 50 per cent respectively. I n
addition, the latent period was markedly prolonged. These
results are similar to our previous findings on the effect of
acute penile artery occlusion and are i n agreement w i t h sev­
eral clinical studies reporting a delayed weak response to i n t r a ­
cavernous injection of vasoactive agents i n patients w i t h arte­
rial disease.
Interestingly, we found t h a t w i t h the reduction
i n arterial blood flow the duration of detumescence was signif­
icantly reduced—by about 34 and 53 per cent w i t h 25 and 50
per cent reduction, respectively. I n other studies i n our labo­
ratory i n which detumescence was characterized as tri-phasic,
the first phase was determined to be dependent mainly on
arterial flow (manuscript i n preparation). Reduction w i l l abol­
ish this phase, and may provide an explanation for our results.
W h e n both venous leakage and arterial insufficiency were
combined, the erectile response was markedly impaired. M i n o r
venous leakage (created by a 30G needle) or a 25 per cent
reduction i n arterial flow alone resulted i n a slight decrease i n
erectile response; when combined, they caused a 49.7 per cent
decrease i n peak intracavernous pressure, close to that induced
by either 16G leakage or a 50 per cent reduction alone.
These findings draw attention to the importance of evaluat­
ing the competence of both the arterial and venous systems
when a vascular origin is suspected.
Two main factors
underlie this recommendation. First, evaluation of one system
alone m i g h t reveal m i l d impairment that would otherwise re­
quire no surgical treatment (especially true i n patients w i t h
mild venous leakage, which usually does not require surgical
intervention). Second, the degree of impairment of each system
w i l l influence the choice of surgical treatment. I f the venous
system alone is impaired, venous ligation would be the appro­
priate procedure; i f arterial insufficiency is the cause, a bal­
loon dilation or arterial revascularization procedure may be
indicated.
I f both systems are impaired, a procedure t h a t
will increase both arterial flow and venous resistance should be
considered: deep dorsal vein a r t e r i a l i z a t i o n
or cavernous
vein arterialization.
From this study, we conclude: 1) both the arterial and venous
systems play an important role i n the hemodynamics of erec­
tion; 2) m i l d impairment of the venous system alone can be
compensated for to some extent by other systems; and 3)
diagnostic evaluation of patients w i t h vasculogenic impotence
should include assessment of both the arterial and venous
systems for proper quantification of the degree of impairment
of each system and better selection of surgical treatment.
Investigation should begin w i t h the arterial system because, i f
adequate, i t has the potential to compensate for minor venous
leakage. Moreover, treatment of minor venous leakage may
not prove beneficial to the patient i f an existing arterial insuf­
ficiency has not been uncovered and treated.
14,15
16
17-19
20 2 3
24
25
26-27
22,28,29
30
19
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