Evaluation and therapy of urinary tract infection: a critique.
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Biomedical subjects
Publications and source records attributed to D W Soderdahl.
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The case of a sixty-four-year-old man who progressively created a penoscrotal hypospadias on himself is presented. Although genital self-mutilation is normally considered symptomatic of deep psychotic disturbance, the details and evaluation of this case would classify it as nonpsychotic, though unusual behavior.
Although varicocele remains the most frequently diagnosed cause of male infertility, and improvement in semen quality is associated with repair of varicocele, improvement in spermatozoal fertilizing capacity has not been conclusively demonstrated. The sperm penetration assay was employed to monitor prospectively surgical (n = 59) and nonsurgical (n = 40) groups of men with varicocele. There were no significant increases in the average count, motility, morphologic features, or sperm penetration assay results for either group. Varicocele surgery enhanced assayable egg penetration rates in 14 of the 59 patients (23.7%), whereas the nonsurgical group had 10% spontaneous improvement. Of those in the surgery group who showed assayable fertility enhancement and were attempting conception, pregnancies were achieved in 70% (7 of 10 patients). Of patients in the nonsurgical group who improved in the assay, no pregnancies were obtained.
Sources of variability in the zona-free hamster egg penetration assay were evaluated. Internal consistency in the assay was examined in replicate experiments using sperm from 23 donors. The average difference in the percentage of fertilization between the replicates was 3.9%. Optimal preincubation conditions and insemination time were examined and shown to be 0.5 to 1.0 X 10(7) sperm/ml and 2 to 3 hours. Abstinence time was found to be a variable, and a critical abstinence of more than 12 hours was required. Prolonged exposure to seminal plasma (i.e., more than 30 minutes) produced a reduction in the fertilization test results. If the variables studied here are consistently controlled, then changes in the assay results greater than the experimental error should reflect true changes in the semen sample.
Causal relationship of varicocele to infertility is controversial. Studies of hormonal milieu, semen and testicular tissue yield data of debatable significance. We herein assay the fertilizing ability of men with varicocele and monitor changes consequent to surgical correction of varicocele. Zona-free hamster ova were used to determine fertilizing ability. A fertilization rate of less than 10 per cent correlates with infertility. Between May 1978 and November 1979, 75 men with varicocele presenting for fertility evaluation and 23 men with painful varicocele were tested. Of the patients infertile clinically and by in vitro fertilization assay 42 elected ligation of the internal spermatic vein(s). Average fertilization rate of the painful varicocele group was 20.5 per cent and for the infertile group it was 1.2 per cent. Average fertilization rates postoperatively in the infertile group were 2.9 per cent (3 months), 7.7 per cent (6 months), 2.8 per cent (9 months), 7.8 per cent (12 months), 17.5 per cent (15 months) and 8.0 per cent (18 months). Pregnancies occurred only in partners of men whose fertilization rates were between 2.9 and 8.3 per cent preoperatively and who improved to greater than 10 per cent postoperatively. The in vitro fertilization assay may help select those individuals with varicocele and infertility most likely to benefit from varicocele repair.
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This series of 24 female patients with stress urinary incontinence managed surgically by a pubis-pubovaginal fascia fixation demonstrates success comparable or superior to other techniques. Several advantages in carefully selected patients are noted.
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Renal actinomycosis is an endogenous systemic fungal disease with rare renal involvement. Diagnosis, pathogenesis, and therapy are discussed.
Two patients with Henoch-Schönlein syndrome presented with clinical pictures mimicking testicular torsion. No evidence of testicular torsion was found. A review of the literature revealed that testis torsion is very rarely associated with testicular involvement in Henoch-Schönlein syndrome, and hence only rarely is surgical exploration required.
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The unusual complication of colocutaneous fistula following retroperitoneal lymphadenectomy for testis tumor is presented. Etiology, management and prevention are emphasized.
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