Biomedical subjects
Publications and source records attributed to R A Appell.
Urinary incontinence affects millions of elderly American men and women. This paper reviews the causes of urinary incontinence and the evaluation that can be easily accomplished as an outpatient with minimal expense and morbidity.
Urinary incontinence is a common problem that affects millions of elderly men and women and their caregivers. Evaluation of incontinence is easy and inexpensive and does not require hospitalization. A basic evaluation consists of history taking (including a review of drug use), physical examination, and appropriate laboratory testing. Urodynamic evaluation may also be necessary. Treatment may consist of behavior modification techniques (eg, Kegel exercises, biofeedback, bladder retraining), use of a mechanical device or pharmacologic agent, or surgery. Should medical and surgical methods fail, alternatives are available to ensure patients' well-being and comfort.
The Magnetip* double J type ureteral stent has been used in a wide variety of clinical urological settings. We reviewed the use of the stent in 50 patients. In 45 patients stents were placed in conjunction with extracorporeal shock wave lithotripsy, stone manipulation, obstruction due to pregnancy or malignancy, pyeloplasty and ureteroneocystostomy. In 83 per cent of the attempts the stent was placed successfully. Retrieval with the Magnetriever* was accomplished in 86 per cent of the cases (100 per cent in female and 76 per cent in male patients). Details of stent use are described.
Changes in the in vitro capacity to convert progesterone (4-pregnen-3,20-dione) to its metabolites were studied in testes of experimentally cryptorchid adult rats for varying lengths of time. Cryptorchidism resulted in a decrease in testicular, seminal vesicle, and prostatic weights, implying suppression of in vivo androgen production and this decrease was confirmed in vitro. Cryptorchidism decreased the conversion of androgen from progesterone and increased the formation of 20 alpha-dihydroprogesterone (20 alpha-dihydroxy-4-pregnen-3-one). This indicated that enzyme activity for androgen analysis synthesis from a progesterone substrate in the rat testis was heat-sensitive and suggested 20 alpha-dihydroprogesterone may have an important role as the primary steroid produced in experimental cryptorchidism.
In 10 patients with obstructive manifestations of prostatic enlargement the urethral closure pressure profile was observed before and after the effective blockade of thoracolumbar sympathetic outflow by epidural anesthesia. While epidural anesthesia significantly decreased urethral closure pressure considerable profile responses still remained in these patients. This fact suggests that the bulk of the prostatic tissue is responsible for the bladder outlet obstruction, since urethral closure pressure persists despite urethral smooth and skeletal muscular relaxation as a result of epidural anesthesia. After transurethral resection of the prostatic tissue in these patients the urethral closure pressure did decrease to zero. The result of the prostatic resection is to decrease the urethral closure pressure and, thereby, increase the efficiency of voiding.
The previous demonstration that sperm kept at body temperature (37 degrees C) had a marked deterioration in motility accompanied by an overgrowth of bacteria in the semen and a concomitant decrease in pH led to this study to test the hypothesis that the decrease in motility was caused by the bacteria or by bacterial alteration of seminal pH. Semen specimens from fertile prevasectomy patients with and without added antibiotics were maintained at 20 degrees C and 37 degrees C and evaluated at 3, 12, and 18 hours after collection. There was still a significant deterioration in spermatozoal motility in the samples kept at 37 degrees C even when bacterial growth and change in pH were prevented by buffered antibiotics. Although the decrease in spermatozoal motility at body temperature may in part be attributed to bacterial growth or the products of bacterial metabolism, clearly another factor is present related to time and temperature and independent of the presence of bacteria.
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Semen specimens from fertile prevasectomy patients maintained at 4 degrees, 20 degrees, and 37 degrees C were evaluated at 3, 6, 12, and 18 hours after collection. Sperm viability, assessed by eosin-nigrosin stain, and motility decreased with time at 20 degrees and 37 degrees C, but at a significantly higher rate at 37 degrees C (where the motility was halved by 12 hours). The slope of the decrease in viability closely paralleled that of the motility except at 4 degrees C, where motility was nearly absent at 6 hours but viability was retained through 18 hours. Bacterial counts rose markedly and the pH fell at 37 degrees C, which may explain the decrease in motility and viability. It is clear from this study that semen should be kept at room temperature (20 degrees C) and not at 37 degrees C if there is to be any delay in its analysis, or a falsely lowered motility will result.
In specimens of semen kept at 37 degrees C sperm lose their motility and viability. If kept at 4 degrees C they retain their viability but lose their motility from so-called thermal shock. The best temperature to keep semen in order to preserve sperm motility is 20 degrees C. Loss of motility at 37 degrees C is not entirely prevented by prevention of bacterial contamination with antibiotics.
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