Peyronie's Disease: A Historical Perspective.

Peyronie's disease (PD), more commonly known as penile curvature, is caused by plaque formation in the connective tissue of the penis. PD affects 0.3% to 8.

Estrogen replacement increased the citrate and calcium excretion rates in postmenopausal women with recurrent urolithiasis.

Purpose: Epidemiological data indicate a sharp increase in urinary calcium stone formation after menopause. We investigated the role of menopausal estrogen replacement therapy on the urinary constituents and characteristics that may influence recurrent calcium oxalate stone disease.

Materials And Methods: Urinary constituents in 28 postmenopausal women on estrogen replacement therapy for more than 6 months were compared with those in 41 women who had never been exposed to estrogen after menopause.

Calcium Oxalate Stone Agglomeration Inhibition [tm] Reflects Renal Stone-Forming Activity.

Louisiana and other Gulf South states comprise a "Stone Belt" where calcium oxalate stone formers (CaOx SFs) are found at a high rate of approximately 5%. In these patients, the agglomeration of small stone crystals, which are visible in nearly all morning urine collections, forms stones that can become trapped in the renal parenchyma and the renal pelvis. Without therapy, about half of CaOx SFs repeatedly form kidney stones, which can cause excruciating pain that can be relieved by passage, fragmentation (lithotripsy), or surgical removal.

Serum prostate specific antigen is a strong predictor of future prostate growth in men with benign prostatic hyperplasia. PROSCAR long-term efficacy and safety study.

Purpose: We analyze patterns of prostate growth in men diagnosed with benign prostatic hyperplasia (BPH) and treated with placebo during 4 years, and determine which baseline parameters were the strongest predictors of growth.

Materials And Methods: A total of 3,040 men were enrolled in the 4-year randomized, placebo controlled Proscar Long-Term Efficacy and Safety study. Of these men a subgroup of 10% underwent pelvic magnetic resonance imaging prostate volume measurement at baseline and yearly thereafter.

Comparison of mobile lithotripters at one institution: healthtronics lithotron, Dornier MFL-5000, and Dornier Doli.

Background And Purpose: Extracorporeal shockwave lithotripsy (SWL) has replaced most surgical and endourologic procedures for upper urinary tract stone disease. Our institution contracted with mobile lithotripter companies to provide SWL. We reviewed the outcomes of 50 patients treated on each machine with regard to efficacy, complications, and retreatment rates.

Agglomeration inhibition reflected stone-forming activity during long-term potassium citrate therapy in calcium stone formers.

Objectives: The agglomeration of preformed crystals of calcium oxalate has been hypothesized to be the rate-limiting step in renal stone-forming activity (SFA). The effect of urine on the in vitro inhibition of agglomeration of seed crystals of calcium oxalate monohydrate, designated [tm], has been used to monitor SFA in calcium oxalate stone formers (CaOxSF). The objective of the present study was to determine whether [tm] could be used to help monitor the long-term effectiveness of oral potassium citrate therapy (K-Cit-Rx) in CaOxSF.

Urologic experience in 48 heart transplant recipients.

Background: Urologic experience in heart transplant recipients as a population group has not been reported.

Methods: We reviewed the charts of 48 consecutive heart transplant recipients who were evaluated and treated in our outpatient urologic clinic. Patients were treated for various urologic conditions by both medical and surgical means.

Liquid sterilization versus high level disinfection in the urologic office.

Objectives: Systems are available for liquid sterilization (LS) and high level disinfection (HLD) of flexible cystoscopes. Guidelines from the Association of Operating Room Nurses and the Association for Professionals in Infection Control and Epidemiology recommend HLD for urologic endoscopic equipment. We examine these methods emphasizing costs, performance of procedure, and maintenance.

Large transitional cell carcinoma of the proximal third of the ureter in a young man.

We report an unusual case of a 37-year-old black man found to have a large transitional cell carcinoma of the proximal third of the ureter. This case is of interest because of the relatively young age of the patient, the upper third ureteral origin of the tumor, and the volume of the tumor burden.

Urinary Tamm-Horsfall protein increased after potassium citrate therapy in calcium stone formers.

Objectives: To evaluate the effect of oral potassium citrate therapy on urinary excretion rates of citrate. Tamm-Horsfall protein (THP), and on calcium oxalate monohydrate crystal agglomeration inhibition [tm], in patients with recurrent calcium stone formation.

Methods: To evaluate the effect of oral therapy with potassium citrate on urinary citrate, THP, and [tm], 24-hour urine samples were collected before and at least 2 months after initiation of oral potassium citrate therapy in 33 calcium stone-forming patients who had no dietary restrictions.

Calcium oxalate stone agglomeration reflects stone-forming activity: citrate inhibition depends on macromolecules larger than 30 kilodalton.

To evaluate the clinical utility of in vitro calcium oxalate monohydrate (COM) crystallization kinetics measurements and to determine the effect of quantitative removal of urinary Tamm-Horsfall glycoprotein on such measurements, we examined 24-hour, room temperature urine collections of patients from our Stone Clinic and of normal subjects from our research laboratories at Ochsner Medical Institutions in New Orleans, LA, and compared their COM kinetic parameters in vitro before and after urine ultrafiltration (30 kd). Data from 53 calcium oxalate stone-forming patients (26% women; mean age, 47 years) who demonstrated radiographic or other evidence of forming at least one stone were compared with data from 22 healthy volunteers (25% women; mean age, 40 years). Hypercalciuria (> 7.

Incidence and simple management of priapism following dynamic infusion cavernosometry-cavernosography.

Of 239 patients with erectile dysfunction (aged 36 to 70 years) who were evaluated with dynamic infusion cavernosometry-cavernosography, 32 (13.4%) developed priapism after the procedure and were successfully managed with immediate intracorporal injection of phenylephrine. No single risk factor for the development of priapism was identified in this group.

The titanium intraprostatic stent: the United States experience.

This multicenter, cooperative study represents the initial United States experience using an expandable, titanium intraprostatic stent in 68 patients (60 to 93 years old). The stents were inserted under direct vision and expanded to 33F using a balloon catheter. All patients had a symptom score analysis, and underwent measurement of peak urine flow and rate and post-void residual urine volume as part of the initial evaluation.

Transurethral ultrasound-guided laser-induced prostatectomy: National Human Cooperative Study results.

Between November 1990 and March 1992, 150 patients at 10 United States institutions were treated with transurethral ultrasound-guided laser-induced prostatectomy (TULIP) for the relief of bladder outlet obstruction secondary to benign prostatic hypertrophy. The TULIP system incorporates ultrasound visualization with a 90-degree angle, side-firing laser to effect coagulation necrosis of prostate tissue. The overall preoperative prostate volume in this TULIP study was 40 cc and all types of prostatic enlargement, including median lobe obstruction, were treated.

Invasive bladder cancer following 125iodine implants.

We present 2 cases of invasive transitional cell carcinoma of the bladder following implantation of 125iodine seeds for the treatment of localized adenocarcinoma of the prostate. These tumors, which occurred approximately 6 years after radiotherapy, were located in the trigone and prostatic urethra within the previous radiation treatment field. The development of high grade transitional cell carcinoma in these patients may be due to the tumorigenic effects of 125iodine radiation.

Metastatic renal cell carcinoma presenting as an intrasellar mass on computerized tomography.

We report a case of renal cell carcinoma metastatic to the pituitary gland. A review of the literature indicated breast carcinoma to be the most frequent primary tumor metastatic to this site, while renal cell carcinoma metastasis has not been reported previously. This case emphasizes the capricious nature of renal cell carcinoma, particularly in a patient presenting with no evidence of disseminated disease.

Renal cell carcinoma: the Ochsner Medical Institution experience (1945-1978).

We reviewed 161 patients operated upon for renal cell carcinoma between 1945 and 1978. Life table and survival analyses were computed to compare the effects of stage, tumor differentiation, cell type, surgical technique, renal vein involvement and sex on the years of survival. Patients with stage I and well differentiated tumors had the best prognosis.

Azoospermia: diagnosis and management.

By using a detailed history and physical examination, endocrinologic studies, and, in some cases, testicular biopsy, we assign azoospermic men to three pathogenic groups: pretesticular, testicular, and posttesticular. This and further subclassification allow physicians to provide prognostic information. A few patients will have lesions amenable to surgical correction, or endocrinologic abnormalities that can be treated by replacement therapy or, as in the case of prolactin elevation, by surgery, irradiation, or bromocriptine therapy.

Critical evaluation of 1-stage cystectomy--reducing morbidity and mortality.

Although it is a major surgical effort removal of the bladder can be done with reasonable safety. In our opinion cystectomy and urinary diversion by an ileal conduit can be performed as a conjoined procedure without need for staging to reduce risks. Mortality up to 3 months postoperatively was 3.

Priapism: review of simple surgical procedure.

For the surgical treatment of priapism we have created a percutaneous fistula between the glans penis and the corpus cavernosum with good results. This is our preferred method of management for all patients except those undergoing sickle cell crisis.

Treatment of condylomata acuminata with carbon dioxide laser.

Ten patients with condyloma acuminatum were treated successfully with carbon dioxide laser photocoagulation. There are no side effects, damage to the surrounding tissue is minimal, and, in our experience, the lesions have not recurred. It is particularly useful for lesions which are recalcitrant to other types of therapy.