Quantifying thread tension is of clinical use in Stamey bladder neck suspension: analysis of clinical parameters

Tension on the nylon loops in a Stamey endoscopic bladder neck suspension has been quantified for the first time by using a spring scale. Clinical data were compared between 14 patients with undetermined tension (control group) and 57 with tension of either 400, 600, 700, 800 or 1,000 gm. Experimental study during the operation demonstrated that changes in the posterior urethrovesical angle and distance that the bladder neck was elevated were not proportional to the tension: the lower the thread tension the larger the change in these 2 parameters. Compared to the control group a significant decrease in the period of suprapubic drainage was observed in patients with quantified tension. Operative success was obtained in 86 per cent of the control group and 91 per cent of those in whom tension was quantified. A tension of 400 to 600 gm. seemed to be most appropriate for a successful outcome. We conclude that quantifying the thread tension is useful to prevent either over-tightness of the nylon loops or insufficient suspension of the bladder neck, and that with a spring scale it is easy to instruct a beginner on how tightly to tie the threads.

In-vitro contractility of human seminiferous tubules in response to testosterone, dihydrotestosterone and estradiol

The effects of steroids (testosterone, dihydrotestosterone and estradiol) on human seminiferous tubules in vitro were ascertained by recording the intratubular pressure with a servonull micropressure measuring device. We describe here the first response of the human seminiferous tubule to steroids. Testosterone and dihydrotestosterone had a biphasic effect on tubular contractility. Higher doses of both testosterone and dihydrotestosterone induced contractions of the seminiferous tubules whereas lower doses of these compounds induced relaxation. Estradiol (10(-9) M to 10(-6) M) induced relaxation of the seminiferous tubules in a dose-dependent manner. The results from these experiments suggested that steroids may be involved in the control of contraction of the human seminiferous tubule and may regulate the movement of spermatozoa from the testes.

Scanning electron microscopic study on the shape of infertile seminiferous tubules: a hypothesis of pathogenesis of idiopathic male infertility

The shape of infertile seminiferous tubules was studied on testicular biopsied specimens from patients with idiopathic male infertility using the scanning electron microscope. A parallel study of the same sections was performed by ordinary light microscopy. Normal seminiferous tubules were revealed to be shaped like a weaving cylinder, whereas infertile seminiferous tubules were strangulated in various places, or appeared similar to a tail-like rope which became gradually more slender. These strangulated or slender parts of tubules seemed to correspond to the smaller tubules with thickened tubular walls that were recognized under the light microscope. It is suggested that these thickened tubular walls suppress spermatogenesis by a nutritional disturbance, and the strangulations of infertile tubules interfere with sperm transport by tubular blockage or germinal disorganization and interrupted contractions of the tubules.

Increased mast cells in the limiting membrane of seminiferous tubules in testes of patients with idiopathic infertility

In the course of our histological studies on the testes of idiopathically infertile men, we found an increased number of mast cells in the limiting membrane of the seminiferous tubule. In 16 patients with idiopathic infertility, quantification of mast cells within the limiting membrane of the seminiferous tubule was performed. There apparently was a tendency to increased numbers of mast cells in the seminiferous tubule wall with decreased sperm count and an average Johnsen score for each tubule. These findings suggest that quantification of mast cells in the seminiferous tubule wall may be a useful marker in the histopathological evaluation of testis biopsies in patients with idiopathic infertility.

[Assessment of obstructive nephropathy using diuretic 99mTc-DTPA renogram and 99mTc-DMSA renoscintigraphy]

99mTc-DMSA and diuretic 99mTc-DTPA renoscintigraphy were performed on 51 kidneys suspected of obstructive nephropathy based on excretory urography to evaluate the residual renal function and the degree of urinary flow impairment respectively. We classified the response to diuretics into 6 patterns: I. normal, IIa. severely damaged renal function, IIb. slow RI excretion without urinary tract visualization (pattern II had no response to furosemide), IIIa. rapid elimination of tracer from the obstructed upper tract, IIIb. slow elimination, and IV. gradual tracer accumulation in the pelvicalyceal system with fairly well preserved renal function but no response. Hydronephrosis varied according to pattern type, in the ascending order of I, IIIa, IIIb and IV (p less than 0.05). Degree of hydronephrosis was inversely related to 99mTc-DMSA uptake, but without statistical significance. 99mTc-DMSA uptake was lower for pattern III as a whole (IIIa + (IIIb) than for pattern I (p less than 0.005), but there was no difference between IIIa and IIIb. Pattern IIa exhibited a significantly lower uptake than any of the other groups. (p less than 0.005) In contrast to previous views, we believe that pattern IIIa indicates a mild obstruction of urinary flow and impaired renal function. Consequently, assessment of obstructive nephropathy should not be based only on urodynamic study but also on differential renal function test.

Comparison of enoxacin and norfloxacin in patients with cystitis

The urinary antibacterial drugs enoxacin and norfloxacin were compared for efficacy and side effects in the treatment of lower urinary tract infections. Thirty-five patients received enoxacin and 25 received norfloxacin for one week. The antibacterial spectrum of enoxacin was noted to be better than that of norfloxacin, but both drugs performed well in clearing the infections caused by susceptible organisms. The incidence of side effects was higher with norfloxacin than with enoxacin.

[A case of giant vesical diverticulum with malignant neoplasm]

We experienced a case of giant vesical diverticulum with a malignant neoplasm in which the preoperative diagnosis was difficult. It simultaneously occurred with a vesical tumor. The patient, a 68-year-old man, visited our hospital complaining of pollakisuria, nycturia and microscopic hematuria. He had urinary retention and his vesical urine volume was 1,450 ml. X-ray examination and ultrasound examination revealed a giant vesical diverticulum and moderate hypertrophy of the prostate. A vesical tumor was suspected. Cystometrogram revealed a flaccid pattern with vesical capacity over 900 ml. Diverticulectomy and resection for a vesical tumor were performed. A malignant neoplasm in the vesical diverticulum was found during the operation. Transurethral resection of the prostate was performed after two months. There has been no evidence of recurrence for 3 years postoperatively.

[Fournier's gangrene: a case report]

Since necrotizing fasciitis of the genitalia was first described by Fournier in 1883, approximately 400 cases have been reported. It has been seldom reported in Japan. Because its mortality rate is still high, the importance of early diagnosis and the subsequent vigorous treatment has been emphasized. A 73-year-old man who had poor controlled diabetes mellitus was admitted to our hospital with painful swelling of scrotum. Chemotherapy using broad spectrum antibiotics and debridement of scrotal skin was performed combined with insulin therapy. As culture of pus and excised tissue from the gangrenous patches yielded the growth of candida, we used 8 g/day of 5-fluorocytosine. Because the gangrene was not healed, we performed bilateral orchiectomy. After the operation, the gangrene was healed and the wound was closed. Diabetes mellitus was controlled well and his general condition was improved.

[The course of pyuria after transurethral resection of the prostate and factor analysis of its duration]

The course of pyuria and bacteriuria was reviewed in 54 patients undergoing transurethral resection of prostate. Pyuria, which was seen in all cases, lasted for 70.1 +/- 24.7 days and bacteriuria defined as more than 10(4)/ml occurred in 16 patients (30%) postoperatively. To analyze the factors affecting the duration of pyuria, we utilized Hayashi's multidimensional quantification I theory. The factors included age, serum protein, preoperative indwelling catheter, preoperative urinary tract infection, resected weight, postoperative infection, the duration of postoperative indwelling catheter, and the way of antibacterial prophylaxis. The most important factor was resected weight (range 42.8 days), the second was postoperative infection (range 23.9 days) and the third preoperative infection (range 20.9 days). The other factors had no significance. Our analysis showed good correlation between the observed and predicted duration of pyuria (r = 0.82, p less than 0.005).

Response of the isolated human seminiferous tubule to prostaglandins F1 alpha, F2 alpha, E1 and E2

In an attempt to ascertain whether prostaglandins alter the in vitro contractile activity of the human seminiferous tubule, the effects of prostaglandins on the isolated human seminiferous tubule were examined by recording the intratubular pressure with a servonull pressure with a servonull pressure measuring device. We describe here the first response of the human seminiferous tubule to prostaglandins. Prostaglandin F2 alpha (10(-9) M to 10(-6) M) produced contractions of the seminiferous tubules in a dose-dependent manner. In contrast, prostaglandins F1 alpha (10(-8) M to 10(-6) M), E1 (10(-9) M to 10(-6) M) and E2 (10(-8) M to 10(-6) M) produced relaxations of the seminiferous tubules which were dose dependent. The results from these experiments suggest that prostaglandins modulate the in vitro contractility of the human seminiferous tubules and thus may regulate the transport of spermatozoa and tubular fluid to the rete testis.

Overall morphology of basement membrane of rat seminiferous tubule as revealed by scanning electron microscopy

Scanning electron microscopic observation of the basal surface of the basement membrane of the rat seminiferous tubule has revealed that the basement membrane appears to be like a tiled floor, and formation of meshwork structure of collagen fibrils is evident in some exfoliated areas of basement membrane. This meshwork structure is considered to ensure fluid regulation from the intertubular medium toward the lumen of the seminiferous tubules.

Evidence for innervation of the myoid cell in the human seminiferous tubule

Although the existence of the seminiferous tubule contractions attributed to myoid cells is established, the control of the contractions is poorly understood. Recently, we have suggested the possible neural control mechanism for contractility of the human seminiferous tubule. In an effort to identify the nerve supply to the myoid cells in the human seminiferous tubules, we studied the paraffin sections of biopsied testicular specimens using a protein silver impregnation technique (Bodian's method). Here we demonstrate evidence for the presence of nerve fibers close to the myoid cells. It is highly suggested that contraction of the human seminiferous tubule may play an important role in the transport of spermatozoa, and neurohumoral regulatory mechanism may partly exist in this connection.

Successful treatment of oligospermic and azoospermic men with alpha 1-blocker and beta-stimulator: new treatment for idiopathic male infertility

We studied the effect of oral administration of alpha 1-blocker and beta-stimulator on 20 idiopathically infertile men. Bunazosin (alpha 1-blocker, 2 mg/day) and procaterol (beta-stimulator, 100 micrograms/day) were given orally twice daily for 5 months. The administration of alpha 1-blocker and beta-stimulator elicited an increase in sperm output and seminal volume in 16 patients (80%). The increase in sperm output seems to be associated with relaxations of myoid cells, which lead to dilatation of stenotic areas of seminiferous tubules, occurring discontinuously, and subsequent maintenance of good tubular fluid flow. No adverse effects were observed in this series.