Postcatheterization urethral strictures following cardiac surgery in children

Ten children among 221 with congenital cardiac anomalies developed urinary symptoms after removal of urethral catheters, which were routinely inserted for monitoring purposes during and after cardiac surgery. Six children developed urethral strictures. Poor tissue perfusion concomitant with serious congenital cardiac anomalies, together with secondary urine infection in the presence of a urethral catheter, are proposed as significant factors in the causation of such strictures in children undergoing cardiac surgery.

Ureaplasmal infections of the male urogenital tract, in particular prostatitis, and semen quality

Ureaplasma urealyticum is considered an etiologic agent in urogenital tract infections, especially prostatitis. Using the 'four-specimen technique', diagnosis can be based upon significant numbers of these microorganisms. In ejaculate, the critical number seems to be 10(3) cfu/ml of semen to discriminate between real infection and contamination during urethral passage. In our study, 46 of 412 samples (11.2%) exceeded this critical number. Most but not all patients suffering from ureaplasma-associated prostatitis established by the 'four-specimen technique' revealed significantly high ejaculate numbers, whereas all samples from patients with prostatodynia and healthy controls had lower numbers. In these cases, numbers of round cells in semen, i.e. all leukocytes and spermatides, were significantly increased as compared to prostatodynia. A significantly negative correlation was detected between the numbers of ureaplasmas and zinc concentration in semen, and an almost identically negative correlation to the content of fructose, thus indicating secretory dysfunction of the accessory glands in ureaplasmal infections of the prostate.

Framboesiform lesions in primary herpes simplex infection: a case report

A 27 year old homosexual man developed unusual sacral lesions during a disseminated primary herpetic attack, which was confirmed by viral culture and rising antibody titre. The lesions had a striking framboesiform appearance and healed without ulceration or scarring. Review of modern and historical published reports suggests that this may be the first illustrated description of such infection.

The importance and frequency of mixed infections with Chlamydia trachomatis and mycoplasmas in acute gonococcal urethritis

Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis are frequently involved in gonococcal urethritis. We investigated 143 male White and Black patients with gonococcal urethritis (average age 22,5 years). Of these 29% had coexisting Chlam. trachomatis infection, 34% U. urealyticum infection and 13% Mycoplasma hominis infection. Conventional penicillin therapy did not affect Chlam. trachomatis, U. urealyticum or Mycoplasma hominis, which persisted in the lower urogenital tract, causing a so-called 'post-gonococcal urethritis.' Additional therapy with tetracycline or erythromycin was successful in most cases.

Nongonococcal urethritis

Nongonococcal urethritis is a frequent genital infection, in most cases caused by Chlamydia trachomatis or Ureaplasma urealyticum. Diagnosis requires demonstration of urethritis and exclusion of Neisseria gonorrhoeae infection. Preferred treatment is seven days of tetracycline hydrochloride or doxycycline, to both the patient and partners. Physical sequelae are infrequent but include epididymitis and Reiter's syndrome.

Intraurethral immunoglobulin in the treatment of non-specific urethritis

We report on a 25 year old man with agammaglobulinaemia and refractory non-specific urethritis. After seven months of unsuccessful antibiotic treatment, his symptoms responded to the administration of intraurethral immunoglobulin.

Chlamydia trachomatis infections in men with Reiter's syndrome

Chlamydia trachomatis was isolated from 9 of 19 men with acute, nondiarrheal Reiter's syndrome who had not recently taken antibiotics. None of 8 untreated men with other forms of arthritis were infected with this organism. Chlamydia trachomatis-specific antibody titers and cellular immune responses were positive significantly more often in 35 treated and untreated men with acute, nondiarrheal Reiter's syndrome than in 7 men with diarrhea-associated Reiter's syndrome and 8 men with other forms of arthritis. Mean peak chlamydial antibody titers and mean lymphocyte transformation stimulation indices were significantly higher in C. trachomatis-infected men with Reiter's syndrome than in C. trachomatis-infected men with uncomplicated nongonococcal urethritis. We concluded that C. trachomatis is capable of "triggering" Reiter's syndrome in susceptible men and that an exaggerated immune response to this organism may play a role in the pathogenesis of the disease.

A combined treatment in prevention of postgonococcal urethritis

The authors report a study carried out on 82 patients affected with gonococcal urethritis, in order to investigate the activity of minocyclin in the prevention of postgonococcal urethritis.

Urogenital syndromes and spondarthritis

During the last 50 years there has been an obvious change in the relationship between Reiter's syndrome and spondarthritis, probably due to the introduction of antibiotics. Postgonorrhoeic prostatovesiculitis was formerly common: Romanus' spondylitics in the 1940s had a history of gonorrhoea in 35% of cases and 50% of my patients with chronic uro-arthritis in the 1950s had had gonorrhoea. Urogenital syndromes nowadays rarely develop into ankylosing spondylitis; on the other hand, sacroiliitis is still a rather common late sequela, especially in females, however often asymptomatic. The HLA-B27 tissue type is much less frequent in the urogenital syndromes than in ankylosing spondylitis. Accordingly one may postulate that patients with HLA-B27 negative sacroiliitis run a small risk that the disease will progress to ankylosing spondylitis.

Rheumatoid factor-negative arthritis, especially ankylosing spondylitis, and infections of the male urogenital tract

146 men with rheumatoid factor-negative (sero-negative) arthritis, i.e., 97 patients with ankylosing spondylitis, 36 patients with Reiter's syndrome, and 13 patients with reactive arthritis, were examined for infections of the urogenital tract by following recently established criteria. 74 patients (50.7%) had infections of the male adnexes: 3 patients suffered from balanitis, 14 patients from urethritis, 49 patients from prostatitis, 1 patient from epididymitis, and 7 patients from urinary tract infection. Balanitis and urethritis were almost exclusively associated with Reiter's syndrome. In 37 of 97 patients with ankylosing spondylitis, a urogenital tract infection, mainly a prostatitis (31 patients), was detected. The microorganisms isolated most frequently from patients suffering from urethritis and prostatitis, were Chlamydia trachomatis and Ureaplasma urealyticum.

Clinical aspects of Reiter's disease

The clinical manifestations and results of investigations in a series of 221 patients diagnosed as suffering from Reiter's disease are described in detail. Attention is drawn to the very varied natural history of the disease, the relapse rate of 60% and the development of serious complications and disability in young people. The failure to establish the cause of the condition or to unravel its relationship to nonspecific urethritis and bacillary dysentery contrasts with the reported presence of the human leucocyte antigen HLA-B27 in 76% of patients. There is no curative treatment but symptomatic treatment will relieve pain and stiffness and may shorten the duration of individual attacks. Prolonged follow-up of established cases, monitoring of activity of the disease by regular measurements of the erythrocyte sedimentation test and prompt treatment of relapses may prevent the development of serious locomotor disability.

Urethral strictures in children

During a 12-year period 57 children presented for treatment of urethral strictures. The patients ranged in age from 2 months to 18 years and there was 1 girl. Of the strictures 8 were congenital, 34 were iatrogenic, 4 were inflammatory and 11 were traumatic. Diagnosis can be suspected from the history and physical examination (observation of the voided stream), and confirmed radiographically and endoscopically. Urethral dilation was definitive treatment in only 28.6 per cent of the patients in whom it was used. Of 4 inflammatory strictures 2 responded to dilation as the only treatment, while only 1 of 5 congenital strictures and 1 of 5 iatrogenic strictures responded to dilation. Direct vision urethrotomy was successful in 1 of 2 congenital and in 5 of 5 iatrogenic bulbar strictures. A 1-stage urethroplasty seems preferable to multistaged procedures, since only 2 of 7 patients managed with staged procedures were treated successfully in 2 operations, while 5 of 9 treated with a 1-stage procedure have required no further intervention.

Factors associated in the aetiology of peyronie's disease

In a retrospective study of 408 patients with Peyronie's disease 8 (1.9%) patients gave a positive family history for the condition. Sixty-three (15.4%) patients had a Dupuytren's contracture and trauma was considered to be an aetiological factor in 88 (21.5%) patients. One hundred and twenty-two (29.9%) patients had evidence of atherosclerosis and this is thought to be a factor in the pathogenesis of the disease. Peyronie's disease is not a single disease entity and is associated with many aetiological factors.