α-Adrenergic drugs in retrograde ejaculation

functioned normally but postmortem examination showed foreign body reaction adjacent to the prosthesis and a thin coat of brownish proteinacious material without encrustation in 2 of the test animals. Low pressure reflux but no high pressure reflux was demonstrated by cystograms. One of the female patients had bilateral hydronephrosis secondary to radiotherapy for carcinoma of the cervix. The right ureter was mobilized surgically, but the left could not be freed intact and was excised. A Scurasil ureter prosthesis was inserted and the patient had an uneventful postoperative course. A cystogram demreflux even after fifteen onstrated low-pressure months but a well-functioning prosthesis despite continued impairment of upper tract function. The second patient was a thirty-nine-year-old woman with ureteral obstruction secondary to advanced cervical carcinoma. Prostheses were inserted bilaterally. Function of the left kidney was restored within a week, but replacement with a prosthesis of smaller diameter was required approximately one month later because of leakage at the pelvic anasan abscess tomosis. Four months postoperatively formed at the pelvic anastomosis on the right side, and subsequently the prosthesis and kidney were removed. Nephrostomy on the right side had been performed prior to insertion of the prosthesis, but this kidney did not recover function even after the nephrostomy was performed. Follow-up intravenous pyelograms showed normal function of the left kidney throughout the period after insertion of the prosthesis, but the patient died of carcinomatosis approximately six months later. At postmortem examination the left kidney and pelvis were of normal size, and the prosthesis was patent despite being invested with tumor tissue.

FERTILITY

AND

by W. Keiserman,

STERILITY M. D.

A Relationship Between Testicular Biopsy Score Count and Fertility of Men Treated for Oligospermia, J, H. Aafjes and J. C. M. Van Der Vijver (25: 809, 1974) - The purpose of this report was to show that a testicular biopsy score count is related to the fertilization capacity of a selected group of men treated for oligospermia. The testicular biopsy score count as described by Johnsen, with slight modification, was employed. Score numbers were given for the various degrees of sperm maturation, and in a group of 28 men treated for oligospermia there appeared to be a relationship between the score count and their fertilization capacity. In contrast, such relationship was not found for the number of spermatozoa and for the motility or the percentage of normal spermatozoa in the ejaculate.

434

cY-Adrenergic Drugs in Retrograde Ejaculation, K. Stockamp, F. Schreiter, and J. E. Altwein (25: 817, 1974) - A therapeutic trial of cu-adrenergic drugs was conducted in 6 patients with complete or partial loss of ejaculation following retroperitoneal lymphadenectomy. The patients averaged twenty-nine years in age and the interval since operation was an average of twenty-one months. Each patient was free of demonstrable metastases, and each was reported to possess normal potency prior to surgery. Following node dissection, 4 were unable to ejaculate and 2 had near azospermatic specimens. The use ofa-adrenergic drug resulted in lower sperm count, and all but 1 patient demonstrated a high retrograde sperm count in the urine. The authors conclude that the therapy was helpful only ifthe vas maintained its normal peristalsis.

NEW ENGLAND by M. Berson,

JOURNAL

OF MEDICINE

M.D.

Correlation of Pretreatment Serum NonproteinBound Cortisol and Total 17-Hydroxycorticosteroid Values with Survival in Patients with Prostatic Cancer, C. E. Blackard, D. P. Byar, U. S. Seal, R. P. Doe, and the Veterans Administration Cooperative Urologic Research Group (291: 751,1974) - Levels of serum nonprotein-bound cortisol (NPC) and total 17-hydroxycorticosteroids (17-OHCS) were investigated for prognostic value in survival of 715 patients with prostatic carcinoma. Patients with histologically confirmed and previously untreated prostatic malignancy were appropriately staged and then managed with either placebo or radical prostatectomy plus placebo for Stages I and II, and either placebo alone or various hormonal agents (diethylstilbestrol, conjugated estrogens and/or medroxyprogesterone acetate) for Stages III and IV. Serum NPC and 17-OHCS levels were determined before and after treatment in 715 patients with all stages of prostatic cancer. Patients with Stages III and IV carcinoma who had lower pretreatment NPC levels had increased survivals during the first year of treatment when compared with those with higher pretreatment values. Similarly, higher pretreatment levels of 17-OHCS correlated with poorer survivals during the first year of treatment regardless of the initial stage of prostatic malignancy. The increased rate of death in patients with higher initial NPC and 17-OHCS levels could not be simply attributed to increased mortality from the cancer alone. Cardiovascular diseases and infection also were found to have contributed to the higher mortality seen. This may have been due to the suppressive effect of glucocorticoids on inflammatory and immunologic responsiveness as well as increased blood coagulability. In addition, increased glucocorticoids may have contributed to cardiovascular deaths through their

UROLOGY

/ MARCH 1975 / VOLUME

V, NUMBER 3