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Coccidiodomycosis of the prostate gland
patients. At this time, exstrophy is repaired: first mobilizing the bIadder and then narrowing the area of the bladder neck. Decision is then made as to immediate or delayed ureteroneocystotomy which will be necessary in most patients. Finally, the bladder is closed and the muscle and skin defects are closed, either directly or with flaps. They note that it takes at least one year to determine success with regard to continence. The authors suggest that their improved results may be attributed to several factors: (1) more selectivity in choosing patients (not attempting primary repair on a small capacity bladder); (2) closure done at a later age (sixteen months’ average compared with eight to twelve months in the earlier group); (3) less attempt at tight closure of the bladder neck; (4) more attention to reflux prevention, and (5) better control of infection with antibiotics. AIso, in the future they will abandon osteotomies unless the gap in the pubes is very wide, in that this procedure did not appear to improve continence. Finally, the authors suggest that one third of all cases of classic exstrophy should, with improved technique, be amenable to primary repair and should not need diversion.
ACTA CHIRURGICA by F. P. Yuvienco,
SCANDINAVICA
by M. Cohen,
JOURNAL OF SURGERY M.D.
Red Cell Mass and Plasma Volume Changes during Transurethral Resection of the Prostate, V. Colapinto, D. J. Armstrong, and D. C. Finlayson (16: 144,1973) The authors studied red cell mass and plasma volume changes during and following transurethral resection of the prostate in 12 patients. The double isotope tagging technique was used to measure plasma volume and red cell mass, and the authors believe that this method of blood volume determination is accurate for the evaluation of some of the changes seen follow-
696
ARCHIVES OF PATHOLOGY by C. S. Khang, M.D. Coccidiodomycosis of the Prostate Gland, H. J. Bellin, and B. S. Bhagavan (96: 114,1973)-This case report is reviewed because of the uncommon involvement ofthe prostate with coccidiodomycosis. Although this disease is endemic in the southwestern United States, involvement of the urogenital tract is seldom clinically recognized. Including the present report, there are 13 cases of coccidiodomycosis of the male genital tract diagnosed antemortem, The epididymis, prostate, vas deferens, and testis have been reported sites of infection. In an autopsy series, however, of 50 military personnel, with disseminated disease, 60 per cent of the patients had renal involvement and 6 per cent prostatic involvement. Recognition of involvement of the genitourinary tract by coccidiodomycosis should result in earlier detection and treatment.
M.D.
Stones in the Ureter, H. E. Carstensen, and T. S. Hansen (433: 66, 1973)-The course of 346 cases of ureteral calculi was analyzed. They were grouped according to position into upper abdominal and lower pelvic, and according to size into large (6 mm. or over), medium (4 to 5.9 mm.), and small (3.9 mm. or less). The patients were followed up with repeated x-ray studies until the stones passed spontaneously or had to be rimmed surgically because of threatening complications. Data obtained showed that spontaneous passage is likely to occur with abdominal stones 4 mm. or smaller, and with pelvic stones 6 mm. or smaller. Larger stones will usually require surgery.
CANADIAN
ing transurethral resection of the prostate. However, in the total group there appears to be no significant alterations in blood or plasma volume unless the clinical course has been complicated by either bleeding, hypotension, or significant irrigant uptake.
PLASTIC AND RECONSTRUCTIVE SURGERY by B. Lazarus,
M.D.
Treatment of Hypospadias by the Byars Technique, J. C. Nosti, and J. W. Davis (52: 2, 128, 1973)-Fifty cases of hypospadias repaired by the Byars technique are presented. Results and complications are analyzed. The Byars repair of hypospadias is done in two stages. In the first stage the chordee is corrected and skin from the dorsal prepuce is slit and applied in two flaps over the ventral surface. The second stage, performed six or more months later, consists of constructing a tube between the tip and the hypospadias opening and covering the new urethra in two layers with skin from either side of the tube. A diverting perineal urethrostomy is done. Seventeen cases required repair of the chordee only, while 33 were either penile, penoscrotal, or scrotal hypospadias, necessitating the construction of a new urethra. Twenty needed repair in two stages, 4 required a third procedure to close a residual urethrocutaneous fistula, and 9 required four or more procedures to complete the repair. Complications included hematoma in 2 cases, local staphylococcal infection in 1 case, persistent leak at the perineal urethrostomy in 1 case, and small urethrocutaneous leaks in 9 cases. Late complications of stricture and intraurethral hair have not been encountered in this technique.
UROLOGY
I
DECEMBER
1973
/
VOLUME
II, NUMBER
6
ACTA CHIRURGICA by F. P. Yuvienco,
SCANDINAVICA
by M. Cohen,
JOURNAL OF SURGERY M.D.
Red Cell Mass and Plasma Volume Changes during Transurethral Resection of the Prostate, V. Colapinto, D. J. Armstrong, and D. C. Finlayson (16: 144,1973) The authors studied red cell mass and plasma volume changes during and following transurethral resection of the prostate in 12 patients. The double isotope tagging technique was used to measure plasma volume and red cell mass, and the authors believe that this method of blood volume determination is accurate for the evaluation of some of the changes seen follow-
696
ARCHIVES OF PATHOLOGY by C. S. Khang, M.D. Coccidiodomycosis of the Prostate Gland, H. J. Bellin, and B. S. Bhagavan (96: 114,1973)-This case report is reviewed because of the uncommon involvement ofthe prostate with coccidiodomycosis. Although this disease is endemic in the southwestern United States, involvement of the urogenital tract is seldom clinically recognized. Including the present report, there are 13 cases of coccidiodomycosis of the male genital tract diagnosed antemortem, The epididymis, prostate, vas deferens, and testis have been reported sites of infection. In an autopsy series, however, of 50 military personnel, with disseminated disease, 60 per cent of the patients had renal involvement and 6 per cent prostatic involvement. Recognition of involvement of the genitourinary tract by coccidiodomycosis should result in earlier detection and treatment.
M.D.
Stones in the Ureter, H. E. Carstensen, and T. S. Hansen (433: 66, 1973)-The course of 346 cases of ureteral calculi was analyzed. They were grouped according to position into upper abdominal and lower pelvic, and according to size into large (6 mm. or over), medium (4 to 5.9 mm.), and small (3.9 mm. or less). The patients were followed up with repeated x-ray studies until the stones passed spontaneously or had to be rimmed surgically because of threatening complications. Data obtained showed that spontaneous passage is likely to occur with abdominal stones 4 mm. or smaller, and with pelvic stones 6 mm. or smaller. Larger stones will usually require surgery.
CANADIAN
ing transurethral resection of the prostate. However, in the total group there appears to be no significant alterations in blood or plasma volume unless the clinical course has been complicated by either bleeding, hypotension, or significant irrigant uptake.
PLASTIC AND RECONSTRUCTIVE SURGERY by B. Lazarus,
M.D.
Treatment of Hypospadias by the Byars Technique, J. C. Nosti, and J. W. Davis (52: 2, 128, 1973)-Fifty cases of hypospadias repaired by the Byars technique are presented. Results and complications are analyzed. The Byars repair of hypospadias is done in two stages. In the first stage the chordee is corrected and skin from the dorsal prepuce is slit and applied in two flaps over the ventral surface. The second stage, performed six or more months later, consists of constructing a tube between the tip and the hypospadias opening and covering the new urethra in two layers with skin from either side of the tube. A diverting perineal urethrostomy is done. Seventeen cases required repair of the chordee only, while 33 were either penile, penoscrotal, or scrotal hypospadias, necessitating the construction of a new urethra. Twenty needed repair in two stages, 4 required a third procedure to close a residual urethrocutaneous fistula, and 9 required four or more procedures to complete the repair. Complications included hematoma in 2 cases, local staphylococcal infection in 1 case, persistent leak at the perineal urethrostomy in 1 case, and small urethrocutaneous leaks in 9 cases. Late complications of stricture and intraurethral hair have not been encountered in this technique.
UROLOGY
I
DECEMBER
1973
/
VOLUME
II, NUMBER
6