Influence of Vasectomy on the Volume of the Non-Hyperplastic Prostate in Men

Af\JDROLOG\'.

Widely Dis§emi:rmted Cun:ninghamel.la Mucormycosis in an. Adult Renal Transplant Patient: Ca.ie Repo:.-t and Review of the Literature P. C. KOLBECK, R. G. MAKHOUL, R. R. BOLLINGER AND F.

Departments of Pathology and Surgery, Duke University Medical Center, Durham, North Carolina

SANFILIPPO,

prognosis of those with invasive tumors, -,,,,,-,,,·J side effects were observed in a significant proportion of the long-term survivors. Further efforts to determine the etiology of upper tract dilatation in patients with an ileal conduit diversion are justified. G. P. M. 1 figure, 1 table, 15 references

Amer. J. Clin. Path., 83: 747-753 (June) 1985 A case of widely disseminated mucormycosis involving Cunninghamella bertholletiae is reported. This represents the first report of Cunninghamella infection in a transplant patient. Only 7 cases of human infection by this saprophytic fungus have been reported. The study is similar to others in that the patient was immunocompromised and that the diagnosis was made late in the course of the infection. However, it differs from the previously reported cases in that the major signs and symptoms mimicked myocardial infarction, there was more extensive dissemination of the infection (heart, brain, lungs, lymph nodes and entire gastrointestinal tract) and the fungus was identified retrospectively in surgical tissue removed 2 weeks before death. Thus, this case demonstrates that 1) the timely diagnosis of fungal infections in immunocompromised patients remains difficult because of the lack of specific early clinical signs or symptoms, 2) all surgical specimens, especially those from immunocompromised patients, showing areas of necrosis should be examined carefully with fungal stains regardless of an apparent etiology for the necrosis (for example severe rejection), 3) C. bertholletiae is not a common contaminant of clinical laboratory cultures and, when isolated from clinical specimens, seems to be susceptible to amphotericin B therapy and 4) the autopsy remains an essential mechanism to establish clinical pathological correlations in cases when the clinical diagnosis is unknown or when there is an unsuspected pathological condition. A. J. W. 5 figures, 2 tables, 14 references

DIVERSION Complicatiomi of Heal Conduit Diversion in Adults With Cancer Followed Up for at Least Five Years D. E. NEAL, Department of Urology and University Department of Surgery, Department of Freeman uu~u,,u,. Newcastle upon

ANDROLOGY On the Origin of P:rostaglandins in Human Seminal Fluid E. BENDVOLD, K. SVANBORG, M. BYGDEMAN ANDS. NOREN, Departments of Obstetrics and Gynecology, and Urology, Karolinska Hospital, Stockholm, Sweden

Int. J. Androl., 8: 37-43 (Feb.) 1985 When prostaglandins were first found in human seminal fluid, their name was based on the belief that they originated from the prostate gland. Later studies have indicated that the seminal vesicles are the preferential site of production, although some controversy still exists on this point. The authors believe that, to date, information available regarding the site of production of human seminal prostaglandins is scarce and the result is somewhat equivocal. To elucidate further the origin of seminal prostaglandins they analyzed genital tract fluids for prostaglandin content before and after vasectomy, and in a patient in whom secretion from the testis could be obtained separately from that of the seminal vesicles and prostate gland. Six patients delivered semen samples before and after vasectomy. In these patients the prostaglandin concentration remained essentially unchanged, although sperm density decreased to 0. In another patient secretory products from the testis and epididymis, and the ejaculate representing mainly the secretion of the seminal vesicles and prostate gland, were collected separately. Secretions obtained from the testis and epididymis did not contain detectable amounts of prostaglandin, while in the ejaculate from the same patient the concentration was within normal limits. The authors conclude that the testis and epididymis do not contribute significantly to prostaglandin content of human seminal fluids, and agree with the previous assumption that the seminal vesicles are the main source of seminal prostaglandins. The quantitative analyses done were on prostaglandin Es, PGFs, 19-0H-PGEs and 190H-PGFs. A. J. W. 2 tables, 15 references

Brit. Med. J., 290: 1695-1697 (June 8) 1985 A total of 111 adults with malignant disease of the bladder was studied to determine the long-term complications of ileal conduit diversion. Each patient had survived at least 5 years (mean 10 years) after cystectomy. At final followup the radiological appearance of 1 or both kidneys had deteriorated in 50 of 107 patients (47 per cent); deterioration worsened significantly (p <0.01) with increasing duration of followup. A total of 18 patients (16 per cent) had biochemical evidence of impaired renal function, 4 of whom died of complications of renal failure. Bilateral upper tract dilatation was noted in 30 patients (28 per cent) and in 21 its cause was obscure. Renal stones formed in 10 patients and an additional 12 required further operations on the conduit or stoma. Despite the age of patients with bladder cancer and the poor

Influence of Vasectomy on the Volume of the Non-Hyperplastic Prostate in Men H. JAKOBSEN AND N. JUUL, Department of Urology and Ultrasonic Laboratory, Herlev Hospital, University of Copenhagen, Herlev, Denmark Int. J. Androl., 8: 13-20 (Feb.) 1985 The influence of vasectomy on the volume of the nonhyperplastic prostate was investigated in 24 men referred consecutively for vasectomy. A comparison of transrectal prostatic volume determined ultrasonically before vasectomy and 3 months postoperatively revealed a highly significant decrease (p <0.01) in the volume of the periurethral portion of the gland. The absolute mean was 5.8 cc preoperatively and 4.5 cc post-

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RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY

operatively. The volume of the outer zone of the prostate did not change significantly (p >0.1). A direct influence of vasectomy on prostatic volume has not been demonstrated previously. The decrease in volume of the periurethral prostatic zone after vasectomy is postulated by the authors to indicate a direct influence on prostatic function. They believe that this influence possibly may be hormonal in nature, and may be abolished by interruption of vasal continuity and/or simultaneous occlusion of the deferential vein. It is difficult to imagine what events other than the operation could have caused the observed changes. An alteration in the frequency of ejaculation postoperatively theoretically might influence the prostatic volume but no such change was reported by the authors. Sexual abstinence for 48 hours before scanning presumably prevented any unintended influence of ejaculation on the measurements. It is unknown whether this influence of vasectomy on prostatic volume is temporary but longitudinal studies on this subject should aid further understanding of prostatic function, and its relationship to vasal integrity and physiology. A. J. W. 4 figures, 2 tables, 20 references

PEDIATRIC UROLOGY Development of New Renal Scars: A Collaborative Study J.M. SMELLIE, P. G. RANSLEY, I. C. S. NORMAND, N. PRESCOD AND D. EDWARDS, University of Southampton, Southampton,

and University College Hospital and The Hospitals for Sick Children, London, England Brit. Med. J., 290: 1957-1960 (June 29) 1985 Few reports exist regarding the development of new renal scars in children. This report is a retrospective collection of 74 patients seen in 23 British centers during 20 years. All of the patients acquired new scars while under medical observation. Of 87 kidneys that demonstrated new scarring 74 initially were normal radiographically and further scars developed in 13 already scarred kidneys. Although no intrarenal reflux was identified, vesicoureteral reflux was seen in 67 children (72 kidneys) with new scars. In 6 patients reflux was found only in the contralateral ureter. One child did not have cystography and cystography showed no reflux in 6 patients. Every child with new renal scarring had infection of the urinary tract. Escherichia coli was the infecting organism in 61 cases. All but 1 infection occurred shortly before the last excretory urogram (IVP) that did not show a new scar. The mean interval between the last IVP without a new scar and the first IVP showing a new scar was 2. 7 years. Of the children 34 were 5 years old or more when the new scar developed. Twenty-eight children underwent ureteral reimplantation. In 18 patients new scars were seen preoperatively and in 10 the new scar was not identified until after the operation. The management of these patients was varied but few were on prophylaxis, and many had a delay in the diagnosis and treatment of the urinary tract infection. The authors believe that the causal relationship among reflux, infection and subsequent renal scarring is supported by this study. Surprisingly, a third of the new renal scars occurred after the child was 5 years old. G. F. S. 1 figure, 2 tables, 24 references

Long-Term Follow-Up of Patients Who Underwent Unilateral N ephrectomy in Childhood P.

ROBITAILLE, J.-G. MONGEAU, L. LORTIE AND P. SINNASSAMY, Department of Paediatrics, Nephrology Divi-

sion, Hopital Sainte-Justine, University of Montreal, Montreal, Quebec, Canada Lancet, 1: 1297-1299 (June 8) 1985 Substantial renal mass reduction in animals leads to progressive azotemia, proteinuria and glomerulosderosis. After extensive renal ablation, single nephron glomerular filtration rate in the functioning nephrons increases because of an increase in glomerular capillary hydraulic pressure and an augmented glomerular capillary plasma flow rate. These physiological changes lead to glomerular lesions, including endothelial and epithelial damage, and an increase in mesangial matrix and, eventually, glomerulosclerosis. Several reports have suggested that the same sequence of events operates in man to produce proteinuria, hypertension and even renal failure in patients with renal agenesis, and in those who have undergone unilateral nephrectomy. The long-term damaging potential of remnant nephron hyperperfusion was investigated in 27 patients who had undergone unilateral nephrectomy in childhood (mean 23.3 years ago). The average creatinine clearance was 83.9 ± 16.5 ml. per minute per 1.73 m. 2 or 74.3 per cent of that in healthy controls with 2 kidneys; this value was similar to that reported 3 to 6 months after nephrectomy in kidney donors. Age at nephrectomy, duration of followup or sex had no influence on the residual creatinine clearance. None of these patients had clinically important hypertension or proteinuria. Since so little evidence of kidney damage could be documented after such a long observation period, hyperperfusion would seem to be seldom of clinical importance in man unless other factors were present. W.W. H. 1 table, 18 references

RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY Appraisal of Lupus Nephritis by Renal Imaging With Gallium-67 A. A. BAKIR, V. LOPEZ-MAJANO, D. 0. HRYHORCZUK, H. L. RHEE AND G. DUNEA, Cook County Hospital and the Hektoen Research Institute, Chicago, Illinois

Amer. J. Med., 79: 175-182 (Aug.) 1985 The authors studied 43 patients with systemic lupus erythematosus with gallium imaging to ascertain if this technique could be used to detect lupus nephritis. All patients were assessed by commonly accepted clinical tests, including renal biopsy. The gallium scan was considered positive if the kidneys were imaged at 48 hours after injection; normal kidneys will visualize only rarely as late as 24 hours. Of the patients with a positive scan 67 per cent were hypertensive compared to 27 per cent of those with a negative scan, and 43 per cent with a positive scan were nephrotic, whereas none of those with a negative scan had significant proteinuria. Serum blood urea nitrogen and creatinine levels were not significantly different between patients with a positive or negative scan. Only 2 patients with a negative