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Localization of Acid Phosphatase Activity in Testoster-one-Treated Prostatic Urethra of Human Fetuses
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY
initial position of the voiding curve was calculated, that is that part of the curve relating peak urinary flow rate to volume voided up to 150 ml. In normal patients it was established that there is an initial steep slope to 150 to 200 ml. voided volume, the curve then reaching a plateau up to 600 ml. There is a highly significant correlation between the initial slope of the voiding curve and flow rates at volumes between 200 and 300 ml. Thus, the initial slope with a volume voided <150 ml. correlates fairly well with urinary flow rates at higher volumes. They found this to be true in normal patients as well as men with symptoms. Also identified was a significant negative correlation between the best urinary flow rate with the volumes voided between 200 and 300 ml., and increasing age. Also, the initial voiding slope decreased with age, with most of the decrease seen in men between 20 and 45 years old. Thus, using the information gained, patients with underfilled bladders as well as those with detrusor instability can be studied for voiding function. These data fit the conventional lower limit of normal, that is 15 ml. per second urinary flow rate at a voided volume of 200 ml. The authors recommend 2 urinary flow rate studies per patient to compensate for any natural variability in voiding. 5 figures, 15 references Abstracter's comment. The authors' concepts and data are sound. The clinical implications and applications are practical for all urologists using urinary flow rate in their practice. J.D.S. The Treatment of Large Bladder Diverticula A,
R. E.
J. R. GEDDES AND R. E. SHAW, Department of Urology, Walsgrave Hospital, Coventry, England BLACKLOCK,
Brit. J. Urol., 55: 17-20 (Feb.) 1983 These authors managed large bladder diverticula, defined as >5 cm. in diameter, with diverticulectomy alone if there was no evidence of bladder outlet obstruction. Thus, any prostatic operation is deferred to a later date pending the response of the patient. The authors believe that primary bladder diverticula are more common than appreciated generally. They report on 38 patients seen between 1970 and 1979 who had undergone diverticulectomy, with an average followup of about 4.5 years. Of their patients 3 were <40 years old. Major presenting symptom complexes included urinary retention, urinary infection and prostatism. Other patients had no symptoms. Of 22 patients treated by diverticulectomy alone only 3 later required prostatectomy. The presence of significant trabeculation at cystoscopy is evidence for the diverticulum being secondary to bladder neck obstruction. It is emphasized that the histology of these bladder diverticula is similar regardless of their primary or secondary etiology. Specifically, all diverticula have little muscle. Other evidence of bladder diverticula being secondary to bladder neck obstruction includes the presence of an enlarged prostate, increased intravesical pressure and decreased urinary flow rate. Lastly, the authors prefer the intraperitoneal route for diverticulectomy. J. D.S. 2 tables, 9 references Localization of Acid Phosphatase Activity in Testosterone-Treated Prostatic Urethra of Human Fetuses
p.
KELLOKUMPU-LEHTINEN' Departments of Anatomy and Ra-
1025
diotherapy, and Laboratory of Electron-Microscopy, University of Turku, Turku, Finland Prostate, 4: 265-270, 1983 Androgens produced by fetal testes induce development of the fetal prostate from the urogenital sinus. Human fetal prostatic differentiation begins with mesenchymal changes in the urogenital sinus and epithelial bud formation occurs at 10 weeks of development. Acinar cells differentiate into secretory prostatic cells at the time of maximal androgen concentration in the human fetal testis. The secretion granules of acinar cells contain acid phosphatase enzyme at that time and when testosterone secretion by the fetal testis is low. Also, urethral epithelial cells show acid phosphatase activity in male and female embryos before prostatic differentiation. In this study the author demonstrates that androgens accelerated differentiation of human fetal urethral epithelial cells into secretory prostatic cells in Trowell-type organic culture. These epithelial cells contained supranuclear Golgi complexes in which acid phosphatase enzyme activity could be demonstrated by an electron microscopic histochemical technique. Most of the acid phosphatase activity was localized in lysosomes. Some apical precipitates also could be seen. This apical activity is believed to be in secretory granules. Also, mesenchymal cells in this area of the urogenital sinus contained this enzyme. W. W. H. 7 figures, 18 references
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY Ultrasonic Demonstration of Ectopic Ureterocele P.A. ATHEY, R. J. CARPENTER, F. P. HADLOCK AND T. D. HEDRICK, Departments of Radiology, and Obstetrics and
Gynecology, Baylor College of Medicine, Houston, Texas Pediatrics, 71: 568-571 (Apr.) 1983 Two cases of ectopic ureterocele are presented in which gray scale ultrasound was useful in the diagnosis. An 11-year-old boy with gross hematuria and dysuria was found to have massive right lower pole reflux on voiding cystourethrography. Ultrasound examination demonstrated a right upper pole consisting of a 10 cm. cystic mass without parenchyma and a sonolucent mass on the right posterior aspect of the bladder. The second case of ectopic ureterocele was detected on fetal examination during maternal ultrasound to determine gesta tional age. Bilateral hydroureter and bilateral ureteroceles in the bladder were demonstrated. When done as a primary procedure ultrasound diagnosis of ectopic ureterocele can be made when a hydronephrotic upper pole is demonstrated in conjunction with a cystic mass in the bladder. When an ectopic ureterocele is suspected on excretory urography, ultrasound can provide the following information: 1) hydronephrotic nature of the upper pole mass, 2) the amount ofresidual renal parenchyma, 3) if the dilated upper pole ureter can be followed to the bladder, 4) identification of lower pole hydronephrosis and 5) outline of a sonolucent intravesical mass representing the ectopic ureterocele. H. M. S. 7 figures, 7 references Editorial comment. A majority of patients born with abdominal masses now seem to have the mass, if not the exact
initial position of the voiding curve was calculated, that is that part of the curve relating peak urinary flow rate to volume voided up to 150 ml. In normal patients it was established that there is an initial steep slope to 150 to 200 ml. voided volume, the curve then reaching a plateau up to 600 ml. There is a highly significant correlation between the initial slope of the voiding curve and flow rates at volumes between 200 and 300 ml. Thus, the initial slope with a volume voided <150 ml. correlates fairly well with urinary flow rates at higher volumes. They found this to be true in normal patients as well as men with symptoms. Also identified was a significant negative correlation between the best urinary flow rate with the volumes voided between 200 and 300 ml., and increasing age. Also, the initial voiding slope decreased with age, with most of the decrease seen in men between 20 and 45 years old. Thus, using the information gained, patients with underfilled bladders as well as those with detrusor instability can be studied for voiding function. These data fit the conventional lower limit of normal, that is 15 ml. per second urinary flow rate at a voided volume of 200 ml. The authors recommend 2 urinary flow rate studies per patient to compensate for any natural variability in voiding. 5 figures, 15 references Abstracter's comment. The authors' concepts and data are sound. The clinical implications and applications are practical for all urologists using urinary flow rate in their practice. J.D.S. The Treatment of Large Bladder Diverticula A,
R. E.
J. R. GEDDES AND R. E. SHAW, Department of Urology, Walsgrave Hospital, Coventry, England BLACKLOCK,
Brit. J. Urol., 55: 17-20 (Feb.) 1983 These authors managed large bladder diverticula, defined as >5 cm. in diameter, with diverticulectomy alone if there was no evidence of bladder outlet obstruction. Thus, any prostatic operation is deferred to a later date pending the response of the patient. The authors believe that primary bladder diverticula are more common than appreciated generally. They report on 38 patients seen between 1970 and 1979 who had undergone diverticulectomy, with an average followup of about 4.5 years. Of their patients 3 were <40 years old. Major presenting symptom complexes included urinary retention, urinary infection and prostatism. Other patients had no symptoms. Of 22 patients treated by diverticulectomy alone only 3 later required prostatectomy. The presence of significant trabeculation at cystoscopy is evidence for the diverticulum being secondary to bladder neck obstruction. It is emphasized that the histology of these bladder diverticula is similar regardless of their primary or secondary etiology. Specifically, all diverticula have little muscle. Other evidence of bladder diverticula being secondary to bladder neck obstruction includes the presence of an enlarged prostate, increased intravesical pressure and decreased urinary flow rate. Lastly, the authors prefer the intraperitoneal route for diverticulectomy. J. D.S. 2 tables, 9 references Localization of Acid Phosphatase Activity in Testosterone-Treated Prostatic Urethra of Human Fetuses
p.
KELLOKUMPU-LEHTINEN' Departments of Anatomy and Ra-
1025
diotherapy, and Laboratory of Electron-Microscopy, University of Turku, Turku, Finland Prostate, 4: 265-270, 1983 Androgens produced by fetal testes induce development of the fetal prostate from the urogenital sinus. Human fetal prostatic differentiation begins with mesenchymal changes in the urogenital sinus and epithelial bud formation occurs at 10 weeks of development. Acinar cells differentiate into secretory prostatic cells at the time of maximal androgen concentration in the human fetal testis. The secretion granules of acinar cells contain acid phosphatase enzyme at that time and when testosterone secretion by the fetal testis is low. Also, urethral epithelial cells show acid phosphatase activity in male and female embryos before prostatic differentiation. In this study the author demonstrates that androgens accelerated differentiation of human fetal urethral epithelial cells into secretory prostatic cells in Trowell-type organic culture. These epithelial cells contained supranuclear Golgi complexes in which acid phosphatase enzyme activity could be demonstrated by an electron microscopic histochemical technique. Most of the acid phosphatase activity was localized in lysosomes. Some apical precipitates also could be seen. This apical activity is believed to be in secretory granules. Also, mesenchymal cells in this area of the urogenital sinus contained this enzyme. W. W. H. 7 figures, 18 references
RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY Ultrasonic Demonstration of Ectopic Ureterocele P.A. ATHEY, R. J. CARPENTER, F. P. HADLOCK AND T. D. HEDRICK, Departments of Radiology, and Obstetrics and
Gynecology, Baylor College of Medicine, Houston, Texas Pediatrics, 71: 568-571 (Apr.) 1983 Two cases of ectopic ureterocele are presented in which gray scale ultrasound was useful in the diagnosis. An 11-year-old boy with gross hematuria and dysuria was found to have massive right lower pole reflux on voiding cystourethrography. Ultrasound examination demonstrated a right upper pole consisting of a 10 cm. cystic mass without parenchyma and a sonolucent mass on the right posterior aspect of the bladder. The second case of ectopic ureterocele was detected on fetal examination during maternal ultrasound to determine gesta tional age. Bilateral hydroureter and bilateral ureteroceles in the bladder were demonstrated. When done as a primary procedure ultrasound diagnosis of ectopic ureterocele can be made when a hydronephrotic upper pole is demonstrated in conjunction with a cystic mass in the bladder. When an ectopic ureterocele is suspected on excretory urography, ultrasound can provide the following information: 1) hydronephrotic nature of the upper pole mass, 2) the amount ofresidual renal parenchyma, 3) if the dilated upper pole ureter can be followed to the bladder, 4) identification of lower pole hydronephrosis and 5) outline of a sonolucent intravesical mass representing the ectopic ureterocele. H. M. S. 7 figures, 7 references Editorial comment. A majority of patients born with abdominal masses now seem to have the mass, if not the exact