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Re: Ribbon Dressing for Circumcision, by J. A. Fernandez, D. R. Cain, L. R. Rivera and R. J. Kreutzman, J. Urol., 149: 1501–1502, 1993
0022-5347/94/1522-0492$03.00/0 THE JOURNAL OF UROLOGY Copyright© 1994 by AMERICAN UROLOGICAL AssoCIATION, !Ne.
Vol. 152, 492-495, August 1994
Printed in U.S.A.
Letters to the Editor RE: GANGRENOUS CYSTITIS: CASE REPORT AND REVIEW OF THE LITERATURE
general practitioners and for junior r~sidents in surgery. 1 The only difference is that he did not prefer to tie the ribbon to the mattress sutures but to the long tail of all interrupted sutures so as to avoid removal of the retention sutures. Respectfully, M. Kamuran Bircan and Bilsel Bat; Dicle Universitesi Tip Fakiiltesi Uroloji Anabilim Dali 21280 Diyarbakir Turkey 1. Ugur, D. A.: Siinnet (Circumcision) Teknigi. In: Kii~iik Cerrahi Teknik (Principal :;!urgical Technique). Edited by D. A. Ugur. Ankara: Ankara Universitesi Tip Fakiiltesi Yayinlarindan Sayi: 120, pp. 106-107, 1963.
A. T. Devitt and K. K. Sethia J. Urol., 149: 1544-1545, 1993
To the Editor. Gangrenous cystitis is a clinical and pathological concept that implies the joining of 2 main factors: ischemia of the vesical wall plus presence of infection caused by aerobic or anaerobic microorganisms of great virulence. 1 Several causes of bladder wall ischemia have been reported concerning this entity, including vesical over distention (specifically those cases that occur after medullary shock or due to a Foley catheter left indwelling for an undue period2 ), bladder compression by a gravid uterus and radiation injuries as in the case reported. Most investigators consider the presence of a polymicrobial infection in a bladder with severe alteration of blood supply to be the triggering mechanism of this severe form of vesical infection. This belief is supported by its extremely low incidence since the widespread availability of antibiotics. Organism specificity is not a characteristic but aerobic bacteria, such as Escherichia coli, Pseudomonas aeruginosa or Proteus mirabilis, and anaerobic microorganisms, such as Bacteroides fragilis, Fusobacterium varium and peptostreptococcus species, have been involved in most cases. We reported a unique case in which the ischemic alteration of the bladder was due to compression by a giant vesical stone. 3 The patient had suffered a spinal fracture 15 years previously causing paraplegia and detrusor-urethral sphincter dysfunction, managed by a longterm indwelling bladder catheter. In our case, cultures of the blood, stone and necrotic tissue of the bladder wall yielded Proteus mirabilis and peptostreptococcus species. We are not entirely sure that the term gangrenous cystitis is justified in the case reported by Devitt and Sethia. The absence of organisms revealed by negative urine cultures and the absence of other microbiological studies lead us to believe that what happened was an aseptic ischemic necrosis of the bladder but not a true gangrenous cystitis. Respectfully, Ignacio Moncada, Enrique Lledo, Fernando Verdu and Carlos Hernandez Department of Urology Hospital General Universitario Gregorio Maranon Madrid, Spain 1. Cifuentes, L.: Cistitis enfisematosa. Cistitis gangrenosa. In: Cistitis y Cistopatias. Madrid: BOK S. A. Ediciones, chapt. 9, pp. 91-97, 1989. 2. Busse, K. and Altwein, J. E.: Catheter-induced bladder gangrene. J. Urol., 112: 461, 1974. 3. Moncada, I., Verdu, F., Jara, J., Basquero, B., Martin, J.C., Saiz, A., Herranz, F. and Hernandez, C.: Cistitis gangrenosa inducida por un calculo vesical gigante. Actas Urol. Esp., 16: 154, 1992.
RE: RIBBON DRESSING FOR CIRCUMCISION J. A. Fernandez, D. R. Cain, L. R. Rivera and R. J. Kreutzman
J. Urol., 149: 1501-1502, 1993
To the Editor. The authors state that they developed a new dressing for circumcision. In honor of Dr. Demir A. Ugur, who was a Professor of General Surgery, we must state that this method is well known in our country. He also described this method in 1963 for
RE: THE MANAGEMENT OF PENILE MONDOR'S PHLEBITIS: SUPERFICIAL DORSAL PENILE VEIN THROMBOSIS
S. J. Swierzewski, Ill, J. Denil and D. A. Ohl J. Urol., 150: 77-78, 1993
To the Editor. This article was, indeed, a timely bolt from the blue for us, since 3 similar cases presented to us during the last year and we were trying to find references in the urological literature. Our patients were 20, 22 and 38 years old, and 2 were unmarried. Although Doctors Swierzewski et al highlighted the occurrence of this condition after sexual intercourse, all of our patients reported this condition after vigorous masturbation. Is masturbation more traumatic to the vessel endothelium than sexual intercourse? Although all of our patients denied any history of abnormal use of force or of any device during self-stimulation, the act of masturbation, as opposed to sexual intercourse, is without lubrication. Reassurance was the only treatment given to all of our patients and the phlebitis resolved completely within 6 weeks. Thus, penile phlebitis appears to be a benign self-liiniting condition of 6 weeks in duration. Respectfully, Vivek Birla and D. Sengupta Department of Urology St. George's Hospital Bombay - 400 001 India
Reply by Authors. The self-limited nature of the condition in the 3 patients described by Doctors Birla and Sengupta, with spontaneous resolution within a short period, mimicked the course in our series. Although our patients reported the onset of symptoms after vigorous sexual intercourse, we are certain that any activity that traumatizes the dorsal vein endothelium may cause this condition. The severity of the insult is probably more significant than the specific inciting activity. Nevertheless, since the letter brings to attention the etiology of masturbation, we may need to resurrect a quote from the famous first surgeon of King Louis XV, Francois de la Peyronie. Although there is no evidence that Peyronie's disease is caused by masturbation, as the author believed at the time, we might now say that dorsal penile vein thrombosis "occurred commonly in men who give themselves up to the vivacity of their temperament." 1
492
1. de la Peyronie, F.: Sur quelques obstacles qui s'opposent a !'ejaculation naturelle de la semance. Mem. Acad. Roy. Chir., p. 425, 1743.
Vol. 152, 492-495, August 1994
Printed in U.S.A.
Letters to the Editor RE: GANGRENOUS CYSTITIS: CASE REPORT AND REVIEW OF THE LITERATURE
general practitioners and for junior r~sidents in surgery. 1 The only difference is that he did not prefer to tie the ribbon to the mattress sutures but to the long tail of all interrupted sutures so as to avoid removal of the retention sutures. Respectfully, M. Kamuran Bircan and Bilsel Bat; Dicle Universitesi Tip Fakiiltesi Uroloji Anabilim Dali 21280 Diyarbakir Turkey 1. Ugur, D. A.: Siinnet (Circumcision) Teknigi. In: Kii~iik Cerrahi Teknik (Principal :;!urgical Technique). Edited by D. A. Ugur. Ankara: Ankara Universitesi Tip Fakiiltesi Yayinlarindan Sayi: 120, pp. 106-107, 1963.
A. T. Devitt and K. K. Sethia J. Urol., 149: 1544-1545, 1993
To the Editor. Gangrenous cystitis is a clinical and pathological concept that implies the joining of 2 main factors: ischemia of the vesical wall plus presence of infection caused by aerobic or anaerobic microorganisms of great virulence. 1 Several causes of bladder wall ischemia have been reported concerning this entity, including vesical over distention (specifically those cases that occur after medullary shock or due to a Foley catheter left indwelling for an undue period2 ), bladder compression by a gravid uterus and radiation injuries as in the case reported. Most investigators consider the presence of a polymicrobial infection in a bladder with severe alteration of blood supply to be the triggering mechanism of this severe form of vesical infection. This belief is supported by its extremely low incidence since the widespread availability of antibiotics. Organism specificity is not a characteristic but aerobic bacteria, such as Escherichia coli, Pseudomonas aeruginosa or Proteus mirabilis, and anaerobic microorganisms, such as Bacteroides fragilis, Fusobacterium varium and peptostreptococcus species, have been involved in most cases. We reported a unique case in which the ischemic alteration of the bladder was due to compression by a giant vesical stone. 3 The patient had suffered a spinal fracture 15 years previously causing paraplegia and detrusor-urethral sphincter dysfunction, managed by a longterm indwelling bladder catheter. In our case, cultures of the blood, stone and necrotic tissue of the bladder wall yielded Proteus mirabilis and peptostreptococcus species. We are not entirely sure that the term gangrenous cystitis is justified in the case reported by Devitt and Sethia. The absence of organisms revealed by negative urine cultures and the absence of other microbiological studies lead us to believe that what happened was an aseptic ischemic necrosis of the bladder but not a true gangrenous cystitis. Respectfully, Ignacio Moncada, Enrique Lledo, Fernando Verdu and Carlos Hernandez Department of Urology Hospital General Universitario Gregorio Maranon Madrid, Spain 1. Cifuentes, L.: Cistitis enfisematosa. Cistitis gangrenosa. In: Cistitis y Cistopatias. Madrid: BOK S. A. Ediciones, chapt. 9, pp. 91-97, 1989. 2. Busse, K. and Altwein, J. E.: Catheter-induced bladder gangrene. J. Urol., 112: 461, 1974. 3. Moncada, I., Verdu, F., Jara, J., Basquero, B., Martin, J.C., Saiz, A., Herranz, F. and Hernandez, C.: Cistitis gangrenosa inducida por un calculo vesical gigante. Actas Urol. Esp., 16: 154, 1992.
RE: RIBBON DRESSING FOR CIRCUMCISION J. A. Fernandez, D. R. Cain, L. R. Rivera and R. J. Kreutzman
J. Urol., 149: 1501-1502, 1993
To the Editor. The authors state that they developed a new dressing for circumcision. In honor of Dr. Demir A. Ugur, who was a Professor of General Surgery, we must state that this method is well known in our country. He also described this method in 1963 for
RE: THE MANAGEMENT OF PENILE MONDOR'S PHLEBITIS: SUPERFICIAL DORSAL PENILE VEIN THROMBOSIS
S. J. Swierzewski, Ill, J. Denil and D. A. Ohl J. Urol., 150: 77-78, 1993
To the Editor. This article was, indeed, a timely bolt from the blue for us, since 3 similar cases presented to us during the last year and we were trying to find references in the urological literature. Our patients were 20, 22 and 38 years old, and 2 were unmarried. Although Doctors Swierzewski et al highlighted the occurrence of this condition after sexual intercourse, all of our patients reported this condition after vigorous masturbation. Is masturbation more traumatic to the vessel endothelium than sexual intercourse? Although all of our patients denied any history of abnormal use of force or of any device during self-stimulation, the act of masturbation, as opposed to sexual intercourse, is without lubrication. Reassurance was the only treatment given to all of our patients and the phlebitis resolved completely within 6 weeks. Thus, penile phlebitis appears to be a benign self-liiniting condition of 6 weeks in duration. Respectfully, Vivek Birla and D. Sengupta Department of Urology St. George's Hospital Bombay - 400 001 India
Reply by Authors. The self-limited nature of the condition in the 3 patients described by Doctors Birla and Sengupta, with spontaneous resolution within a short period, mimicked the course in our series. Although our patients reported the onset of symptoms after vigorous sexual intercourse, we are certain that any activity that traumatizes the dorsal vein endothelium may cause this condition. The severity of the insult is probably more significant than the specific inciting activity. Nevertheless, since the letter brings to attention the etiology of masturbation, we may need to resurrect a quote from the famous first surgeon of King Louis XV, Francois de la Peyronie. Although there is no evidence that Peyronie's disease is caused by masturbation, as the author believed at the time, we might now say that dorsal penile vein thrombosis "occurred commonly in men who give themselves up to the vivacity of their temperament." 1
492
1. de la Peyronie, F.: Sur quelques obstacles qui s'opposent a !'ejaculation naturelle de la semance. Mem. Acad. Roy. Chir., p. 425, 1743.