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Torsion of intra-abdominal seminoma of testis
of patients with moderate reflux would seem to be meddlesome. On the other hand, the fact that scarring did develop in I out of 58 children with moderate reflux points out the need for continuing medical follow-up with this group. Anyone who is interested in this subject should read the article by Rolleston, Shannon, and Utley,’ as it is, I think, an important contribution in this somewhat controversial field. C. D. Vermillion, The Billings Billings, Montana
M.D. Clinic 59103
References 1. ROLI,ES?.ON. G. L., SHANNON, F. T., ~~~UTLEY, W. L.: Relationship of infantile vesicoureteric reflux to renal damage, Br. Med. J. 1: 406 (1970). 2. SHANNON, F. T.: Personal communication, 1973.
TORSION OF INTRA-ABDOMINAL SEMINOMA OF TESTIS To the Editor: It is interesting to note that one more case of torsion of intra-abdominal seminoma of testis is reported by Dr. Douglas Dahl in his article on “Torsion of Intra-Abdominal Seminoma of Testis” (UROLOGY, vol. 4, page 590). Please note that after a case described by Garber and Kauffer in 1967,’ three more cases have been added to the literature. The twenty-fourth case of torsion of intra-abdominal testis with tumor (seminoma) was reported by me in 1969.* This case was noteworthy, since this patient was the oldest in the series (fifty-two years of age). Although a differential diagnosis of intra-abdominal torsion of the left testis was entertained, it was not strongly considered because the patient insisted that his left testicle had been removed at the time of his inguinal hemiorrhaphy at age twenty-nine. Dr. Dahl’s case thus becomes the twenty-fifth to be reported in the literature. I would like to reemphasize that the diagnosis of intra-abdominal torsion of the testis should be strongly considered if a male patient has abdominal pains and a nonpalpable gonad. Unless there is documented histopathologic evidence that the specimen removed is testis, mere history of orchiectomy for an undescended testicle should not hinder one from making a presumptive diagnosis of torsion of intra-abdominal testis in such circumstances. It is recognized that when a testis remains intra-abdominal torsion and tumor are distinct hazards. Mustan D. Jhaveri, M.D. 129 N.E. IO2nd Street Portland, Oregon 97220
UROLOGY
I FEBRUARY 1975 / VOLUME V, NUMBER Z
References 1. GARBER, H. E., and KAUFFER, 6. I.: Torsion of an intra-abdominal testicular seminoma. J. Ural. 98: 684 (1967). 2. JHAVERI, M. D., JACOBSON. MM.E.. and RORINSON. F. W.: Testis, tumor and torsion; torsion of intra-ahdominal testis with tumor, J. Kansas W Sot. 70: 451 (1969).
BEHAVIORAL AND PENILE
TECHNIQUE ERECTION
To the Editor: We read with interest the article “Injection Technique to Induce Penile Erection,” by R. F. Gittes, M.D., and A. P. McLaughlin, III, M.D., in the October issue (vol. 4, page 473) of UROLOGY. The authors are certainly to be commended for their simple technique to induce penile erection when careful observation is needed to correct a penile deformity. We wish, however, lo call the attention of the readers to recent advances in the field of psychology which offer another simple technique to achieve penile erection in the office. Rubin and his colleagues’*’ have shown that it is possible to achieve voluntary control over the occurrence of penile erection by exposing the subjects to erotically stimulating motion pictures with or without a description of the behavioral content of the erotic stimulus film. The subjects are later able to achieve erection voluntarily in the absence of the erotic stimuli. To monitor changes in penile circumference, these authors employed a mercury strain gauge which is fitted around the penis.3 We were also able to condition penile erection in response to sexually arousing auditory stimuli in a young male homosexual by providing him feedback of changes in penile erection as measured by changes in penile temperature sensed by a thermistor attached to the skin of the patient.4 If a patient is trained, through behavioral techniques, to control the penile erection response voluntarily, he will then be able to achieve erection in the physician’s office when needed. Victor A. Colotla, Ph.D. Department of Psychology, Toronto Western Hospital, Toronto, Canada M5T 2S8 Benjamin Dominguez, M. SC. Faculty of Psychology, National University of Mexico, Mexico City, Mexico.
References 1. LAWS, D. R., and RUBIN, H. B.: Instruction control of an autonomic sexual response. J. Appl. Behav. Anal. 3: 93 (1969).
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M.D. Clinic 59103
References 1. ROLI,ES?.ON. G. L., SHANNON, F. T., ~~~UTLEY, W. L.: Relationship of infantile vesicoureteric reflux to renal damage, Br. Med. J. 1: 406 (1970). 2. SHANNON, F. T.: Personal communication, 1973.
TORSION OF INTRA-ABDOMINAL SEMINOMA OF TESTIS To the Editor: It is interesting to note that one more case of torsion of intra-abdominal seminoma of testis is reported by Dr. Douglas Dahl in his article on “Torsion of Intra-Abdominal Seminoma of Testis” (UROLOGY, vol. 4, page 590). Please note that after a case described by Garber and Kauffer in 1967,’ three more cases have been added to the literature. The twenty-fourth case of torsion of intra-abdominal testis with tumor (seminoma) was reported by me in 1969.* This case was noteworthy, since this patient was the oldest in the series (fifty-two years of age). Although a differential diagnosis of intra-abdominal torsion of the left testis was entertained, it was not strongly considered because the patient insisted that his left testicle had been removed at the time of his inguinal hemiorrhaphy at age twenty-nine. Dr. Dahl’s case thus becomes the twenty-fifth to be reported in the literature. I would like to reemphasize that the diagnosis of intra-abdominal torsion of the testis should be strongly considered if a male patient has abdominal pains and a nonpalpable gonad. Unless there is documented histopathologic evidence that the specimen removed is testis, mere history of orchiectomy for an undescended testicle should not hinder one from making a presumptive diagnosis of torsion of intra-abdominal testis in such circumstances. It is recognized that when a testis remains intra-abdominal torsion and tumor are distinct hazards. Mustan D. Jhaveri, M.D. 129 N.E. IO2nd Street Portland, Oregon 97220
UROLOGY
I FEBRUARY 1975 / VOLUME V, NUMBER Z
References 1. GARBER, H. E., and KAUFFER, 6. I.: Torsion of an intra-abdominal testicular seminoma. J. Ural. 98: 684 (1967). 2. JHAVERI, M. D., JACOBSON. MM.E.. and RORINSON. F. W.: Testis, tumor and torsion; torsion of intra-ahdominal testis with tumor, J. Kansas W Sot. 70: 451 (1969).
BEHAVIORAL AND PENILE
TECHNIQUE ERECTION
To the Editor: We read with interest the article “Injection Technique to Induce Penile Erection,” by R. F. Gittes, M.D., and A. P. McLaughlin, III, M.D., in the October issue (vol. 4, page 473) of UROLOGY. The authors are certainly to be commended for their simple technique to induce penile erection when careful observation is needed to correct a penile deformity. We wish, however, lo call the attention of the readers to recent advances in the field of psychology which offer another simple technique to achieve penile erection in the office. Rubin and his colleagues’*’ have shown that it is possible to achieve voluntary control over the occurrence of penile erection by exposing the subjects to erotically stimulating motion pictures with or without a description of the behavioral content of the erotic stimulus film. The subjects are later able to achieve erection voluntarily in the absence of the erotic stimuli. To monitor changes in penile circumference, these authors employed a mercury strain gauge which is fitted around the penis.3 We were also able to condition penile erection in response to sexually arousing auditory stimuli in a young male homosexual by providing him feedback of changes in penile erection as measured by changes in penile temperature sensed by a thermistor attached to the skin of the patient.4 If a patient is trained, through behavioral techniques, to control the penile erection response voluntarily, he will then be able to achieve erection in the physician’s office when needed. Victor A. Colotla, Ph.D. Department of Psychology, Toronto Western Hospital, Toronto, Canada M5T 2S8 Benjamin Dominguez, M. SC. Faculty of Psychology, National University of Mexico, Mexico City, Mexico.
References 1. LAWS, D. R., and RUBIN, H. B.: Instruction control of an autonomic sexual response. J. Appl. Behav. Anal. 3: 93 (1969).
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