Biomedical subjects
Publications and source records attributed to J N Kabalin.
Inflammatory pseudotumor of the bladder is an unusual benign lesion arising from the bladder submucosa. We present 2 cases and describe the clinical presentation, and radiographic and histological findings. This benign lesion must be differentiated histologically from several malignant lesions of the bladder. Complete surgical excision, either by transurethral resection or partial cystectomy, appears to be curative.
Intrauterine devices have been plagued by many early and late complications, including uterine perforation and migration into adjacent structures. To our knowledge only 18 cases have been reported in the literature of migration of an intrauterine device into the bladder. We report on a 38-year-old woman in whom an intrauterine device eroded from the uterus 3 years after placement. The device remained asymptomatic in the pelvis for an additional 13 years before the patient presented with urinary symptoms. The literature is reviewed.
This is a retrospective analysis of 79 spinal cord injury patients who have had penile implants from one to 14 years. The primary indication for implants was the loss of condom catheter with a small retractile penis. Mean period after injury to when the implants were placed was 8.24 years (range 1-21 years). Mean total length of time the implants have been followed was 7.08 years (1-14 years). Sixty patients responded to our detailed questionnaire and they have been subjected to further analysis: prior to the implant 46 patients (77%) frequently lost their condoms. Fourteen of the patients (23%) had indwelling catheters, and 3 (5%) had a suprapubic cystostomy since they could not retain an external condom for urinary drainage because of retraction of a small penis. Post implant, 81% of patients had no accidents involving condom loss, while 19% still lost condoms. All indwelling catheters could be removed except for one patient who continued with a suprapubic catheter following transurethral sphincterotomy (TURS) and a penile implant. Sixty-eight percent used the implant for sex and felt their wives were satisfied. Patient satisfaction survey showed a markedly increased self esteem, increased mobility without fear of condom loss, and an improved sex life. Overall, the long term prosthesis failure rate was 8%. The specific infection complication rate was less than 2%. The Flexirod semirigid, hinged prosthesis proved ideal in meeting the requirements for these patients.
Explore the source record for details and available documents.
Prostate specific antigen (PSA) has replaced prostatic acid phosphatase as the preeminent clinical tumor marker in the management of patients with prostate cancer. Serum PSA levels have been shown to be proportional to clinical and pathologic stage of prostate cancer and in particular to correlate closely with prostate cancer volume. Serum levels of PSA thus serve as a useful adjunct in the initial clinical staging of men with prostate cancer. Serum PSA values provide a unique and valuable tool in monitoring prostate cancer progression over time and its response to surgical, radiation, and/or hormonal therapies. Unfortunately, its lack of specificity for prostate cancer leaves many questions unanswered as to the efficacy and advisability of using PSA as a screening test for this cancer.
Serum levels of prostate-specific antigen have assumed a prominent clinical role in the management of prostate cancer. Little is known about the production of prostate-specific antigen, its mechanism of entry into the serum in normal and pathologic states, and mechanism(s) of removal from the serum. This study examined nephrostomy urine specimens, finding no significant excretion of prostate-specific antigen into the renal pelvic urine. Similarly, no significant lowering of serum prostate-specific antigen levels occurred during routine hemodialysis in men with chronic renal failure, nor were ambulatory, pre-dialysis serum prostate-specific antigen levels in these same men with chronic renal failure elevated. It appears unlikely that the kidney plays a significant role in the clearance of prostate-specific antigen from human serum.
Explore the source record for details and available documents.
The treatment of Peyronie's disease remains controversial. Patients who fail conservative therapy may require surgical intervention to restore the ability to have sexual intercourse. Plaque excision and dermal grafting have not been universally successful, and alternate procedures that rely on the placement of a penile prosthesis have gained in popularity. We reviewed our experience with 35 patients with advanced Peyronie's disease treated with a penile prosthesis. Preoperatively, 55% of the patients were unable to engage in intercourse due to pain or angulation of the penis and 25% were unable to achieve any erection at all. Postoperatively, with a mean followup of 6.9 years, 88% of the patients were able to engage in intercourse and were satisfied with the results obtained. In selected patients with advanced disease the implantation of a penile prosthesis remains a highly successful and satisfying alternative for the treatment of Peyronie's disease.
Results of 273 consecutive macroscopic vasovasostomy procedures performed at a single institution over a nine-year period between 1978 and 1987 were reviewed. When patients operated on less than five years after vasectomy were compared with those in whom more than five years had elapsed since vasectomy, significant declines in technical success rates as measured by return of sperm to the ejaculate (93% vs. 74%, p less than 0.004), biologic recovery as measured by mean sperm counts (55 million vs. 35 million) and mean progressive sperm motility (30% vs. 13%), and clinical success as measured by pregnancy rates (52% vs. 30%, p less than 0.02), were observed. Examination of complications of vasovasostomy showed a 7.7 percent overall complication rate and a 1.5 percent incidence of major complications.
The Scientific Board of the California Medical Association presents the following inventory of items of progress in urology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in urology that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Urology of the California Medical Association, and the summaries were prepared under its direction.
Explore the source record for details and available documents.
Two cases of bladder leiomyoma are reported. Both are women who presented with a palpable mass on pelvic examination, one asymptomatic and the second with significant bladder outlet obstruction. Results of ultrasound examinations are presented. Complete local resection was curative in both patients.
Explore the source record for details and available documents.
Even in the presence of a penile prosthesis, a subset of spinal cord injury patients remains unable to maintain a condom catheter securely due to inadequate penile shaft length and disappearance of the corpora beneath the pubic fat pad when in the sitting position. We describe 3 patients in whom a successful resolution to this problem has been achieved with rational surgical management, including lysis of the suspensory ligament of the penis, approximation of the infrapubic soft tissues posterior to the corpora so as to advance the corpora anteriorly and buttress against posterior migration (retraction) in the sitting position, maximizing the length and fit of prosthetic rods, and, when indicated, release of infrapubic skin tethering with a modified Z-plasty technique.
The interaction of fibroblasts with adult human prostatic epithelial cells was studied in vitro. Stimulation of epithelial cell proliferation, measured by clonal growth assay, was demonstrated when prostatic epithelial cells were grown in coculture with fibroblasts. Epithelial growth in cocultures with fibroblasts was greater than could be obtained in isolated culture in an "optimized," serum-free medium previously described. Fibroblasts were able to compensate for the deletion of several growth factors from this "optimized" medium, including epidermal growth factor and insulin, but were notably unable to replace bovine pituitary extract. Epithelial growth stimulation identical to that achieved in coculture was produced by medium conditioned by fibroblasts. Similar results were obtained by using fibroblasts of adult human prostate origin, adult human skin, human fetal lung fibroblasts (IMR-90), and mouse 3T3 cells. No difference in response was demonstrated between prostatic epithelial cells derived from normal or malignant tissues. Fixed fibroblast monolayers and extracellular matrix prepared from fibroblast cultures failed to stimulate prostatic epithelial growth. These results suggest that a soluble growth factor is secreted by prostatic fibroblasts and other human fibroblasts of nonprostatic origin, as well as by embryonic mesenchymal cells from nonhuman species, which is capable of producing a marked proliferative response in vitro from adult human prostatic epithelium. This proliferative response could not be reproduced by the addition of a variety of known growth factors to prostatic epithelial cell cultures.
Our ten-year experience from September, 1975, to December, 1985, with 417 penile prostheses in 290 patients is presented. Arteriosclerosis and diabetes mellitus were the two most common causes of impotence in our patient population. The Scott inflatable penile prosthesis accounted for the majority of all implants and all device failures. Complications leading to device failure and/or reoperation occurred in 36 percent of all prostheses. However, including repairs, 91 percent of patients were left with a functional prosthesis. Examination of reoperated patients showed an average increase in corporeal length of 1.67 cm with repeat prosthesis operations (p less than 0.001). No increase in incidence of prosthesis failure could be shown after multiple reoperations.
We present our experience with implantation of penile prostheses in 6 organ transplant recipients, including 2 patients after renal transplantation and 4 patients after cardiac transplantation. We have seen no problems related to prosthesis surgery in this patient population, and in particular have experienced no infectious complications. All patients received strict perioperative antibiotic and steroid coverage. We conclude that erectile impotence in the male organ transplant patient can be successfully treated with penile prosthesis surgery without incurring undue morbidity and with considerable benefit in terms of quality of life in a generally young patient population.
Transrectal, ultrasound guided needle biopsies were performed in 27 men greater than 18 months (mean 5.2 years) after radiation therapy for prostate cancer. Of the patients 18 (67 per cent) originally had localized (stage A or B), 6 had stage C and 3 had stage D1 prostate cancer. In addition to biopsies directed at any hypoechoic regions of the prostate, multiple systematic biopsies were performed from the apex to the base bilaterally and the seminal vesicles also were biopsied regardless of appearance. Of 27 patients 25 (93 per cent) had post-irradiation biopsies positive for cancer, including 5 of 5 with prostate induration and 20 of 22 (91 per cent) with normal post-irradiation digital rectal examinations. Ultrasound findings per se were poorly correlated with pathological findings in the irradiated prostate. Directed biopsies of hypoechoic areas were positive for cancer in 67 per cent of the cases and isoechoic areas were positive for cancer in 65 per cent. Seminal vesicle biopsies were positive in 7 patients (26 per cent), including 4 with normal post-irradiation rectal examinations and 4 with normal ultrasound appearance. Of 12 patients 10 (83 per cent) with serum prostate specific antigen levels less than 10 ng. per ml. had positive biopsies, as did all 15 with levels greater than 10 ng. per ml.