Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Thomas J. Smith, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD; Derek Raghavan, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Douglas W. Blayney, Stanford Cancer Institute, Stanford University School of Medicine, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA; Therese Marie Mulvey, Southcoast Center for Cancer Care, Southcoast Health System, New Bedford, MA; Dana S. Wollins, American Society of Clinical Oncology, Alexandria, VA.

https://ascopubs.org/doi/pdfdirect/10.1200/JCO.2012.42.8375

American Society of Clinical Oncology Identifies Five Key Opportunities to Improve Care and Reduce Costs: The Top Five List for Oncology

Urotrauma: aua guideline

[Glucose-6-phosphate dehydrogenase].

Background. Nitric oxide has been identified as an endothelium-derived relaxing factor in blood vessels. We tried to determine whether it is involved in the relaxation of the corpus cavernosum that allows penile erection. The relaxation of this smooth muscle is known to occur in response to stimulation by nonadrenergic, noncholinergic neurons. Methods. We studied strips of corpus cavernosum tissue obtained from 21 men in whom penile prostheses were inserted because of impotence. The mounted smooth-muscle specimens were pretreated with guanethidine and atropine and submaximally contracted with phenylephrine. We then studied the smooth-muscle relaxant responses to stimulation by an electrical field and to nitric oxide. Results. Electrical-field stimulation caused a marked, transient, frequency-dependent relaxation of the corpus cavernosum that was inhibited in the presence of N-nitro-L-arginine and N-amino-L-arginine, which selectively inhibit the biosynthesis of nitric oxide from L-arginine. The a...

Nitric Oxide as a Mediator of Relaxation of the Corpus Cavernosum in Response to Nonadrenergic, Noncholinergic Neurotransmission

Urinary tract infections are the most common urologic disease in the United States and annually account for over 7 million office and 1 million emergency department visits. In adults, diagnosis of urinary tract infection is typically based on characteristic clinical features and abnormal laboratory values. Imaging is usually reserved for patients who do not respond to therapy and for those whose clinical presentation is either atypical or potentially life threatening. Urinary tract infection typically originates in the urinary bladder; when it migrates to the kidney or is seeded there hematogenously, a tubulointerstitial inflammatory reaction ensues, involving the renal pelvis and parenchyma. The condition is characterized as pyelonephritis. Complicated and uncomplicated pyelonephritis, xanthogranulomatous pyelonephritis, and tuberculosis are all urinary tract infections for which imaging evaluation adds diagnostic information important for patient care. Computed tomography (CT), when performed before, immediately after, and at delayed intervals from contrast material injection, is the preferred modality for evaluating acute bacterial pyelonephritis. CT is also preferred over conventional radiography and ultrasonography (US) for assessing emphysematous pyelonephritis. Xanthogranulomatous pyelonephritis is a chronic granulomatous process, induced by recurrent bacterial urinary tract infection. Although US is useful in the diagnosis of this condition, CT is the main imaging tool, as it provides highly specific findings and accurate assessment of the extrarenal extent of disease, which is essential for surgical planning. The increasing prevalence of tuberculosis and continued emergence of antibiotic-resistant strains have significance for genitourinary radiologists, as the urinary tract is the most common extrapulmonary site of tuberculosis. Familiarity with the renal manifestations of the disease--pelvoinfundibular strictures, papillary necrosis, cortical low-attenuation masses, scarring, and calcification--will help in the diagnosis, even in the absence of documented pulmonary disease.

Pyelonephritis: radiologic-pathologic review.

Nitric oxide (NO) is formed from the conversion of L-arginine by nitric oxide synthase (NOS), which exists in three isoforms: neuronal (nNOS), endothelial (eNOS), and inducible (iNOS) nNOS is expressed in penile neurons innervating the corpus cavernosum, and eNOS protein expression has been identified primarily in both cavernosal smooth muscle and endothelium NO is released from nerve endings and endothelial cells and stimulates the activity of soluble guanylate cyclase (sGC), leading to an increase in cyclic guanosine-3′,5′-monophosphate (cGMP) and, finally, to calcium depletion from the cytosolic space and cavernous smooth muscle relaxation The effects of cGMP are mediated by cGMP dependent protein kinases, cGMP-gated ion channels, and cGMP-regulated phosphodiesterases (PDE) Thus, cGMP effect depends on the expression of a cell-specific cGMP-receptor protein in a given cell type Numerous systemic vasculature diseases that cause erectile dysfunction (ED) are highly associated with endothelial dysfunction, which has been shown to contribute to decreased erectile function in men and a number of animal models of penile erection Based on the increasing knowledge of intracellular signal propagation in cavernous smooth muscle tone regulation, selective PDE inhibitors have recently been introduced in the treatment of ED Phosphodiesterase 5 (PDE5) inactivates cGMP, which terminates NO-cGMP-mediated smooth muscle relaxation Inhibition of PDE5 is expected to enhance penile erection by preventing cGMP degradation Development of pharmacologic agents with this effect has closely paralleled the emerging science

Nitric oxide-cyclic GMP pathway with some emphasis on cavernosal contractility.

OBJECTIVE

To determine whether a preliminary period of clean intermittent self-catheterization (CISC) before transurethral resection of the prostate (TURP) improves bladder contractility and surgical outcome in men with chronic urinary retention (CUR), and whether pressure-flow studies (PFS) before TURP predict the outcome.



PATIENTS AND METHODS

The study was a two-centre, pragmatic and randomized trial. Included were 41 men scheduled for TURP with lower urinary tract symptoms (LUTS), an International Prostate Symptom Score (IPSS) of > 7, benign prostatic enlargement and a persistent postvoid residual urine volume (PVR) of > 300 mL. They had conventional PFS using unphysiological filling. The patients then gave consent and were randomized into two treatment groups; the first had TURP after stabilizing renal function by indwelling catheterization if indicated, and the second was taught CISC. Men in both groups were reviewed at 3 and 6 months after surgery or the start of CISC, by the IPSS, urine culture and assay of plasma creatinine, and upper tract imaging and repeat PFS at 6 months. The primary outcome variables were IPSS, maximum urinary flow rate, voiding and end-filling pressures, and mean PVR; secondary variables included treatment failure, complications and other urodynamic measures.



RESULTS

Of the 41 patients, 17 (mean age 67 years, range 52–84) were randomized to immediate TURP and 24 (mean age 69 years, range 55–85) to CISC. There was a significant improvement in IPSS and quality of life at 6 months in both groups (P < 0.001). In the CISC group there was a significant improvement in voiding and end-filling pressures, indicating recovery of bladder function (P < 0.001 for each). Of the 41 men, nine (22%) with voiding pressures of ≤ 45 cmH2O had no significant improvement in symptoms or urodynamic variables. Detrusor overactivity was found in 17 (41%) patients, of whom six had upper tract dilatation which resolved after treatment.



CONCLUSION

The present results emphasize the usefulness of CISC in ensuring the recovery of bladder function in men with CUR. Measuring the voiding pressure before TURP can predict the surgical outcome. Both CISC and immediate TURP are effective for relieving LUTS and result in a better quality of life. A preliminary period of CISC before TURP for men with CUR and low voiding pressure may be valuable. The presence of upper tract dilatation is associated with high end-void and end-fill bladder pressures, and such men have a good outcome from surgery.

A prospective randomized trial comparing transurethral prostatic resection and clean intermittent self‐catheterization in men with chronic urinary retention

Background : We compared the efficacy of microdissection testicular sperm extraction (microdissection TESE) and conventional TESE in patients with non-obstructive azoospermia (NOA) and related the positive sperm recovery to certain variables: follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, testicular volume and histology. Methods : Sperm retrieval rates (SRR) in patients with NOA who underwent microdissection TESE (n = 65) or conventional TESE (n = 68) were compared and related to the different variables. Results : SRR by microdissection TESE (56.9%) was significantly higher than conventional TESE (38.2%). There was a positive relation between the SRR and increased testicular volume or decreased FSH levels. No effect of Testosterone or Prolactin levels on SRR by using either technique was observed. Sperm were recovered from those with hypospermatogenesis in 84% and 92.9% by conventional and microdissection TESE, respectively (P = 0.3). In cases of maturation arrest the SRR was 27.3% and 36.4%, respectively (P = 0.6). In cases of Sertoli-cell-only syndrome (SCOS) the SRR was 6.2% and 26.9%, respectively (P = 0.03). No major operative complications occurred in any patient in either group, and no patient required post-operative hormone replacement to treat hypogonadism. Conclusions : Microdissection TESE significantly had twice better probability of success of SRR when compared to conventional TESE. No secure pre-operative prognostic elements of sperm recovery exist for NOA patients. Microdissection TESE appears to be recommendable in cases of atrophied testicles, high FSH concentration, or when SCOS with high FSH concentration can be predicted. doi:10.4021/jocmr542w

/pdf/clinical-comparison-of-conventional-testicular-sperm-4301sgxnwx.pdf

Clinical Comparison of Conventional Testicular Sperm Extraction and Microdissection Techniques for Non-Obstructive Azoospermia

Xanthogranulomatous Pyelonephritis: Analysis of 18 Cases

Purpose
To evaluate the relationship between urodynamic detrusor overactivity (DO) and overactive bladder (OAB) symptoms in men and women.

/pdf/urodynamic-detrusor-overactivity-in-patients-with-overactive-42wfufhhfo.pdf

Ibrahim Fathi Ghalayini

Papers

Nitric oxide-cyclic GMP pathway with some emphasis on cavernosal contractility.

A prospective randomized trial comparing transurethral prostatic resection and clean intermittent self‐catheterization in men with chronic urinary retention

Clinical Comparison of Conventional Testicular Sperm Extraction and Microdissection Techniques for Non-Obstructive Azoospermia

Xanthogranulomatous Pyelonephritis: Analysis of 18 Cases

Urodynamic detrusor overactivity in patients with overactive bladder symptoms.