Penile fracture was treated by early surgical repair of the rent in the tunica albuginea in three patients resulting in restoration of satisfactory sexual function. Review of the literature on penile fracture reveals desirability of early operative management consisting of evacuation of haematoma and repair of the rent in tunica albuginea and urethral tear if present. A comparison of the results of conservative management and surgical repair show that immediate operative treatment is accompanied by significantly fewer complications and shorter hospital stay.

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A 19 year old male presented with a swelling on the dorsal aspect of the penis at its root, more on the right side of the midline, since birth (Fig). It was painless, spherical, soft, non-tender, mobile and measured 2.5 X 2.5 cm. Cord structures were palpable on the left side and extended up to the proximal end of swelling which was on right prepubic area. Scrotum was well developed bilaterally but was empty on the left side. Right testis and cord were normal. Secondary sexual characters were well developed. Routine investigations and the semen analysis were within normal limits. A provisional diagnosis of a left ectopic testis was made and left inguinal exploration was performed. A normal sized testis with normal cord structures was seen on the right side of the root of the penis. The testis was easily mobilized and was repositioned in the left scrotal sac within a sub-dartos pouch. Testicular tissue was collected for histological examination. No hernial sac was encountered. Post-operative recovery was uneventful. Histological report showed normal adult testicular tissue.

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Intravesical application of 3 mg suppository of 15 (S) 15 methyl prostaglandin F2-alpha during 15 instances in 11 females with chronic urinary retention resulted in reflex voiding after each application. The detrusor reflex activity occurred at intravesical volume of 281 plus minus 33.84 ml subsequent to the drug. Vesical compliance decreased from 21.57 plus minus 2.8 ml/cm H2O to 6.33 plus minus 0.92 ml/cm H2O (p less than 0.001). Mild, self limiting, colicky lower abdominal pain was observed on eleven occasions which did not require any medication. The duration of response to PG suppository (i.e. reflex voiding with residual urine less than 50 ml) was 10.33 plus minus 3.55 weeks. The age of the patient, spinal level of lesion, and time elapsed after the injury/disease before PG administration showed no correlation with the degree of response to PG (decrease in bladder capacity, decrease in vesical compliance) or with the duration of response to the drug or with the occurrence of side effects. In conclusion, intravesical application of 3 mg suppository of 15 (S) methyl prostaglandin F2-alpha was found to induce reflex voiding with minimal side effects thus encouraging its use in non-pregnant women suffering from chronic urinary retention unaccompained by any structural disease of the urethra.

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Serum gentamicin concentrations were estimated by solid-phase radioimmunoassay before and 10, 20, 30, 60, 120, 240, 360 and 480 minutes after a bolus intravenous injection of gentamicin (1.5 mg/kg) in four patients with incomplete spinal lesion, within two weeks of spinal trauma and in four healthy adults. The serum levels showed a distinct distribution phase and an elimination phase. The serum gentamicin levels at 10 and 20 minutes in spinal injury cases were significantly higher than those of the controls (p less than 0.05; p less than 0.01 respectively). However, no significant difference was found in the volume of distribution (Vd), elimination rate constant (Kel), elimination half-life and clearance between the two groups. The significantly higher serum gentamicin levels in the spinal injury group during the distribution phase suggest differences in kinetic parameters of a peripheral compartments between the spinal cord-injured and the normal individuals.

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The incidence of sexual dysfunction in 75 diabetic adult males was 45.33 percent. The evaluation utilized (a) psychosexual history, (b) Nocturnal penile tumescence (NPT) monitor, (c) bulbocavernous (BC) muscle EMG and BC reflex study, (d) Doppler indices for penile blood flow, (e) serum testosterone and prolactin assay. Nineteen patients (55.88 percent) had underlying psychogenic factors and 15 (44.12 percent) had organic factors (7 neurogenic, 5 vasculogenic, 3 combined neuro-and vasculogenic). The correct aetiologic evaluation may help in achieving therapeutic success.

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100 cases of carcinoma of the urinary bladder, managed over the last 4 years, were subjected to immune evaluation by the DNCB skin test. Their immune responses were correlated against the grade, stage, survival and prognosis respectively. The results showed that a) a larger percentage of bladder tumor patients showed a poor response when compared to the general population b) cases which showed a poor response were of a more advanced stage and grade c) the disease was rapidly progressive and fatal in patients who showed no response (anergy) d) cases which showed a good response had low stage, low-grade tumors e) the degree of reactivity had a significant correlation with grade, stage, prognosis and survival.

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Thyrotropin releasing Hormone (TRH) produces an excitatory action on spinal motor neurons, besides interacting with the catecholaminergic system, opioids, substance P and 5-hydroxytryptamine. The effect of TRH (4 mg, i.v.) upon the urethra was investigated. Urethral pressure profilometry (UPP) was performed with Urolab 1154 in eight healthy males before, during intravenous infusion of normal saline, during infusion of TRH, and five minutes after the administration of TRH. The maximum urethral pressure (MUP) was 118 plus minus 13.66 cm H2O in the basal study, and 116 plus minus 13.44 cm H2O in the profilometry performed during infusion of normal saline (p greater than 0.2). Administration of TRH resulted in a significant increase in the MUP of 19.5 plus minus 6.84 cm H2O (p less than 0.05). The TRH-induced increase in MUP was short-lived and the UPP performed five minutes after TRH administration showed a significant decrease in the MUP (17.5 plus minus 6.93 cm H2O; p less than 0.05). TRH analogues which have a more potent central action and lower neuro-endocrine activity than TRH hold promise in the urological rehabiliation of selected cases of spinal cord injuries with sphincter incontinence.

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Adrenal Gland NeoplasmsPheochromocytomaAdrenalectomyHumanCase ReportFemaleAdult

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