The effect of pharmacological agents on ejaculation

Regional differences in the functional and biochemical properties of endothelin receptor subtypes in the rabbit prostatic urethra

OBJECTIVE

To examine the regional differences in the functional (pharmacological) and biochemical properties of endothelin (ET) receptors in the rabbit prostatic urethra.

MATERIALS AND METHODS

The properties of ET receptors in 6-month-old male rabbit prostatic urethras were examined using isolated muscle-bath and radioligand receptor-binding techniques. Using plasma membrane suspensions, saturation and inhibition experiments with [(125)I]ET-1 and unlabelled agonists and antagonists (ET(A)-selective antagonist BQ123, and ET(B)-selective agonist sarafotoxin 6c, STX6c) were done to determine the ET receptor densities and their subtype specificities in the different regions of the urethra.

RESULTS

The ETs (ET-1 and ET-3) produced significant concentration-dependent contractile responses in the smooth muscle strips from the different regions of the urethra. Although the maximum contractile responses induced by ET-1 were similar in the different regions, the maximum contractile responses induced by ET-3 were greater in the distal region than in the proximal or middle regions, suggesting that the contractile response to ET-1 is more potent than that to ET-3 in all regions, and that there are region-specific differences in the responses to ET-3 but not ET-1. Moreover, the ET-3-induced contractile response was suppressed by BQ788 (a selective antagonist of the ET(B) receptor) suggesting that the ET(B) receptor subtype contributes to the contractile responses mediated by ET-3. The ET receptors were expressed in higher concentrations in the distal than in the proximal or middle regions. BQ123 and STX6c inhibited [(125)I]ET-1 binding in all regions with high and low affinity constants, indicating the presence of both ET(A) and ET(B) receptor subtypes. The proportions of high-affinity binding sites for BQ123, representing ET(A) receptors, were approximately 68%, 63% and 42% in the proximal, middle and distal regions, respectively. By contrast, the proportions of high-affinity binding sites for STX6c, representing ET(B) receptors, were approximately 27%, 35% and 52% in the proximal, middle, and distal regions, respectively. These data indicate the presence of regional differences in the densities and subtype specificities of ET receptor subtypes, and the existence of regional differences in the rabbit prostatic urethra.

CONCLUSION

The results suggest regional differences in ET(B) receptor subtypes that mediate contractile responses to ET-3, reflecting differences in the densities and specificities of the ET receptor subtypes in the rabbit prostatic urethra.

A comparison of the effects of tamsulosin and alfuzosin on neurally evoked increases in bladder neck and seminal vesicle pressure in rats

OBJECTIVE

To assess the effects of the alpha 1-adrenoceptor antagonists alfuzosin and tamsulosin on the physiological events associated with ejaculation in the rat, because when these drugs are used for treating symptomatic benign prostatic hyperplasia in men they may affect ejaculation by impairing bladder neck closure and seminal vesicle contraction.

MATERIALS AND METHODS

In clinical trials the incidence of ejaculatory disorders in men is typically < 1% with alfuzosin and 4-18% with tamsulosin. The effects of tamsulosin and alfuzosin on bladder neck and seminal vesicle pressures (BNP and SVP) in the rat were analysed. Increases in BNP and SVP were induced in urethane-anaesthetized. Wistar rats by electrical stimulation (ES) of the hypogastric nerve (HN) before and after an intravenous injection with vehicle, 3 or 10 micrograms/kg of tamsulosin or alfuzosin (10 rats/group). The mean amplitude and area under the curve (AUC) of the BNP and SVP were expressed as the percentage of the response to ES of HN before the treatment.

RESULTS

The amplitude and AUC of the SVP were significantly decreased by both doses of tamsulosin, and marginally decreased by the same doses of alfuzosin. The amplitude of the BNP was significantly decreased by 3 and 10 micrograms/kg of tamsulosin and 10 micrograms/kg alfuzosin, and marginally decreased by 3 micrograms/kg alfuzosin. The AUC of the BNP was significantly decreased by both doses of tamsulosin, but barely affected by alfuzosin at the same doses.

CONCLUSION

Over the doses assessed, alfuzosin had significantly less deleterious effect on increases in BNP and SVP induced by ES of the HN than had tamsulosin.

An in vivo evaluation of the therapeutic potential of sympatholytic agents on premature ejaculation

OBJECTIVE

To evaluate the therapeutic potential of sympatholytic agents on premature ejaculation in an animal model, using monitoring of rat seminal vesicle pressure change in response to electrical stimulation of the lesser splanchnic nerve.

MATERIALS AND METHODS

Male Wistar rats (aged 12-14 weeks) were injected intra-arterially with sympatholytic agents (phenoxybenzamine, prazosin, WB-4101, chloroethylclomidine, yohimbine and RX 821002) at various concentrations 10 min before electrical stimulation of the lesser splanchnic nerve. The change in phasic tension (triangle upmmHg) of the seminal vesicle induced by electrical nerve stimulation before and after the addition of sympatholytic agents was used for statistical analysis. The maximum inhibition and the concentration required to induce 50% inhibition of the maximal contractile response (IC50) were obtained from the concentration-response curves, and used to determine the potency of test agents.

RESULTS

The seminal vesicle contractile response to electrical nerve stimulation was suppressed in a dose-dependent manner by all test drugs except RX 821002. The mean (sd) maximal inhibition was 78.4 (9. 3)% by 0.03 mg/kg of phenoxybenzamine, 77.1 (10.1)% by 0.03 mg/kg of WB-4101, 73.4 (6.0)% by 0.1 mg/kg of yohimbine, 67.9 (9.7)% by 0.1 mg/kg of prazosin, 75.5 (7.5)% by 3 mg/kg of chloroethylclomidine and 25.3 (4.8)% by 0.01 mg/kg of RX 821002. The potencies of WB-4101 (IC50 3 microgram/kg) and yohimbine (IC50 0.8 microgram/kg) were similar to that of phenoxybenzamine (IC50 0.5 microgram/kg) and much higher than that of prazosin (IC50 0.03 mg/kg) or chloroethylclomidine (IC50 0.3 mg/kg).

CONCLUSIONS

Phenoxybenzamine, prazosin, WB-4101, chloroethylclomidine and yohimbine all inhibit the contractile response of the rat seminal vesicle to electrical nerve stimulation. As phenoxybenzamine is effective in treating premature ejaculation, the comparable in vivo potencies of WB-4101 and yohimbine strongly suggest that they have clinical therapeutic potential.

Azoospermia due to aperistalsis of the vas deferens: successful treatment with pseudoephedrine

Three patients presenting with infertility were found to have low volume azoospermia. All 3 were taking sympatholytic medications; 2 were taking antipsychotics and 1 was taking an alpha-blocker. Low volume azoospermia may result from the use of sympatholytic medications, which cause aperistalsis of the adrenergically innervated vas deferens and seminal vesicles. Two patients had normal spermatogenesis on biopsy and were unobstructed on vasography. In 1 patient, biopsy and vasography were avoided. Pseudoephedrine, a sympathomimetic agent, was given to all 3 patients, resulting in marked improvement in semen analysis parameters. A trial of pseudoephedrine can obviate the need for biopsy and vasography in such patients.

In vivo evaluation of serotonergic agents and alpha-adrenergic blockers on premature ejaculation by inhibiting the seminal vesicle pressure response to electrical nerve stimulation

OBJECTIVE

To evaluate the effect of drugs on premature ejaculation using a rat animal model in which the seminal vesicle was electrically stimulated via its lesser splanchnic nerve and changes in the pressure response monitored.

MATERIALS AND METHODS

Male Wistar rats (aged 12-14 weeks) were injected intravenously with prazosin and serotonergic agents (serotonin, clomipramine, fluoxetine, imipramine and indatraline) at various concentrations 10 min before electrical nerve stimulation (ENS) of the lesser splanchnic nerve; the initial increase in seminal vesicle pressure in response to ENS was then compared.

RESULTS

The pressure response to ENS was reduced in the presence of prazosin or serotonergic agents. The mean (SEM) maximum inhibition values were 84.1 (8.9%) by fluoxetine at 0.1 mg/kg, 67.9 (8.7)% by prazosin at 0.1 mg/kg, 60.9 (11.0)% by serotonin at 3 mg/kg, 54.9 (4.6)% by clomipramine at 3 mg/kg, 30.0 (11.0)% by imipramine at 0.1 mg/kg, and 20.9 (4.3)% by indatraline at 0.1 mg/kg. From the concentration-response curve, the potency of prazosin was lower than that of fluoxetine, but was higher than that of serotonin or clomipramine.

CONCLUSIONS

Like serotonin, fluoxetine and clomipramine can reduce the pressure response of the seminal vesicle to ENS. Among these inhibitory agents, including prazosin, fluoxetine was the most effective and may be valuable for the clinical treatment of ejaculatory dysfunction in man.

Observations on seminal vesicle dynamics in an in vivo rat model

PURPOSE

To gain understanding of the seminal vesicle as a muscular organ, seminal vesicle compliance and contractile properties were quantified with an in vivo, microsurgical rat model.

MATERIALS AND METHODS

Microsurgical dissection was performed on anesthetized rats to enable simultaneous organ filling and monitoring of intraluminal pressures. The reliability and reproducibility of post-ganglionic hypogastric nerve-induced ipsilateral (4 rats) and bilateral (5 rats) seminal vesicle contractile responses were assessed during repeated nerve stimulation. Seminal vesicle resting compliance was assessed during a constant saline infusion (10 rats). Functional performance curves were obtained at fixed fill-volumes by measuring organ contraction after nerve stimulation (4 rats).

RESULTS

A reproducible seminal vesicle contractile response was obtained with a nerve stimulation interval > 15 minutes. Bilateral seminal vesicle responses were observed with unilateral nerve stimulation. The resting organ compliance curve with saline filling exhibited a characteristic, triphasic response. Functional performance studies revealed that contractile performance improves as the fill-volume increases until the distensibility limit of the organ is reached.

CONCLUSIONS

A reliable, in vivo, rat model of seminal vesicle organ compliance and contractility is described. The seminal vesicle is a highly contractile, compliant smooth muscular organ with dynamic properties analogous to that of the urinary bladder. This experimental system may allow for the investigation of pharmacologic and other physiological influences on in vivo organ activity.

Yohimbine prevents the retrograde flow of spermatozoa into the urinary bladder of dogs induced by xylazine

This study was carried out to determine whether yohimbine antagonizes the retrograde flow of spermatozoa into the urinary bladder of dogs caused by xylazine. Adult dogs were assigned to one of four groups of six dogs each and treated as follows: saline control, xylazine (2.2 mg/kg, i.m.), yohimbine (0.2 mg/kg, i.m.), yohimbine/xylazine (yohimbine, 0.2 mg/kg, i.m., followed 10 min later by xylazine, 2.2 mg/kg, i.m.). Pre- and post-treatment urine were collected by cystocentesis from all dogs. The mean (+/- SD) adjusted total number of spermatozoa in the post-treatment urine of xylazine-treated dogs (141.02 +/- 136.75 x 10(6)) was 15 times higher (P < 0.05) than the number in the post-treatment urine of control dogs (9.16 +/- 20.26 x 10(6), 1763 times higher (P < 0.05) than the number in the urine of yohimbine-treated dogs (0.08 +/- 0.20 x 10(6), and 56 times higher (P < 0.05) than the total number in the post-treatment urine of yohimbine/xylazine-treated dogs (2.54 +/- 4.54 x 10(6)). These results confirm that xylazine induces a significant (P = 0.007) displacement of spermatozoa into the urinary bladder of dogs and demonstrate that pre-treatment with yohimbine prevents this effect.

Retrograde ejaculation accompanying hyperprolactinemia

A patient, 38 years of age with 10 years of infertility, suffered from an ejaculation disorder for 2 years. Based on a diagnosis of retrograde ejaculation, sperm retained in the bladder was collected and homologous artificial insemination was carried out, but pregnancy was not achieved. The subject was examined at the Department of Urology and hormone tests were conducted showing hyperprolactinemia, hypogonadotropinemia, and hypotestosteronemia. A CT scan showed a pituitary tumor. Administration of 7.5 mg/day of bromocriptine was initiated to treat this tumor. Antegrade ejaculation recurred 1 month after administration, and pregnancy was achieved from normal sexual intercourse 5 months after administration.

Psychoactive drugs and human sexual behavior: the role of serotonergic activity

A wide range of both prescription and nonprescription drugs has been reported to affect human sexual functioning. While the sexual side effects resulting from drug use have often been attributed to adrenergic, anticholinergic or dopaminergic activity, the present review considers the potential role of serotonin. Based on animal studies, serotonin has been shown to either facilitate or inhibit sexual activity depending on which serotonin receptor subtype is activated. However, few studies have been done in the human that assess the effects of drugs that bind selectively to serotonin receptors. Consequently, little is known about the role of serotonin in human sexual functioning. In this review, a wide range of drugs that affect both brain serotonergic systems and human sexual behavior is examined in an effort to determine the possible role of serotonin in human sexual behavior. A review of the literature is consistent with the hypothesis that the 5-HT1A and the 5-HT2 receptor subtypes play a facilitatory role in human sexual behavior. The evidence suggests that drugs that act as agonists on these receptor sites enhance sexual functioning in the human, while those that act as antagonists inhibit sexual functioning.

Effects of the alpha 1-adrenoceptor antagonist R-(-)-YM12617 on isolated human penile erectile tissue and vas deferens

The effects of the selective alpha 1-adrenoceptor antagonist, R-(-)-YM12617 (5-[2-[[2-(0-ethoxyphenoxy)ethyl]amino] propyl]-2-methoxybenzenesulphonamide HCl), were investigated in isolated human corpus spongiosum, corpus cavernosum, and vas deferens. R-(-)-YM12617 concentration dependently and competitively inhibited contractions induced by noradrenaline in human penile erectile tissue (pA2 value in corpus spongiosum = 9.92), and the drug was approximately 12 times more potent than prazosin (pA2 value = 8.83). In the vas deferens, R-(-)-YM12617 and prazosin inhibited electrically induced contractions concentration dependently, and abolished the contractions at 10(-6) and 10(-5) M, respectively. The -log IC50 values for R-(-)-YM1261 and prazosin were 8.46 and 7.50, respectively. It is concluded that R-(-)-YM12617 is a potent inhibitor of alpha 1-adrenoceptors in human penile erectile tissues and vas deferens, and that the drug, if injected intracavernosally, may be useful for the treatment of penile erectile dysfunction.

Pathologic changes in the accessory sex glands of rats treated with a sympatholytic hypotensive agent (losulazine)

Groups of 25 male Sprague-Dawley rats were treated by gastric intubation with either vehicle control (modified methylcellulose) or a suspension of losulazine at 4, 8, 16, or 32 mg/kg/day for 1 yr. Ten rats/group were killed after 6 months of treatment. Reversibility of drug-induced changes was evaluated in 8 rats/group treated for 6 months and held without treatment for 5 months. Daily clinical signs and weekly body weight changes were monitored. Seminal vesicle/coagulating glands were weighed in rats treated for 6 months. Gross and microscopic evaluation of the accessory sex glands (ampullary glands, prostate, seminal vesicles and coagulating glands) was conducted in all rats killed at 6 months, after the recovery period, and in rats that survived through the one-yr treatment period. Ptosis, somnolence, and fecal softening were detected in all groups treated with losulazine. There was a nonreversible body weight gain retardation in groups treated with 8 to 32 mg/kg/day of losulazine for 6 months or 1 yr. Absolute and relative weights of the seminal vesicle/coagulating glands of treated rats were not significantly different from those of control rats. The ventral prostate in a few rats in all treated groups had yellow to tan granular foci. Treatment, but not dose-related sperm granulomas or glandular impaction with inspissated secretion (formation of corpora amylacia) in the ampullary glands, enhanced cellular exudation into the acini of the ventral prostate, and impaction of the seminal vesicles with altered granular to globular secretion were found in rats treated with losulazine.(ABSTRACT TRUNCATED AT 250 WORDS)

Prazosin, an adrenergic blocking agent inadequate as male contraceptive pill

The purpose of this study was to investigate the efficacy and the acceptability of Prazosin as a male contraceptive pill. Acceptable antifertility drugs for men are proving difficult to produce, and the possibility of using pharmacological agents to block selectively or to inhibit normal sperm transport through the male genital tract is an interesting approach. Prazosin administered in doses up to 10 mg/day did not cause azoospermia following ejaculation. In conclusion, we have not been able to confirm either the efficacy or the acceptability of the alpha 1-adrenoceptor antagonist Prazosin as a male contraceptive drug. Homonnai et al. confirmed the fact that phenoxybenzamine blocks ejaculation, but it should be noted that although both drugs are alpha 1-adrenoceptor blocking agents, they are not chemically identical.

Electroejaculation for recovery of semen after retroperitoneal lymph node dissection: case report

Electroejaculation with a rectal probe was used successfully for semen recovery 8 years after bilateral suprarenal hilar lymph node dissection for stage IIB embryonal cell cancer. An adequate ejaculate was obtained in relation to total sperm count, motility and normal morphology. Prior use of sympathomimetic drugs, including imipramine and ephedrine, was unsuccessful in producing an ejaculation. Electrostimulation via a rectal probe seems to be a useful technique for semen recovery in the patient with anejaculation after retroperitoneal lymph node dissection.

Effect of drugs interacting with adrenoreceptors and muscarinic receptors in the epididymal and prostatic parts of the human isolated vas deferens

Electrical field stimulation of ring preparations of the epididymal (Ve) and prostatic (Vp) parts of the human isolated vas deferens produced contractions with similar frequency-dependence and appearance. The contractions of Ve, but not of Vp preparations were abolished by tetrodotoxin (10(-6)M). Noradrenaline (NA), phenylephrine, and methoxamine, but not clonidine induced repetitive, phasic contractions in both Ve and Vp preparations, and increased the amplitude of electrically induced responses. Clonidine concentration-dependently decreased electrically induced contractions in Ve preparations, but had no significant effects in Vp preparations. Phentolamine and prazosin abolished electrically induced contractions in Ve but not in Vp preparations. In Ve rings the contractions were increased by rauwolscine; no such effect was observed in Vp preparations. Isoprenaline, propranolol, acetylcholine and carbachol had no effects in the Ve or Vp preparations. Scopolamine and atropine reduced electrically induced responses. Clonidine decreased and rauwolscine increased the electrically induced release of 3H in both Ve and Vp preparations pre-loaded with 3H-NA. Phenylephrine, prazosin, isoprenaline, propranolol, carbachol and scopolamine had minor or no effects on the 3H release. Radioligand receptor binding experiments using 3H-prazosin and 3H-rauwolscine as ligands revealed similar densities of alpha 1- and alpha 2-adrenoreceptors in the human vas deferens. There seemed to be no differences in their distribution between the epididymal, middle and prostatic part of the organ. It is concluded that the neurotransmission in the human vas deferens is noradrenergic and mediated via alpha 1-adrenoreceptors. The prazosin and tetrodotoxin resistant part of the electrically induced contraction in Vp preparations may be caused by direct smooth muscle stimulation.

Phenoxybenzamine--an effective male contraceptive pill

Phenoxybenzamine (PBZ), administered in doses up to 20 mg/day, caused aspermia following male orgasm. This led to the development of a male contraceptive pill, PBZ being the active drug. It has been shown that small doses of the drug do not change the hormonal balance of the body, nor do they affect blood pressure. In 2 to 3 days, PBZ blocks ejaculation; this is fully reversed with the cessation of treatment. The drug does not affect semen quality (testicular function), even after a long period of medication. During treatment, the vas deferens, the ampulla and the ejaculatory ducts are probably paralyzed. Cessation of medication brought full recovery of these effects and the reappearance of normal ejaculation. Men complaining of premature ejaculation reported marked improvement in their sexual performance. The recommended regimen for administering PBZ as a male contraceptive is discussed.

Sexual dysfunction due to antihypertensive agents

A review of sexual dysfunction due to antihypertensive agents is presented. Sexual dysfunction is a relatively common complication of antihypertensive drug therapy and has been associated with nearly all of the antihypertensive agents. The physiology of the normal sexual response, proposed mechanisms of sexual dysfunction, and the types of disorders and relative incidence rates associated with individual agents are discussed. Since a disturbance in sexual function may lead to poor compliance with the drug regimen, it is important that the clinician be familiar with this topic. Information on the detection of antihypertensive-agent-induced sexual dysfunction, patient counseling, and therapeutic alternatives, should a disorder in sexual function occur, also is provided.

The possible use of phenoxybenzamine as a male contraceptive drug: studies on male rats

Treatment of male rats with phenoxybenzamine hydrochloride (PBZ), 70 micrograms/100 g body weight for 5 weeks, caused infertility of the rats. This effect was fully reversible. Studies on the weights of the testes, epididymides, and male accessory sex glands, revealed increased glandular weights (significantly in the testes, epididymides and seminal vesicles). The number of spermatozoa found in the epididymis and vas deferens was significantly increased in the treated rats. Thus, PBZ caused a temporary cessation of sperm transport and paralysis of the muscles of the accessory glands, leading to the absence of ejaculation. In proestrous females mated with treated rats, this caused pseudopregnancy. No changes were found in the sexual behavior of the treated male rats, which was also supported by the absence of changes in the testosterone levels in serum and in testicular tissue. We recommend the use of PBZ in clinical trials, using this well-known drug as the active material for a future contraceptive pill.

Experience with the classification, diagnosis, and therapy of nonejaculatory intercourse

Twenty-one consecutive patients complaining of nonejaculatory intercourse were studied. Fifteen patients had anejaculation of various types, and sex therapy succeeded in 4 of 7 cases. Three patients had retrograde ejaculation that could be corrected by ephedrine sulfate in two cases having a neurologic cause. In one of three patients having nonemission, ejaculation was restored after stopping the drug thioridazine. A juvenile diabetic patient was discovered to have nonemission and not retrograde ejaculation. A classification of the disorders leading to nonejaculatory intercourse based on pathogenetic and clinical data is presented, including anejaculation, retrograde ejaculation, nonemission, and aspermia.

Thoracic spinal cord ependymoma presenting with ejaculatory failure. Case report

✓ A case of thoracic spinal cord ependymoma presenting with ejaculatory failure is described. This mode of onset has not previously been reported in patients with thoracic intraspinal tumors.

Pharmacosexology: the effects of drugs on sexual function a review

The literature on the sexual side effects of drugs and chemicals has been reviewed. There are many substances which alter the human sociosexual response cycle either negatively, positively or both. Many of the drugs used therapeutically have been reported to have adverse effects on sexuality, and this must be taken into account when these drugs are used clinically. Many substances which are used for recreational purposes (or sometimes abused) also have profound effects on sexual response. Many of these substances are used in such a way that they can correct underlying sexual problems. Treatment of a drug abuser may well prove unsuccessful without consideration of preexistent sociosexual problems and concerns. From the dawn of recorded history, many substances have been used for the purpose of sexual enhancement. Some of these have known success and their reputations have been passed down through the millenia. The chapter has not yet been closed on aphrodisiacs, even though none have survived the rigors of scientific scrutiny. As long as humans place value on optimal sexual functioning, there will be a demand for sex-enhancing drugs. In order for the scientific and medical community to successfully meet these challenges, more effective and relevant study designs will have to be utilized in order to separate fact from fancy. The study of pharmacosexology is in its infancy, and in order for it to grow and contribute to the world body of knowledge, more researchers and clinicians must be trained in both pharmacology and sexology.

Effect of phenoxybenzamine (dibenzyline) on sexual function in man

Phenoxybenzamine (Dibenzyline) has been extremely effective in treating patients with detrusor dyssynergia. Its minimal side effects include: mouth dryness, nasal congestion, drowsiness and fatigue, nausea and vomiting, palpitations, ejaculatory failure, and retrograde ejaculation. Nineteen men treated with phenoxybenzamine for detrusor dyssynergia reported ejaculatory failure during treatment; normal ejaculation returned after treatment was discontinued. Postmasturbation urine and semen samples were analyzed for sperm and fructose. The results of the study suggest that ejaculatory failure was due to the lack of seminal emission into the posterior urethra, rather than retrograde ejaculation. Some implications of this study are also discussed.

The effects of cancer and cancer therapy on male fertility

Multimodality treatments have increased the survival of cancer patients in recent years. With cure the quality of life also should be taken into consideration. Maintenance of the reproductive capacity is of great concern to many young patients. Until now the cause of sterility was attributed to the long-term side effects of treatment when recovery could not be predicted. Pre-treatment sperm banking is advised routinely for many of these patients. Our own observation as well as a few other reports show that cancer itself seems to have an adverse effect on fertility before any form of treatment. As assessed by semen quality the majority of our patients were subfertile when first seen. Hence, sperm banking may be a poor guarantee for future reproduction in these patients.

Management of neurogenic bladder in infancy and childhood

Sixty-two patients, age twelve years and under, were treated for incontinence due to neurogenic bladder secondary to spina bifida (58) or trauma (4) with a follow-up period of three to thirty-two months (mean, ten months). In early life, patients were managed with the Credé maneuver (18 patients). Older children were managed with intermittent clean catheterization (44 patients) with or without pharmacologic agents. Continence was achieved with intermittent clean catheterization in 77 per cent, thus enabling these children to be more acceptable to their peers and in many cases attend schools from which they had previously been excluded because of urinary incontinence. With the Credé maneuver, renal deterioration was noted in 11 per cent on follow-up IVP, and in 2 per cent of the patients on intermittent clean catheterization. Recurrent asymptomatic bacteriuria occurred in 33 per cent of those with the Credé maneuver and in 55 per cent of the patients using intermittent clean catheterization. The use of antibiotic bladder irrigations reduced this incidence to 5 per cent. All patients with renal deterioration except one responded to intermittent clean catheterization; this patient was treated with cutaneous vesicostomy. Urodynamic assessment was performed in 15 patients, and this diagnostic tool assisted in the therapeutic management of these children.

Improved management of nonseminomatous testis tumors

Two contributions to the management of nonseminomatous germinal cell (NSGC) tumors of the testis are reviewed. First, a midline technique of extended retroperitoneal lymph node dissection (RPLND) has been developed allowing good access to both renal suprahilar zones as well as the traditional hilar and infrahilar areas. This has been employed at Indiana University Medical Center for staging patients with embryonal carcinoma or teratocarcinoma of the testis who had negative preoperative chest tomography. Of 58 consecutive patients from 1965-1975, 30 were Stage A and 28 Stage B. Thirty of 30 Stage A patients survived (100%) and 24 of 28 (86%) operated Stage B patients survived, for an overall survival of 54/58 (93%). The second contribution relates to development of a new combination chemotherapy protocol for Stage C disease. Preoperative Stage C lesions are treated with Platinum, Velban and Bleomycin (PVB). Those who achieve clearance of pulmonary tumors but who have anatomic or serologic evidence of persistent retroperitoneal tumor after PVB chemotherapy are later treated with RPLND. Six of 12 such patients have been rendered tumor free and now enjoy complete remission. Furthermore, 33 of 50 (66%) patients with disseminated Stage C disease achieved initial complete remission using this drug combination. Twenty-six remain in continuous complete remission with no evidence of disease from 2 to 4 years. Seven are alive, in partial remission, and 17 are dead. Improving chemotherapy opens alternative methods of managing advanced testis cancer.

Infertility in men with retrograde ejaculation: the action of urine on sperm motility, and a simple method for achieving antegrade ejaculation

The profound effect of urine on sperm motility is demonstrated. Two patients with retrograde ejaculation and infertility who achieved antegrade passage of semen by ejaculation on a full bladder are described. The use of this method of management in patients with infertility due to retrograde ejaculation is discussed.

Clinical report about some cases with retrograde ejaculation

The incidence of retrograde ejaculation may be expected to increase by factors as a higher incidence of vascular- and colon-surgery, the increase of road accidents with as a result transversal lesions as well as the increased use of medicines particularly hypotensive drugs. After some remarks about the mechanism of ejaculation and the closing mechanism of the sphincter internus, some cases-histories are dealt with. After these case-histories, a survey is given about the etiology of the retrograde ejaculation. Finally some possibilities in treating this disorder are given, such as intravaginal deposit of urine after intercourse and the administration of a drug, called phenylpropanolamine, a so-called a-sympathicomimetic.

Hyperprolactinaemia and impotence

Clinical, laboratory and radiological findings were evaluated in twenty-nine men who had raised serum prolactin concentrations and pituitary tumours. Twenty-one had functionless pituitary tumours ('prolactinomas') and eight had acromegaly. Supraseller extension was detected in twenty of the twenty-six men who had lumbar airencephalography. Three patients were studied before, sixteen before and after and ten only after pituitary ablative therapy. Seventeen of these men complained of complete lack of libido and impotence and six had impaired libido and sexual potency; only six patients in this series denied reproductive symptoms. Thirteen of the impotent subjects had small soft testes, ten reduced facial and body hair and three had marked gynaecomastia. No features of hypogonadism were noted in the six patients without reproductive symptoms and none of the patients had galactorrhoea. Serum prolactin concentrations were higher and serum testosterone concentrations lower in the impotent men compared with those with normal sexual potency. Serum LH and FSH (both basal and in response to LHRH) oestradiol and oestrone concentrations were not different between the two groups and, except in those with post-operative hypopituitarism, were within the normal range. Following successful lowering of prolactin concentrations by surgery or bromocripitine or both, serum testosterone rose and potency returned; by contrast failure to lower prolactin concentrations was associated with persistent impotence and hypogonadism. The endocrine profile of low serum testosterone concentrations with gonadotrophins which had not risen into the range usually seen in primary hypogonadism (together with the parallel increase of LH and testosterone in one patient studied sequentially during treatment which suppressed prolactin levels to normal), suggested that the impaired gonadal function was caused by a prolactin-mediated disturbance of hypothalamic-pituitary function.