SOX2 boosts major tumor progression genes in prostate cancer and is a functional biomarker of lymph node metastasis

Critical issues in prostate cancer (PC) are a. identification of molecular drivers of the highly aggressive neuroendocrine differentiation (NED) in adenocarcinoma, and b. early assessment of disease progression.

The SRY (sex determining region Y)-box 2 gene, SOX2, is an essential embryonic stem cell gene involved in prostate tumorigenesis. Here we assessed its implications in NED and progression of PC and its diagnostic and prognostic value.

Laser microdissection, qRT-PCR, quantitative Methylation-Specific PCR and immunohistochemistry were used to analyze SOX2 gene expression and regulation in 206 PC samples. Results were examined according to the patient's clinical pathological profile and follow-ups. Functional studies were performed using PC cells transfected to overexpress or silence SOX2.

SOX2 was consistently downregulated in PC, except in cell clusters lying within lymph node (LN)-positive PC. Multivariate analysis revealed that SOX2 mRNA expression in the primary tumor was significantly associated with LN metastasis. When SOX2 mRNA levels were ≥1.00, relative to (XpressRef) Universal Total RNA, adjusted Odds Ratio was 24.4 (95% CI: 7.54–79.0), sensitivity 0.81 (95% CI: 0.61–0.93) and specificity 0.87 (95% CI: 0.81–0.91). Patients experiencing biochemical recurrence had high median levels of SOX2 mRNA.

In both PC and LN metastasis, SOX2 and NED marker, Chromogranin-A, were primarily co-expressed. In PC cells, NED genes were upregulated by SOX2 overexpression and downregulated by its silencing, which also abolished SNAI2/Slug dependent NED. Moreover, SOX2 upregulated neural CAMs, neurotrophins/neurotrophin receptors, pluripotency and epithelial-mesenchymal transition transcription factors, growth, angiogenic and lymphangiogenic factors, and promoted PC cell invasiveness and motility.

This study discloses novel SOX2 target genes driving NED and spread of PC and proposes SOX2 as a functional biomarker of LN metastasization for PC.

Time-domain analysis of scrotal thermoregulatory impairment in varicocele

Varicocele is a common male disease defined as the pathological dilatation of the pampiniform plexus and scrotal veins with venous blood reflux. Varicocele usually impairs the scrotal thermoregulation via a hemodynamic alteration, thus inducing an increase in cutaneous temperature. The investigation of altered scrotal thermoregulation by means of thermal infrared imaging has been proved to be useful in the study of the functional thermal impairment. In this study, we use the Control System Theory to analyze the time-domain dynamics of the scrotal thermoregulation in response to a mild cold challenge. Four standard time-domain dynamic parameters of a prototype second order control system (Delay Time, Rise Time, closed poles locations, steady state error) and the static basal temperatures were directly estimated from thermal recovery curves. Thermal infrared imaging data from 31 healthy controls (HCS) and 95 varicocele patients were processed. True-positive predictions, by comparison with standard echo color Doppler findings, higher than 87% were achieved into the proper classification of the disease stage. The proposed approach could help to understand at which specific level the presence of the disease impacts the scrotal thermoregulation, which is also involved into normal spermatogenesis process.

A diagnostic dilemma: dystrophic calcified nodule of the testicle in a patient with no other symptoms - case report and review of the literature

Dystrophic calcified nodule of the testicle represents an exceptional lesion with an unknown etiology and controversial diagnostic approach. There are very few reports in the literature that have examined this feature. Here, we report the fourth case of dystrophic testis nodule, identified in a 46-year-old man who presented the urologist with a palpable mass on his left testicle and no other symptoms. Histopathological findings were discussed and pooled with those of all previously published series. We believe that this description is particularly innovative because of the absence of symptoms and testicular pain associated with the lesion, and interesting as an attempt to determine the recognition of this rare entity.

Androgen deprivation boosts prostatic infiltration of cytotoxic and regulatory T lymphocytes and has no effect on disease-free survival in prostate cancer patients

PURPOSE

The value of neoadjuvant hormone therapy (NHT) prior to radical prostatectomy as a means of restraining prostate cancer (PCa) and strengthening its immunotherapy is still uncertain. This article asks whether it subverts immunoregulatory pathways governing tumor microenvironments, and has an impact on patient outcome.

EXPERIMENTAL DESIGN

We microdissected epithelium and stroma from cancerous and normal prostate specimens from 126 prostatectomized patients, of whom 76 had received NHT, to detect cytokine/chemokine gene expression levels by real-time reverse transcriptase PCR. Confocal microscopy was used to identify cytokine/chemokine cell sources, and immunostainings to characterize lymphocyte subsets whose prognostic effects were assessed by Kaplan-Meier analyses.

RESULTS

NHT boosted the expression of IL-7 in the stroma and that of IFNγ-inducible protein-10/CXCL10 in the glandular epithelium of normal prostate tissue, and restored the CD8(+) lymphocyte depletion occurring in PCa, whereas it significantly increased the CD4(+) lymphocyte infiltrate. Lymphocytes, mostly with CD8(+) phenotype, expressed the T-cell intracellular antigen-1, granzyme-B, and perforin, typical of cytotoxic-effector T cells. NHT also induced thymus and activation-regulated chemokine/CCL17 production by monocytes/macrophages in the prostate and draining lymph nodes, and increased the number of their Forkhead box P3 (Foxp3)(+)CD25(+)CD127(-) T regulatory (Treg) cells. The χ(2) test disclosed the lack of association (P = 0.27) between NHT and the high intratumoral CD8(+)/Treg ratio indicative of a good prognosis.

CONCLUSIONS

Androgen withdrawal regulates cytokine/chemokine gene expression in normal prostate and lymphoid tissues, and this probably favors both CD8(+) and Treg infiltrates, leaves their intratumoral balance unchanged, and thus has no impact on disease-free survival.

Open partial nephrectomy with no clamping of the pedicule: a good surgical option in treatment of renal cancer

AIM

The aim of the present work was to describe authors' surgical experience using the partial nephrectomy technique without intraoperatory pedicle clamping for masses even up to 4 cm of size.

METHODS

The study enrolled 96 patients with an average age of 59.7 years, who underwent partial nephrectomy without pedicle clamping. The average dimensions of the masses treated were 3.7x3x3.8. In preoperative and in postoperative time creatinine, hemoglobine, hematocrit and platelets were monitored. The follow-up was of 1-3-6 months. At the third month postoperatively a renal US scan was performed, together with a control CT scan and at the sixth month of follow-up the patients underwent also a control Tc99/DMSA renal scintigraphy in back, front, oblique and right posterior oblique left rear projections.

RESULTS

Surgery and anesthesia time have been respectively of 1 h 51 min e 2 h 30 min. In the postoperative time the average values were: creatinine 1.46 ng/mL (±0.45), hemoglobin: 11.25 g/dL (±1.6), hematocrit: 36.4 % (±3), platelets: 205 x 103 (±45 x 103). At follow-up at 1-3-6 months the average values were: creatinine 1.16 ng/dL (±0.66), hemoglobin 14.13 g/dL (±0.13), hematocrit 42.43% (±1.03), platelets 204 x 103 U/L (±1.66 x103). After six months the renal function demonstrated intraparenchymal homogeneous distribution of the drug in all the patients, with a 7% of difference of relative uptake by the operated kidney than the healthy controlateral one.

CONCLUSION

The partial nephrectomy without intraoperative pedicle clamping can be a good therapeutic option for the treatment of kidney cancer for masses even up to 4 cm of size. The follow-up should be longer to assess oncological results.

Scrotal thermoregulatory model and assessment of the impairment of scrotal temperature control in varicocele

Varicocele is defined as the pathological dilatation of the pampiniform plexus and scrotal veins with venous blood reflux. Varicocele may impair scrotal thermoregulation and spermatogenesis, even when present in asymptomatic forms. In this study, we use the control system theory to model scrotal thermoregulation in response to a standardized cold challenge in order to study the functional thermal impairment secondary to varicocele. The proposed model is based on a homeostatic negative feedback loop, characterized by four distinct parameters, which describe how the control mechanisms are activated and maintained. Thermal infrared images series from 49 young patients suffering from left varicocele and 17 healthy controls were processed. With respect to healthy controls, left varicocele patients presented higher basal scrotal temperature and faster recovery of the left hemiscrotum. The model indicated that varicocele alters local heat exchange processes among cutaneous layers and inner structures. The estimated model parameters help in the assessment of the scrotal thermoregulatory impairment secondary to the disease.

Early Clinical Experience with Different Mesh in Correction of High-Degree Cystocele

Background

Cystocele is connected to an ingravescent relaxation of uretrovesical support system. During surgical correction of this disease, a mesh has been introduced to strengthen weak tissue. The aim of the study was to compare different material aspects and various devices.

Methods

From June 2002 to December 2008, 80 patients underwent surgical correction for high-degree cystocele. None of the patients had stress-incontinence. All the patients were studied with cistography and urodynamic test. Three different kinds of mesh were employed, such as: Goretex (26 pt.), Prolene (27 pt.), Bovine Pericardium (27 pt.). During surgery the mesh have been modelled if necessary and fixed by detached sutures.

Results

By comparing the devices: in Goretex group there were excellent results about anatomical correction, in the follow-up too (6 months), good continence and an improving of quality of life; in Prolene group no post-surgery complication, 3 pts. referred urge incontinence resolved in about 3 months. After 6 months a subset of patients reported sensation of foreign vulvar body and moderate dyspareunia; in Bovine Pericardium group we had an intra-operatory difficulty, for its softness a high risk to tear the net itself. No post-surgery complications. No urinary symptoms. After 3 months 5 of the patients referred a sensation of foreign vulvar body and dyspareunia. After 6 months, 4 patients still have the same sensation.

Conclusion

We hypothesize that Goretex mesh is an excellent device for its operator manageability, good anatomical results, and good tolerability. Further investigation is warranted to determine the effect of each of these techniques.

The lack of epithelial interleukin-7 and BAFF/BLyS gene expression in prostate cancer as a possible mechanism of tumor escape from immunosurveillance

PURPOSE

The human prostate is endowed with intraepithelial and stromal lymphocytes, which may develop lymphoid follicles (LF) and allow a local immune response. We sought to investigate whether interleukin (IL)-7 and BAFF/BLyS, two fundamental survival factors for T and B cells, are expressed in the normal and neoplastic prostate and affect intraprostatic lymphocyte homeostasis.

EXPERIMENTAL DESIGN

We have used real-time reverse transcription-PCR of microdissected prostatic glands and confocal microscopy to detect cytokine production, combined with immunohistochemistry to characterize intraprostatic lymphocytes.

RESULTS

Prostatic epithelia constitutively produce IL-7 and, to a lesser extent, BAFF/BLyS. Indeed, we show that IL-7 receptor alpha is expressed by intraepithelial T lymphocytes and parafollicular T cells, whereas BAFF-R is found on periglandular B lymphocytes and mantle zone B cells of LFs. Prostate-homing B and T lymphocytes are scarcely proliferating, whereas most of them express the antiapoptotic protein bcl-2 and reveal a low apoptotic index in the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay. The transition from normal to neoplastic glands in prostate cancer (PCa) is marked by a dramatic decline of IL-7 and BAFF/BLyS production. Accordingly, PCa is characterized by a significant reduction of intraepithelial lymphocytes and loss of LFs. B-cell and T-cell expression of bcl-2 decrease, whereas the apoptotic events increase. The remaining PCa-infiltrating lymphocytes are mostly CD8(+) T cells that lack terminal differentiation and barely penetrate neoplastic glands.

CONCLUSIONS

These results suggest that epithelial IL-7 and BAFF/BLyS production support intraprostatic lymphocyte survival. Its loss in PCa is associated with a severe depletion of prostate-associated lymphocytes and points to a novel tumor escape mechanism.

Quality of life evaluation by the EORTC QLQ-C30 questionnaire in patients treated with hormonal treatment in Italy. A QuABIOS group study

OBJECTIVES

An observational study was planned by the QuABIOS group, to survey the hormonal treatment administered to prostate cancer patients in Italy within a time window of 12 months. We report here a prospective quality of life (QOL) evaluation over time and by hormonal treatment modalities.

METHODS

Patients with diagnosis of prostate cancer and treated with hormonal therapy were eligible for this study. The EORTC QLQ-C30 v.3 questionnaire was administered at enrolment, after 6 months and after 12 months from enrolment.

RESULTS

587 patients were enrolled by 33 urological centers. When 1518 visits were considered together independently of time, antiandrogen monotherapy was associated with a significantly better QOL than LHRH-analogue containing treatment modalities in almost all functional scales; cyproterone acetate demonstrated a better physical function and general health status than bicalutamide. When QOL was analyzed in a prospective 12-month window, a worsening of physical function and general health status was observed, notwithstanding, antiandrogens remained significantly associated to a better QOL than LHRH-analogue therapies also over time: a favourable physical function and general health status appeared again to be related to cyproterone acetate than bicalutamide.

CONCLUSIONS

Androgen deprivation therapy is associated with decline in QOL, particularly in the domains of physical function, energy, and general health status. This survey demonstrated that antiandrogens had a better QOL profile than LHRH-analogue containing therapies;furthermore, a more favourable tolerability for cyproterone acetate as compared to bicalutamide is suggested.

Dynamics of male sexual arousal: distinct components of brain activation revealed by fMRI

The peripheral mechanisms of male sexual arousal are well known. Recently, neuroimaging techniques, such as PET or fMRI, allowed the investigation of the subjacent cerebral mechanisms. In ten healthy subjects, we have simultaneously recorded fMRI images of brain activation elicited by viewing erotic scenes, and the time course of penile tumescence by means of a custom-built MRI-compatible pneumatic cuff. We have compared activation elicited by video clips with a long duration, that led to sexual arousal and penile erection, and activation elicited by briefly presented still images, that did induce sexual arousal without erection. This comparison and the use of the time course of penile tumescence in video clips allowed to perform a time resolved data analysis and to correlate different patterns of brain activation with different phases of sexual response. The activation maps highlighted a complex neural circuit involved in sexual arousal. Of this circuit, only a few areas (anterior cingulate, insula, amygdala, hypothalamus, and secondary somatosensory cortices) were specifically correlated with penile erection. Finally, these areas showed distinct dynamic relationships with the time course of sexual response. These differences might correspond to different roles in the development and appraisal of the sexual response. These findings shed light on the psychophysiology of male sexuality and open new perspectives for the diagnosis, therapy, and possible rehabilitation of sexual dysfunction.

[Pathology of the gynecologic ureter]

OBJECTIVE

Ureteral lesions due to pelvic endometriosis, gynecological surgery and post-actinic are common findings in urology. Pelvic endometriosis can also be caused by a direct or indirect ureteral lesion after laparoscopic procedures. Stenosing ureteral lesions can be found after major gynecological surgery and after laparoscopic procedures. Many surgical techniques have been described to reduce the risks and to correct the complications.

MATERIALS AND METHODS

In our experience (1985-2000) we registered 2 ureteral lesions due to pelvic endometriosis. The patients were treated with resection and end-to-end anastomosis. We also protected the site of suture with omentoplasty. 49 patients developed a post-actinic ureteral lesion (43 unilaterally and 6 bilaterally). In 20 cases we performed an end-to-end anastomosis, in 25 cases we re-implanted the ureter and in 10 cases we performed a psoas hitch. In 36 patients we performed an omentoplastic procedure. Ureteral lesions after gynecological surgery were registered in 44 patients (33 after trans-vaginal hysterectomy, 6 after colposuspension, 5 after Wertheim). 40 ureters underwent open air surgery (26 patients, resection + end-to-end anastomosis, 6 patients simple re-implantation, 4 psoas hitch). In 32 patients we performed an omentoplastic procedure. 4 patients were corrected with an endoscopic procedure. These patients had a fulgurating lesion of the ureter with a consequent urinary fistula. A long-term drainage with endoureteral stent avoided the operation. All patients with an acute ureteral lesion were treated with a nephrostomic drainage and a short term repair.

RESULTS

In 2 patients with ureteral lesions due to pelvic endometriosis the results after corrective operation (3-4 years follow-up) were excellent with a good conservation of kidney function. In patients that underwent operation due to post-actinic ureteral stenosis, long-term results were: 78% complete preservation of kidney function without the need for permanent stents, 20% preservation of kidney function with need to conserve endoureteral stents, 2% loss of kidney function and consequent nephrectomy. Long-term results in patients that underwent an operation for ureteral lesions following surgical gynecological procedures were: 87% complete preservation of kidney function without the need of permanent stents, 13% conservation of kidney function but no need to preserve the endoureteral stent.

DISCUSSION

Lower urinary tract lesions after gynecological surgery are present in every surgical study. Most authors describe that intraoperative cystoscopy can immediately enhance the problem avoiding a re-operation. The laparoscopic risk seems to be for the cardinal ligaments when they divide beneath the uterine veins. Most authors seem to agree with the immediate need for a nephrostomic drainage followed by a postponed intervention. These procedures seem to reduce morbidity and the risk for a re-operation. In extended ureteral lesions there is agreement that psoas hitch is the best procedure. In our experience a nephrostomic drainage and a postponed intervention (2 weeks) has given comparable results with the best in literature as far as kidney function is concerned. The worst results were registered in patients with chronic lesions and with a deteriorated kidney function at the moment of the corrective procedure.

Current status of local penile therapy

Guidelines for management of patients with erectile dysfunction indicate that intraurethral and intracavernosal injection therapies represent the second-line treatment available. Efficacy of intracavernosal injections seems superior to that of the intraurethral delivery of drugs, and this may explain the current larger diffusion of the former modality. Safety of these two therapeutic options is well established; however, the attrition rate with these approaches is significant and most patients eventually drop out of treatment. Newer agents with better efficacy-safety profiles and using user-friendly devices for drug administration may potentially increase the long-term satisfaction rate achieved with these therapies. Topical therapy has the potential to become a first-line treatment for erectile dysfunction because it acts locally and is easy to use. At this time, however, the crossing of the barrier caused by the penile skin and tunica albuginea has limited the efficacy of the drugs used.

Counselling the patient with prostate cancer about treatment-related erectile dysfunction

At present, a significant proportion of patients with prostate cancer are diagnosed at an early stage and may receive treatments able to bring about the long-term control of the disease. Thus, the impact of available treatments on the patient's quality of life has been gaining increasing importance; for patients with prostate cancer, counselling on the treatment-related effects on sexual function has become mandatory. Radical prostatectomy is very frequently performed in patients with clinically localized prostate cancer. Postoperative erectile function has been reported as being satisfactory in the majority of the patients operated on in centers of excellence for this procedure. However, overall, the results for postoperative potency are disappointing in view of the large amounts of data available from community practices. Attempts to improve postoperative potency include the intraoperative use of cavernous nerve stimulation and grafting of peripheral nerves to restore the innervation of the corpora cavernosa. Erectile dysfunction has also been associated with prostate radiotherapy. It has been shown that both ultrasound-guided brachytherapy and three-dimensional conformal radiation therapy cause an impairment of erectile function that is usually seen some time after the completion of therapy. Treatment with sildenafil citrate remains a viable option both for patients treated with radical prostatectomy (in whom the cavernous nerve function is at least partially present) and in patients treated with radiotherapy.

[Simultaneous intrauterine and tubal pregnancy. A clinical case]

The presence at the same time of intrauterine and ectopic (heterotopic) pregnancy is unusual. A case of acute abdomen by tubaric haemorrage in a patient with ectopic pregnancy and evolutive intrauterine pregnancy during first trimester is reported. After surgical therapy, the intrauterine pregnancy had a good evolution.

[Evaluation of the effect of a "Mediterranean diet" and pre-pregnancy body mass on fetal growth]

In this study we compared the pregravidic body mass index (Quetelet index) with some variables recorded during pregnancy (caloric intake; weight increase, neonatal birth weight) in a group of patients consumers of a typical mediterranean diet. We studied the dietary habits of 100 pregnant women with gestational ages between 13 and 38 weeks. Each woman has been provided with daily, for seven consecutive days. The data have been analyzed evaluating, for each dietary componene, the caloric, proteic, glucidic, lipidic and microelements share. Our results showed degree of pregravidic obesity. However also in overweight patients that used diets with caloric intake as low as about 1600 Kcal/day, the neonatal weights were always within the normal range, confirming the adequacy of the "mediterranean diet" to the specific nutritional needs in pregnancy. Neonatal weight was better correlated to the pregravidic IQ than to the caloric intake.

[Transcoccygeal radical prostatectomy: surgical technical notes and our current indications]

From October 1992 to December 1993, radical transcoccygeal prostatectomy was performed in 23 patients. The surgical technique as well as our clinical indications to the operation are described in this paper.

Failures and complications of transurethral ureteroscopy in 297 cases: conventional rigid instruments vs. small caliber semirigid ureteroscopes

To evaluate the safety and effectiveness of ureteroscopic stone manipulation, we retrospectively reviewed the failure and complication rates of two series of retrograde ureteroscopies (URS) according to the instrument used: the conventional rigid ureteroscopes and the new fiberoptic small size ureteroscopes. From July 1985 to December 1992, we performed 248 URS in 238 patients using a conventional rigid ureteroscope. From January 1992 to December 1992, we performed 49 URS in 47 patients using a semirigid ureteroscope. The failure rate was 14.5% in the first group of patients. The early and late complications observed were: urinary tract infections (UTI) in 22.5%, small mucosal lesions (false route) in 24.5%, full-thickness perforations in 11.2%, migration of the stone fragments into the retroperitoneum in 0.4% and the rupture of the tip of an alligator forceps into the ureteral lumen in 0.4%. Ureteral stenosis was observed in 1.6% of the cases. Often two or more complications occurred in the same patient. In the second group the failure rate was 10.2% and the complication rate 8.1%. We reported one case of ureteral perforation (2%), 3 mucosal lesions (6.1%) and UTI in 2 cases (4%). We conclude that URS using a small-caliber semirigid ureteroscope is a safer procedure than URS with conventional instruments. The majority of failures with semirigid scopes is related to the laser ineffectiveness in fragmenting the stone.

Detubularized sigmoid colon for bladder replacement after radical cystectomy

During the last 6 years 24 sigmoid colon neobladders were constructed at our institute according to a surgical technique that provides for an optimal spherical configuration of the orthotopic reservoir. All patients underwent radical cystectomy for locally advanced or superficial recurrent bladder cancer. The surgical complication rate was minimal. Mean followup was 38.3 months (range 7 to 70). Patients were evaluated at 9 and 18 months with urodynamic tests. Daytime continence was achieved in 20 of 21 (95.2%) and in 16 of 17 (94.1%) patients, respectively. Nocturnal incontinence was noted in 9 of 21 (42.8%) and 5 of 17 (29.4%) patients. The mean neobladder capacity was 414 cc and 492 cc, respectively. Endoluminal pressure at the maximum reservoir capacity was 31 cm. water (range 23 to 54) and this did not change significantly at 18 months. Minimal post-voiding residual volume was evidenced in all but 1 patient and was maintained at 18 months. Our modified sigmoid colon neobladder is an easy surgical procedure that provides satisfactory total bladder replacement in select patients.

[Analytic evaluation of a "Mediterranean" diet in pregnancy]

OBJECTIVE

To evaluate the effectiveness of the Mediterranean diet in pregnancy in relation to the increased maternal nutritional needs and to fetal outcome.

SUBJECTS AND METHODS

We studied dietary habits of 100 pregnant women with gestational ages between 13 and 38 weeks. Each woman has been provided with a questionnaire to explore types and amount of food taken daily, for 7 consecutive days. The data have been analyzed evaluating, for each dietary component, the caloric, proteic, glucidic, lipidic and microelement share. The results obtained have been compared with the "recommended levels of daily intake of calories and nutrients for the Italian population" (LARN), and with the American "Recommended Daily Dietary Allowances" (RDA).

RESULTS AND CONCLUSION

The Mediterranean diet proved able to completely satisfy pregnancy's increased biological needs except for iron. In fact the daily mean iron intake of the examined population was about 13 mg/day, while the recommended intake is about 36 mg/day. The dietary caloric intake was represented by proteins (16%), glucides (47.5%) and lipids (36.5%), with bread and cereals giving the higher energetic share (38%) in the examined diets. The mean caloric intake resulted lower than the one recommended by LARN and RDA, however neonatal birth weights were always within the normal range.

[Use of ultrasonography in morphofunctional evaluation of orthotopic neo-bladder]

Seventeen patients submitted to radical cystectomy and orthotopic bladder replacement according to Reddy's technique were studied at the 1, 3, 6 and 12-month, then annually follow-up by physical examination, intravenous pyelogram, cystourethrography, suprapubic and transrectal ultrasonography and complete urodynamics. Sixteen patients (94%) reported day-time urinary continence and twelve patients (70%) day-time and nocturnal continence. Cysto-manometry showed a mean bladder capacity of 450 cc with a maximal endocavitary pressure of 40 cm. H2O and satisfactory peak flow rate. Vesico-ureteral reflux was never detected at roentgenography. Ultrasonography may be useful in the study of a possible reflux or stenosis of the neovesico-ureteral junction by detecting renal scars or dilatation of the renal cavities. Sovrapubic ultrasonography can quantify the capacity of the neo-bladder (300-600 cc), study its shape, walls and contractions that do not cause the involuntary opening of the neo-bladder neck. Transrectal ultrasonography studies the bladder neck shape and its dynamic function. Residual urine volume never exceeded 50 cc. Ultrasonography demonstrated its effectiveness and reliability and limited the application of more invasive roentgenographic procedures.

The use of dexon and plain catgut in circumcision

Published clinical literature on the handling properties and qualities of Dexon (polyglycolic acid) suture material is reviewed. Of 68 patients (aged 3 months to 56 years) requiring circumcision, 37 were sutured with Dexon and 31 with plain catgut. There was no tissue reaction to Dexon in 36 patients (97.3 per cent) nor did any infection develop, but there was delay in absorption. Only 7 patients (22.5 per cent) sewn up with catgut were free from tissue reaction, and infection occurred in 8 of these patients. Catgut was absorbed more quickly. Dexon sutures had disappeared by the twenty-first day in 19 patients (51.3 per cent) and catgut had disappeared in the same time in 19 patients (63.3 per cent). In 5 of I2 patients photographed postoperatively there was a knobbly-looking, foreskin at 19–27 days. This was associated with Dexon in 4 patients and was probably due to unabsorbed suture material. The relative lack of tissue reaction to Dexon in comparison with catgut supports the findings of other clinicians. A way of tying Dexon and slipping the knot into place (like catgut) is also described.