Successful treatment of retrograde ejaculation with sperm recovered from bladder washings. A report of two cases

BACKGROUND

Retrograde ejaculation causes < 2% of male infertility but is the leading cause of aspermia. The incidence of retrograde ejaculation is increasing due to the aggressiveness of modern urologic cancer surgery and an increase in diabetes mellitus. Generally, the only adverse effect is on fertility. Various approaches have been proposed for treatment, ranging from insemination with sperm-rich urine obtained after masturbation to intracytoplasmic sperm injection (ICSI). We used a protocol involving bladder washing.

CASES

Case 1 involved a man with retrograde ejaculation secondary to a successful right orchiectomy and retroperitoneal lymph node dissection for stage B1 embryonal cell carcinoma. He was treated with bladder washing and intrauterine insemination. He fathered three children from six insemination cycles. Case 2 involved a man with idiopathic retrograde ejaculation and a wife with ovulatory dysfunction. He received treatment similar to that in case 1 and fathered one child from two insemination cycles.

CONCLUSION

Larger studies need to be done specifically comparing treatments. Our method resulted in four normal infants in two couples over eight total insemination cycles and, taken together with other results from the literature, seems a good choice for clinicians who are treating retrograde ejaculation for the first time. We agree with others who have recommended that in vitro fertilization/ICSI not be the first step for treating the usual couples with retrograde ejaculation.

Renal oncocytoma: preoperative diagnosis using technetium 99m sestamibi imaging

OBJECTIVES

To determine if 99mTc-sestamibi (technetium 99m-methoxyisobutylisonitrile) can be used preoperatively to differentiate renal oncocytomas from other renal masses.

METHODS

We performed 99mTc-sestamibi scans on 6 patients with various renal masses, using a standard technique. The diagnosis in each patient was determined either by radiologic methods.

RESULTS

There was significantly increased uptake in the patient with the renal oncocytoma, whereas the other lesions had decreased uptake in comparison to normal kidney. This was determined visually and by mean pixel analysis.

CONCLUSIONS

Technetium 99m sestamibi scanning appears to have a potential role in the nonoperative diagnosis of renal oncocytomas, in combination with pathologic fine-needle biopsy confirmation. More definitive pathologic experience is required before recommending standard use.

Comparison of ultrasound-guided and digitally directed transrectal biopsy of palpable prostate lesions

The role of ultrasound in the diagnosis of prostate cancer is still evolving. We used ultrasound to examine 202 patients with palpably abnormal prostates. Of 151 patients undergoing biopsy, ultrasound-guided biopsy was comparable to digitally directed biopsies in cancer detection (92% vs 90.7%). The two methods are complementary and should both be considered in patients with palpably abnormal prostates.

In utero detection of horseshoe kidney with unilateral multicystic dysplasia

Unilateral renal dysplasia in a horseshoe kidney is very uncommon. A case which was detected in utero is presented. The management of multicystic kidneys is reviewed.

Bilateral epidermoid cysts of the testicle

An 11-year-old boy presented with bilateral testicular masses that consisted of hyperechoic centers with hypoechoic rims on ultrasound. Surgical exploration revealed bilateral epidermoid cysts. To our knowledge this is the first reported case of bilateral epidermoid cysts in a child. Recognition of this entity requires surgical confirmation but it may obviate removal of the testicle.

Sucralfate inhibition of tumor cell implantation in the murine urinary bladder

Superficial transitional cell carcinoma of the bladder has a 50 to 70% recurrence rate. Recurrences may be related to tumor cell implantation during transurethral resection which disrupts the glycosaminoglycan layer of the bladder. This study demonstrated decreased tumor formation in murine bladders which were pre-treated with sucralfate, a synthetic glycosaminoglycan, prior to tumor cell instillation. These results suggest a possible role for sucralfate as a glycosaminoglycan supplement.

Emergency lobectomy for massive hemoptysis in cystic fibrosis

Massive hemoptysis occurs in 50% to 70% of patients with cystic fibrosis and carries an immediate mortality of up to 32%. Cystic fibrosis is regarded by many as a disease in which thoracic operations are ill-advised. A 21-year-old woman with mild cystic fibrosis presented with unrelenting massive hemoptysis, was not helped by medical management, and underwent a successful left upper lobectomy. We suggest that thoracotomy does have a role in the management of massive hemoptysis in selected patients with cystic fibrosis. On the basis of our case and all other cases reported in the English literature, we suggest criteria for determining which patients are suitable candidates for emergency thoracotomy.

Massive hemoptysis in cystic fibrosis

Massive hemoptysis occurs in 5% to 7% of patients with cystic fibrosis. Approximately 11% of these patients will die within 48 hours of manifestation because of uncontrolled hemoptysis and asphyxiation. If conservative medical treatment fails to control hemoptysis, fiberoptic or rigid bronchoscopy is the least risky and most accurate method of localizing the source of hemoptysis. Acute control of hemoptysis can be obtained in up to 100% of patients with endobronchial Fogarty balloon tamponade and in up to 88% of patients with bronchial artery embolization. Emergency thoracotomy can be performed if the above fail, but only in patients with mild cystic fibrosis and adequate pulmonary reserve.