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PURPOSE: We evaluated the efficacy of a new lidocaine-prilocaine cream in preventing premature ejaculation. MATERIALS AND METHODS: An open pilot, unblinded study was done using lidocaine-prilocaine cream in 11 healthy, married men with premature ejaculation without organic or erectile problems. The patients were instructed to apply 2.5 gm. of the cream 30 minutes before sexual contact and to cover the penis with a condom. Patients were asked to grade the effect of the cream on ejaculation after each application. RESULTS: There was a significant improvement in premature ejaculation statistically and clinically. Five patients graded the result as excellent compared to baseline, 4 graded it as better and 2 claimed to have no change compared to ejaculation before use of the cream. No adverse effects were noted. CONCLUSIONS: These promising results should prompt a large double-blind placebo-controlled trial. If confirmed, this therapy may be a breakthrough in the treatment of the most common form of male sexual dysfunction.

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Between 1984 and 1986 at the Wellesley Hospital in Toronto, 210 percutaneous renal nephrostomies were performed for drainage and 140 were done to provide access for nephrolithotomy. Less than 2% of the patients experienced complications requiring intervention and less than 0.5% required an open surgical approach for the management of procedure-related problems. Complications that were managed conservatively included splenic puncture, false aneurysm, laceration of the renal artery, arteriovenous fistula, hemorrhage requiring transfusion, pneumothorax-empyema, urinoma, septic shock and the hemolysis-hyponatremia-renal shutdown syndrome.

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The management of malignant ureteral obstruction (MUO) has undergone major changes due to the availability of percutaneous drainage techniques and new ureteral stents for endoscopic insertion. These procedures are less morbid than conventional surgical techniques so that the indications for urinary diversion due to untreated or relapsing malignancy have to be reconsidered. During the period of technological change from 1978 to 1984, 135 patients with unilateral (37) or bilateral (98) MUO were managed. Open nephrostomy is now almost never necessary. Initial retrograde ureteral stenting (RS) was successful under local anaesthesia in 41% of patients. Forty-seven had percutaneous nephrostomy (PN), nine of whom underwent antegrade ureteral stenting (AS) and elimination of external appliances. Twenty-nine patients underwent miscellaneous open procedures mostly in the earlier years, with a 57% morbidity rate compared to the minimal morbidity associated with the newer techniques. The overall mean survival post diversion was 9.9 months, which is significantly longer than that reported using open procedures. MUO can now be successfully relieved with little morbidity and frequently without the use of external urine collection devices. The relative ease of diversion can complicate decision making in patients with progressive renal failure due to bilateral MUO.

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Seventy-four biopsies of human bladder carcinoma were assessed by implantation as xenografts in immune-deprived mice and/or by culture of cell suspensions in agar or methylcellulose. The quality of the cell suspensions was assessed immediately after plating in vitro. The results were compared with the pathological stage and grade of the biopsies and with the clinical course of the disease in patients from whom the biopsies were obtained. We found that (a) progressively growing xenografts were generated from 20 of 53 biopsies (38%). These xenografts grew with mean volume doubling times in the range of 1 to 3 weeks; all of them examined histologically were consistent with transitional cell carcinoma. (b) Colony formation occurred from 21 of 49 cell suspensions (43%), and plating efficiency was in the range of 0.0004 to 1.7%. The majority of cell suspensions were found to have residual small clusters of cells. Colony formation sometimes originated from these clusters, an effect that would be expected to introduce artifacts when the in vivo cloning assay is used for chemosensitivity testing. (c) There was no evident correlation between expression of clonal growth in vitro and success of xenografting, and no correlation between the results of either of these experimental procedures with stage, grade, or clinical course of the disease. Further improvements in tissue culture and xenograft technology will be required before these methods can be used as a guide to patient management.

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Ultrasonography is the modality of choice in differentiating between cystic and solid renal lesions. It is somewhat less effective in demonstrating renal calculi. We report here a patient referred for investigation of a calcified renal mass, in whom ultrasonography permitted the diagnosis of milk of calcium in a calyceal diverticulum.

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Angiography of the ileopudendal vascular tree was performed for the evaluation of impotence in 73 patients. This technique proved useful in identifying those cases caused by vascular lesions in major arteries and small penile vessels. Organic diseases cause a much higher proportion of impotence than in generally suspected, with vascular occlusions causing the greatest number of cases. Nocturnal penile tumescence (NPT) studies are the best screening procedure in the author's view. In this series, NPT was followed by angiography, which provided the definitive diagnosis.

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The excretory urograms of 184 consecutive patients admitted to hospital with a diagnosis of benign prostatic hyperplasia who subsequently underwent prostatectomy were reviewed to determine the usefulness of preoperative urography. Of 184 urograms reviewed, 10 were normal, 136 showed changes consistent with benign prostatic hyperplasia, and 38 revealed other abnormalities. Twenty-seven of 184 urograms (14.7 per cent) revealed significant pathologic conditions requiring further consideration, investigation, or treatment, of which 23 would not have been suspected without this radiologic examination.

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A "catheter team", consisting of two hospital assistants specially trained to catheterize male patients, inserted indwelling catheters in 435 men over a two-year period. The infection rate was 33%; in the 200 patients not treated with antimicrobial drugs (study group) the rate was 37%, while in the 235 patients who were so treated (antibacterial group) the infection rate was 29%. Fifty percent of patients not treated were infected after 6.3 days, whereas in patients on antibacterial therapy a 50% infection rate was not reached until 14 days after insertion. Therefore, no antibacterial therapy is necessary if it is anticipated that the catheter will be necessary for less than four days. On the other hand, prophylactic antibacterial therapy would delay the onset of infection considerably if catheterization were expected to continue for more than four days. Sulfisoxazole was our drug of choice for prophylactic treatment.

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