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Male genital self-mutilation is uncommon, with repeat mutilation even more rare. Our case is unique in that a urological complication of the first mutilating act (meatal stenosis) helped to precipitate the second incident. This case underscores the need not only for immediate urological and psychiatric care at the time of initial mutilation but also for close, combined followup care as well. In the majority of cases, when properly monitored, the men do not repeat the mutilating act.

Until the discovery of prostate specific antigen as a tool to detect prostate carcinoma, the rectum has always been necessary to allow the best evaluation and biopsy of the prostate, whether by digital examination or transrectal ultrasound. We describe a simple, accurate, computerized tomography-guided method to biopsy the prostate in men who have undergone proctectomy.

Administration of anabolic steroids carries many risks. We present a series of 15 patients with primary hypogonadism who as a group had statistically significant increases in whole body hematocrit and red blood cell volume while on testosterone therapy of 300 mg. intramuscularly every 3 weeks. A small decrease in plasma volume over-all was not significant. Subsequent analyses compared subgroups whose whole body hematocrit during testosterone therapy was either 48% or greater (9) or less than 48% (6). Interaction effects indicated that the subgroups were similar when off testosterone but when on testosterone the former group exhibited an increase in red blood cell volume and a decrease in plasma volume, while the latter group had little change in either measurement. Subsequent to stopping testosterone therapy 2 patients in the whole body hematocrit 48% or greater group suffered strokes and 1 had transient ischemic attacks while on therapy. No one in the whole body hematocrit less than 48% group has had any cerebrovascular symptoms. Clinical implications, as well as cost-effective and practical suggestions for detecting possible dangerous hemoconcentration are discussed.

Successful implantation of a penile prosthesis involves more than an operation. Psychological factors can be crucial before, during and after the operation. If these issues are not addressed the true goal of restoring the pleasure of sexual intercourse will not be achieved, regardless of the type of prosthesis used or the technical success of the procedure.

Radical prostatectomy has a significant role in the treatment of early stage carcinoma of the prostate, with a 6-fold difference in the radically and conservatively treated groups. Since 32 per cent of carcinomas will be missed even by experienced examiners on rectal examination, we believe that open perineal biopsy of the posterior lamella as described in 1968 would increase the yield of carcinoma and the subsequent cure by a radical operation. We have found that older patients do well with the perineal surgery--the extreme lithotomy position is no great problem and the postoperative course, without a painful abdominal wound, is less complicated.

A series of post-radical perineal prostatectomy patients was studied by carbon dioxide cystometry. Of 30 patients questioned 17 were available for urodynamic assessment. All patients had shortened functional urethral lengths and decreased maximal closure pressures and incontinent patients had changes in the standing position. A review of the pertinent literature is presented. We believe that such studies in these patients can be clinically contributory and are of academic interest but history and cystourethroscopy remain more important in the over-all patient evaluation and care. With the ever-growing enthusiasm for urodynamics it is important to reveal its limitations as well as its benefits.

It has been shown that some patients with stress incontinence after prostatectomy may have significant improvement with electrical anal stimulation. The use of a transcutaneous stimulator is the easiest and least invasive method to try initially. Results may be quite satisfying whether the mechanism is physiologic or placebo. This is the first report of the use of transcutaneous electrical nerve stimulation in patients with stress incontinence.

Much of the research on the postoperative adjustment of penile prosthesis recipients and their partners has been hampered by retrospective designs, unreliable assessment procedures and other methodological limitations. To address these shortcomings and to increase current knowledge regarding postoperative adjustment, we completed a prospective, longitudinal study of 19 implant recipients and their partners. Our results suggest that most patients and partners were satisfied with the prosthesis 1 year postoperatively, although use of the prosthesis sometimes was accompanied by short-term complications. Satisfaction tended to be lower among spouses than patients. Frequency of sexual intercourse increased during the followup period but there were no changes in sexual desire. Neither marital nor psychological adjustment changed significantly during this period.

The calcium content and calcium kinetics of the fatty tissue complex comprising the renal sinus organ of the rat kidney are reported. A comparison is made to control brown and white fat in the same animal. The calcium content of the renal sinus tissue is significantly greater than controls. Calcium localization in the mitochondria of the sinus tissue complex is demonstrated. Radioactive isotope studies (45Ca, 85Sr and 99mTc) indicate a dynamic exchange of calcium between the systemic pool and the sinus organ. Active accumulation appears to be operative. Supporting evidence for the existence of a portal vascular system joining the renal sinus complex and the renal parenchyma is presented. The significance of a calcium sink in the renal sinus tissue of the rat kidney is discussed.