Testicular veins: anatomy and role in varicocelogenesis and other pathologic conditions

The anatomy of the testicular veins of 42 male cadavers were studied to determine the extent of their role in varicocelogenesis and other pathologic conditions. The results of that study are presented.     

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XXIII. An injection technique for the treatment of idiopathic pruritus ani

An injection technique for the treatment of idiopathic pruritus ani is presented. The technique was performed on 67 patients after failure of other methods to achieve permanent cure. The technique comprises injection of 5% solution of phenol in almond oil in the subcutaneous tissue of the rectal neck aiming at destruction of the "epithelial debris" which exists in this area and is considered the primary cause in idiopathic pruritus. Cure was obtained in 62 patients (92.5%). The remaining five patients underwent recurrence after a period of remission, and were cured after a second injection. The advantages of the present technique over others in common use are discussed.     

The vesicocavernosus reflex: Role in the act of micturition

The paper studies the action and clinical significance of a reflex termed vesicocavernosus in 24 healthy volunteers (mean age 44.6 years, 15 men and 9 women). A balloon-tipped catheter was introduced into the urinary bladder and inflated with air in increments of 50 ml up to 300 ml. The response of the two cavernosus muscles to rapid vesical inflation and deflation, as well as to interruption and termination of micturition, was displayed on an EMG apparatus. The muscles contracted upon rapid vesical inflation or deflation, and upon the interruption or termination of micturition. These results were reproducible. In the male, bulbocavernosus muscle contraction seems to compress and expel the urine into the bulbous urethra. Ischiocavernosus muscle contraction helps to elevate the penile shaft. The role of the cavernosus muscles at micturition in women is unknown. The vesicocavernosus reflex could be of diagnostic significance in neurologic conditions.     

Study of the electromechanical activity of the urinary bladder

Summary The electromechanical activity of the urinary bladder (UB) was studied in 16 dogs. With the animals under anesthesia, the UB was exposed and four electrodes were sutured serially to its anterior wall. Electric activity simultaneously with vesical pressure was recorded for periods of 30 min daily on 10 days. Triphasic pacesetter potentials (PP) were registered from electrodes 1–4, having identical frequency and regular rhythm by all electrodes and being consistent in the individual dog on all test days. Action potentials (AP) followed PP randomly and were accompanied by vesical pressure increase; they represented vesical contractile waves. Balloon distension of the UB effected increased PP and AP frequency. Annular vesical myotomy led to PP and AP disappearance distal but not proximal to the myotomy, which would suggest that (a) the waves spread caudally and (b) a pacemaker exists at the upper part of the UB and triggers the PP.     

The electrorectogram in Hirschsprung's disease

The electrorectographic pattern of Hirschsprung's disease (HD) was studied in 14 HD patients with a mean age of 4.6 ± 1.5 years; 7 healthy children acted as controls. Monpolar recordings were made from a silver-silver chloride electrode situated 1 cm from the tip of a 4 F catheter attached to the rectal mucosa by suction. At least four 120-min recording sessions were performed for each subject. No complications were encountered. Regular and reproducible triphasic pacesetter potentials (PP) were recorded from all healthy children, followed randomly by bursts of action potentials (AP). No PP or AP were recorded from patients with HD; the silent electrorectogram (ERG) was reproducible. Since numerous difficulties in histopathologic interpretation affect the reliability of rectal biopsy for the diagnosis of HD, the ERG may play a role in this respect. The ERG is noninvasive and nonradiologic; however, until this investigati tool is substantiated by the work of other investigators, a histologic diagnosis needs to be made before undertaking a pull-through procedure.     

Electrovasogram in patients with obstructive azoospermia and absent vas deferens

Summary The electric activity of the vas deferens (electrovasogram, EVG) was studied in 22 patients with obstructive azoospermia (OA), in 9 patients with bilaterally absent vasa deferentia, in 10 patients who had undergone epididymovasostomy for OA, and in 12 healthy volunteers (controls). Two electrodes were applied to the posterior aspect of the upper scrotum. EVG in normal subjects showed pacesetter potentials (PPs) that had the same frequency, amplitude, and velocity of conduction from both electrodes and were consistent in the individual subject on all test days. The PPs were followed randomly by action potentials (APs). The EVG in OA exhibited bradyvasa, i.e., diminished PP frequency, amplitude, and velocity, in 14 patients and a silent EVG in 8. Eight of the ten patients in whom azoospermia persisted after epididymovasostomy had a silent EVG. The remaining two patients, whose semen character had normalized after epididymovasostomy, revealed a normal EVG. A silent EVG was recorded for the nine patients with absent vasa deferentia. The electric activity is believed to be responsible for vasal motility. The bradyvasa or silent EVG encountered in OA might be attributable to the arrested function of the vas deferens and resultant vasal inertia. The latter may persist after epididymovasostomy and be responsible for the failure of the semen to normalize, as occurred in eight patients. In conclusion, EVG is a simple, easy, noninvasive, and nonradiologic technique that might be used as a diagnostic tool in the investigation of vas deferens disorders and infertility.     

Combined partial fistulectomy and electro-cauterization of the intersphincteric tract as a sphincter-sparing treatment of complex anal fistula: clinical and functional outcome

Background

The aim of this study was to report a simple, effective and safe procedure, associated with minimal risk of incontinence and recurrence, for treating complex anal fistulas.

Methods

This was a prospective study of 53 consecutive patients with complex anal fistulas. The technique used included excision of the distal part of the fistula tract down to the external anal sphincter and electro-cauterization of the intersphincteric part of the tract with simple closure of the internal opening. Data collected included patient characteristics, fistula type determined by magnetic resonance imaging, pre- and postoperative continence status evaluated using the Wexner incontinence score (0–10), previous operations, hospital stay, healing time, recurrence rate and complications.

Results

The patients had a mean age of 41.37 ± 7.82 years; the most frequent fistula type was the high transsphincteric fistula; the mean follow-up period was 19 months with a success rate of 92.5 %; the mean wound healing time was 3.6 weeks; the incontinence scores were the same as before the procedure. The recurrence rate was 7.5 %.

Conclusions

Partial fistulectomy combined with electrocauterization of the intersphincteric fistula tract is a simple, and effective procedure for the treatment of complex anal fistulas.     

Study of the Rectal Electric Activity of the Uninhibited Rectal Detrusor (Overactive Rectum): A New Concept of Pathogenesis

Abstract

Background/Objective: One of the causes of fecal incontinence is uninhibited rectal detrusor syndrome (URDS). Patients with this condition either perceived the first rectal sensation after the onset of involuntary rectal contraction or not at all. We investigated the hypothesis that the abnormal rectal contractility in URDS may be caused by deranged rectal electric activity.

Methods: Twenty-five patients with URD (14 women and 11 men; age, 44.7 ± 10.3 years) and 10 healthy volunteers (6 women and 4 men; age, 42.8 ± 8.7 years) were studied. URDS was diagnosed by rectometry and provocative test. A transcutaneous EMG was performed with one electrode placed lateral to each sacroiliac joint and the third one midway between the greater trochanter and the ischial tuberosity. Two 20- minute recording sessions were performed for each subject.

Results: Slow waves (SWs) with regular rhythm and similar parameters (frequency, amplitude, conduction velocity) from the 3 electrodes were recorded from the healthy volunteers. They showed a significant increase in the parameters on saline filling of the rectum. The SWs of patients with URDS exhibited a “dysrhythmic” pattern with irregular parameters, which were different in the 3 electrodes and inconsistent during recording. They showed areas of tachyrhythmia, bradyrhythmia, and arrhythmia. On provoking rectal overactivity, the SWs showed an increased dysrhythmic activity.

Conclusions: The patients with URD exhibited a “dysrhythmic” electric pattern with areas of variable electric activity. The tachyrhythmic areas seem to initiate the urgency and fecal incontinence of URDS. It is suggested that a disordered rectosigmoid pacemaker causes the dysrhythmic waves.     

Effect of Perineal Compression on the Rectal Tone

PURPOSE: Digital pressure on the perineum was reported to result in an increase of the rectal tone. This effect has been related to a reflex action named perineorectal reflex but was not verified. The mechanism of action of perineal pressure on the rectal tone was studied. METHODS: Eighteen healthy volunteers (mean age +/- standard deviation, 39.7 +/- 11.8 years; 10 males) were studied. The barostat system used consisted of a polyethylene balloon connected to a strain gauge and a computer-controlled, air-injection system. The balloon was introduced into the rectum, and the rectal tone was assessed by recording the balloon volume variations in response to digital pressure on the perineum. The test was repeated after individual anesthetization of perineum and rectum. It was performed again using normal saline instead of Xylocaine. RESULTS: During perineal pressure, all the volunteers exhibited rectal tone increase with a mean decrease in the balloon volume of 72.3 +/- 14.7 percent. There was no significant difference (P > 0.05) in the rectal tone response between females and males nor between young and elderly patients. The mean latency was 17.3 +/- 1.8 ms. Perineal pressure 20 minutes after individual anesthetization of perineum and rectum effected no significant rectal tone changes. The response returned after the anesthetic effect had waned. The rectal tone response after saline administration was similar to that before administration. CONCLUSION: The study has shown that rectal tone increase during digital perineal pressure represents most probably a reflex action. This was evidenced by absence of rectal tone response on individual anesthetization of the assumed two arms of the reflex arc: perineum and rectum. The perineorectal reflex may be of diagnostic significance in rectal motor disorders and has the potential to be used as an investigative tool, provided further studies are performed to prove these points.