The Gore-tex sling procedure for female sphincteric incontinence: indications, technique, and results

We constructed a pubovaginal sling using the Gore-tex Soft Tissue Patch and 2-0 polytetrafluoroethlene (PTFE) suspension suture and placed it in 122 consecutive incontinent women with urethral hypermobility and/or intrinsic sphincter deficiency. We performed a retrospective outcome analysis using a questionnaire-based telephone survey. The mean follow-up period was 24.4 months. Stress incontinence was cured in 88% of patients (equally effective in type II and type III incontinence), de novo postoperative urinary frequency occurred in 32% of cases, and preoperative urinary frequency resolved postoperatively in 51% of patients. Significant urinary obstruction occurred in 5% of patients. Vaginal granulation tissue with exposed sling occurred in 4% of patients. There was no urethral or bladder erosion. The treatment of female stress incontinence with a PTFE sling is effective and durable with minimal complications. Furthermore, this technique addresses many of the presumed technical shortcomings of endoscopic needle suspensions.     

Generation of an anti-interleukin 2 factor in healing wounds

Previously we have noted that fluid obtained from ten-day-old healing wounds noncytotoxically inhibits the blastogenesis of lymphocytes in response to mitogens or antigens. Since these lymphocytic responses are interleukin 2 (IL-2)-mediated, we looked for a specific IL-2 inhibitor in wound fluid. We have found that wound fluid blocks the response of thymic lymphocytes and of two cloned T-helper cell lines (D10 and HT2) to exogenous human recombinant IL-2. The wound fluid enhances fibroblast proliferation, thus demonstrating that its proliferative inhibitory activity is specific for lymphocytes. The findings suggest that wound fluid contains a factor that impairs lymphocyte response to IL-2, probably at the receptor or postreceptor level.     

Comparison between testosterone oenanthate-induced azoospermia and oligozoospermia in a male contraceptive study. IV. Suppression of endogenous testicular and adrenal androgens

Administration of supraphysiological doses of testosterone to normal men causes inhibition of spermatogenesis, but while most become azoospermic, 30-55% maintain a low rate of spermatogenesis. We have investigated whether there are differences in endogenous androgen production, of testicular and adrenal origin, which may be related to the degree of suppression of spermatogenesis. Thirty-three healthy Caucasian men were given weekly i.m. injections of 200 mg testosterone oenanthate (TE), 18 became azoospermic, while 15 remained oligozoospermic. Urinary excretion of epitestosterone, a specific testicular product, was reduced to <10% of pretreatment values, with no differences between the groups. Similar results were obtained for other markers of testicular steroidogenesis. Urinary and plasma adrenal androgens were also reduced during TE treatment: a statistically significant decrease in both (P < 0.001 and P < 0.05 respectively) was seen in the azoospermic but not oligozoospermic responders. These results suggest that testicular steroidogenesis is decreased to <10% by the administration of supraphysiological doses of exogenous testosterone. Differences in the degree of ongoing steroidogenesis in the testis do not appear to account for incomplete suppression of spermatogenesis, thus differences in androgen metabolism may underlie this heterogeneous response. A small but significant reduction in secretion of adrenal androgens was also detectable, the relevance of which is unclear.      

Experience with the penile prosthesis and artificial urinary sphincter

The therapy of two common urologic problems, erectile dysfunction and urinary stress incontinence, has been revolutionized over the last 20 years by the incorporation of principles of hydraulic mechanics into the field of silicone prosthesis implantation. The inflatable penile prosthesis is surgically implanted into men with impotence due to organic or psychogenic etiology. The artificial urinary sphincter has found widespread use in males and females in both the adult and pediatric populations with stress incontinence from a variety of causes. Associated with these popular devices are various complications relating to the anatomic site as well as the host's immunologic response. The use of these implants, as well as the technologic innovations resulting from various adverse effects, are reviewed herein.