FORMALIN INSTILLATION AND VESICOURETERAL REFLUX 1‘0 thu ~~clitor: In their article on “Fatal Complication of Intravesical Formalin During Control of Intractable Hemorrhage from Radiation Cystitis,” published in the June issue (vol. 11, page 588) of UROLOGY. Dr. kl. S. Rao and colleagues implicate the absorption of formalin through the bladder as the cause of acute tubular necrosis. They may indeed be correct in their clinical appraisal of this patient, but certain factors must also be cited that put this impression in doubt. 1. Blood formic levels in the postinstillation period were not reported, thus documentation of formalin absorption through the bladder wall was not documented. 2. Though prior to the first instillation of formalin, a cystogram was performed which showed no evidence of vesicoureteral reflux, no such documentation was made one month after the initial instillation of formalin and prior to its second instillation. Is it possible that during this period, as a result of the first formalin instillation, vesicoureteral reflux did develop? Is it therefore further possible that the patient’s acute tubular necrosis was secondary to direct finmalin entry into the kidney? The precautions cited in the article upon instilling mrmalin into the bladder appear to be reasonable. Perhaps in addition to these a cystogram should be performed prior to any formalin instillation to document each and every time that vesicoureteral reflux has not appeared.
North
Norman h. Bloom, Beach, Florida
Miami
LlICROSURGICAL REPLANTATION AMPUTATED PENIS
\(I. D.
33162
OF
Nakamura, and bIotomiya,” who utilized microneurovascular repair of a profunda arten, a dorsal vein, two dorsal arteries, and two dorsal nenes. III both cases very satisfactory urinary. sensory, and erectile4 function was obtained without complication. The numerous complications in previously reported nonmicroneurovasoular replantations are noted by Dr. Bux and his colleagues. Their exc*ellent results notwithstanding, microneurovascular reconstruction, when technically feasible. represents the most physiologic approach to penile replantation.
S.U.N.Y.
1. hlendez R, Kiely WF, and Morrow J\V: Shelf-ellrasculation, J Ural. 107: 981 (1972). 2. Cohen BE, May JW Jr, Daly JSF. and Young HH II: Successful clinical replantation of an amputated penis h\ Inicroneurovascular repair, Plast. Reconstr. Surg. 59: 27fj (197fi. 3. Talnai S, Nakamura Y, and Motomiya Y. Clicrosurgical replantation of a completely amputated penis and wrotum. ihirl 60: 387 (1977). 4. Young HH II: Personal communication
A REBUT
the article “Primary Penile Reanastomosis” by R. Bux, M.D., P. Carroll. M.D.. 11. Berger. M.D., and W. Yarbrough, hI.D., in the .Ilay issue (vol. 11, page 500) of UROLOGY, the authors described two successful penile replantations utilizing repair of the urethra and corpora without attempt at microneurovascular reconstruction. Their results are gratifying. Skin necrosis requiring split thickness grafting in one of the cases is the only complication noted. On page 502 of their report, Dr. Bux and his colleagues state that, “No me has reanastomosed the dorsal vessels or nerves with the tkxception of Mendez, Kiely, and Morrovv’ who reported anastomosing the dorsal vein, the patency of which was questionable.” I would like to bring to the attention of the authors the very- receilt reports of Cohen, et al. ’ who utilized rnicroneurovascular repair of a dorsal vein, two dorsal arteries and two dorsal nerves; and that of Tamai. the
Editor:
In
TO A REBUKE
To the Editor: The March, 1978. issue (vol. 11, page 316) of UROLOGY displayed a delightful verse that told of some of the mishaps that could beset the unwaT male as he “Did It Standing Up.” While I read the rhyme, I was reminded of the wild Army stories that gloriously extolled the ladies who had developed such exquisite control that they could “Do It Into a ‘Coke’ Bottle.” With such inspiration, I could not resist the urge to compose “‘4 Rebut to a Rebuke. ” Guffaw Your
To
XIarc C:ol(lstein. .\I. D. Downstate Il~dical Cent69 Hroold\w. Nrv York 11203
and
deft
fie
rebuke
I
say to this of men who miss.
There’s naught the lass been found ;I\ y 111 M’ho can aith verve and skill beset To hunch her loins o’er bottle slim fill the cruet to the rl’hen asked by Dot for The flustered lass begins “How will I hit that tiny .4nd
brim. sample trllr. to stew
\+al, k’ct not m) finger tips defile1Y The answer that leaves nil to cha~~w. But rrcks of skill and elegance. Say perch upon the throne as nornl And makr the splash in blissfill fort11 Then scoop a cup of wate? pet For Lab to check, where thr!. will wt. Thew is no doubt thr lass is clean. Her urine‘s two per cent chlorine,!
North
Norman h. Bloom, Beach, Florida
Miami
LlICROSURGICAL REPLANTATION AMPUTATED PENIS
\(I. D.
33162
OF
Nakamura, and bIotomiya,” who utilized microneurovascular repair of a profunda arten, a dorsal vein, two dorsal arteries, and two dorsal nenes. III both cases very satisfactory urinary. sensory, and erectile4 function was obtained without complication. The numerous complications in previously reported nonmicroneurovasoular replantations are noted by Dr. Bux and his colleagues. Their exc*ellent results notwithstanding, microneurovascular reconstruction, when technically feasible. represents the most physiologic approach to penile replantation.
S.U.N.Y.
1. hlendez R, Kiely WF, and Morrow J\V: Shelf-ellrasculation, J Ural. 107: 981 (1972). 2. Cohen BE, May JW Jr, Daly JSF. and Young HH II: Successful clinical replantation of an amputated penis h\ Inicroneurovascular repair, Plast. Reconstr. Surg. 59: 27fj (197fi. 3. Talnai S, Nakamura Y, and Motomiya Y. Clicrosurgical replantation of a completely amputated penis and wrotum. ihirl 60: 387 (1977). 4. Young HH II: Personal communication
A REBUT
the article “Primary Penile Reanastomosis” by R. Bux, M.D., P. Carroll. M.D.. 11. Berger. M.D., and W. Yarbrough, hI.D., in the .Ilay issue (vol. 11, page 500) of UROLOGY, the authors described two successful penile replantations utilizing repair of the urethra and corpora without attempt at microneurovascular reconstruction. Their results are gratifying. Skin necrosis requiring split thickness grafting in one of the cases is the only complication noted. On page 502 of their report, Dr. Bux and his colleagues state that, “No me has reanastomosed the dorsal vessels or nerves with the tkxception of Mendez, Kiely, and Morrovv’ who reported anastomosing the dorsal vein, the patency of which was questionable.” I would like to bring to the attention of the authors the very- receilt reports of Cohen, et al. ’ who utilized rnicroneurovascular repair of a dorsal vein, two dorsal arteries and two dorsal nerves; and that of Tamai. the
Editor:
In
TO A REBUKE
To the Editor: The March, 1978. issue (vol. 11, page 316) of UROLOGY displayed a delightful verse that told of some of the mishaps that could beset the unwaT male as he “Did It Standing Up.” While I read the rhyme, I was reminded of the wild Army stories that gloriously extolled the ladies who had developed such exquisite control that they could “Do It Into a ‘Coke’ Bottle.” With such inspiration, I could not resist the urge to compose “‘4 Rebut to a Rebuke. ” Guffaw Your
To
XIarc C:ol(lstein. .\I. D. Downstate Il~dical Cent69 Hroold\w. Nrv York 11203
and
deft
fie
rebuke
I
say to this of men who miss.
There’s naught the lass been found ;I\ y 111 M’ho can aith verve and skill beset To hunch her loins o’er bottle slim fill the cruet to the rl’hen asked by Dot for The flustered lass begins “How will I hit that tiny .4nd
brim. sample trllr. to stew
\+al, k’ct not m) finger tips defile1Y The answer that leaves nil to cha~~w. But rrcks of skill and elegance. Say perch upon the throne as nornl And makr the splash in blissfill fort11 Then scoop a cup of wate? pet For Lab to check, where thr!. will wt. Thew is no doubt thr lass is clean. Her urine‘s two per cent chlorine,!
