mobilization. Dartos and cremasteric contractions during the healing had obviously been at fault in pulling the testis up, where it had healed in place, at the top of the scrotum. We abandoned the Torek technique of rigid fixation because of occasional testis atrophy, and we also found the “intrascrotal-pocket technique” technically unas satisfactory. Th e scrotal pouch technique, described by us, has proved to be technically sound, during the many years we have employed it. Testis ischemia has not followed the gentle rubber-band traction format we advocate. The adjunctive postoperative gonadotropin therapy, plus long-term manual cord-stretching have not been followed by ill effects, according to our pediatric psychiatrist, Dr. Reck. On the contrary, although countless unreenforced techniques may have sufficed for others, we have found the “scrotal pouch technique” to bear the test of time and to be highly effective. Although dubbed anachronistic, antiquated, and antedeluvian by the letter writers, we say that dependability is a prime objective with us, and we can only reply in the modern language of our Madison Avenue friends, “Try it - you’ll like it.” John K. Lattimer, M.D., Arthur M. Smith, 630 West 168 New York, New York

D.Sc. M.D. Street 10032

BROMPHENIRAMINE IN TREATMENT RETROGRADE EJACULATION

OF

To the Editor: After review of the article, “Treatment of Retrograde Ejaculation with by Vincent Andaloro, Jr., Brompheniramine,” M.D., and Arthur Dube, M.D., published in the April issue of UROLOGY (vol. 5, page 520), I saw a thirty-year-old diabetic male patient who complained of retrograde ejaculation of one year’s duration with resultant infertility. The recommended dose of brompheniramine, 8 mg. orally, twice a day, was prescribed. Four days after initiation of therapy, he achieved normal ejaculation; the only side-effect was a dry mouth. This additional case of successful treatment of retrograde ejaculation in diabetic male patients

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with brompheniramine should encourage further controlled clinical trials to determine the mechanisms of action of this drug. Also, as was stated in the article, further investigation of patients with retrograde ejaculation secondary to retroperitoneal surgery and bladder neck surgery seems to be indicated. I congratulate Dr. Andaloro and Dr. Dube for a stimulating and timely report. Henry A. Budd, Jr., M.D. Martland Hospital 645 Bergen Street Newark, New Jersey 07107

RETROPERITONEAL

PARAGANGLIOMA

The case profile for March (vol. 5, To the Editor: page 415), consisting of paraganglioma simulating a renal carcinoma, was extremely interesting. I would, however, like to question Dr. Kallett’s comment about this being a benign tumor. In the recent Armed Forces Institute of Pathology abstract, Dr. George G. Glenner pointed out that this rare tumor has an incidence of metastasis in about 38 per cent of cases reported by Olsen and Abel. It is my understanding from recent information that the aortico-sympathetic group of paragangliomas, which would include Dr. Kallett’s case, has an increased incidence of malignancy compared to other tumors of the paraganglion system. In view of this fact, one must follow these patients with a careful search for metastatic lesions or other foci of tumor formations. We recently have encountered a tumor similar to the one described which mimicked a renal mass. This would support Dr. Kallett’s conclusion that paragangliomas must be differentiated from other retroperitoneal masses. A urine assay for catecholamines should be included in the preoperative workup for such masses. Apparently Dr. Olsen and Dr. Abel’s impression, reported in Cancer, 1969, that this tumor occurs more frequently than the scarcity of reported cases indicates, is a valid one. Jack E. Butterworth, M.D. 28 Midway Street Bristol, Tennessee 37620

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