Vol. 118, July, Part 1
THE JOURNAL OF UROLOGY
Printed in U.S.A.
Copyright © 1977 by The Williams & Wilkins Co.
Letters to the Editor GLUCAGON To the Editor. We report an unanticipated finding of concomitant relaxation of the ureter with passage of calculi, noted during an investigation of the use of glucagon, a smooth muscle relaxant, for the relief of ureteral pain. Glucagon has been effective in the production of duodenal relaxation during the completion of peroral cannulation of the ampulla of Yater and in hypotonic duodenography. It also has been useful in barium enema studies, especially in cases of colonic spasm and of diverticular disease. Recent reports on the effective use of glucagon during hysterosalpingography also have been noted. An unexpected observation was made during a study that we are now pursuing, evaluating the effects of diuretics on contrast excretion of the urinary tract. Glucagon, used as a ureteral relaxant, was found to be a strikingly effective drug for the reduction of pain and flank discomfort in some patients with ureteral calculi. A dose of 1 mg. per cc glucagon was given intravenously in 10 cases. The presence of ureteral calculi was confirmed radiologically in each patient. Striking relief of the pain was reported in the cases so treated. Patients with a history of a possible pheochromocytoma or an insulinoma, or patients with a possible sensitivity to glucagon or poorly controlled diabetes were not given the drug and were excluded from the study. There were no significant changes in the pulse rate or blood pressure recorded before and after the administration of glucagon. In 3 cases there was a spontaneous passage of the calculi from the ureteral lumen within 4 to 8 hours after administration of the glucagon. We are not willing to draw any conclusions concerning a causal relationship between the glucagon and the passage of calculi at this time but our studies are continuing. The duration of the relief of pain after the administration of glucagon ranged from 1 to 3 hours in cases so treated. As yet we have made no comparison studies, randomization or the use of placebos in the evaluation of the effects of glucagon. The mode of action of glucagon is not known. We are reporting on the concomitant phenomenon noted during the use of this drug.
Respectfully, Robert M. Lowman, Norberto A. Belleza, John B. Goetsch, Harvey I. Finkelstein, Robert R. Berneike and Arthur T. Rosenfield Departments of Radiology and Urology Yale University School of Medicine New Haven, Connecticut 06504
mon. 1 We performed reduction scrotoplasty for filarial scrotal elephantiasis. In the majority of patients there was a reappearance of the scrotal elephantoid condition within a few years. The reason for this recurrence was considered to be the continued presence of lymphatic blockage in the skin used for scrotoplasty. The best longstanding results were obtained by complete excision of the scrotal and penile skin with implantation of the testes in a subcutaneous pouch on the medial aspects of the thighs and split thickness skin graft over the penis. If the patient was not circumcised the inner layer of the prepuce was used for skin grafting. This inner layer of the prepuce was almost never involved in the elephantoid process. The cosmetic and functional results of skin grafting over the penis were excellent. Respectfully, N. V. Raghavaiah University a/Tennessee Center for the Health Sciences Memphis, Tennessee 38103 1. Khedroo, L. G.: Reduction perineoplasty for scrotal elephantiasis:
a method of surgical reconstruction of the penis and scrotum. J. Urol., 116: 679, 1976.
RADIOISOTOPE UROFLOWMETRY IN THE EVALUATION OF PROSTATISM To the Editor. Uroflowmetry is important in the evaluation of prostatism. This test clearly differentiates patients with prostatism owing to prostatitis, cystotrigonitis and hyperirritable bladder who do not need an operation from those with obstructive disease, requiring surgical relief of the obstruction.' We had been using radioisotope uroflowmetry for such evaluations. 2 The procedure consists of injecting measured quantities of 131I hippurate intravenously and obtaining the standard renograms. After the isotope has been excreted into the bladder the probe is placed over the bladder and the patient is asked to urinate. A uroflowmetric graph is obtained, from which the voiding pattern and flow rate are computed. At the end of micturition the residual bladder counts are noted and the residual urine in the bladder is calculated. This procedure is extremely simple and useful in evaluating prostatism. The advantage of radioisotope uroflowmetry over the conventional method is that the estimation of post-voiding residue is possible and may give an estimate of the degree of obstruction.
Respectfully, N. V. Raghavaiah University a/Tennessee Center for the Health Sciences Memphis, Tennessee 38103 1. Abrams, P. H.: Prostatism and prostatectomy: the value of urine
RECONSTRUCTION OF SCROTAL AND PENILE SKIN IN ELEPHANTIASIS To the Editor. The procedure described by Khedroo is useful in tropical countries where filariasis and genital elephantiasis are com.
128
flow rate measurement in the preoperative assessment for operation. J. Urol., 117: 70, 1977. 2. Raghavaiah, N. V.: Bladder outlet obstruction: functional evaluation by radioisotope method. Urology, 5: 356, 1975.
THE JOURNAL OF UROLOGY
Printed in U.S.A.
Copyright © 1977 by The Williams & Wilkins Co.
Letters to the Editor GLUCAGON To the Editor. We report an unanticipated finding of concomitant relaxation of the ureter with passage of calculi, noted during an investigation of the use of glucagon, a smooth muscle relaxant, for the relief of ureteral pain. Glucagon has been effective in the production of duodenal relaxation during the completion of peroral cannulation of the ampulla of Yater and in hypotonic duodenography. It also has been useful in barium enema studies, especially in cases of colonic spasm and of diverticular disease. Recent reports on the effective use of glucagon during hysterosalpingography also have been noted. An unexpected observation was made during a study that we are now pursuing, evaluating the effects of diuretics on contrast excretion of the urinary tract. Glucagon, used as a ureteral relaxant, was found to be a strikingly effective drug for the reduction of pain and flank discomfort in some patients with ureteral calculi. A dose of 1 mg. per cc glucagon was given intravenously in 10 cases. The presence of ureteral calculi was confirmed radiologically in each patient. Striking relief of the pain was reported in the cases so treated. Patients with a history of a possible pheochromocytoma or an insulinoma, or patients with a possible sensitivity to glucagon or poorly controlled diabetes were not given the drug and were excluded from the study. There were no significant changes in the pulse rate or blood pressure recorded before and after the administration of glucagon. In 3 cases there was a spontaneous passage of the calculi from the ureteral lumen within 4 to 8 hours after administration of the glucagon. We are not willing to draw any conclusions concerning a causal relationship between the glucagon and the passage of calculi at this time but our studies are continuing. The duration of the relief of pain after the administration of glucagon ranged from 1 to 3 hours in cases so treated. As yet we have made no comparison studies, randomization or the use of placebos in the evaluation of the effects of glucagon. The mode of action of glucagon is not known. We are reporting on the concomitant phenomenon noted during the use of this drug.
Respectfully, Robert M. Lowman, Norberto A. Belleza, John B. Goetsch, Harvey I. Finkelstein, Robert R. Berneike and Arthur T. Rosenfield Departments of Radiology and Urology Yale University School of Medicine New Haven, Connecticut 06504
mon. 1 We performed reduction scrotoplasty for filarial scrotal elephantiasis. In the majority of patients there was a reappearance of the scrotal elephantoid condition within a few years. The reason for this recurrence was considered to be the continued presence of lymphatic blockage in the skin used for scrotoplasty. The best longstanding results were obtained by complete excision of the scrotal and penile skin with implantation of the testes in a subcutaneous pouch on the medial aspects of the thighs and split thickness skin graft over the penis. If the patient was not circumcised the inner layer of the prepuce was used for skin grafting. This inner layer of the prepuce was almost never involved in the elephantoid process. The cosmetic and functional results of skin grafting over the penis were excellent. Respectfully, N. V. Raghavaiah University a/Tennessee Center for the Health Sciences Memphis, Tennessee 38103 1. Khedroo, L. G.: Reduction perineoplasty for scrotal elephantiasis:
a method of surgical reconstruction of the penis and scrotum. J. Urol., 116: 679, 1976.
RADIOISOTOPE UROFLOWMETRY IN THE EVALUATION OF PROSTATISM To the Editor. Uroflowmetry is important in the evaluation of prostatism. This test clearly differentiates patients with prostatism owing to prostatitis, cystotrigonitis and hyperirritable bladder who do not need an operation from those with obstructive disease, requiring surgical relief of the obstruction.' We had been using radioisotope uroflowmetry for such evaluations. 2 The procedure consists of injecting measured quantities of 131I hippurate intravenously and obtaining the standard renograms. After the isotope has been excreted into the bladder the probe is placed over the bladder and the patient is asked to urinate. A uroflowmetric graph is obtained, from which the voiding pattern and flow rate are computed. At the end of micturition the residual bladder counts are noted and the residual urine in the bladder is calculated. This procedure is extremely simple and useful in evaluating prostatism. The advantage of radioisotope uroflowmetry over the conventional method is that the estimation of post-voiding residue is possible and may give an estimate of the degree of obstruction.
Respectfully, N. V. Raghavaiah University a/Tennessee Center for the Health Sciences Memphis, Tennessee 38103 1. Abrams, P. H.: Prostatism and prostatectomy: the value of urine
RECONSTRUCTION OF SCROTAL AND PENILE SKIN IN ELEPHANTIASIS To the Editor. The procedure described by Khedroo is useful in tropical countries where filariasis and genital elephantiasis are com.
128
flow rate measurement in the preoperative assessment for operation. J. Urol., 117: 70, 1977. 2. Raghavaiah, N. V.: Bladder outlet obstruction: functional evaluation by radioisotope method. Urology, 5: 356, 1975.
