of patients with moderate reflux would seem to be meddlesome. On the other hand, the fact that scarring did develop in I out of 58 children with moderate reflux points out the need for continuing medical follow-up with this group. Anyone who is interested in this subject should read the article by Rolleston, Shannon, and Utley,’ as it is, I think, an important contribution in this somewhat controversial field. C. D. Vermillion, The Billings Billings, Montana
M.D. Clinic 59103
References 1. ROLI,ES?.ON. G. L., SHANNON, F. T., ~~~UTLEY, W. L.: Relationship of infantile vesicoureteric reflux to renal damage, Br. Med. J. 1: 406 (1970). 2. SHANNON, F. T.: Personal communication, 1973.
TORSION OF INTRA-ABDOMINAL SEMINOMA OF TESTIS To the Editor: It is interesting to note that one more case of torsion of intra-abdominal seminoma of testis is reported by Dr. Douglas Dahl in his article on “Torsion of Intra-Abdominal Seminoma of Testis” (UROLOGY, vol. 4, page 590). Please note that after a case described by Garber and Kauffer in 1967,’ three more cases have been added to the literature. The twenty-fourth case of torsion of intra-abdominal testis with tumor (seminoma) was reported by me in 1969.* This case was noteworthy, since this patient was the oldest in the series (fifty-two years of age). Although a differential diagnosis of intra-abdominal torsion of the left testis was entertained, it was not strongly considered because the patient insisted that his left testicle had been removed at the time of his inguinal hemiorrhaphy at age twenty-nine. Dr. Dahl’s case thus becomes the twenty-fifth to be reported in the literature. I would like to reemphasize that the diagnosis of intra-abdominal torsion of the testis should be strongly considered if a male patient has abdominal pains and a nonpalpable gonad. Unless there is documented histopathologic evidence that the specimen removed is testis, mere history of orchiectomy for an undescended testicle should not hinder one from making a presumptive diagnosis of torsion of intra-abdominal testis in such circumstances. It is recognized that when a testis remains intra-abdominal torsion and tumor are distinct hazards. Mustan D. Jhaveri, M.D. 129 N.E. IO2nd Street Portland, Oregon 97220
UROLOGY
I FEBRUARY 1975 / VOLUME V, NUMBER Z
References 1. GARBER, H. E., and KAUFFER, 6. I.: Torsion of an intra-abdominal testicular seminoma. J. Ural. 98: 684 (1967). 2. JHAVERI, M. D., JACOBSON. MM.E.. and RORINSON. F. W.: Testis, tumor and torsion; torsion of intra-ahdominal testis with tumor, J. Kansas W Sot. 70: 451 (1969).
BEHAVIORAL AND PENILE
TECHNIQUE ERECTION
To the Editor: We read with interest the article “Injection Technique to Induce Penile Erection,” by R. F. Gittes, M.D., and A. P. McLaughlin, III, M.D., in the October issue (vol. 4, page 473) of UROLOGY. The authors are certainly to be commended for their simple technique to induce penile erection when careful observation is needed to correct a penile deformity. We wish, however, lo call the attention of the readers to recent advances in the field of psychology which offer another simple technique to achieve penile erection in the office. Rubin and his colleagues’*’ have shown that it is possible to achieve voluntary control over the occurrence of penile erection by exposing the subjects to erotically stimulating motion pictures with or without a description of the behavioral content of the erotic stimulus film. The subjects are later able to achieve erection voluntarily in the absence of the erotic stimuli. To monitor changes in penile circumference, these authors employed a mercury strain gauge which is fitted around the penis.3 We were also able to condition penile erection in response to sexually arousing auditory stimuli in a young male homosexual by providing him feedback of changes in penile erection as measured by changes in penile temperature sensed by a thermistor attached to the skin of the patient.4 If a patient is trained, through behavioral techniques, to control the penile erection response voluntarily, he will then be able to achieve erection in the physician’s office when needed. Victor A. Colotla, Ph.D. Department of Psychology, Toronto Western Hospital, Toronto, Canada M5T 2S8 Benjamin Dominguez, M. SC. Faculty of Psychology, National University of Mexico, Mexico City, Mexico.
References 1. LAWS, D. R., and RUBIN, H. B.: Instruction control of an autonomic sexual response. J. Appl. Behav. Anal. 3: 93 (1969).
289
HENSON, D. E., and RUBIN, H. B.:
of eroticism,
Voluntary
control
ibid. 4: 37 (1971).
BARLOW, D. H., BECKER, R., LEITENBERC, H., and AGRAS, W. S.: A mechanical gauge for recording penile circumference change, ibid. 3: 73 (1970). DOMINGUEZ, B., and COLOTLA, V. A.: Unpublished data.
ACCURACY OF TERMINOLOGY RADIONUCLIDE TECHNIQUES
IN
To the Editor: The article, “Pelvic Kidney Secondary to False-Positive Renal Scan: Error in Diagnosis,” by Mahendra S. Shah, M.D., Joel C. Ullman, M.D., and Joseph Karp, M.D. (UROLOGY, vol. 4, page 212) calls attention to false interpretation of an intravenous pyelogram and a “renal scan.” The latter terminology must be objected to vigorand it appears to be against any ously, however, editorial principle not to have techniques spelled out. The article discusses the uptake of radioactivity above the bladder, but nowhere does it mention which radionuclide was utilized nor the compound labeled. It is rather basic in any scientific article that methods be described in such a manner that they are meaningful to the reader, and it is regrettable not only to continuously hear but to also see in print the term “renal scan” utilized for any kind of radionuclide demonstration of renal tissue. It first of all should be pointed out that a “scan” is obtained by a movable probe over an area containing radioactivity; the pictures illustrating this article are those of a scintiphoto obtained by a stationary probe and thus does not constitute a “scan” by the terminology used today. Second, it makes a great deal of difference as to whether the scintiphoto was obtained with sodium iodohippurate 1311 (Hippuran-131),
290
chlormerodrin 19’Hg and 203Hg (Neohydrin-197 and -203), or any of the technetium compounds which are commonly used. Basically you might as well talk about an x-ray compared to a scan; both terminologies are meaningless unless defined in terms of the specific physiologic parameters to which one attempts to adhere for the demonstration of hmctioning tissue. I must blame the editors as much as the authors for failing to provide meaningful information in conformity with fundamental and editorial principles. My comments, however, are not so much to be interpreted as critical as an attempt to express my feelings that there is a tremendous need for more knowledge on behalf of the average urologist concerning the use of radionuclides, so that interpretation of such studies can provide as meaningful and useful information as our standard armamentarium of radiologic examinations. It is, in my opinion, the responsibility of the urologist to be adequately informed about the physiologic parameters involved with the various radionuclides and radiopharmaceuticals; it might have prevented the misinterpretation described in the article.
Professor Tulane
EDITOR’S curacy
NOTE:
Dr.
of terminology
J. U. Schlegel, M.D., Ph.D. and Chairman, Department of Surgery, Section of Urology, University School of Medicine New Orleans, Louisiana 70112 Schlegel’s
insistence
in radionuclide
on ac-
techniques
is
well taken. We also agree that there is a need for more knowledge
on the part of urologists concerning
of radionuclides, can be meaningful
UROLOGY
/
so that interpretation
the use
of such studies
and useful.
FEBRUARY 1975
/ VOLUME V, NUMBER 2
M.D. Clinic 59103
References 1. ROLI,ES?.ON. G. L., SHANNON, F. T., ~~~UTLEY, W. L.: Relationship of infantile vesicoureteric reflux to renal damage, Br. Med. J. 1: 406 (1970). 2. SHANNON, F. T.: Personal communication, 1973.
TORSION OF INTRA-ABDOMINAL SEMINOMA OF TESTIS To the Editor: It is interesting to note that one more case of torsion of intra-abdominal seminoma of testis is reported by Dr. Douglas Dahl in his article on “Torsion of Intra-Abdominal Seminoma of Testis” (UROLOGY, vol. 4, page 590). Please note that after a case described by Garber and Kauffer in 1967,’ three more cases have been added to the literature. The twenty-fourth case of torsion of intra-abdominal testis with tumor (seminoma) was reported by me in 1969.* This case was noteworthy, since this patient was the oldest in the series (fifty-two years of age). Although a differential diagnosis of intra-abdominal torsion of the left testis was entertained, it was not strongly considered because the patient insisted that his left testicle had been removed at the time of his inguinal hemiorrhaphy at age twenty-nine. Dr. Dahl’s case thus becomes the twenty-fifth to be reported in the literature. I would like to reemphasize that the diagnosis of intra-abdominal torsion of the testis should be strongly considered if a male patient has abdominal pains and a nonpalpable gonad. Unless there is documented histopathologic evidence that the specimen removed is testis, mere history of orchiectomy for an undescended testicle should not hinder one from making a presumptive diagnosis of torsion of intra-abdominal testis in such circumstances. It is recognized that when a testis remains intra-abdominal torsion and tumor are distinct hazards. Mustan D. Jhaveri, M.D. 129 N.E. IO2nd Street Portland, Oregon 97220
UROLOGY
I FEBRUARY 1975 / VOLUME V, NUMBER Z
References 1. GARBER, H. E., and KAUFFER, 6. I.: Torsion of an intra-abdominal testicular seminoma. J. Ural. 98: 684 (1967). 2. JHAVERI, M. D., JACOBSON. MM.E.. and RORINSON. F. W.: Testis, tumor and torsion; torsion of intra-ahdominal testis with tumor, J. Kansas W Sot. 70: 451 (1969).
BEHAVIORAL AND PENILE
TECHNIQUE ERECTION
To the Editor: We read with interest the article “Injection Technique to Induce Penile Erection,” by R. F. Gittes, M.D., and A. P. McLaughlin, III, M.D., in the October issue (vol. 4, page 473) of UROLOGY. The authors are certainly to be commended for their simple technique to induce penile erection when careful observation is needed to correct a penile deformity. We wish, however, lo call the attention of the readers to recent advances in the field of psychology which offer another simple technique to achieve penile erection in the office. Rubin and his colleagues’*’ have shown that it is possible to achieve voluntary control over the occurrence of penile erection by exposing the subjects to erotically stimulating motion pictures with or without a description of the behavioral content of the erotic stimulus film. The subjects are later able to achieve erection voluntarily in the absence of the erotic stimuli. To monitor changes in penile circumference, these authors employed a mercury strain gauge which is fitted around the penis.3 We were also able to condition penile erection in response to sexually arousing auditory stimuli in a young male homosexual by providing him feedback of changes in penile erection as measured by changes in penile temperature sensed by a thermistor attached to the skin of the patient.4 If a patient is trained, through behavioral techniques, to control the penile erection response voluntarily, he will then be able to achieve erection in the physician’s office when needed. Victor A. Colotla, Ph.D. Department of Psychology, Toronto Western Hospital, Toronto, Canada M5T 2S8 Benjamin Dominguez, M. SC. Faculty of Psychology, National University of Mexico, Mexico City, Mexico.
References 1. LAWS, D. R., and RUBIN, H. B.: Instruction control of an autonomic sexual response. J. Appl. Behav. Anal. 3: 93 (1969).
289
HENSON, D. E., and RUBIN, H. B.:
of eroticism,
Voluntary
control
ibid. 4: 37 (1971).
BARLOW, D. H., BECKER, R., LEITENBERC, H., and AGRAS, W. S.: A mechanical gauge for recording penile circumference change, ibid. 3: 73 (1970). DOMINGUEZ, B., and COLOTLA, V. A.: Unpublished data.
ACCURACY OF TERMINOLOGY RADIONUCLIDE TECHNIQUES
IN
To the Editor: The article, “Pelvic Kidney Secondary to False-Positive Renal Scan: Error in Diagnosis,” by Mahendra S. Shah, M.D., Joel C. Ullman, M.D., and Joseph Karp, M.D. (UROLOGY, vol. 4, page 212) calls attention to false interpretation of an intravenous pyelogram and a “renal scan.” The latter terminology must be objected to vigorand it appears to be against any ously, however, editorial principle not to have techniques spelled out. The article discusses the uptake of radioactivity above the bladder, but nowhere does it mention which radionuclide was utilized nor the compound labeled. It is rather basic in any scientific article that methods be described in such a manner that they are meaningful to the reader, and it is regrettable not only to continuously hear but to also see in print the term “renal scan” utilized for any kind of radionuclide demonstration of renal tissue. It first of all should be pointed out that a “scan” is obtained by a movable probe over an area containing radioactivity; the pictures illustrating this article are those of a scintiphoto obtained by a stationary probe and thus does not constitute a “scan” by the terminology used today. Second, it makes a great deal of difference as to whether the scintiphoto was obtained with sodium iodohippurate 1311 (Hippuran-131),
290
chlormerodrin 19’Hg and 203Hg (Neohydrin-197 and -203), or any of the technetium compounds which are commonly used. Basically you might as well talk about an x-ray compared to a scan; both terminologies are meaningless unless defined in terms of the specific physiologic parameters to which one attempts to adhere for the demonstration of hmctioning tissue. I must blame the editors as much as the authors for failing to provide meaningful information in conformity with fundamental and editorial principles. My comments, however, are not so much to be interpreted as critical as an attempt to express my feelings that there is a tremendous need for more knowledge on behalf of the average urologist concerning the use of radionuclides, so that interpretation of such studies can provide as meaningful and useful information as our standard armamentarium of radiologic examinations. It is, in my opinion, the responsibility of the urologist to be adequately informed about the physiologic parameters involved with the various radionuclides and radiopharmaceuticals; it might have prevented the misinterpretation described in the article.
Professor Tulane
EDITOR’S curacy
NOTE:
Dr.
of terminology
J. U. Schlegel, M.D., Ph.D. and Chairman, Department of Surgery, Section of Urology, University School of Medicine New Orleans, Louisiana 70112 Schlegel’s
insistence
in radionuclide
on ac-
techniques
is
well taken. We also agree that there is a need for more knowledge
on the part of urologists concerning
of radionuclides, can be meaningful
UROLOGY
/
so that interpretation
the use
of such studies
and useful.
FEBRUARY 1975
/ VOLUME V, NUMBER 2
