VAS E~EFERENS ABSCESS POST VASECTOMY
if.9 tt~ Editor. In their Letter to the Editor: "Vas l ) e f ~ r e n s Abscess Six Years Post V a s e c t o m y , " pub[ shed in :he August issue (vol. 38, page 191, 29911 of URe:LOCY, Bruce R. Gilbert and Kevin Karr[son repcrted on a complication after, or of, vase( tomy. Many of us will recognize this as a ease of funiculitis, an infection that began in the infected prostatic urett,ra and traveled up the vas to the point of obstruction, to the point of vasectomy. The vasectomy prew,'nted the infeetion from reaching the epididymis and limited the infection to the urethral side of the ; as and Sl~,ermatie eord. The six-year interval is uncommon, but not unique. Their references go back to 1974 H a d they gone further back, they would[ have found more on the subject? -3 A number of things contribute to this ascending infectfon. A urinary infection, as the patient had, preeedes this. Any severe straining may cause (infected) urine t:e ascend the vas. Instrumentation in the face of a urinary infection increases the risk, and the no longer c o m m o n practice of ehecking for residual urine in the early postprostatectomy period caused m a n y purulent cases of epididymitis and funiculitis. For this reason a preoperative vasectomy was carried out as a preventive measure. In this case the coughing undoubtedly caused the reflux of the infected urine. Since the vas was "left open in the pelvic cavity," the condition could recur and cause a retroperitoneal abscess which might be difficult to diagnose. The patient should be aware of this possibility and of the need for frequent examinations of his urine.
1. Young HH, and Davis DM: Young's Pra Philadelphia, W.B. Saunders, 1926, vol 1, p 21 2. Hinman F St: The Principles and Practice delphia, W.B. Saunders, 1937, p 808. 3. Schmidt SS, and Hinman F: The effect o the incidence of epididymitis after prostateetoi 810 operations, J Urol 63:872 (1950).
Stanwood S. Schmidt, M.D. Department of Urology University of California School of Medicine San Francisco, California 94122
1. Casfleden C, George C, Renwick A, an( ramine, a possible alternative to current theral continence in the elderly, J Urol 125:318-320 2. Korczyn A, and Kish I: The mechanism enuresis nocturna, Clin Exp Pharmacol Physio]
IMIPRAMINE H Y D R O C H L O R I D E : B E N E F I C I A L D R U G FOR "NIGHT-
To the Editor: My practice includes ber of young, teenage school lads present complaining of "night-fall emission of semen. In one of them "1 occurred every night for the past ye~ become anxious and upset about this o are even afraid to meet the opposite, I have found that treatment with quite successful. The starting dose is night which can be increased gradual mg. The course is short for two to thr mode of action of imipramine seems tc action which alters the depth of slee vents psychogenic erection and sexua (2) antieholinergic effect which cau erection and o r g a s m - - t h e erection b, nantly a parasympathetic phenomenc A. K. Sharma, M.S., I Department of S S. N. Medical Collel Agra References
UROLOGY / NOVEMBER1991 / VOLUMEXXXVIiI'N~:~'