Few Drops Of Urine Research Articles

Congenital Megalourethra Associated With Urethral Duplication: A Case Report

A 28 years old male with well developed secondary sexual characteristics was admitted in BSMMU with a grossly swollen, malformed phallus and passage of urine mostly through an opening in the perineum. After birth, his parents noticed that when the baby micturates the phallus is swollen and few drops of urine comes out through the external urethral meatus but most of the urine comes out through an opening in the perineum. No treatment was taken by his parents for this complaint. At puberty his secondary sexual characteristics developed normally. He felt sexual urge towards females but his penis was not erected. At the peak of his sexual excitement, orgasm occurs with release of whitish seminal fluid which comes mostly through perineal opening. His general physical examination was unremarkable & examination of the genitalia revealed well developed scrotum. Both of the testes were normal in size, shape and consistency but the penile shaft was large and flabby, and the ventral aspect of the penis appeared as a sac with mild pseudo phimosis. Careful palpation suggested the absence of the corpus spongiosum & corpora cavernosa. Both these findings were subsequently confirmed by a duplex colour doppler study. The penis distended ventrally when he tried to micturate and the urinary stream was narrow. About 75% of urine flow evacuates through perineal opening which was located about 2 cm from anal opening in the midline ventrally. A voiding cystourethrogram revealed that whole of the anterior urethra was grossly dilated with narrowing at the bulbar part & external urerthral meatus. There was another passage (about 5 cm) from the scrotal margin up to proximal posterior urethra. Cystogram showed a bladder diverticulum at left lateral wall. An urethrocystoscopic examination revealed that just proximal to the stenosed external urethral meatus the urethra is widely dilated which seemed like a transparent fusiform sac with irrigating fluid. Whole of the anterior urethra was very thin walled with transmitting lights through it. Proximal part of the urethra near the external sphincter was grossly narrowed. Urethrocystoscope was also introduced through the abnormal urethral opening into the perineum which was located in the midline raphe of the perineal region about 2 cm from the anal verge. This urethra joined with the penile urethra distal to the external sphincter. Prostatic part of the common urethral channel was normal containing verrumontanum and a normal bladder neck. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.53-56

Urinary circulating DNA and circulating antigen for diagnosis of schistosomiasis mansoni: a field study.

To evaluate three non-invasive assays for the diagnosis of schistosomiasis mansoni in an Egyptian village. Urine was collected for the detection of circulating cathodic antigen (CCA) and cell-free parasite DNA (cfpd) by Point-of-contact (POC)-cassette assay and PCR, respectively. These tests were compared to Kato-Katz (KK) faecal thick smear for detection of Schistosoma mansoni eggs. Disease prevalence by POC-CCA assay was 86%; by PCR it was 39% vs. 27% by KK. Compared to KK, the sensitivity of POC-CCA reached 100%, but its specificity was only 19.2% with 41% accuracy. Sensitivity of the PCR assay for cfpd was 55.56%, and specificity was 67.12% with 64% accuracy. A new end point was calculated for combined analysis of KK, POC-CCA assay and PCR. Sensitivity for the three tests was 52.94%, 90.2% and 76.47%; specificity was 100% for KK and PCR and 18.37% for POC-CCA. The accuracy calculated for the three tests at the end point was 76% for KK, 55% for POC-CCA assay and 88% for PCR. Conventional PCR assay for detection of cfpd provides a potential screening tool for intestinal schistosomiasis with reliable specificity, reasonable accuracy and affordable financial and technical cost.

Urethral bulking for recurrent stress urinary incontinence after midurethral sling failure.

To assess the effectiveness of a polyacrylamide hydrogel (PAHG; Bulkamid®) in treating recurrent stress urinary incontinence (SUI) following a previous midurethral sling (MUS) implant. This observational study, conducted since 2009, included 60 patients with recurrent SUI or mixed urinary incontinence (MUI) after a previous MUS and who chose to be treated with PAHG. Objective and subjective outcomes were assessed at 1, 6, and 12 months after the initial injection. Patients were classified as cured based on a negative cough test (supine and standing) and <2 g urine on 1-hr pad test and a VAS score improved by ≥90%. Improved were those with the loss of only a few drops of urine during the cough test and 2-10 g urine on 1-hr pad test or a reduction >50% compared with preoperative urine loss and a VAS score improved by ≥75%. The volume of PAHG injected in the current study ranged from 1-3 ml. Cured/improved rates were 93.3% (56/60), 88.3% (53/60), and 83.6% (46/55) at 1, 6, and 12 months, respectively. Patients with MUI had a cured urgency urinary incontinence rate of 36.8%, 47.4%, and 38.9%, respectively. Voiding dysfunction rates were 13.3% (8/60), 8.3% (5/60), and 1.8% (1/55) at 1, 6, and 12 months and urinary tract infection rates were 5% (3/60), 11.7% (7/60), and 3.6% (2/55), respectively. Other adverse events were short-term and/or observed in <4% of patients. PAHG can be used to treat recurrent SUI after MUS failure with good outcome and low complication rates. Neurourol. Urodynam. 36:722-726, 2017. © 2016 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.

The Concept of Tubularized Incised Plate Hypospadias Repair for Different Types of Hypospadias

Using the concept of tubularized incised plate (TIP) urethroplasty technique for proximal, distal, primary, secondary and complicated cases of hypospadias. From June 2002 to December 2003 TIP urethroplasty was performed in 15 patients between the age of 1-18-year-old with penosecrotal, mid shaft and subcoronal hypospadias. In 13 of them TIP urethroplasty used as the primary repair while in two of them as secondary repair. No clinically important complications were observed in those boys who underwent primary reconstruction. One of them had meatal stenosis at the early postoperative period which was corrected by dilatation of the external meatus by feeding catheter at intervals up to 2 months postoperatively. Three boys had very narrow fistula which just allow leak of few drops of urine through urination. One boy with penoscrotal hypospadias who underwent two-stage repair had fistula. The concept of TIP urethroplasty is the procedure of choice for the treatment of proximal hypospadias and, it seems to be suitable for distal, secondary and even complicated hypospadias reconstruction. The advantages of this procedure include its simplicity, low complication rates and very good appearance of the glance with normal meatus.

Impact of unilateral interposition sural nerve grafting on recovery of urinary function after radical prostatectomy

Objectives To test the hypothesis that unilateral sural nerve graft (SNG) interposition may improve the rate of urinary function (UF) recovery after radical retropubic prostatectomy (RRP) in patients undergoing unilateral nerve resection (UNR). Methods We studied 111 consecutive patients who underwent RRP with purposeful UNR performed by a single surgeon. Of the 111 patients, 53 underwent unilateral SNG interposition. All patients were invited to complete a questionnaire that included the validated University of California, Los Angeles, Prostate Cancer Index. The time to UF recovery above the median value of the group and urinary control status were evaluated. Results The median follow-up was 26 and 12 months for the UNR and UNR+SNG patients, respectively. At 12 months after RRP, 94.7% of patients with UNR+SNG reported having complete urinary control or leakage of only a few drops of urine compared with 58.3% of patients with UNR alone ( P = 0.012). In multivariate Cox regression models, UNR+SNG was associated with a 9.95 times greater rate of reaching a UF score above the median versus UNR alone ( P <0.001). In multivariate logistic regression analyses, SNG status increased the odds of having complete urinary control or leakage of only a few drops of urine by 14.99 and 29.19 at 6 and 12 months after RRP, respectively (both P <0.05). Conclusions In patients undergoing UNR surgery, SNG interposition is associated with a greater rate of UF recovery and a higher likelihood of urinary control after RRP. These findings need to be validated in larger, multicenter, prospective, randomized studies.

Why anti-incontinence surgery succeeds or fails.

Defining success and failure in anti-incontinence surgery is becoming increasingly complex. Except in unusual cases, the impact of urinary incontinence is assessed by the degree of subjective bother to the patient. The amount, frequency, or volume of urinary incontinence is not necessarily related to the degree of bother and may be irrelevant to the patient. Large-volume urinary incontinence may be acceptable to some patients with the appropriate use of incontinence pads. Other women are socially incapacitated by losing a few drops of urine once per month. The amount of bother to the patient and not the amount of leakage is, in fact, what we treat with interventions for urinary incontinence. Success or failure in the treatment of urinary incontinence is tied to the patient's perception of success or failure and may differ from the surgeon's perception. New onset urgency and any unpredictable urgency incontinence may, in fact, be considered failure to the patient, despite the cure of "stress" incontinence. In the medical literature, success is defined by the surgeons (or authors). These definitions are variable and subject to bias. Recent reports showing differences between surgeon- and patient-defined success have refocused the evaluation of therapy for stress urinary incontinence (SUI).1,2 Success or failure in anti-incontinence surgery are increasingly being measured with quality of life questionnaires and outcome evaluations, which are strongly tied to patient satisfaction. The surgical objective for stress incontinence procedures is to create sufficient outlet resistance to prevent urine loss until a socially acceptable time and place. Unsuccessful surgeries fail to do this. Failure includes persistent SUI, de novo or worsened urge incontinence, obstructive or irritative voiding symptoms, urinary retention, and postoperative pelvic prolapse or surgical complications such as bleeding, fistula, infection, and/or dyspareunia. We will discuss the mechanisms for urinary continence and incontinence, describe a successful anti-incontinence operation, and finally discuss the etiologies of failed anti-incontinence surgery.

Patient self-assessment of complications and quality of life after conformal neutron and photon irradiation for localized prostate cancer.

Although neutron irradiation for prostate cancer has been associated with significant morbidity, pilot data in patients with early stage disease suggested that conformal neutron and photon irradiation was well tolerated without severe complications. A self-assessment questionnaire was mailed to the first 83 patients treated with conformal neutron and photon irradiation to objectively evaluate the impact on quality of life of this regimen. In total, 75 patients (90%) returned the completed questionnaire. These patients had received either 9 neutron Gy (N Gy) plus 38 photon Gy (50 patients) or 10 N Gy plus 38 photon Gy (33 patients) for stage T1/T2 N0 M0 prostate cancer (Gleason score < or = 7). The irradiated volume included the prostate and seminal vesicles with a 1.5 cm margin. Neutrons were delivered as a boost to the prostate only with a non-axial four field beam arrangement. Approximately 50% of the dose to the prostate was from neutron irradiation. Follow-up ranged from 6 to 25 months (median 13 months). The questionnaire used was a validated quality of life instrument used previously in patients treated with surgery or radiation. Prior to irradiation, 29% of patients reported urinary symptoms and 11% had prostate surgery (TURP). At follow-up, 23% reported persistent urinary symptoms. Of these, 21% dripped a few drops of urine, 3% used pads but none leaked > 1 tablespoon/day. One patient underwent surgery to dilate a urethral stricture. Although 55% of patients had gastrointestinal symptoms during radiation therapy, only 26% had persistent symptoms at the time of questioning. These included minor rectal bleeding in 20% and significant hematochezia in 3%. Of the 85% of patients able to obtain full or partial erections prior to irradiation, 87% maintained their potency. Fifteen percent sought treatment for impotence. Overall, at last follow-up, 84% felt little or no physical discomfort, 91% were very satisfied with their treatment, and 97% would choose radiation therapy again. This patient self-assessment questionnaire confirmed that this regimen of conformal neutron and photon irradiation resulted in levels of chronic toxicity acceptable to the patient.

Sequelae of definitive radiation therapy for prostate cancer localized to the pelvis

Objectives. To evaluate sequelae and estimate quality of life utilizing a survey instrument in 133 consecutive patients who have undergone definitive radiation therapy for localized prostate cancer. Methods. All patients reported on have been followed for 14 to 60 months (median, 31 months) after radiation therapy and only patients with definitive prostate radiation therapy are included. Of the patients still alive at time of follow-up, 115 were mailed the questionnaire. Data regarding tumor grade and stage as well as treatment were extracted from patient files. Results. Of the 91% of patients who returned the questionnaire, 11% used a pad and 13% leaked more than a few drops of urine daily. Of all the respondents, 9% stated that incontinence was a problem, and 31 % found urinary leaking significantly worsened after radiation therapy compared with before their diagnosis of prostate cancer. With respect to sexual function, 77% recalled being able to have full or partial erections prior to radiation therapy. At some time after radiation therapy, 22% of previously potent respondents were able to have a full erection and 41 % were able to have a partial erection. Twenty-nine percent of all patients who were able to establish an erection prior to radiation therapy reported that impotence was a problem at the time of follow-up. Forty-nine percent of patients had abdominal pain, diarrhea, or abdominal cramping during or after radiation therapy and 31% of all patients still had some intestinal symptoms at the time of follow-up. Eighteen percent of all patients were significantly bothered by one or more of these bowel problems. Overall, 31% of all patients reported a persistent degree of physical discomfort that they believed was secondary to their prostate cancer or the effect of treatment. Eighty-one percent were satisfied with radiation therapy and 97% of the patients said they would have radiation therapy again if faced with the decision. Conclusions. Utilizing a sensitive questionnaire on patients who had definitive radiationtherapy for prostate cancer, we found the incidence of patients bothered by incontinence to be surprisingly frequent and higher than previously reported. The frequency of impotence is similar to previous studies. However, when our incontinence and impotence data were compared to Medicare patients who had undergone radical prostatectomy, the frequencies after radiation therapy were significantly lower. Despite the rates of sequelae, the patients were generally satisfied with the decision to undergo radiation therapy and with the medical treatment received.

Sequelae of radical prostatectomy

To evaluate the sequelae of radical prostatectomy, using a survey instrument. Ninety-three consecutively treated patients who had undergone radical prostatectomy and who had been followed-up for between 12 and 48 months (mean 22.5) were sent a questionnaire by post. Of these, 86 (92%) completed and returned the questionnaire. The mean age of the patients at time of surgery was 64 years (range 49-75) and at time of follow-up was 66 years (range 50-77). Of the 86 patients who responded, 47% used a pad and 59% leaked urine daily. Thirty per cent dripped more than a few drops of urine daily and 34% found their incontinence bothersome. Eighty-four per cent of patients recalled that they had erectile potency before surgery. At follow-up, 9% were able to have a full erection and 38% were able to have a partial erection. Fifty-one per cent reported a substantial problem with reduced or absent erection. Twenty per cent had undergone treatment for bladder neck contracture and more than half of these had had more than one intervention. In all, 24% of the patients reported some persisting degree of physical unpleasantness which they believed to be secondary to their prostate cancer or the effects of treatment. Despite this, 74% were satisfied with their surgery and 88% said they would undergo surgery again. Using this survey instrument, we found adverse sequelae of radical prostatectomy to be surprisingly high. However, patients were generally satisfied with their decision to undergo surgery.

Fertility Awareness: Jet-Age Rhythm Method?

The optimal use of natural family planning (NFP) requires the daily measurement of basal body temperature combined with examination of cervical mucus to estimate the onset of ovulation. Popularity and efficacy of the method are low mainly because of the required lengthy abstinence from intravaginal coitus; reliance upon the sympto-thermal method of NFP requires an average of 17 days of such abstinence. The accurate measurement of certain biochemical changes however could reduce the required period of abstinence by more than 50% and boost the popularity and use of NFP. Home tests could be used to detect hormonal changes in a womans saliva and urine over the course of her menstrual cycle. Indeed it is now possible to accurately measure the increase in progesterone metabolites in a few drops of urine. The use of two dipsticks to measure estradiol and progesterone levels in saliva would however be ideal. Research and development efforts are needed to that end. This latter approach would require no toxicology US Food and Drug Administration scrutiny should be much shorter than with drugs legal exposure would be minimal and the undertaking is within the technical and financial resources of relatively small diagnostic companies. The level of market demand for such home tests remains undetermined. Women attempting to avoid unwanted pregnancies as well as female athletes flight attendants traversing multiple time zones on a regular basis and professional women postponing childbearing until their late thirties can all potentially benefit from tools capable of increasing their individual awareness of their fertile periods.

Diagnosis of Gonorrhea in Male Patients by Culture of Uncentrifuged First-Voided Urine

THE VAST majority of gonococcal infections in men are localized in the uniquely accessible male urethra, where the disease usually manifests itself as an acute or chronic urethritis with recognizable symptoms and signs. The urethral site of these infections offers an unusually favorable opportunity for a simple method of collecting laboratory specimens, because the urethra can easily be washed out by the patient himself with a small amount of his own readily available urine. The report by Moore et al1in 1973 is apparently the only major study in the past 20 years on the use of urine for diagnosis of gonorrhea in the male. Riggs,2in a short letter to the editors ofThe Journalin 1975, recommended the use of a few drops of urine passed on a swab which is used as a culture sample. With the exception of Riggs' brief note, all previous studies

The Ileocecal Bladder: A New Method for Urinary Diversion After Radical Cystectomy (A Preliminary Report)

Ten patients underwent radical cystectomy and ileocecal bladder reconstruction for carcinoma of the bladder. The ileocecal region was used as an artificial bladder, its valve protecting the kidneys from back pressure exerted by the external urethral sphincter. The ureters were anastomosed to the ileal part and the cecum was anastomosed to the prostatic urethra in 7 men and to the bladder neck in 2 women and 1 man. Two patients died postoperatively. All patients had perfect control of micturition during the day. Those in whom the bladder neck was preserved were also fully continent at night. The remaining patients had a minor degree of nocturnal enuresis with only a few drops of urine voided involuntarily during sleep. All patients feel the desire to void when the bladder is full. Voiding cystograms in all patients did not reveal reflux in the ureters. IVP's done up to 11 months postoperatively showed preservation and improvement of kidney function and configuration. Followup cystometric studies and serum electrolyte determinations are under investigation.

Screening Asymptomatic Male Patients For Gonorrhea

To the Editor.— The first few drops of urine, voided onto a dry swab and inoculated on Thayer-Martin medium, may be utilized to screen nonsymptomatic male patients for gonorrhea. It is now apparent that the female of the species is not the only hidden reservoir of gonorrhea. The male sexual contact of a person with gonococcal infection is also often an asymptomatic carrier, and routine screening of nonsymptomatic males admitted to a venereal disease clinic reveals 5% to 10% positive for Neisseria gonorrhoeae . The recommended procedure for securing an intraurethral specimen from the male without discharge has been use of a platinum loop or preferably a calcium-alginate-tipped, wire, urethrogenital swab. The loop or swab is then used to inoculate Thayer-Martin medium. 1 Either procedure generally requires presence of a physician, and the latter method is painful. An alternate procedure is urine culture of the sediment from a centrifuged specimen of

A SIMPLE RAPID METHOD FOR DETERMINATION OF SPECIFIC GRAVITY OF SMALL SAMPLES OF URINE

THE THERAPY of infants with disturbances in fluid balance is greatly assisted by knowledge of the specific gravity of the urine. Frequently only a few milliliters can be collected at any one time, while a minimum sample of 25 ml is necessary for use of the smallest urinometers currently available. The existing methods of determining specific gravity of one drop of urine are somewhat laborious, and require expensive equipment and the services of a relatively skilled technician. The present report describes a method which is rapid and simple and requires only a few drops of urine in its use. It is similar in principle to the determination of specific gravity of blood by the copper-sulfate method. For use with urine, mixtures are employed of two relatively nonvolatile liquids, immiscible with water, and with specific gravities nearly equally above and below the range in urine. The specific gravity of urine is determined by allowing one drop to fall into each of a series of tubes containing a mixture of the two liqquids made up to various specific gravities ranging from 1.005 to 1.030 (Fig. 1). That mixture in which the drop of urine comes most nearly to remaining still (neither rising nor falling after coming to rest) approximates the specific gravity of the urine. The total sample needed is only a few drops, which can be quite small if a dropper with a small opening (2 mm) is used. The determination takes a few minutes. A year's supply of the mixtures can be made in one afternoon and costs less than $6.00. MATERIALS The two solutions used were selected from the flotation method of Kirk, using a density gradient system. These are Liquid 1, dibutyl-n-phthalate (Eastman), specific gravity 1.04820°; and Liquid 2, kerosene, specific gravity 0.8220°. (Similar results were obtained by substituting California mineral oil, specific gravity 0.842-0.88420°, for kerosene.)

EQUIPMENT FOR CATHETERIZATION OF FEMALE INFANTS

THE IMPORTANCE of examining the urine of infants, especially females, cannot be overemphasized. It is getting a fresh specimen that sometimes presents the problem. This is true for the pediatrician making a home call and sometimes in office work. The apparatus to be described offers a sort of one-man catheter set that can be used in the home or office. Figure 1 shows that the apparatus can be carried in a medical bag; the 4-ounce, wide-neck bottle makes a small package. The equipment consists of a 4-ounce, wide-neck, Americantype bottle; a two-hole rubber stopper; two pieces of glass rod and a No. 8 soft rubber catheter. The apparatus is assembled, wrapped in a towel and autoclaved. Several of these sets can be kept ready. It is not often necessary to catheterize male infants. The catherization of female infants can be done in the home with the mother as the only assistant. The vaginal area is cleansed with soap, preferably Phisoderm®. The apparatus does not allow for the escape of the first few drops of urine before collecting; our experience has led us to believe that this is not necessary, if proper cleansing and inspection has been done. It is well to remember that the urethra of the female infant baby is "C" shaped. The meatus represents the bottom end of the "C." The catheter should be started downward. The thighs should be widely abducted but held fully extended, not flexed on the abdomen. This position will not angulate the "C" curve of the urethra. The specimen is collected in the stoppered bottle which does not require holding. This allows free use of both hands. The specimen is collected in a closed apparatus and offers a fresh specimen for study and culture.

DETECTION OF DIABETES

<h3>To the Editor:—</h3> Dr. Joslin states in his excellent article on diabetes therapy (The Journal, January 1, p. 1) that for every known diabetic person there is an unknown diabetic. With this I think there is little disagreement. He makes the very interesting suggestion that, in order to uncover these unknown persons with diabetes, the physician and the diabetic patient do urinalyses on the relatives of known diabetics, especially the fat ones. This is a good plan, but I would go a step further. Why does not everyone, not just diabetics but everyone, check his own urine for sugar—say once each week? It occurred to me some time ago, after testing a urine sample for sugar with the "clinitest," how simple a procedure this is— just a matter of adding a tablet to a few drops of urine and water. A child could be taught how to perform this test

Carcinoma of the Urethra of a Female Dog

Carcinoma of the urethra is a rare finding in both man and the dog. Sticker, Hutyra and Marek, Joest, Nieberle and Cohrs, and Feldman, all of whom have reported on a large series of animal tumors, made no mention of carcinoma of the urethra in the dog. We were able to find no reference to a similar case in the veterinary medical literature. Carcinoma of the urethra is probably as rare an occurrence in man as it is in the dog. Menville reviewed the literature to 1935 and found only 149 cases of primary neoplasms of the female urethra. Carcinoma is less frequent in the male urethra than it is in the female urethra. The most common neoplasm was the squamous-cell carcinoma, and the two most prevalent symptoms were urinary difficulty or retention and hematuria. Report of Case A well nourished female Boston terrier, aged thirteen years, which appeared ill. had had progressive urinary difficulties for three months. The owner stated that during this period the dog frequently had attempted to void with little or no success. The attempt usually had been prolonged for several minutes and never more than a few drops of urine had been voided. This urgency had become progressively worse until at the time of examination there was a constant futile attempt to urinate. A constant dribbling from the urethra had been present. This had been most marked when the dog was asleep. No bleeding from the urethra had been observed. Constipation and difficult defecation had developed during the third month of the illness. The animal had appeared to be in pain during the acts of micturition and defecation. There had been a marked increase in thirst but the appetite for food had not been altered.

DIURNAL INCONTINENCE IN WOMEN

There is a type of urinary incontinence in women, termed diurnal incontinence, which usually follows the trauma of childbirth, but which presents no visible injury or infection of the bladder, and has no relation to vesical fistulas. The onset is slow and insidious, the patient rarely being able to determine a definite beginning. The first symptom is the escape of a few drops of urine when the patient coughs, sneezes or makes any sudden movement which increases abdominal pressure. The condition may progress slowly until a continuous leak is present, although occasionally it remains constant; in fact, its limits vary between a slight dribbling on exertion to continuous loss, even when the patient is recumbent. Few infirmities are productive of so much inconvenience, discomfort and mental depression, nor does any other physical disability interfere so completely with the present comfort or future prospects of its victims. It has always seemed

Reconstruction of the urethra and vesical sphincter by employing the levator ani muscles

These patients have been followed for periods ranging from six months to four years, and we find that they are completely continent except for the very occasional loss of a few drops of urine. They do not find it necessary to wear pads. Firm pressure in the midpoint of the vaginal floor opens the urethra permitting the escape of urine. The attachment of each sphincter end across under the urethra to the opposite side of the vaginal roof gives a constriction of the urethra by scissor-like mechanism of fibromuscular tissue. The method may be useful if any similar cases are encountered. We believe it would be advisable not to suture the perineal muscles too tightly following transplantation, as any pull on the perineal floor seems to pull down on the urethral floor which favors leakage. Two of our patients are able to produce visible voluntary contractions of the synthetic sphincter. We believe that transplantation of the levator muscles may be used with profit in the repair of certain vesical sphincter defects in the female.

SPECIFIC GRAVITY OF URINE

To the Editor: —May I call your attention to the fact that the method for the determination of the specific gravity of a few drops of urine, published inThe Journal, August 14, was described by Professor Noeggerath, University of Freiburg, and me in the Archiv fur Kinderheilkunde ( 70 :161), where it is critically discussed. As we have shown there, the attempt to use the exact floating point for the determination is inaccurate. However, Kirkpatrick and Kling's use of a nonvolatile fluid theoretically seems to have a distinct advantage.