Despite the progress made in understanding the factors regulating sexual differentiation, infants born with ambiguous genitalia face significant problems. The authors reviewed a group of 84 children with ambiguous genitalia managed surgically between 1986 and 1993. The most frequent condition was male pseudohermaphroditism (PM) (58%); 31% had female pseudohermaphroditism. Fifty-seven percent of patients were raised as males and 43% as females. In each group of patients, feminine and masculine reconstructive operations were performed. In only 31% of PM and 60% of PF cases was the diagnosis made within the first 2 months of life. In 41% of PF and 40% of PM patients, treatment was begun before the second year of life, which we consider an acceptable time. The timing and type of vaginoplasty were determined by the point of entry of the vagina into the urogenital sinus. Of the 29 patients reared as females, 22 required perineal vaginoplasty, had pull-through vaginoplasty, and 2 had colovaginoplasty. Since 1986, we have applied Mollard's clitoroplasty, which preserves the neurovascular bundle and is important for experiencing orgasm. Seventeen percent of patients with feminization procedures experienced complications. The optimal time for masculinization procedures is 2 years of age, after obligatory testosterone treatment. If there is utriculus prostaticus (UP) type II or III, it is removed before urethroplasty. This is not done for UP types 0 and 1. In PM cases, the number of feminization and masculinization operations was 2.1 and 4.05 per patient, respectively. It is easier to make a vagina than a phallus, not taking into consideration dimensions, aesthetics, or capability of erection of the phallus.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors present an account of results of examinations in 162 patients with cancer of the prostate, benign hyperplasia of the prostate, inflammatory diseases of the prostate and patients with a normal finding on palpation of the prostate. The patients were subjected to clinical, laboratory, histopathological and transrectal ultrasonography of the prostate. In one patient a CT examination of the prostate was made. In the group were seven patients with cystic prostate lesions (4.3%). In the group of patients with inflammatory diseases of the prostate they observed cystic changes in five patients (14.2%). The most important group was formed by two patients with abscesses of the prostate and one patient with an ascended utriculus prostaticus. Transrectal ultrasonography of the prostate was the supreme method for the diagnosis of cystic prostate lesions.

We investigated the utriculus prostaticus from the fetal period up to adulthood in 148 prostates. During the second half of gestation the utriculus had a simple tubular or a cystic form and was lined with metaplastic squamous epithelium which showed immunohistochemical positivity for different keratins, carcinoembryonic antigen, and peanut agglutinin binding sites. After birth, alveolar outgrowths of the utriculus developed. After puberty, the utriculus had become a complicated and variable structure. The epithelium no longer differed from that of the prostate glands either morphologically or immunohistochemically. Within the epithelium numerous endocrine cells were found containing neuron-specific enolase, chromogranin, and serotonin. The utriculus and ejaculatory ducts were embedded in a fibrous stroma with, after birth, numerous plexus-like blood vessels. This fibrous zone was peripherally bordered by a layer of smooth muscle. There was no evidence for a function of the utriculus differing from that of the prostate glands. Since the epithelium of both structures is identical immunohistochemically, the epithelium of the sinus urogenitalis most likely particpates in the lining of the utriculus during embryogenesis.

Fifty carcinomas that were partially to completely papillary in nature were examined. According to urethroscopic and rectal palpation findings, six of the carcinomas were located centrally, 40 tumors were in the prostate proper, and four were clinical stage T0. The epithelium of the papillary portions of the tumors was dark in some instances, light in others. Immunohistochemistry revealed that 20 of 22 tumors were positive for prostatic acid phosphatase (PAP) and prostate-specific antigen (PSA). In no case was a topical relationship to the utriculus prostaticus demonstrable. The epithelium of the utriculus in seven additional patients who were not involved in this series also stained positively for PAP and PSA. Usual carcinomas of the prostate proper can develop endometrioid structures that do not differ immunohistochemically from ordinary portions of the carcinoma. Tumors located in central portions of the prostate are, in our opinion, morphologic variants of usual prostatic carcinomas, and apparently arise in prostatic ducts. We conclude that a distinction between endometrioid carcinomas and tumors of prostatic ducts does not seem justified and that papillary prostatic carcinomas should be treated like common prostatic cancer.

The behaviour of keratins in the human prostate is investigated immunohistochemically by polyclonal rabbit antibodies against keratins from human stratum corneum (kit from ORTHO/Heidelberg) and compared to the behaviour of prostatic acid phosphatase (PAP) and prostate-specific antigen (PSA). In normal glands and cribriform as well as adenomatous hyperplasia only basal cells contain keratin. The secretory epithelium is keratin-negative and in contrast to the basal cells PAP- as well as PSA-positive. In prostatic ducts and utriculus prostaticus keratin is demonstrable in basal cells and urothelium. As in normal glands, the light cylindric epithelium is keratin-negative and PAP- as well as PSA-positive. The cells in atrophic glands and postatrophic hyperplasia may contain keratin as well as PAP and PSA. Urothelial and squamous metaplasia are strongly keratin-positive. PAP and PSA are not found. The cylindric epithelium of the ejaculatory ducts contains keratin at many places. PAP and PSA are not demonstrable. The utriculus does not differ from normal prostatic glands immunohistochemically. This supports the view that the epithelium of the sinus urogenitalis is involved in the embryogenesis of normal prostatic glands and the utriculus as well. Urothelial and squamous metaplasia obviously arise from basal cells which share the same immunohistochemical features. Whether the cells in atrophic glands and postatrophic hyperplasia derive from basal cells or secretory epithelium cannot be decided. The keratin composition of the prostate should be further analyzed by keratin-specific monoclonal antibodies.

Since previous literature suggested that estrogen-treated male mice are models for human benign prostatic hypertrophy, a series of studies was designed to examine urine retention and urogenital tract changes in rodents given chronic estradiol-17 beta (E) and dihydrotestosterone (DHT) treatments. In Study 1, intact and castrate male mice received E, DHT or E plus DHT for four weeks via subcutaneous Silastic capsules. Bladder urine volume increased in the groups given E and this effect was not altered by castration, DHT or removal of E capsules two weeks before necropsy. Estrogen treatment also increased mortality. In Study 2, intact male, intact female, adrenalectomized (Adx) male and sham Adx male mice received 16 weeks of steroid treatments. Bladder urine volume increased in all E treated groups regardless of sex or Adx. Hydronephrosis, hydroureter and increased mortality were found in the E treated mice of both sexes. Estrogen induced epithelial changes and edema of the prostate, vas deferens and the utriculus prostaticus. In further studies male rats, hamsters and guinea pigs were given several different dosages of E but no evidence of urine retention or increased mortality was found. Taken together these studies suggest that E-induced urine retention is unique to mice. Although urine retention and hydronephrosis found in the mice were similar to those in humans with BPH, the lesion that results in the urine obstruction is not similar.

The accessory glands of seven species of male chiropterans are described. The unpaired prostate and paired Cowper's glands occur in all the species. The seminal vesicles are present only in Cynopterus and Taphozous. The ampullary glands occur in all the species except Cynopterus sphinx. The presence of solid rounded bodies is a characteristic feature of the seminal vesicles of Cynopterus sphinx. The urethral gland is present in all the species except Taphozous and Rhinopoma; utriculus prostaticus was not seen in any of the species investigated. The study reveals that the male accessory glands show great diversity and remarkable differences are seen even between closely related species.