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Prostate cancer (CaP) is the leading cancer among men of African descent in the USA, Caribbean, and Sub-Saharan Africa (SSA). The estimated number of CaP deaths in SSA during 2008 was more than five times that among African Americans and is expected to double in Africa by 2030. We summarize publicly available CaP data and collected data from the men of African descent and Carcinoma of the Prostate (MADCaP) Consortium and the African Caribbean Cancer Consortium (AC3) to evaluate CaP incidence and mortality in men of African descent worldwide. CaP incidence and mortality are highest in men of African descent in the USA and the Caribbean. Tumor stage and grade were highest in SSA. We report a higher proportion of T1 stage prostate tumors in countries with greater percent gross domestic product spent on health care and physicians per 100,000 persons. We also observed that regions with a higher proportion of advanced tumors reported lower mortality rates. This finding suggests that CaP is underdiagnosed and/or underreported in SSA men. Nonetheless, CaP incidence and mortality represent a significant public health problem in men of African descent around the world.

Dilation and internal urethrotomy are useful in a select group (approximately 70% of all patients) who are stricture-free at 3 months, and of whom 50 to 60% will remain stricture-free up to 48 months. A second dilation or urethrotomy for early stricture recurrence (at 3 months) is of limited value in the short term (24 months) but of no value in the long term (48 months), whereas a third repeated dilation or urethrotomy is of no value.

Acute radiation cystitis occurs during or soon after radiation treatment. It is usually self-limiting, and is generally managed conservatively. Late radiation cystitis, on the other hand, can develop from 6 months to 20 years after radiation therapy. The main presenting symptom is hematuria, which may vary from mild to severe, life-threatening hemorrhage. Initial management includes intravenous fluid replacement, blood transfusion if indicated and transurethral catheterization with bladder washout and irrigation. Oral or parenteral agents that can be used to control hematuria include conjugated estrogens, pentosan polysulfate or WF10. Cystoscopy with laser fulguration or electrocoagulation of bleeding points is sometimes effective. Injection of botulinum toxin A in the bladder wall may relieve irritative bladder symptoms. Intravesical instillation of aluminum, placental extract, prostaglandins or formalin can also be effective. More-aggressive treatment options include selective embolization or ligation of the internal iliac arteries. Surgical options include urinary diversion by percutaneous nephrostomy or intestinal conduit, with or without cystectomy. Hyperbaric oxygen therapy (HBOT) involves the administration of 100% oxygen at higher than atmospheric pressure. The reported success rate of HBOT for radiation cystitis varies from 60% to 92%. An important multicenter, doubleblind, randomized, sham-controlled trial to evaluate the effectiveness of HBOT for refractory radiation cystitis is currently being conducted.

There is no significant difference in efficacy between dilation and internal urethrotomy as initial treatment for strictures. Both methods become less effective with increasing stricture length. We recommend dilation or internal urethrotomy for strictures shorter than 2 cm., primary urethroplasty for those longer than 4 cm. and a trial of dilation or urethrotomy for those 2 to 4 cm. long.

The role of the gubernaculum during testicular descent was investigated in a study of 119 male pig fetuses obtained at gestational ages ranging from 53 to 116 days. Histologically the gubernaculum was shown to consist of primitive mesenchymal cells with an abundant intercellular material containing glycosaminoglycans (mucopolysaccharides). Rapid descent of the testis through the inguinal canal occurred between 77 and 88 days' gestation, while sustained but slower descent occurred up to 109 days. There was a dramatic increase in the total wet mass of the gubernaculum at the commencement of rapid testicular descent from 77 to 81 days, and a further increase in wet mass during sustained descent from 91 to 95 days. In the period just prior to rapid testicular descent (day 74-81) the percentage increase in the water content of the gubernaculum was larger than the percentage increase in the dry mass. After descent of the testis (day 95-109) there was a decrease in the water content, but also an increase in the dry mass of the gubernaculum. No comparable increase in the water content of umbilical cord or striated muscle tissue occurred during the period of testicular descent. Thus, the marked swelling of the gubernaculum, which dilates the inguinal canal and scrotum and may possibly exert traction on the testis by the force of its expansion, is due largely to an accumulation of water by the gubernaculum. This process may be mediated by the intercellular glycosaminoglycans, since these poly-anionic macromolecules are known to have a large hydrodynamic volume and can act as a "water trap."

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