Treatment with stromal vascular fraction of Peyronie's disease - a study protocol.

INTRODUCTION: Peyronie´s disease is the result of an acquired fibrotic plaque in the tunica albuginea. It remains unknown why the condition appears, but it seems to affect up to 9% of all men. It can result in a debilitating curvature of the erect penis, which has extensive impact on the quality of life for many men. Thus, the disease may result in low self-esteem, depression and impaired sexual performance. METHODS: This is a prospective pilot study investigating the feasibility and safety of stromal vascular fraction injection into the plaque of 22 men with Peyronie´s disease in the chronic phase. The stromal vascular fraction is obtained from a small liposuction of 250 ml fat in general anaesthesia and injected the same day. CONCLUSION: We hope to show that injection of stromal vascular fraction is safe and effective in reducing curvature in men with Peyronie´s disease. FUNDING: The study was made possible with funding from: the Region of Southern Denmark, Louis-Hansen Fund, Lizzi and Mogens Staal Fund, Karola Jørgensen Fund, Marie and Børge Kroghs Fund, the Senior Doctors Research Fund OUH, the Fund for gentle Surgery OUH and the PhD fund of the executive board of the South West Denmark Hospital. The funding sources had no influence on the trial design, data collection, analysis or publication. CLINICALTRIALS: gov NCT04771442, EudraCT 2020-004297-22, Danish Medicines Agency 2020090057, National Ethics Committee 74705 and Danish Data Protection Agency (record no. 1/21757).

[Diagnosis and treatment of male infertility].

A male factor plays a role in half of infertility cases. The causes are summarised in this review, and they include hormonal disturbances, genetic alterations, testicular disease, obstruction, and ejaculatory dysfunction. Evaluation may reveal a correctable cause or uncover underlying disease. In a few cases of pretesticular infertility, medical treatment may have effect, and in cases of obstruction or varicoceles, surgical treatment may correct the problem. In cases with ejaculatory dysfunction, assisted ejaculation often produce viable sperm. Sperm for assisted reproduction may also be obtained by aspiration or surgery.

[Varicocele testis].

In this review, we discuss varicocele testis, which is found in 15% of men from the general population, but more frequently in infertile populations. It can cause physical symptoms or impaired fertility. Varicocele severity is graded 1-3 by clinical examination, and increasing grade is associated with poorer semen quality. Treatment effect on symptoms and fertility has been documented. A microsurgical approach seems to have the best outcome in terms of lowest frequency of recurrence and complication. Treatment of this common condition is recommended only in patients with symptoms or evidence of affected testicular function.

[Organic erectile dysfunction].

This review covers the possible treatment modalities of organic erectile dysfunction (ED). About 30% of men over 40 years of age suffer from ED. At diagnosis, organic ED should be distinguished from psychological ED, and it is crucial to identify underlying diseases including endocrine disorders, neurological problems and cardiovascular diseaplase. Management of organic ED is initiated by treating such underlying problems, and lifestyle changes are central. Symptomatic treatments include tablets, injections, intraurethral medication, vacuum pumps, and penile implants. Current research focuses on regenerative medicine, which may play a future role.

Initial experience with hand-assisted laparoscopic donor nephrectomy: a single-centre experience over 5 years.

OBJECTIVE: The objective of this study was to evaluate outcome after hand-assisted live donor nephrectomy with a retroperitoneal approach during a 5 year period. MATERIALS AND METHODS: All donor nephrectomies at Odense University Hospital, Denmark, from January 2008 to December 2012 were identified retrospectively, and the medical records were examined. RESULTS: In total, 108 patients were enrolled: 68 females, with a median age of 50 years (range 24-68 years), and 40 males, with a median age of 51 years (32-70 years). The median body mass index (BMI) was 25 kg/m² (19-33 kg/m²) in females and 27 kg/m² (21-38 kg/m²) in males. The median intraoperative bleeding was 175 ml. The median warm ischaemia time was 3.2 min (1.5-6.7 min). The median operative time was 230 min (161-360 min). The median hospital stay was 4 days (2-10 days). Thirty donors (28%) had 34 early complications. Six donors (6%) needed reoperation. Late complications were seen in seven (7%). Sixteen donors (15%) were obese (BMI ≥30 kg/m²), which was associated with significant complications (p < .0001). There was a significantly higher complication rate in donors who were smokers and ingested alcohol above the Danish recommended limits (p < .0001). Fifteen donors (13%) developed hypertension postoperatively within the first year. There was no mortality. A total of 104 (96%) of the recipients had a functional transplant after 1 year. CONCLUSION: Hand-assisted donor nephrectomy is a safe procedure. Potential candidates should be advised to stop smoking and to avoid alcohol before surgery, especially those with a BMI of 30 kg/m² or higher.

[Fistula as cause of cyclic haematuria in a woman].

We report a case of a 32-year-old female with a vesicouterine fistula (Youssef's syndrome). She had had a low segment caesarean section and subsequently developed cyclic haematuria and menorrhoea. There was a significant delay in diagnosis of the fistula because of problems with visualising the fistula. In this case the fistula was lastly diagnosed with magnetic resonance imaging (MRI), the patient was treated with hysterectomy (patient's wish) and the fistula tract was repaired succesfully. If investigation with ultrasonography, cystoscopy and computerised tomography at a highly specialised department is negative, we recommend that MRI should be performed.

[Are ice-skating ramps dangerous?]. / Er ramper på isskøjtebaner farlige?

INTRODUCTION: Before the new temporary ice rink in Esbjerg was built, opponents feared that it would disproportionately increase the number of traumas needing medical care at the hospital. The reason for this concern was that it was built with ramps. MATERIAL AND METHODS: During the winter of 2004 an estimated 30,000 people visited the two ice rinks in Esbjerg. The temporary rink had ramps, whereas the permanent rink had no ramps. A total of 104 persons were injured and needed treatment at the emergency room of orthopaedic surgery. They all received a questionnaire in order to obtain information about a) whether the accident took place on one or the other ice rink, and b) how frequently safety equipment was used. RESULTS: The answers from the questionnaire were used along with information obtained from the emergency room journals. We wanted to establish if accidents on the temporary ice rink were more serious or if the proportion of injuries was higher compared to accidents on the permanent ice rink. DISCUSSION: There was no significant difference in the number of injuries or in the severity of the traumas resulting from skating on the temporary ice rink compared with the permanent rink. Only 4% used safety equipment. CONCLUSION: Having ramps on the ice rink produced no significant increase in the proportion of injuries, nor did it produce more severe traumas. Safety equipment protecting hand and wrist would probably decrease the number of soft tissue injuries presented at hospital.