[Microsurgical varicocele operation: a retrospective statement of Danish results]. / Mikrokirurgisk varicoceleoperation: en retrospektiv opgørelse af danske resultater.

INTRODUCTION: Varicoceles are present in about 15% of the male population. The treatment is surgical and internationally there has been an increase in the use of a subinguinal microsurgical approach in which the veins of the spermatic cord are ligated. The purpose of this paper is to evaluate the results of the first microsurgical varicocelectomies performed in Denmark. MATERIAL AND METHODS: The medical records of boys and men who underwent microsurgical varicocelectomy between 1 February 1999 and 1 June 2007 at Rigshospitalet, Gentofte Hospital and Herlev Hospital, were reviewed. RESULTS: A total of 132 patients were included in the study. Ten recurrences (8%) and ten complications (8%) were found (one lesion of the vas deferens, six haematomas, two hydroceles and one patient with haematoma/infection). Following surgery, two patients underwent orchiectomy due to a lack of blood flow and sustained pain from the scrotum one year after the operation, respectively. When pain was the indication for surgery, resolution of this symptom was seen in 69 of 77 patients (90%). In one patient, the pain increased. After the implementation of a structured surgery schedule and after assigning the procedure to a single surgeon only, the number of recurrences and complications for the last 47 operated patients decreased to 0% and 4%, respectively. CONCLUSION: In trained hands microsurgical varicocelectomy was an effective method with few complications and recurrences.

Urinary calculi following traumatic spinal cord injury.

OBJECTIVE: To investigate the time aspect of the development of renal and bladder calculi in individuals with traumatic spinal cord injury (SCI) and a possible relation between the development of calculi and the bladder-emptying method. MATERIAL AND METHODS: The study comprised a retrospective data collection from medical records and a questionnaire follow-up at least 10 years after the SCI. RESULTS: A total of 236 individuals with SCI (82% male, 18% female; 47% tetraplegic, 53% paraplegic) who were injured between 1956 and 1990 participated in the study and the response rate was 84.6%. The mean age at the time of follow-up was 50.5 years (range 28-84 years). The mean duration from the time of SCI was 24.1 years (range 10-45 years). During follow-up 47 participants (20%) had at least one episode of renal calculi and 32 (14%) had at least one episode of bladder calculi. The risk of first renal and bladder calculus was highest within the first 6 months post-injury. The cumulative proportion of calculi-free participants 45 years post-injury was 62% for renal calculi and 85% for bladder calculi. For participants who did not develop renal calculi within the first 2 years post-injury, the risk of having a renal calculus within the next 43 years was 34%. For bladder calculi the corresponding risk of having a bladder calculus within the next 43 years was 5%. No significant differences were found regarding the bladder-emptying method and either renal or bladder calculi, only a non-significant trend that more participants with bladder calculi used indwelling catheters. Participants with renal or bladder calculi were not statistically significantly different from the remainder of the study group regarding gender, para- or tetraplegia or Frankel classification. CONCLUSIONS: The risk of developing renal and bladder calculi was higher in the SCI population compared to the normal population. Bladder calculi primarily occur early post-injury and renal calculi appear both early post-injury and years later. Therefore, it is important to follow individuals with SCI regularly by means of urological investigations from the time of the injury until death.

Fast-track open transperitoneal nephrectomy.

OBJECTIVE: Hospital stay after open transperitoneal nephrectomy is usually 5-10 days, the limiting factors being pain, ileus, stress-induced organ dysfunction and fatigue. Recent studies have shown that aggressive multimodal rehabilitation may improve recovery and shorten hospitalization after other abdominal procedures. We therefore studied the effect of a multimodal rehabilitation regimen in patients undergoing open transperitoneal nephrectomy. MATERIAL AND METHODS: A total of 25 consecutive patients scheduled for elective transperitoneal nephrectomy were studied after the introduction of a multimodal rehabilitation regimen (continuous epidural analgesia, enforced mobilization and oral nutrition and revision of the transurethral catheterization and drain regimen) and compared with 50 consecutive patients treated before the introduction of this regimen. RESULTS: The multimodal rehabilitation regimen decreased hospital stay from 8 to 4 days (p < 0.001) with mobilization for approximately 6 h on the first postoperative day and 8 h on the second and third days. Use of a drain was shorter with the multimodal regimen (1 vs 4 days; p < 0.001), as was transurethral catheterization (1 vs 5 days; p < 0.001). "Medical" 30-day morbidity was low (6-8%) in both groups. CONCLUSION: Our results suggest that a multimodal rehabilitation regimen with optimized pain relief, enforced mobilization, early oral nutrition and short-term transurethral catheterization and drain placement may reduce hospital stay after open transperitoneal nephrectomy.

Pressure/cross-sectional area relations in the proximal urethra of healthy males: the time dependent pressure response following forced dilation. Part IV: results in healthy volunteers.

The significance of the anatomical location and age on the urethral response to a sudden forced dilation was studied in 30 healthy males aged 23-85 years. The pressure decay after dilation was fitted with a double exponential function of the form: P(t) = P(equ) + P(alpha)e(-t/tau(alpha) + P(beta)e(t/tau(beta) where P(t) is pressure at time t, P(equ) is equilibrium pressure after dilation, P(alpha) and P(beta) are pressure decay, and tau(alpha) and tau(beta) are time constants. The pressure response was highly affected by the location of the measurement, with the maximum values of the pressure components in the high pressure zone and significantly lower values in the prostatic part of the urethra. The variation in pressure thus concurs closely with the density of the striated rhabdosphincter. No significant correlation between age and the pressure components could be demonstrated, whereas the velocity of the pressure decay following dilation proved significantly related to age in all urethral segments. The causal background for this correlation is uncertain, but may be discovered in age dependent changes in the periluminal tissue composition, or in changing neuromuscular activity in these structures.