Percutaneous biopsy of retroperitoneal lymph nodes. A multicentric study.

Percutaneous transperitoneal biopsy of retroperitoneal lymph nodes is a fast and well tolerated procedure to improve the diagnosis of metastasis for staging primary tumours and general lymphatic disease. In 303 patients examined by lymphography and biopsy, cytology disclosed metastases in almost twice as many patients as lymphography alone. By combining both examinations, staging operations can be omitted in many patients.

[Laser therapy of penile carcinoma]. / Lasertherapie des Peniskarzinoms.

The conventional treatment for superficial penile cancer is amputation of the penis. In contrast, the use of the neodymium-YAG laser yields better survival rates without mutilation. In a long-term follow-up (7 years) we found a survival rate of 95%. There may be an additional advantage in combined use of the laser in the treatment of advanced cases of penile cancer. We conclude that the neodymium-YAG laser should be used as first-line therapy.

[Interstitial laser coagulation of benign prostatic hyperplasia]. / Die interstitielle Laserkoagulation der benignen Prostatahyperplasie.

We report on the new method of interstitial laser coagulation for the treatment of benign prostatic hyperplasia (BPH). The procedure is based on the interstitial application of Nd:YAG laser irradiation, delivered through a new light guide system. Such light applicators coagulate constant tissue volumes in a homogeneous manner, as proven by in vitro studies in different tissues, including surgically removed prostate adenoma. The extent of the coagulation is determined by laser power and irradiation time. At 5 W, for example, and during a 10-min period, this zone reached a diameter of up to 20 mm. Temperatures generated in the process were over 100 degrees C, as measured by time/space resolution. These results were confirmed by in vivo studies in canine prostates. In the course of 7 weeks, the coagulated areas formed scars with degeneration and fibrosis, accompanied by marked shrinking. Neighbouring organs were not affected. The method was successfully transferred to clinical practice. The application of the light guides to the lateral lobes was performed percutaneously from the perineum under transrectal ultrasound guidance. The median lobe was punctured transurethrally under direct vision. Twenty-seven patients with an average age of 67.7 years were treated between July 1991 and March 1992. At the time of evaluation 15 patients had a follow-up of more than 2 months. They experienced a mean increase of peak flow rate from 6.6 to 15.2 ml/s and a mean decrease of residual volume from 206 to 38 ml. This was accompanied by a marked lessening of symptoms. The average prostate weight decreased from 63 to 44 g. Sexually active patients did not experience retrograde ejaculation.(ABSTRACT TRUNCATED AT 250 WORDS)

[European Association of Urology guidelines on urinary and male genital tract infections]. / Synoptische Leitlinie der sexuell übertragbaren Erkrankungen (STD) mit Primärsymptomen im männlichen Genitale (S1). Leitinien der Deutschen Gesellschaft für Urologie.

Today, the classical bacteria that cause venereal diseases, e.g. gonorrhea, syphilis, chancroid and inguinal granuloma, only account for a small proportion of all known sexually transmitted diseases (STDs). Other bacteria and viruses as well as yeasts, protozoa and epizoa must also be regarded as causative organisms of STD. Taken together, all sexually transmitted infections comprise more than 30 relevant STD pathogens. However, not all pathogens that can be sexually transmitted manifest diseases in the genitals and not all infections of the genitals are exclusively sexually transmitted. Concise information and tables summarising the diagnostic and therapeutic management of STDs in the field of urology allow a synoptic overview, and are in agreement with the recent international guidelines of other specialist areas. Special considerations (i.e. HIV infection, pregnancy, infants, allergy) and recommended regimens are presented.

[Sarcoidosis of the spermatic cord and epididymus]. / Sarkoidose des Samenstrangs und des Nebenhodens.

INTRODUCTION: Sarcoidosis (Boeck's disease) is of unknown etiology with an incidence of 10 - 40/10(5) people. In 75% of the cases, pulmonary manifestations are found, with histological findings of noncaseating epithelial granulomas. Bilateral enlargement of the hilus lymph nodes are common and divided into three grades of enlargement. The initial symptoms are cough, fever and dyspnea. CASE REPORT: We report a man, 43 years old, first admitted to our hospital in 1988 with a tumor at the right spermatic-cord. Histological examination revealed a granulomatous inflammation, fitting to sarcoidosis, which was verified in the same year by mediastinoscopy. Partial resection of the left epididymal testis was performed in 2001 due to marked rigidity and histological fibrosis. CONCLUSIONS: Urological manifestation of Boeck's disease is rare. Approximately 30 cases have been described in literature with various urological associations. In most cases, urological sarcoidosis is found accidentally during examination of the most common form, pulmonary sarcoidosis.

Value of the neodymium-YAG laser in the therapy of penile carcinoma.

Mutilation with associated functional losses characterizes current therapy of penile carcinoma. In addition, the recurrence rate is extremely high. Treatment with the neodymium-YAG laser provides a new therapy concept for T1 and T2 tumors, namely devitalization of all tumor cells with minimal tissue ablation. Following excision of the actual tumor, the base and margins of the excision are subjected to deep thermal denaturation without tissue removal. Over a mean observation period of 5 years, no local recurrence was found in 17 patients treated with this technique; only 1 patient died of metastases that remained undetected during primary staging.

[Experience with percutaneous embolization of renal tumours (author's transl)]. / Erfahrungen mit der perkutanen Ebolisation von Nierentumoren

We have repeated first observations of various authors of blocking angiography in 8 patients with renal tumours. Comparing angiographic findings and the surgical specimens, the success of embolization could be assessed. Control angiography 2 months following an inoperable renal tumor showed shrinking of the tumour by about one half and improvement of the general condition of the patient.

Prevention of anaphylactoid reactions after radiographic contrast media infusion by combined histamine H1- and H2-receptor antagonists: results of a prospective controlled trial.

In a prospective randomized trial, 800 patients undergoing intravenous urography were pretreated with either intravenous prednisolone (group I), the H1-antagonist clemastine (group II), a combination of clemastine and the H2-antagonist cimetidine (group III) or 0.9% saline (group IV). There was an overall incidence of 18 - 19% side reactions, when subjective and objective symptoms were regarded together. There was no significant difference between the four groups in the total incidence. The same applies when considering subjective side effects including the symptom 'heat sensation' that occurred in 10 - 12% of all patients. However, when side effects excluding the symptom 'heat sensation' were regarded and the individual groups were compared, there was a significant difference in frequency between the control group (12%) and the combined H1/H2 group (6%). Prednisolone and clemastine did not produce a significant reduction of side effects. The combined application of histamine H1- and H2-antagonists might be useful in prophylaxis of radiographic contrast media-induced adverse reactions.

[CT and lymphography correlations in the evaluation of patients with testicular tumours (author's transl)]. / Lymphknotenmetastasen maligner Hodentumoren in Lymphographie und Computertomographie--eine vergleichende Studie.

27 patients with testicular tumours were examined by lymphography and computerized tomography for evaluation of metastatic spread in the retroperitoneal lymphnodes. A good correlation of results was found in 23 patients. In 4 cases lymphography failed to show metastatic disease, which was easily recognized by CT. In account of the lymphatic spread pathways of testicular tumours leading mainly to the lymphnodes close to the kidney pedicle CT appears to be method of choice in the staging of these patients, as the lymphnodes in this area are often not demonstrated by lymphography. Computerized tomography allows the exact localisation and extension of neoplastic lymphnodes and at the same time a good evaluation of the surrounding organs.

Regulated high frequency diathermy for bipolar electrocoagulation--a new method for the treatment of carcinoma of the bladder.

In the endoscopic treatment of bladder cancer, especially for stages beyond T2, transurethral resection does not seem to be sufficient. The risk of bladder wall perforation, the possibility of incomplete resection, seeding of tumor cells and high recurrence rates support the former statement [6]. Results of a multicentre prospective randomised study have exemplified that irradiation with the Neodymium-YAG Laser has been a reasonable alternative in the therapeutic approach to bladder cancer [2]. Diathermy coagulation must produce a sufficiently deep, homogeneous and well demarcated tissue necrosis. The coagulation depth has to be adjustable and heat production during coagulation should not lead to bladder wall perforation and consequent damage to the bowel. These criteria were investigated using regulated bipolar high frequency diathermy. The innovation in this method is, that thermal side effects on the tissue, e.g. vaporisation and carbonisation are prevented by a protective relay with constant current flow. Animal experimental studies have shown that this method meets all postulated requirements and therefore clinical trials can proceed.