Obstruction of ureter by abnormal right spermatic vein.

The first reported case of an enlarged right spermatic vein with an atypical course causing hydronephrosis and hydroureter in a twenty-eight-year-old man is presented. Transection of the obstructing spermatic vein improved the hydronephrosis. Causes, symptoms, and treatment of obstruction of the ureter by enlarged gonadal veins are discussed. The similarities between the "ovarian vein syndrome" in the female and this case are pointed out.

[Ectopia of vas deferens with opening into the ureter (author's transl)]. / Ektopie des Ductus deferens mit Einmündung in den ureter.

A 13 years old boy with a 2 year history recurrent rightsided epididymitis was found to have an ectopic orifice of the vas deferens opening into the distal part of the left ureter of a hypoplastic left kidney. Because of possible interference with fertility vasovesiculography was not done. Therefore it could not be identified whether the vas deferens was of right or left sided origin. The genesis of this extremely rare malformation is discussed.

[Transposition of penis and scrotom (author's transl)]. / Transposition von Penis und Skrotum.

A complete transposition of penis and scrotum with cleft of the glans penis and penile hypospadia is described in a 43-year-old man. The embryology of this rare malformation is discussed and the literature reviewed. The surgical correction of the reported case is described.

[Crossed dystopia of the kidney and an ectopic ureteral orifice]. / Gekreuzte Dystopie der Niere und ektope Harnleitermündung.

We report on a case of crossed renal ectopia with fusion and a refluxing single ectopic ureteral orifice in the prostatic urethra in a renal transplant recipient. The diagnosis was made on the basis of a chronic urinary tract infection and a refluxing ectopic ureteral stump. Crossed ectopia with fusion was found intraoperatively. Nephroureterectomy cured the urinary tract infection.

[Seminal duct malformations: clinical picture, diagnosis and therapy]. / Missbildungen der Samenwege: Klinik, Diagnostik und Therapie.

Seminal duct abnormalities occur more often than generally assumed. In most cases, they remain undetected if diagnostic measures are not undertaken because of infertility or recurrent urinary tract infections. An IVP should be performed if aplasia of the vas is detected, since ipsilateral agenesis of the kidney may also be present. In spite of the improved techniques available today, reconstructive surgery on seminal duct abnormalities usually yields poor results.

[Sonographic examination in diseases of the scrotal area (author's transl)]. / Sonographische Untersuchung bei Erkrankungen des Skrotalinhaltes.

Sixty-two patients with diseases of the scrotal area were examined sonographically. In 11 out of 12 testicular tumors, a preoperative diagnosis could be confirmed by examination with ultrasonication, including one case with large accompanying hydrocele, which made an exact palpation of the testicles impossible. Despite the still small number of cases, we feel that ultrasonic examination of the testicles makes it possible to speed up the diagnosis of testicular tumors, which is often drawn out over weeks or months, and to provide the patients with early operative therapy.

[Failure following fertility vasectomy]. / Misserfolge nach Fertilitätsvasektomie.

PIP: Although rare, failure of vasectomy can occur and should be avoided. Incidence of failure is put at 0-3%. Causes of failure are: 1) non-severance of vas deferens, 2) non-observance of period to sperm-free ejaculate after successful vas ligation, 3) recanalization of vas deferens after ligation, and 4) duplication of vas deferens was not recognized. The vas deferens is occasionally confused with neighboring structures especially in a bloody field. Verification of vas deferens resection should be done histologically. Spermatozoa can be found up to several months after successful vas ligation. They originate from seminal vesicle glands and vas deferens. Intraoperative injection of 5 ml. 0.9% aqueous nitrofurantoin solution in the central ductus stump results in inhibition of sperm motility and azoospermia. No coitus without contraceptive protection should be undertaken until proof of azoospermia is established. First spermiogram is done 6-8 weeks after procedure. Spontaneous recanalization may occur depending on vasectomy method. Factors in this process may be proliferation of ductus endothelium, formation of sperm granulomas, and tissue necrosis leading to reattachment of severed ends. Recanalization can be prevented by large resection (3-5 cm), electrocoagulation of stump epithelium or doubling over of ligated stumps. Spermatozoa antibodies develop in 50% of all vasectomized men. They cause permanent sterility even in successful vasectomy reversal. Duplication of testis and vas deferens is rare and an unlikely cause of vasectomy failure. Couples seeking vasectomy should be informed of possible failure and especially of pregnancy possibility without azoospermia.^ieng

Pharmacokinetics of cefamandole in patients with normal and impaired renal function.

The pharmacokinetics of cefamandole, a new cephalosporin, were investigated in 23 patients with urinary tract infections and normal or varying degrees of impairment of renal function. A daily dose of 1.5 to 3.0 g administered intramuscularly was tolerated well and resulted in very high urine concentrations. The pharmacokinetics of the antibiotic were compared with isotopically labeled [(131)I]hippurate and [(125)I]iothalamate, which were used for determination of effective renal plasma flow and glomerular filtration rate, respectively. It was shown that cefamandole was excreted by glomerular filtration as well as by active tubular secretion. Probenecid inhibited the tubular secretion of cefamandole. The serum half-life of cefamandole in patients with normal renal function was approximately 1.5 h and increased in patients along with increasing impairment of renal function. Our studies indicate that a dosage regimen of 1 g of cefamandole every 8 h in patients with normal renal function results in urine concentrations sufficiently high for treatment of most common urinary tract infections. In patients with impaired renal function, the dosage interval should be increased or the dosage lowered according to the serum creatinine values.

Crossed ectopia of seminal vesicles, renal aplasia and ectopic ureter.

A unique case of left ureteral opening into a seminal vesicle, ipsilateral renal hyperplasia and crossed ectopia of the seminal vesicles is reported. This 24-year-old white man underwent a nephroureterectomy for relief of symptoms of lower urinary tract infection. The embryological development of this abnormality is discussed briefly.

[Results with the Marshall-Marchetti bladder neck suspensionplasty in female stress incontinence]. / Ergebnisse mit der Blasenhals-Suspensionsplastik nach Marshall-Marchetti bei der weiblichen Stress-Inkontinenz.

Bladder neck suspension as described by Marshall and Marchetti 1949 is the procedure of first choice for vertical descensus of the urinary bladder. Our experiences with this operation between January 1979 and January 1982 are reported on 23 cases. The procedure was successful in 78% although there were previous operations in 14 out of 23 patients. The rate of complications such as wound-infection, urinary tract infection and ostitis pubis was low. There was no mortality. Treatment failures only occurred in obese women, who gained weight considerably in the postoperative period.

[Significance of postoperative substitution of plasma proteins]. / Uber die Bedeutung der postoperativen Zufuhr von Plasmaproteinen.

In the course of a pilot study 30 patients, who had to undergo extensive urological-abdominal surgery, were randomized and divided into two groups. One group received 500 ml of the stored serum Biseko on the day of operation as well as on the first postoperative day, the other group was given a placebo. The two groups were compared with regard to their complications rates (wound healing disturbance, respiratory disturbance on account of septicemia). It turned out, that there occurred clearly less complications in the group treated with Biseko than in the control group.

Ureteroscopy under local anaesthesia with and without intravenous analgesia.

In a prospective study of 302 ureteroscopic procedures, 161 were commenced and 133 completed without the use of general or regional anaesthesia. In 15 patients ureteroscopy (URS) was performed with lignocaine jelly in the urethra only, and in 118 with additional intravenous analgesia. Alfentanil, a synthetic morphine derivative, was used for intravenous analgesia. Ureteroscopy was performed prior to extracorporeal shock wave lithotripsy in 46 patients, for stone basketing in 40, for stone fragmentation in 29, for diagnostic purposes in 14 and for cold knife ureterotomy in 4. Ureteric lesions were observed in 9 patients (6.8%) treated under intravenous sedoanalgesia. This percentage is within the range reported in other series of patients treated under general anaesthesia. The findings suggest that URS, when performed without general or regional anaesthesia, does not increase the risk of complications or compromise the results of treatment.

Changes in erythropoietin serum levels by extracorporeal shock wave lithotripsy.

Erythropoietin (EPO) serum levels were measured in 30 patients before, during and immediately after shock wave treatment by an enzyme immunoassay. Shock wave treatment was performed in the Dornier lithotripter HM3 under a constant voltage of 18 kV. In 16 out of 30 patients, an increase in the EPO serum level of over 10 U/l more than the value obtained prior to the treatment was observed. Differences ranged from 11 to 50 U/l. In 3 patients EPO serum concentration after shock wave treatment rose above the physiological limit of 54 U/l. Increased EPO serum levels have been observed after applications both under and over 1,000 shock waves. The small number of cases does not allow a statistical correlation between the number of shock waves and the elevation of the EPO serum concentration. Further investigations are necessary to define the circumstances by which an increase in EPO serum level occurs under shock wave treatment.

[Treatment of chlamydial urethro-adnexitis with erythromycin]. / Behandlung von Chlamydien-Urethro-Adnexitiden mit Erythromycin.

Besides mycoplasmas and ureaplasmas chlamydias are able to cause an urethro-adnexitis in men. Jeasts, trichomonas and herpes-viruses are in our patients of less importance. Therapy with erythromycine of chlamydial urethroadnexitis is successful.

[The infrared contact coagulator for hemostasis in the renal parenchyma (author's transl)]. / Blutstillung am Nierenparenchym mit dem Infrarot-Kontakt-Koagulator

Investigations on hemostasis with the infrared contact coagulator (ICC) after renal pole resections in dogs with and without clamping of the renal vessels are reported. Clamping the renal vessels led to less bleeding, but the coagulation time was distinctly prolonged. In addition the use of ICC in renal pole amputations in humans is described in two cases of urogenital tuberculosis. In both cases we were able to stop the bleeding quickly and satisfactorily without clamping the renal vessels. The results of animal experiments and the significance of using the ICC in man are discussed.