Urodynamic outcome of waterjet-assisted total mesorectal excision.

BACKGROUND: Waterjet dissection has been proposed for total mesorectal excision. The present study investigated its impact on urodynamic function and oncological outcome. METHODS: Thirty patients with rectal cancer were recruited to this prospective study, of whom 25 underwent urodynamic evaluation both before and after surgery. RESULTS: All patients were capable of spontaneous micturition at a median of 5 months after surgery. Urodynamic measurements revealed a decrease in detrusor pressure of more than 30 mmHg, and residual urine volumes of between 100 and 200 ml, in three patients. No patient had a complete neurogenic voiding disorder. Local recurrences developed in two of 22 patients. CONCLUSION: The extent of micturition disorders observed after total mesorectal excision using the waterjet method in this small series is encouraging.

Effects of promoters on DNA synthesis in C3H/10T1/2 mouse fibroblasts.

The synthesis of DNA has been studied by autoradiography and by measurements of tritiated thymidine ([3H]TdR) incorporation in cultured C3H/10T1/2 mouse embryo fibroblasts. The cells were first treated with 3-methylcholanthrene as an initiator and then with promoters according to schedules that produce oncogenic transformation. The levels of 3-methylcholanthrene used did not affect the growth or [3H]TdR incorporation of the cells. Treatment during the log phase of growth with 12-O-tetradecanoyl-phorbol-13-acetate, phorbol didecanoate, or 4alpha-phorbol didecanoate produced a transient inhibition of [3H]TdR incorporation with the maximum at 12 hr after treatment. This resulted in a temporary delay of growth followed by recovery of the normal cell-doubling time. Phorbol did not produce these effects, suggesting that the inhibition of DNA synthesis is associated with the process of promotion. Although treatment of the cells with 12-O-tetradecanoyl-phorbol-13-acetate during stationary phase resulted in a 2- to 3-fold stimulation of [3H]TdR incorporation, multiple treatments spanning log and stationary phases were found to be necessary for promotion.

Sacral electrical neuromodulation as an alternative treatment option for lower urinary tract dysfunction.

Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives.

Prognostic value of p27Kip1 and p21WAF/Cip protein expression in muscle invasive bladder cancer.

Two genes, namely p27Kip1 and p21WAF/Cip1 that reveal distinct structural homology, have been identified as inductors of cell cycle arrest at the G1-checkpoint to prevent entry of somatic cells into the S phase of the cell cycle when substantial DNA damage has occurred. It was demonstrated that the p21WAF/Cip1 gene is induced by pathways dependent and independent from a functionally intact p53 tumour suppressor protein. It has been suggested that decreased expression both of the p21WAF/Cip1 and p27Kip1 protein may contribute to the development of human malignancies due to loss of critical antiproliferative mechanisms. So far, the role of altered p21WAF/Cip1 and mainly of a decreased p27Kip1 protein expression in patients with muscle invasive bladder cancer has not been investigated. In the present study, 50 tumour specimens from 50 patients undergoing radical cystectomy (T2-T4) were investigated for different biological and clinical characteristics as possible prognostic factors: age, depth of tumour infiltration (T-stage), histological grading (G), lymph node status as well as immunohistochemical staining for the p21WAF/Cip1 and p27Kip1 proteins. The median recurrence-free survival for patients with and without retained p21WAF/Cip1 protein expression was 54 months (3-86 months) and 13 months (1-40 months), respectively (p=0.07). During univariate analysis, loss of p21WAF/Cip1 protein expression (p=0.02), T-stage (p=0.02) and histological grading (p=0.03) were significant prognostic factors for survival, among which a negative reaction for the p21WAF/Cip1 protein (p=0.02) as well as T-stage (p=0.005) remained independent significant predictors during multivariate analysis. Loss of p27Kip1 protein expression was not correlated with the recurrence-free or the overall survival of the patients. Prospective studies are needed to confirm the independent prognostic potential of cell-cycle associated proteins such as p21WAF/Cip1 in patients with muscle invasive bladder cancer. The availability of more refined prognostic factors should assist decision making regarding the value of more aggressive treatment options, such as adjuvant or neoadjuvant chemotherapy, for defined subgroups of patients.

Symptomatic sulfadiazine crystalluria in AIDS patients: a report of two cases.

As the incidence of toxoplasma encephalitis (TE) in AIDS patients increases, sulfadiazine/pyrimethamine combination therapy is broadly administered. Two cases of acute and chronic renal sulfadiazine crystallization with acute renal failure and nephrolithiasis are reported. Controlled alkalinization of the urine and high fluid intake are recommended for prophylaxis of crystalluria.

[Selective embolization of the internal iliac artery in life-threatening hemorrhaging prostatic cancer]. / Selektive Embolisation der Arteria iliaca interna bei lebensbedrohlich blutendem Prostatakarzinom.

The catheter embolization of the a. iliaca interna is a quick, little straining and effective method in order to control bleedings threatening life in the region of the organs of the small pelvis. It is superior to surgical ligature because of the better result and the less straining intervention. With the illustration of a case report the method will be demonstrated again and indications and complications will be discussed.

[Percutaneous sclerotherapy as primary treatment of testicular insufficiency in idiopathic varicocele]. / Die perkutane Sklerotherapie zur primären Behandlung der Testikularisinsuffizienz bei idiopathischer Varikozele.

Among 1217 percutaneous retrograde phlebographies of the left renal/testicular vein 1069 were performed for primary treatment of left-sided idiopathic varicocele. In 989 of these patients (92.5%) an insufficient testicular (internal spermatic) vein with reflux to the pampiniform plexus could be shown phlebographically, in 802 cases percutaneous sclerotherapy could be performed. This amounts 75.0% of patients with varicocele or 81.1% of the cases with a phlebographically proven testicular vein insufficiency. In this group percutaneous sclerotherapy has proven to be a safe and effective treatment of idiopathic varicocele on an outpatient basis and has replaced surgical ligation as method of choice. However, with anatomical and technical obstacles to sclerotherapy, especially in patients with varicocele but without phlebographic evidence of an insufficient testicular vein, surgery remains an essential means of therapy.

[Prolapsed ureterocele--a case report]. / Prolabierte Ureterozele--Eine Falldarstellung.

A case of a 24-year old female patient with prolabated ureterocele and duplex kidney on the left side is demonstrated. The ureterocele was resected transvesically and the duplex ureters were reimplanted into the bladder by the Politano-Leadbetter technique. Nine months later the excretory urography showed normal kidney function on both sides. Symptoms, diagnostic investigations and therapy of ureteroceles are discussed.

[Effectiveness and safety of cavernous body auto-injection therapy with papaverine/phentolamine. Study group]. / Effektivität und Sicherheit der Schwellkörper-Autoinjektionstherapie mit Papaverin/Phentolamin. Studiengruppe.

A multicenter long-term study at 13 urologic clinics in Germany and Austria tested the efficacy and safety of a papaverine (15 mg/ml) and phentolamine (0.5 mg/ml) mixture (ANDROSKAT) in achievement of pharmacologically aided erection. The study population of 157 men with chronic erectile dysfunction received a total of 559 injections administered by physicians, to establish the individual minimal dose of the mixture needed by each patient for a rigid erection. Rigidity sufficient for intercourse was achieved by 94% of these men. In the second phase of the study, 92 men administered a total of 4717 self-injections (mean 51.2, SD 7.7), with an average follow-up of 14 months. The mean therapeutic dose was 1.02 ml (SD 0.72). The latency time to full erection averaged 10.3 min (SD 5.5). The average duration of the erection induced was 67.1 min (SD 40.8, min. 11.2, max. 236). Sexual intercourse, orgasm and ejaculation were reported following 90%, 88% and 86%, respectively, of all injections. In the initial diagnostic phase, prolonged erections were seen in 13 patients (3%) and minor bruises at the injection site in 12 men. Side effects of self-injection during home therapy were pain (1.2%), haematoma (2.6%) and prolonged erection (0.9%). We conclude that self-injection with a combination of papaverine and phentolamine is an efficient and safe long-term treatment for erectile dysfunction.

[Urinary retention without subvesical obstruction. Differential diagnostic considerations]. / Harnretention ohne subvesikale Obstruktion. Differentialdiagnostische Uberlegungen.

Acute urinary retention without subvesical obstruction is associated with neurogenic or nonneurogenic disorders of bladder function. Urodynamic investigations differentiates sensoric and/or motoric disturbances of the micturation. Neurologic and laboratory examinations are necessary to clear the etiology. Symptomatic urological treatment and specific etiological therapy should be used to manage this entity.

[Segmental unilateral priapism--a case report]. / Segmentaler, unilateraler Priapismus--ein Fallbericht.

A case of segmental priapism in a 24-year-old man with congenital spherocytosis is presented. Preoperative cavernosography and computer tomography clearly revealed thrombosis of the left proximal corpus cavernosum. Because the lesion had already been in existence for 5 weeks irrigation to flush out the thrombosis was no longer possible.

[Spongious autoinjection therapy following implantation of a penis prosthesis--case report]. / Spongiöse Autoinjektionstherapie nach Penisprothesenimplantationeine Fallbeschreibung.

Due to relative shortness of his penis a 67-year-old patient suffering from erectile dysfunction could not perform sexual intercourse, despite the implantation of a penile prosthesis. After intraspongious injection of 3 ml of a vasoactive substance mixture (papaverine 15 mg/ml and phentolamine 0,5 mg/ml) an increase in glandular circumference of 1.5 cm and in penile length of 1.8 cm took place, lasting for 1 1/2 h. By this means the patient regained the ability of a normal sexual life.

[Diagnosis of enuresis--results of urodynamic studies]. / Diagnostik der Enuresis--urodynamische Untersuchungsergebnisse.

The results of clinical evaluation of 71 patients with primary or secondary enuresis are presented. In 66 patients a complete urodynamic assessment was possible. 35 percent of these patients showed a normal urodynamic pattern, in 45 percent detrusor hyperreflexia and in 18 percent a combination of detrusor hyperreflexia and a functional infravesical obstruction was demonstrated.

[Vasectomy: minor intervention--grave sequelae]. / Vasektomie: Kleiner Eingriff--grosse Folgen.

Claims for compensation following dissatisfaction with the results of medical treatment have increased in frequency over the last few years. Medical records, such as declarations of consent and operation reports, often constitute important evidence in legal proceedings, particularly in the field of surgery. Before a vasectomy is performed for the purpose of contraception, detailed information must be given on how safe this is as a method of birth control and the patient must be made aware of the importance of sperm count controls after the operation. The surgeon is held responsible if it can be shown that a failed sterilization is due to ligation of only one vas deferens or to failure to notice an accessory one. Claims for compensation can include support for children up to the age of 18 years and financial compensation to the mother in respect of the labour pains.

[Testicular and epididymal metastasis of prostate cancer]. / Hoden- und Nebenhodenmetastase eines Prostatakarzinoms.

Metastatic testicular carcinoma is unusual. A case of carcinoma of the prostate with metastases to the testis and epididymis is reported. Routes of metastatic spread of neoplasm to the testis are discussed. Easily removable cancer may remain in the scrotum when using the socalled subcapsular orchiectomy without complete removal of the scrotal contents.

[Penile revascularization surgery in vascular impotence]. / Penile Revaskularisationschirurgie bei vaskulärer Impotenz.

The application of objective diagnostic methods to patients complaining of erectile dysfunctions has proved that 30 to 40% are based on pathologic changes of the penile vascular system. The most important diagnostic procedures (NPT, Doppler, BCR-latency time, dynamic cavernosography with simultaneous passive erection, penile angiography) are emphasized and possible pitfalls with reference to misinterpretation of the diagnostic findings are discussed. Technique and results of current revascularization procedures (epigastricopenile anastomosis, revascularization of cavernous and dorsal arteries using vein grafts, deep dorsal vein arterialization) are discussed and first own experiences with aforementioned techniques presented.

[Selective embolization of the internal iliac artery: last resort in inoperable hemorrhaging prostatic cancer]. / Selektive Embolisation der Arteriae iliacae internae: Ultima ratio bei blutendem inoperablem Prostatakarzinom.

A case of profuse hemorrhage from prostatic carcinoma infiltrating the urinary bladder is presented. Angiography was performed to identify the vascular supply. Selective embolization of the internal iliac arteries is described, potential complications are discussed.

[Ureteral stump metastasis of a hypernephroma. A case report]. / Ureterstumpfmetastase eines Hypernephroms. Ein kasuistischer Beitrag.

Ureteral stump metastasis after tumor nephrectomy is very rare. To date 43 cases have been published. In our patient this type of metastasis was diagnosed 2 years after nephrectomy for renal adenocarcinoma with prominent rhabdomyosarcomatoid components. The pathogenesis of ureteral stump metastasis is discussed.

[Metastatic adult teratoma of the testis. Possibilities of chemotherapy and surgical treatment]. / Das metastasierte adulte Teratom des Hodens. Möglichkeiten der chemotherapeutischen und operativen Behandlung.

We report on a patient with the diagnosis of an adult teratoma metastasizing as choriocarcinoma. The 49-year-old man died of dysfunction of the liver caused by massive metastatic involvement. This case demonstrates the malignant potential of adult teratoma and emphasizes the need for chemotherapy of the same kind as for other malignant germ cell tumours if undifferentiated metastases of the teratoma are present. The chemotherapeutic modalities and the options for surgical treatment of metastatic adult teratomas of the testis are discussed.

[Metaraminol--an antidote in corpus cavernosum autoinjection therapy-induced prolonged erection]. / Metaraminol--ein Antidot bei SKAT-bedingter prolongierter Erektion.

Up to now 65 patients with erectile dysfunction were treated by means of corpus cavernosum-autoinjection-therapy (CAT). The only side effect observed were 6 prolonged erections, which could successfully be treated in 3 cases by puncture and aspiration of the corpora cavernosa. In another 3 cases prolonged erection subsided after an intracavernous injection of 2 mg metaraminol. Erection induced by CAT was immediately interrupted by metaraminol in 10 other patients.