Testicular blood flow, vascular permeability, and testosterone production after stimulation of unilaterally cryptorchid adult rats with human chorionic gonadotropin.

Testicular blood flow, testosterone production, and the formation of testicular interstitial fluid (IF) were studied in unilaterally cryptorchid rats, basally, 8 h and 24 h after treatment with 200 IU human CG (hCG). Testicular blood flow was lower in the abdominal testis in both control rats and hCG-treated rats than in the scrotal testis within the same treatment group. The scrotal testicular blood flow increased significantly 24 h after hCG treatment, but not after 8 h. In the abdominal testis, there was a significant increase of blood flow 8 h after hCG, but not 24 h after. The formation of IF was subnormal in the abdominal testes of control rats, but this was corrected in hCG-treated rats, where there was a significant increase of IF in both abdominal and scrotal testes. The total endothelial surface of small blood vessels was decreased in abdominal testes. Testosterone concentration in the spermatic vein was significantly lower on the abdominal side than on the scrotal side in both control and hCG-treated rats. The concentration of testosterone was lower in IF on the abdominal side in control rats, but after hCG the testosterone concentration was similar in both scrotal and abdominal testes, indicating a trapping of testosterone in the abdominal testis. The outflow of testosterone in the spermatic vein was significantly increased at both 8 and 24 h after hCG from both the scrotal and abdominal testes, although it was always smaller from the abdominal testis. The lower secretion of testosterone from the abdominal testis after hCG was mainly due to reduced blood flow and not to any disability of the Leydig cells of abdominal testes to produce testosterone.

Risk-adapted treatment of clinical stage 1 non-seminoma testis cancer.

250 patients with clinical stage 1 non-seminomatous germ cell tumours of the testis (NSGCT 1) were included into a prospective multicentre protocol during 1990-1994 and treated according to three risk strata: patients without tumour cell invasion of vascular structures in the testis (VASC-) and elevated serum AFP levels (AFP+) at orchiectomy were considered low risk (LR) and only observed closely. VASC- and AFP- or VASC+ and AFP+ patients were presumed intermediate risk (IR) and pathologically staged (PS) by retroperitoneal lymph node dissection (RPLND). VASC+ and AFP-patients were regarded as high risk (HR) and received adjuvant chemotherapy (PEB x 3). At a median observation time of 40 (7-68) months, all patients were alive and without evidence of active germ cell cancer. The actuarial relapse rate in the 106 LR patients was 22%, and 70% (14/20) had elevated serum tumour markers at relapse. One of 32 (3%) HR patients relapsed with a resectable retroperitoneal mature teratoma despite adjuvant chemotherapy. Only 14% of the 99 IR patients who underwent RPLND had PS2 disease, and the actuarial relapse rate in 85 PS1 patients was 18%. This multicentre study demonstrated that excellent therapeutic outcome is possible when 18 comparatively small urological and oncological centres follow a strict and formal cancer care programme. The useful prognostic effect of VASC was once again verified. Pathological staging by RPLND in NSGCT1 is, in our opinion, not necessary, with presumed low-risk patients offered surveillance and high-risk patients offered adjuvant chemotherapy.

The acute effect of oestrogens on testosterone production appears not to be mediated by testicular oestrogen receptors.

Scatchard binding analysis was performed to measure the cytoplasmic oestrogen receptor in the testis of rats. After treatment of rats with the antioestrogen tamoxifen no oestrogen receptor binding was found in testicular low speed supernatant between 12 and 96 h after treatment. Such tamoxifen-treated rats were used to study the acute effect of oestrogens on testosterone secretion, both in vivo and in vitro. Injection of oestradiol benzoate (50 microgram, 24 h prior to experiment) resulted in a significant depression of basal and LH-stimulated plasma testosterone levels in control rats and this effect was unchanged in tamoxifen-pretreated rats. In vitro, oestradiol-17 beta also inhibited the LH-induced rise in testosterone secretion by isolated testicular interstitial cells. This inhibition was not affected if the rats had been pretreated with tamoxifen. These results indicate that the inhibitory effects of exogenous oestrogens on testicular testosterone production are probably not mediated by the oestrogen receptor.

Thanatogen expression during involution of the rat ventral prostate after castration.

After castration the rat ventral prostate undergoes regression. This process occurs due to the induction of apoptosis, or active cell death, in the epithelial cells of the gland. Several genes, including TRPM-2, (testosterone repressed prostate message), RVP.1, fos, and myc, have been shown to be induced in the prostate during this process. We have investigated the expression of several other genes that may be associated with apoptosis, including tissue transglutaminase (TGase), poly(ADP)ribose polymerase (PARP), and heat shock protein 27 (Hsp27). Northern hybridization has been used to determine the steady-state mRNA levels of these genes in the ventral prostate after castration, and the time course of induction has been compared to the changes in the steady-state levels of prostate steroid binding protein (PSBP), alpha-tubulin, and TRPM-2 mRNAs. The results show that the mRNAs for PARP, transglutaminase, and Hsp27, in addition to TRPM-2, are induced by androgen ablation in the rat ventral prostate and reach maximum levels between days 3 and 4 after castration. Using in situ hybridization we have established that these genes are expressed in the epithelial cells of the prostate that are known to undergo active cell death; this result suggests that their gene products may be required in the dying cells to ensure that the biochemical and morphological processes of apoptosis are completed appropriately.

Survival after radical treatment for transitional cell carcinoma of the bladder.

AIMS: To investigate survival after radical treatment for transitional cell carcinomas of the bladder. METHODS: This retrospective study included 135 patients with transitional cell carcinoma of the bladder undergoing radical cystectomy or radiotherapy at Haukeland Hospital, Bergen, Norway, during the period 1981-1986. Forty-five patients had cystectomy and 90 underwent external high-dose radiotherapy. RESULTS: The overall 5- and 10-year survival rates were 39 and 23%, respectively. After cystectomy 10-year overall survival rates for superficial and muscle-infiltrating tumours were 67 and 26%; after radiotherapy, the corresponding survival rates for superficial and muscle-infiltrating tumours were 26 and 5%, respectively. CONCLUSIONS: Long-term survival and cure can be achieved after cystectomy in many patients with aggressive superficial or muscle-infiltrating bladder carcinoma. The introduction of orthotopic neobladder reconstruction should encourage the use of cystectomy in patients with aggressive superficial tumour.

Low-frequency mutation of Ha-ras and Ki-ras oncogenes in transitional cell carcinoma of the bladder.

UNLABELLED: BACKGROUND, PATIENTS AND METHODS: The objective was to study the frequency of mutations of Ha-ras and Ki-ras oncogenes in bladder tumours. Transitional cell tumours of the bladder from 55 patients were subjected to analyses of Ha-ras and Ki-ras oncogenes using a variety of techniques including sequencing to detect mutations. RESULTS: Two tumours (4%) exhibited mutation of the Ki-ras oncogene, both tumours were fast growing and invasive. We did not detect Ha-ras mutation in any of the samples. Nineteen tumours (35%) with established invasion of the detrusor muscle, did not reveal any mutation. CONCLUSION: Analyses of ras oncogenes seem to be of limited value for the biological assessment of transitional cell carcinomas.

Shock wave lithotripsy of urinary calculi with Lithocut C-3000 in a small center.

We report clinical results with the Lithocut C-3000 shock wave lithotriptor used in treatment of kidney and ureteral stones. The Lithocut C-3000 is a low-cost device. There is no need for anaesthesia. The overall success rate after 3 months was 64% in 143 treatment sessions of 120 stones. For small stones (diameter < 10 mm), the success rate was 69% and for stones with a diameter > or = 10 mm, success was achieved in 60%. The treatment-associated morbidity was low. The Lithocut C-3000 device appears to be safe and effective, suitable for small centers.

Effects of ethinyl oestradiol/polyoestradiol phosphate and estramustine phosphate on some proteins related to haemostasis in prostatic carcinoma patients.

Twenty-four previously untreated patients with carcinoma of the prostate were prospectively randomized to one of the following treatments: (1) ethinyl oestradiol combined with polyoestradiol phosphate (EE/EP); (2) estramustine phosphate (EM); (3) bilateral orchiectomy. The effects on some plasma proteins related to haemostasis were studied by measuring the concentrations of alpha-1-antitrypsin, orosomucoid, haptoglobin, antithrombin III, C1-inhibitor and von Willebrand's factor before and 3 months after the start of treatment. Orchiectomy induced a reduction of alpha-1-antitrypsin and haptoglobin, while the other studied proteins were unaffected. It was found that both EE/EP and EM treatment induced significant decreases of orosomucoid, haptoglobin, antithrombin III and C1-inhibitor, while the same treatment increased the plasma concentration of alpha-1-antitrypsin. None of these treatments showed any influence on the plasma concentration of the von Willebrand factor. No differences were observed between EE/EP and EM for any of the studied proteins, suggesting comparable oestrogenic effects of these forms of treatment in patients with prostatic carcinoma. The findings are discussed in relation to the proposed difference in thromboembolic complications between EE/EP and EM treatments of prostatic carcinoma patients.

Interstitial laser coagulation and transurethral needle ablation in the management of lower urinary tract symptoms due to benign prostatic obstruction.

Interstitial laser coagulation and transurethral needle ablation, two different techniques for heat-treatment of symptomatic benign prostatic hyperplasia, are outlined. Both treatments have been performed in sedoanalgesia. The results of this research and data from the literature show that both treatment modalities have a marked effect on symptoms. Objective parameters, such as uroflow, are moderately changed postoperatively. The side-effect profiles appear favourable, especially with respect to bleeding per- and post-operatively. However, further long-term data is required.

On the effects of oestrogen in the male. Some effects of different oestrogenic substances in rats and men with prostatic carcinoma.

In vitro incubations of human testicular tissue responded to human chorionic gonadotrophin with testosterone release in a dose-dependent manner. The release of testosterone increased with incubation time. The stimulated release of testosterone was inhibited by oestradiol and ethinyl oestradiol in a dose-dependent manner, suggesting that these oestrogens exert direct inhibitory effects on the human Leydig cells. Estramustine phosphate, estromustine, diethylstilboestrol and diethylstilboestrol diphosphate did not inhibit testosterone release. Hypophysectomized rats were treated for 8-9 days with human chorionic gonadotrophin, which maintained testicular blood flow within the physiological range. Some of the animals received additional treatment with oestradiol or estromustine. Oestradiol and estromustine depressed plasma testosterone concentration. In contrast to estromustine, oestradiol inhibited testicular blood flow, as measured by the microsphere technique. Intact rats were castrated, supplemented with testosterone and concomitantly treated with different oestrogenic substances. Testosterone supplementation induced increase of prostatic blood flow, which was inhibited by oestradiol, ethinyl oestradiol or diethylstilboestrol. Estramustine and estromustine had no effect on prostatic blood flow. The growth of a transplantable rat prostatic carcinoma (Dunning R3327H) was studied after castration, testosterone substitution or testosterone substitution in combination with oestradiol treatment. Oestradiol inhibited tumour growth, possibly by direct action. The blood flow in tumours in intact animals decreased with increasing tumour volume. Oestradiol treatment enhanced tumour blood flow. The oestrogenic effects of estramustine phosphate, ethinyl oestradiol/polyoestradiol phosphate or orchiectomy were studied in previously untreated prostatic carcinoma patients by measuring serum levels of liver proteins (pregnancy zone protein and sex hormone binding globulin) and pituitary hormones (luteinizing hormone, follicle stimulating hormone and prolactin) during a 6 month period. Both medical treatments induced marked but quite comparable changes of the proteins. Apart from the increase of follicle stimulating and luteinizing hormones, no changes were observed in these serum proteins after orchiectomy.

Follow-up after torsion of the spermatic cord.

Fifty-two patients were examined 4-10 1/2 years after operation for torsion of the spermatic cord. The testicular salvage rate was 56%. Loss of testicular tissue was correlated to preoperative duration of symptoms. Serum testosterone concentration was found to be within the reference range. FSH was elevated in patients with the longest duration of symptoms (> 24 h), suggesting an impairment of testicular function in these patients. There were two our of 13 patients with a severe oligo-azoospermia, both had a previous orchiopexy for undescended contralateral testis.

Acute appendicitis during the first three years of life.

49 children younger than 3 years old and treated for acute appendicitis were investigated retrospectively. The symptoms of this age group are general and diarrhea is not uncommon. Examination of the urine including microscopy should always be performed. The white cell count in peripheral blood is of doubtful value in diagnosing acute appendicitis. A roentgenographic examination of the abdomen was helpful in 78% of the patients studied. The correct diagnosis was delayed in 43% of the cases and this extended the observation time by 2.9 +/- 2.4 days. The appendix was perforated in 79%, complications occurred in 18% and there was no mortality. A high degree of alertness seems essential for the early diagnosis of acute appendicitis in this age group.

Prostatic abscess: imaging with transrectal ultrasound. Case report.

A 50-year-old man presented with acute urinary retention and urosepsis. Transrectal ultrasonography (TUS) of the prostate demonstrated an abscess. Transperineal US-guided aspiration of pus, urinary bladder catheterization together with systemically administered antibiotics led to an uneventful recovery. TUS was a rapid diagnostic aid for differentiation between prostatitis and prostatic abscess; the appearance of an hypoechoic process within the prostate suggests an abscess.

Transurethral microwave thermotherapy in the management of lower urinary tract symptoms from benign prostatic obstruction: follow-up after five years.

OBJECTIVE: This study reports on a 5-year follow-up after transurethral microwave thermotherapy (TUMT) from benign prostatic obstruction using a lower power treatment protocol. MATERIAL AND METHODS: Ninety-one patients with uncomplicated benign prostatic obstruction were treated in a 1-h session using the PRIMUS U + R device. RESULTS: Twenty-nine (32%) of the patients were evaluable after 5 years, while 42 had received additional treatment for their lower urinary tract symptoms. In the 29 patients without additional therapy after TUMT, the decrease in the International Prostate Symptom Score was 37% compared with the pretreatment value. A moderate increase in peak uroflow, seen 1 year after TUMT, was not confirmed in an extended follow-up. Patients still on TUMT monotherapy after 5 years had smaller prostates from the outset than the group receiving additional treatment. No serious side-effects were observed. CONCLUSION: Lower power TUMT has a symptomatic effect of limited duration in most cases; in the long-term perspective only a minority of patients will benefit from this treatment.

Transurethral microwave thermotherapy for management of benign prostatic hyperplasia: one-year results with the PRIMUS U + R device.

We report on one-year results after transurethral microwave thermotherapy (TUMT) in patients with symptoms due to benign prostatic hyperplasia (BPH). The material consists of 91 cases, treated with the PRIMUS U + R device in a single, one-hour out-patient procedure. The International Prostate Symptom Score (I-PSS), S, fell from baseline 23 (17-27) to 12 (7-18.8), quality of life assessment, L, improved from 4 (3-5) to 2 (1-3) and peak urinary flow increased from 9.6 +/- 0.3 to 11.1 +/- 0.4 (ml/sec) after one year. No changes in postvoiding residuals were observed. Sixty five per cent of the patients were assessed as responders to the treatment. Complications were urinary retention and bacteriuria. Neither enlargement of prostate nor a prominent median lobe, seem to be predictors of subjective outcome. TUMT appears to be a safe and, in the majority of patients, effective measure to relieve symptoms due to BPH.

[Torsion of the spermatic cord. A clinical material on 109 patients]. / Funikkeltorsjon. Et klinisk materiale på 109 pasienter.

The authors review experiences from the operation of 109 patients for torsion of the spermatic cord at a single surgical clinic. The peak incidence was seen amongst adolescents. The patients reported the sudden onset of severe scrotal pain. Clinical examination showed a tender scrotal mass. About half of the patients showed testicular retraction or scrotal erythema. 22% underwent orchidectomy because of gangrene. All these patients had a history of more than 24 hours. On the other hand, 95% of patients with a vital testis had a history of less than 24 hours. Significant testicular injury will occur in a large share of these patients as well. The true urgency of this condition is emphasized.

Three-year follow-up after transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia using the PRIMUS U + R device.

OBJECTIVE: We report long-term (3 years) follow-up data of transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH) using a lower-power treatment protocol. MATERIAL AND METHODS: Ninety-one patients were treated in a 1-h session with the PRIMUS U + R device. RESULTS: Forty-five of the patients were still on TUMT monotherapy at 3-year follow-up, while 32 received additional therapy for their lower urinary tract symptoms. In patients with monotherapy there was a 45% decrease in international prostate symptom score (IPSS) when compared to pretreatment values. The moderate increase in peak uroflow seen early after TUMT could not be observed after 3 years. No serious side-effects were seen. CONCLUSION: Three years after lower-power TUMT, 49% of patients treated were on TUMT monotherapy, while 35% received additional therapy for their voiding symptoms. Symptom score decreased 45% in patients with TUMT monotherapy concomitant with unchanged uroflow.

Interstitial laser coagulation in patients with lower urinary tract symptoms from benign prostatic obstruction: treatment under sedoanalgesia with pressure-flow evaluation.

OBJECTIVES: To evaluate the effects on lower urinary tract symptoms and pressure-flow variables after interstitial laser coagulation (ILC) of the prostate using the Indigo diode laser system (Indigo, Palo Alto, USA). PATIENTS AND METHODS: Forty-nine men (median age 68 years, range 52-80) were assessed using symptom scores and voiding variables before and at 3 and 12 months after ILC. A subset of 26 men (median age 68 years, range 63-72) underwent pressure-flow measurements before and at 6 months after ILC. All treatments were performed in the outpatient department using sedoanalgesia. RESULTS: The International Prostate Symptom Score decreased from 22 to 11 at 12 months after ILC. The peak urinary flow (Qmax ) was 8.6 mL/s at baseline and increased to 9.9 mL/s at 12 months. Residual urine volumes were unchanged. The median duration of urinary retention after ILC was 3 days. From pressure-flow recordings, 17 patients were categorized as obstructed and seven as equivocally obstructed before ILC (using the International Continence Society definition). Their Qmax increased from 7.7 to 9.0 mL/s after 6 months, the detrusor pressure at Qmax decreased from 68 to 51 cmH2O and the Abrams-Griffiths number decreased from 54 to 29 (P<0.01). Patients with moderate to equivocal obstruction had a greater relief of symptoms than those who were clearly obstructed. Patients with prostate volumes of >40 mL had a greater decrease in the Abrams-Griffiths number than had patients with smaller prostates. Postoperative perineal pain was reported by 72% of patients; the pain subsided after 1-2 weeks. The re-treatment rate was 15% within the first year. CONCLUSION: Treatment with ILC produced substantial effects on symptoms and moderate to small changes in urodynamic variables. Patients with moderate or equivocal bladder outlet obstruction or large prostates seem to be the best candidates for this treatment. However, treatment was followed by perineal pain for 1-2 weeks in most cases. A long-term follow-up is necessary to determine the role of ILC.

Blood flow in the Dunning R3327H rat prostatic adenocarcinoma; effects of oestradiol and testosterone.

Copenhagen X Fischer F1 rats were implanted with Dunning R3327H prostatic adenocarcinoma and studied over a period of three weeks. The tumour volumes in intact and testosterone supplemented castrated rats showed parallel increases. After castration alone the tumour volumes decreased. Treatment of castrates with oestradiol and testosterone combined produced an arrest of tumour growth, suggesting that oestradiol had a direct inhibitory effect on tumour growth. Blood flow in tumours was measured using the microsphere technique. In intact rats, tumour blood flow per unit of weight decreased with increasing weight of tumours and blood flow in peripheral parts was higher than in central parts of large tumours. Oestradiol in combination with testosterone increased tumour blood flow.

Comparison of polidocanol and tetracycline in the sclerotherapy of testicular hydrocele and epididymal cyst.

OBJECTIVE: To compare the effects and side-effects of polidocanol and tetracycline when used as sclerosants for testicular hydrocele and epididymal cyst. PATIENTS AND METHODS: Forty-five men (median age 67 years, range 42-81) with 46 hydroceles or epididymal cysts were assessed. After puncture and aspiration, the empty sac was instilled with either polidocanol or tetracycline, assigned randomly. Patients recorded any treatment-associated pain on a visual analogue scale. RESULTS: At 9 months of follow-up, nine of 17 men were cured after sclerotherapy with polidocanol compared with 17 of 20 men treated with tetracycline (P < 0.05). Tetracycline produced some pain for 3 days after treatment while polidocanol therapy was almost pain-free. Re-instillation should be considered for recurrences. At the follow-up after 35 months, 16 of 18 men treated with polidocanol and 20 of 22 men treated with tetracycline were satisfied with the outcome. CONCLUSION: Both polidocanol and tetracycline are useful sclerosants for treating testicular hydrocele and epididymal cyst. We prefer polidocanol as a first choice in older patients because there were few short-term side-effects.