Excisional repair of urethral stricture. Follow-up of 90 patients.

One hundred five patients with urethral stricture of various causations were treated with excision of the stricture and oblique end-to-end anastomosis. Fifty-two patients (49%) had had one or more previous operations and dilatations, respectively. The immediate postoperative complication rate was 9 per cent. Ninety patients could be followed for one to eight years. The success rate was 93 per cent. Five patients had recurrent strictures. The failures were due to abscess formation, perineal hematoma, and excessive length of stricture.

Reconstruction of abdominal wall and mons pubis in females with bladder exstrophy.

We report on 3 patients with bladder exstrophy who had considerable scar deformities of the lower abdomen after primary closure of the bladder and/or urinary diversion. The scar tissue was excised, and augmentation of the abdominal wall and mons veneris was achieved by the use of a pedicled, vascularized groin flap with integrated bone from the iliac crest. This procedure is recommended for patients with faulty closure of the pelvic ring and severe defect of the lower abdominal wall.

Exocrine and endocrine testicular function in patients with unilateral testicular disease.

Amongst 30 patients who had undergone untwisting and fixation for unilateral torsion of the testis, seminal analyses were normal in 15, equivocal in 3 and pathological in 12; and of 46 men with cryptorchidism who had had unilateral orchidopexy, seminal analyses were normal in 13, equivocal in 23 and pathological in 10. Follicle-stimulating hormone levels were found to be elevated in those with equivocal and pathological seminal analyses in both groups. Assessment of testicular function before orchidectomy in 36 patients with seminomas and non-seminomatous testicular tumours revealed only one (with a HCG-negative seminoma) with a normal seminal analysis. Men with HCG-positive testicular tumours were found to have decreased follicle-stimulating hormone levels and elevated 17-beta-oestradiol and prolactin levels.

[Urolithiasis in childhood]. / Urolithiasis im Kindesalter.

Our experience with 95 pediatric stone patients in the years 1960-1979 is presented. 2/3 of all stones were diagnosed in the pre-school age. Leading symptoms were infection, hematuria and abdominal pain. 52% of the stones were composed of phosphate. 87.5% of the children up to the age of 6 had urinary tract infection. Phosphate stones were mostly accompanied by urea-splitting organisms. An underlying cause for the stone formation could be found in 62% (urodynamic disturbances 32%, metabolic derangements 21%, proteus infection 8%, foreign body 1%). In 76% of the children the stones had to be removed surgically. The recurrence rate was 22% in 6.2 years. From our experience we recommend to use only a crystallographic stone analysis, to perform an exact metabolic check-up and a long term follow-up of the children.

[Indication, techniques and results of the operative correction of hypospadias using modification of the original Denis Browne technique (author's transl)]. / Indikation, Technik und Ergebnisse der Hypospadiekorrektur-Operation nach unserer Modifikation der Denis-Browne'schen Technik

The experiences with operative correction of hypospadias 416 patients are reported. In 264 of these patients the correction of the hypospadic deformity was completed, using the original Denis Browne technique or a modification described by Marberger. The results and the complications are demonstrated.

[Results of Johanson's urethroplasty (author's transl)]. / Ergebnisse der Harnröhrenplastik nach Johanson

In the period 1951-1974 urethroplasty according to Johanson was carried out in 467 patients. In 391 patients the repair was complete. The authors set forth the pathogenesis and localization of the stenoses and traumas that require plastic correction and point out the various improvements in operative technique that have been developed in recent years. In only 16 of the 391 patients was the Johanson method attended by adverse results; 8 patients had to undergo a further urethral bougienage. Out of 931 interventions in 467 patients, 4 died--none since 1967. Complications were valvular necrosis, suture dehissence hematoma, and abscess formation; such complications were seen in 6% of patients in the early operations. After modification of the surgical procedure this figure was reduced to 3%. Recurrence of stricture occurred in 63 cases. These were controlled after repeating the operation.

[Carcinoma in situ of the urinary bladder: a diagnostic and therapeutic challenge]. / Carcinoma in situ der Harnblase. Eine diagnostische und therapeutische Herausforderung.

Carcinoma in situ (Tis) of the urinary bladder means a challenge for the urologist, because of the uncharacteristic symptoms and the various treatment modalities. Early detection requires wide use of urinary cytology and multiple cold-cup biopsies. Cytology has proven to be sensitive in 95%. Histological grading of the Tis and the concomitant overt tumor is in accordance in 85%. A dedifferentiation of the tumor during the course of the disease was observed in only 14%. Modes of conservative treatment can achieve long-lasing tumor control or remission. Therefore, a cystectomy cannot be justified as the primary treatment in any case.