[The value of hydrostatic balloon dilatation with adjuvant pentosan polysulfate medication in therapy of chronic interstitial cystitis]. / Stellenwert der hydrostatischen Ballondilatation mit adjuvanter Pentosan-Polysulfat-Medikation in der Therapie der chronischen interstitiellen Zystitis.

Twenty-one female patients suffering from interstitial cystitis were treated by oral medication of pentosane-polysulfates (200 mg/6 months). In cases with a capacity below 150 ml (n = 6) a distension therapy of bladder was performed simultaneously. The combined therapy showed good therapeutic effects for 1-2 years defined by the increase of voiding volumina and decrease of nycturia and pains. Medication of pentosane-polysulfates alone was of lower therapeutic value. Concerning urodynamic investigations we found an increase of capacity while the quality of bladder compliance did not change. We recommend these conservative therapies as an experimental alternative therapy before bladder augmentation.

[Autologous retransfusion of washed erythrocytes in transurethral resection of prostatic adenomas. Preliminary report]. / Autologe Re-Transfusion gewaschener Erythrozyten bei der transurethralen Resektion (TUR) von Prostataadenomen. Ein vorläufiger Bericht.

Red blood cells were concentrated from the irrigation fluid used during prostatic resection in 30 patients by means of a cell saver system. The resulting units of packed red cells were analysed for quality and possible contamination. Average blood loss during the procedure was 645 ml, and an average of 580 ml of packed red cells was harvested and retransfused in 25 patients. Retransfusion was well tolerated and no adverse reactions were seen. Our positive clinical experience with the method and the ease of application suggest that it can probably be recommended as a routine procedure during transurethral resection of the prostate.

[Causes, prevention and therapy of complications of lymphadenectomy following tumor nephrectomy]. / Ursachen, Prophylaxe und Therapie von Komplikationen der Lymphadenektomie nach Tumornephrektomie.

In our series of 295 patients who had to undergo a radical nephrectomy. 34% had postoperative wound drainage for longer than 6 days. In 7 patients (2.4%) lymphocele developed, which was cured by percutaneous puncture and drainage in most cases.

[Metaraminol in therapy of various forms of priapism]. / Metaraminol in der Therapie verschiedener Priapismusformen.

A total of 19 patients (aged 17-66 years) with priapism received primarily conservative treatment in the form of aspiration of blood from the cavernous bodies and subsequent intracavernous (i.c.) administration of the alpha-adrenergic drug metaraminol. In 15 patients the priapism was due to i.c. injection of vasoactive agents; 1 patient each it had developed after hemodialysis, during oral prazosin medication, and in conjunction with Fabry's disease; and in 1 patient the etiopathogenesis was unknown. Treatment of priapism with metaraminol was successful in the first 15 patients and in 2 patients with priapism due to hemodialysis and oral prazosin medication. Therapy failed in long-lasting priapism associated with Fabry's disease and in priapism of unknown etiopathogenesis. Penile detumescence took place in the first 15 patients 3 min to 2.5 h after the injection of 2-4 mg metaraminol. Hemodialysis- and prazosin-linked priapism was treated with 5 and 2 mg metaraminol, respectively; in these patients erection subsided within 15 and 4 min after onset of therapy. In a further 2 patients in whom therapy had failed Al-Ghorab shunts were constructed, with the subsequent postoperative complication of erectile impotence. Injection of metaraminol must be carried out under strict supervision of the patient's circulatory system: doses of 4 mg metaraminol or more led to an increase in blood pressure and heart rate. In 15 patients with priapism induced by i.c. application of vasoactive agents, the analysis of blood gas parameters demonstrated a severe hypercapnia (70.3 +/- 10.0 mm Hg) and acidosis (pH 7.08 +/- 0.08) 5-10 h after the onset of erection, but severe hypoxia (37.0 +/- 16.6 mm Hg) was not found until erection had lasted for more than 10 h.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical relevance of radioimmunologic determination of prostate specific antigen in prostate cancer]. / Klinische Relevanz der radioimmunologischen Bestimmung des prostataspezifischen Antigens (PSA) beim Prostatakarzinom.

To recognize progression of an inoperable prostatic cancer we use clinical parameters and the prostate specific phosphatase. The prostate specific antigen (PSA) is a new, sensitive and specific laboratory tumor marker. With 363 specimens of patients without prostatic cancer we defined for the normal range of this serum parameter. In 98 men with histologically proven prostatic cancers we investigated for the clinical relevancy of the serum level of PSA. We believe, that measurement of serum PSA give important information for clinical management of prostatic cancer.

[Kidney cancer with invasion of the vena cava: classification, surgical strategy and results of treatment]. / Nierenkarzinom mit Cavazapfen: Einteilung, Operationsstrategie und Behandlungsergebnisse.

A new classification of vena caval tumor thrombi is recommended from our experience with 37 cases. For advanced tumor thrombi a surgical technique with routinely performed thoracotomy, inserting a Sarns-catheter and preparing the cardiopulmonary bypass is mandatory. If metastases are absent the prognosis of the renal carcinoma is nearly as good as in cases without tumor extension into the vena cava. The total 2-year-survival rate in our series is 47%, for the cases without metastases it is 65%. The total 5-year-survival rate is 25% and for patients without metastases 57%.

Prophylaxis of complications after urological abdominal surgery by substitution of plasma proteins.

A prospective randomized trial on 94 patients undergoing urological-abdominal surgery has been carried out to evaluate the effect of postoperatively administered plasma proteins. A significant difference in the incidence of bronchopulmonary complications has been found between the treatment group and the control group. This may be due to the substitution of alpha 1-antitrypsin as indicated by assaying alpha-antitrypsin activity. A positive trend, but no significant differences, could be demonstrated for wound healing and the need for antibiotics, postoperatively.

Integral laser-photodynamic treatment of multifocal bladder carcinoma photosensitized by hematoporphyrin derivative.

Intravenously administered hematoporphyrin derivative photosensitizes tumorous bladder tissue which can then be destroyed selectively by irradiation with red laser light (630 nm). After experimentally developing a concept since 1978 (light diffusion medium, special bladder catheter) to expose the bladder to the therapeutically effective red laser light, the integral photodynamic therapy is meanwhile performed clinically. The experience gained so far demonstrates that especially the multifocal carcinoma in situ up till now difficult to be detected endoscopically represents a new domain for the integral photodynamic therapy.

Cytologic regression grading of hormone-treated prostatic cancer.

Aspiration cytology during hormone treatment of prostatic cancer has been regularly performed at the University of Munich for 13 years and gives direct information on the primary tumor. To analyse its value in clinical practice, 919 biopsies of 187 patients were reviewed without knowledge of clinical data and the charts were analysed retrospectively. Each biopsy was classified as having good, medium, or poor therapeutic response depending on the regressive changes of the cells. Agreement between two independent observers was 89%. All but 39 of these patients have died and the surviving patients have a minimum observation period of 5.6 years. A poor therapeutic response was seen cytologically in 72 patients (38.5%) at variable times after treatment began. These patients have a statistically significant worse survival in comparison to all other patients. Forty-seven of these 72 patients had deterioration, but clinical signs developed later in 23 cases (mean 1.1 years); in 21 patients cytology and clinical signs were simultaneous and in only three cases clinical deterioration preceded aspiration cytology (mean 4.8 months). In 25 cases there was a cytologically poor therapeutic response, but no clinical signs of deterioration. These patients had the same survival rate as with good or medium treatment response. Serial aspiration cytology is a very valuable parameter in treatment monitoring and is often the early warning sign of endocrine treatment failure.

Extracorporeal shock wave lithotripsy.

Urolithiasis represents the symptomatic manifestation of various metabolic disturbances which persist after elimination of the immediate problem, i.e., urinary stones, and may lead to the development of recurrent stones. Invasive surgical removal of recurrent stones is sometimes associated with considerable problems. Against this backdrop it is not surprising that after development (1974-1980) and clinical testing (1980-1982) at the Department of Urology of the Ludwig Maximilian University in Munich, a meanwhile clinically proven method of totally noninvasive extracorporeal lithotripsy (ESWL) has disseminated within a relatively short time (from October 1983), first in West Germany (April 1986: 20 ESWL centers) and later all over the world (April 1986: 133 ESWL centers). With the advent of ESWL and semiinvasive techniques of stone extraction (percutaneous lithotripsy, ureterorenoscopy) a transformation of the therapeutic strategy for urolithiasis has been ushered in.

The use of neodymium-YAG lasers in urology: indications, technique and critical assessment.

After development and experimental approval of suitable equipment for endoscopic and external use, the neodymium-YAG laser has been used routinely to treat tumors of the bladder and external genitalia in our department. A 2-year followup of 60 patients revealed a significant decrease in local bladder tumor recurrence (5 per cent). Successful laser therapy also was applied in cases of stage T1/T2 penile carcinomas, female urethral carcinomas and condylomata acuminata. Laser application offers an additional useful therapeutic procedure in the treatment of urological malignancies.

[Correction of idiopathic juvenile penis deviation with the modified Nesbit operation]. / Korrektur der idiopathischen juvenilen Penisdeviation mit der modifizierten Nesbit-Operation.

In seven men a congenital penile curvature was corrected using a modified Nesbit operation. All patients obtained an excellent correction of the deformity and satisfactory intercourse. In three cases a small area of hypesthetic skin was observed in the distal parts of the dorsum penis.

[Aminoglutethimide in the treatment of advanced prostatic cancer]. / Aminoglutethimid zur Behandlung des fortgeschrittenen Prostatakarzinoms.

A total of ten previously castrated men with stage D carcinoma received 1000 mg aminoglutethimide and 50 mg/die cortisoneacetate. The patients were evaluated using the criteria of the National Prostate Cancer Project. No patients showed objective response, three patients had reduction of bone pain and subjective improvement. Pretreatment testosterone, prolactine and estradiol levels were measured. Three patients had a statistically significant elevation of testosterone levels.

[NMR tomography in urology. Principles--technics--risks--areas of use]. / NMR-Tomographie in der Urologie. Grundlagen--Technik--Risiken--Anwendungsbereiche.

NMR tomography is a new imaging method based on nuclear magnetic resonance. It is possible to obtain sectional views of the human body in all three planes without ionizing radiation. NMR can differentiate soft tissue better than CT, and large blood vessels can be simultaneously evaluated without using contrast medium. The pathological process could be imaged exactly in every examination. Due to the lack of image clarity caused by breathing movement, NMR is not superior to CT when using contrast medium in the epigastrium. Calculation of relaxation times T1 and 2 shows clear differences between tumor and normal tissue. However, contrary to initial expectations. NMR did not permit a type-specific diagnosis to be made. Three-dimensional images improve the process of staging tumors, especially in the retroperitoneal space and in the pelvis. As with CT, metastatic lymph nodes can only be demonstrated when they have reached a size of at least 1 cm. Further studies will be necessary to evaluate the validity of this new imaging method.

[Expansion of extracorporeal shock were lithotripsy by auxiliary methods]. / Erweiterung der ESWL durch auxiliäre Methoden.

With the introduction of the ESWL, this non-invasive form of treatment has proved itself to be an alternative to surgical renal stone therapy. The increasing application of auxiliary methods has results in a vast extention of the indications for ESWL-monotherapy. Therefore, presently, practically all patients with urolithiasis can be treated non-invasively, where previously, surgery had to be performed.

Surgical correction of rectoprostatic fistula.

A rectoprostatic fistula is a rare complication of prostatic operations, and the literature on the subject is scanty. Three men were treated for rectoprostatic fistulas representing complications of prostatic surgery. Mason's transsphincteric transrectal operation resulted in prompt, primary healing of the fistula. Subsequent colostomy closure left all 3 patients with normal urinary and fecal control. A systematic three-step sequence of operation is advocated for the treatment of rectoprostatic fistulas. The Mason technique provides excellent exposure and reliable closure of rectourinary fistulas.

[Neodymium YAG laser in clinical urology. Current status and clinical experiences]. / Der Neodym-YAG-Laser in der Urologie. Derzeitiger Stand der klinischen Erfahrungen.

Of all the lasers available for medical applications only the Neodymium-YAG laser has been retained with a clear indication for open and endoscopic tumor destruction in urology. This is due to the biophysical properties of this laser. The main indications for Neodymium-YAG laser application are benign and malignant tumors of the glans penis and the penis shaft as well as multiple small tumors distributed over the urethra and bladder mucosa. But tumors of the ureter and renal pelvis can also be destroyed endoscopically with the laser. The advantages of Neodymium-YAG laser application are: the great radicality of the contact-free tumor destruction coupled with closure of the blood and lymphatic vessels of the tumor, no hemorrhages, no anesthesia, only conscious sedation, and above all, short operation times that make the procedure suitable for use in outpatients.

[Prevention of complications following abdominal surgical urologic interventions by plasma protein substitutes]. / Komplikationsprophylaxe nach abdominalchirurgisch-urologischen Eingriffen durch Plasmaproteinsubstitution.

A prospective randomised trial in 94 patients undergoing urological abdominal surgery has been carried out to evaluate the effect of postoperatively administered plasma proteins. A significant difference between the treatment group and the control group has been found in the incidence of bronchopulmonary complications. This may be due to the substitution of Alpha-1 antitrypsin as could be shown by determination of the activity of Alpha-1 antitrypsin levels. A positive trend but no significant differences could be demonstrated for wound healing and the need of antibiotics postoperatively.