Male factors determining the outcome of intracytoplasmic sperm injection with epididymal and testicular spermatozoa.

During a period of 8 years, 1,079 intracytoplasmic sperm injection (ICSI) procedures with aspirated epididymal or testicular spermatozoa were performed. Epididymal spermatozoa were used in 172 cycles and testicular spermatozoa or spermatids in 907 cycles. Multiple biopsies were obtained from at least two different locations in the testes. Retrieved spermatozoa were used after cryopreservation (frozen) or immediately after aspiration (fresh). Three hundred patients had obstructive azoospermia (OA) or ejaculation failure. In 414 cases, azoospermia was caused by impaired spermatogenesis resulting from maldescended testes, chemotherapy/radiotherapy, or by Sertoli-cell-only syndrome, genetic disorders or unknown aetiology. Transfer rates, pregnancy rates and birth rates per ICSI cycle showed no statistically significant differences between testicular and epididymal spermatozoa in men with OA (28% average birth rates in both cases). However, birth rates differed significantly with regard to the status of spermatogenesis. Treatment of men with nonobstructive azoospermia (NOA) resulted in a birth rate of 19% per cycle. In all patient groups, there was no difference in the birth rates achieved with fresh and cryopreserved spermatozoa. While testicular volume, follicle-stimulating hormone level and age of the male patient are no statistically significant prognostic factors, the underlying cause of azoospermia is the most important factor determining the outcome of ICSI with epididymal and testicular spermatozoa. The pregnancy rate is lower in NOA patients than in those with OA.

[Malignant priapism as a sign of a recurrent prostate cancer. Differential diagnosis of induratio penis plastica]. / Maligner Priapismus bei rezidivierendem Prostatakarzinom. Eine Differenzialdiagnose zur Induratio penis plastica.

A 62-year-old patient was referred with the suspected diagnosis of Peyronie disease. The patient showed the clinical picture of a beginning malignant priapism with hematogenous metastases from an recurrent prostatic carcinoma. The penile metastases were misdiagnosed as Peyronie disease. Although both clinical pictures show some superficial similarity, Peyronie disease usually fulfills classical criteria which help to clearly distinguish it from neoplastic diseases.

Extraprostatic production of prostate specific antigen is under hormonal control.

PURPOSE: Prostate specific antigen (PSA) is the most useful tumor marker in urology. It is produced primarily by the epithelial cells of the ducts and acini of the prostate gland. Extraprostatic production of PSA is provided mainly by the periurethral glands, leading to measurable urine but undetectable serum levels of PSA in women and in men following radical prostatectomy for pathologically localized disease. MATERIALS AND METHODS: We investigated the effect of continuous testosterone substitution (250 mg. every 4 weeks) on urinary PSA excretion in 20 patients who converted from the female to male gender. We compared the results to urine levels in 20 women who did not receive testosterone. RESULTS: Mean urinary PSA plus or minus standard deviation was 1.73 +/- 1.68 ng./ml. in controls and 12.03 +/- 10.47 ng./ml. in converted patients, a statistically significant difference (p < 0.0001). Serum PSA did not differ between groups. CONCLUSIONS: Our data demonstrate that extraprostatic PSA production is under androgen control.

Negotiating ureteral stenoses and kinks with a hydrophilic wire.

Negotiating a tortuous or obstructed ureter with a wire can be time-consuming and sometimes tiring. The principle of using a slippery floppy wire and then replacing it with a stiff wire through a 5-french open-ended ureteral catheter yields a high success rate. The ureteral catheter can be used for a radiocontrast study and allows access for a 0.035 'coaxial wire', which can be used as a guide wire for a single or double J stent.

[Microsurgical techniques in urology]. / Mikrochirurgische Techniken in der Urologie.

Microsurgery is an established operative technique for refertilization by vasovasostomy, tubulovasostomy and microsurgical epididymal sperm aspiration. Other andrological indications for the use of a microscope are penile revascularization, resection of varicocele and surgical treatment of Peyronie's disease. Autotransplantation of intra-abdominal testicles and hypospadia correction are indications for microsurgical techniques in pediatric urological surgery. Renal transplant, sex-change surgery and replants of penis and scrotum are further indications for use of microsurgery. Microsurgery will move into new fields of urological surgery, especially neurourology.

[Microsurgical therapy of occlusive azoospermia]. / Mikrochirurgische Therapie der Verschlussazoospermie.

From 5/88 to 8/93 148 patients were operated on for obstructive azoospermia using a microsurgical technique. In 68 patients we performed a vasectomy reversal by vasovasostomy (VT), 42 patients underwent a tubulovasostomy (TT), and 8 patients had a VT with contralateral TT. Two patients had implantation of an alloplastic spermatocele, 9 patients had microsurgical epididymal sperm aspiration (MESA), and 19 patients microsurgical exploration. Patency was achieved in 89% of patients after VT and in 32% after TT. A pregnancy occurred in 34% after VT and in 13% after TT. No pregnancy was achieved after MESA or alloplastic spermatocele. A microsurgical procedure is necessary for the treatment of congenital or acquired obstructive azoospermia.

Prostate-specific antigen in urine.

We investigated concentrations of prostate-specific antigen (PSA) in mid-stream urine of 213 patients. Among them were 34 females. Diagnoses of the male patients were 42 benign prostatic hypertrophy (BPH), 21 localized prostate cancer prior to radical prostatectomy (RP), 15 post-RP without distant or local recurrence, 5 post-RP with local recurrence and 82 with other urological diseases. PSA levels were determined by the Hybritech Tandem E method. Female urine samples were positive in 38% of the cases. This and the finding of PSA in urine of men after RP is most likely due to extraprostatic production by periurethral glands. Urinary PSA levels do not differ between patients with BPH, organ-confined prostate cancer and other diagnoses. In some cases, however, urine PSA levels can be elevated in men with local tumor recurrence after RP when serum levels are still undetectably low. This indicates that the determination of urinary PSA concentration might be useful in the follow-up of patients after RP.

[A comparison of color duplex sonography with selective penile DSA in assessing erectile dysfunction]. / Vergleich der Farbduplexsonographie mit der selektiven penilen DSA bei der Abklärung der erektilen Dysfunktion.

42 patients with suspected vasculogenic impotence were examined via colour duplex sonography. Penile vascular anatomy was mapped and peak velocity was determined in both cavernous arteries before and after intracorporeal injection of 15 mg papaverine and 0.5 mg regitine. In all patients the results could be compared with selective penile pharmacoangiography as the gold standard. In 34/42 patients colour Duplex sonography and angiography led to an identical evaluation of penile blood supply. 4 patients were classified false-negative and 4 patients false-positive. Sensitivity and specificity were calculated for each side separately. Sensitivity was 82.4% for left side angiogram and 83.3% for right side angiogram. Specificity was 88% for left side angiogram and 87.5% for right side angiogram. Peak flow velocity was significantly diminished in pathological angiograms.

Extended femoro-distal bypasses for limb salvage: are they worthwhile?

UNLABELLED: In this report on 93 patients with limb-threatening leg ischemia the surgical procedures applied were malleolar bypasses (14), sequential bypasses (12) and femoro-distal bypasses with adjunct AV fistulas (67). The first two methods resulted in favourable limb-salvage and patency rates. However the results of such reconstructions essentially depend on the quality of primary and secondary foot arcades. In peripheral calf and foot arterial occlusions we have applied a distal arteriovenous fistula as an adjunct measure to maintain bypass patency in the crural region. 67 patients were operated on according to this method: 30 females and 37 males with an average age of 70.3 years. 29% had rest-pain and 71% had gangrene. The majority had already been operated on at least once. 7 patients had been amputated contralaterally. RESULTS: 79% of the patients had a patent graft after one month. The incidence of limb salvage was 77%. At two years 47% of all grafts are still patent and the incidence of limb-salvage is 52%. However, this operation should be exclusively designed for limb-salvage and for cases with extremely poor run-off.