The use of a lithoclast probe for ureterorenoscopic coagulation of bleeding ureteral cancer.

PURPOSE: We describe use of the lithoclast device, normally used for electrohydraulic stone fragmentation, for safe ureteroscopic intraureteral coagulation of a bleeding tumor. MATERIALS AND METHODS: Intraureteral ureteroscopic coagulation of a bleeding transitional cell carcinoma was performed in an 86-year-old high risk patient. A 0.8 mm. probe of the lithoclast device was connected to high frequency current. To avoid short circuit to the ureteroscope the probe was covered with a standard 5Fr ureteral catheter, which served as a perfect isolator. RESULTS: The bleeding intraureteral tumor was coagulated successfully under direct vision. CONCLUSIONS: The lithoclast probe in combination with a standard ureteral catheter can be used for intraureteral coagulation of bleeding tumors. It is an inexpensive device that is often available in nonuniversity departments.

Local recurrent cancer after radical prostatectomy and incontinence. Is the artificial urinary sphincter a useful therapeutic option?

OBJECTIVE: The artificial sphincter AMS AS 800 is the treatment of choice in postprostatectomy urinary incontinence. However, when the incontinence is combined with a local tumour recurrence, the insertion of an artificial sphincter may pose a problem. Tumour mainly localised at the site of the anastomosis could cause problems with the insertion of the cuff. It is also questionable whether this elaborate and expensive operation is appropriate in patients with a progressive carcinoma. MATERIALS AND METHODS: The charts of 220 patients who received a bulbar artificial sphincter between 1986 and 1996 were reviewed. Five patients were selected who suffered from simultaneous urinary incontinence and local recurrence of prostate cancer. The follow-up of these patients was between 18 and 70 months. RESULTS: In all 5 patients the implantation of the artificial sphincter at the bulbous urethra could be performed without any complications. All patients were continent during follow-up. Two changes of the cuff were necessary due to tissue shrinkage of the urethra below the cuff. One patient, 2 years after local excision of recurrent prostate cancer, was found, during implantation, to have a macroscopically inconspicuous though histologically tumour-infiltrated area. In the follow-up 5 years after the implantation his prosthesis is still working well. CONCLUSIONS: Even with local recurrence of prostatic carcinoma after radical prostatectomy, the patients' prognosis 'quo ad vitam' is not bad. The follow-up of patients proves that they profit from implantation of an artificial sphincter in terms of better quality of life. Sphincter-related complications are not more frequent than in comparable groups of patients without local recurrence.

[Cavernous insufficiency after dermal graft corporoplasty]. / Kavernöse Insuffizienz nach Dermalgraftkorporoplastik.

From 1987 to 1993, a total of 27 patients suffering from Peyronie's disease were treated by plaque excision and dermal graft repair. The deformity of the penis was adequately corrected in 25 patients. Preoperatively 18 patients (66.6%) had firm erections, while postoperatively only 4 patients (14.8%) could have sexual intercourse. The loss of rigidity is due to venous leakage. Pre- and postoperative cavernosometric studies in 11 patients showed an increase in maintenance flow from 17 ml/min to 77 ml/min. Cavernosography reveals venous leakage from the deep dorsal vein. Disintegration of the tunica albuginea is discussed as a possible reason for the venous leakage.

[Mesh graft urethroplasty]. / Meshgrafturethroplastik.

Since 1977 124 patients with complicated urethral strictures have been treated by using free-foreskin grafts or split-thickness skin grafts to construct a neourethra in a two-stage procedure. Excellent functional and anatomical results have been achieved in 115 patients. The technique is even useful in exceedingly long or problematic strictures, such as in patients with spinal cord injuries.

[Hydraulic penis prosthesis in fibrosis of the cavernous body. The alloplastic tunica albuginea]. / Hydraulische Penisprothesen bei Schwellkörperfibrose. Die alloplastische Tunica albuginea.

Fibrosis of the cavernous bodies is a rare but serious condition resulting in erectile impotence. When the fibrosis is extensive a simple penile prosthesis sometimes cannot be implanted. In addition, perforation of the tunica albuginea is not uncommon in damaged cavernous bodies, and this will compromise a reimplantation. In such cases, the use of an alloplastic vascular prosthesis permits replacement of lost cavernous wall tissue and insertion of an inflatable penile implant. We used this technique in 10 patients with severely damaged cavernous bodies. In 7 of them, surgery was successful and enabled satisfactory intercourse. This type of surgery, however, should be reserved for selected cases of penile prosthetic surgery.

[Current developments in hydraulic penis prostheses]. / Neuentwicklungen bei hydraulischen Penisprothesen.

The disappointing long-term results of alternative treatments for erectile dysfunction have led to increasing interest in penile implants. Against this backdrop, the development of reliable penile prostheses which offer easy implantation and excellent function is a challenge to bioengineers and urologists with a special interest in the treatment of erectile dysfunction.

[Artificial sphincter in children]. / Le sphincter artificiel chez l'enfant.

The ideal treatment of urinary incontinence in children must refer to the subsequent subjects: reestablishment of urinary control, long term conservation of renal function and finally the preservation of normal body image. In this follow up 39 children from 4-20 years have been treated by implantation of an artificial sphincter. From 1983 the recent model AS 800 has been implanted. Because of bladder hyperreflexia and functional or mecanical obstruction 31 further operations had to be done to assure the balanced emptying of a low pressure reservoir with good capacity. After treatment 87.2% of the children (95.5% in the AS 800 group) were totally dry. Because of mecanical (27%) and surgical (33.3%) complications 22 revisions were necessary. With the model AS 800 the revision rate declined to 26%. This is due to the mecanical improvement of the devices and the increasing surgical experience. The results are discussed in relation to alternative treatments of urinary incontinence as supravesical diversion, ureterosigmoidostomy and intermittent catheterization. In conclusion the implantation of an artificial sphincter is the most effective treatment of incontinence in children. The remaining problems as infection and mecanical failure of the delice and the risk of upper tract deterioration because of bladder hyperreflexia ask for a long term follow-up with urodynamic and radiological examinations.

[Treatment of erectile dysfunction with a penile prosthesis]. / Die Behandlung der erektilen Dysfunktion mit Penisprothesen.

From 1973 to February 1989 a total of 309 patients with erectile dysfunction were treated with hydraulic penile prostheses. In 169 patients a hydraulic prosthesis type AMSIPP700 was implanted; with this prosthesis the primary success rate was 91.1%. As a result of technical improvements to the device the revision rate, initially 52.3% has fallen to 3.3%. Patient acceptance is better with hydraulic prostheses, which provide optimal simulation of the physiological processes of erection and detumescence, than with any other type of prosthesis.