Does fertility improvement after varicocele treatment justify preventive treatment at puberty?

Evolution of fertility parameters in 374 patients who underwent surgical intervention (Palomo technique) for varicocele was studied. Preoperative motility, morphology, and concentration of spermatocytes did not correlate with degree of varicocele. Statistically postoperative parameters all were significantly improved and the left testicle volume increased. However, improvement did not correlate with degree of varicocele, age at intervention, or pregnancy rate. Extrapolation of results to subclinical varicoceles and treatment of varicoceles in adolescents still remains questionable.

Bilateral renal cell carcinoma diagnosed as renal abscesses.

The history of a patient with bilateral renal cell carcinoma, simulating bilateral renal abscesses is reported. Since hypernephroma can present with misleading systemic effects, all diagnostic tools concerning space-occupying lesions of the kidney must be interpreted with care before treatment. Punctures for cytology can be indicated when both kidneys are affected.

Electrophysiological exploration of the sacral conus.

Evoked urethral and anal responses are produced by electrical stimulation of penis, bladder neck and anus. Latency and duration of the responses after bladder neck and anal stimulation are greatly dependent on stimulus parameters, suggesting a polysynaptic reflex; penile stimulation probably involves an oligosynaptic pathway. In pathological conditions the responses are delayed and their duration reduced.

A review of 357 bilateral vasectomies for male sterilization.

A series of 357 bilateral vasectomies for male sterilization performed over a period of 18 months was reviewed to assess the safety of the surgical procedure, the onset of sterility, and the acceptability of the procedure. The surgical procedure proved to be safe with few complications, the patients became sterile after approximately 82 days, and the acceptability was very good. A group of 34 patients (10.8%) had a delay in the onset of aspermia. This is discussed in relation to the findings of other investigators.

PIP: A series of 357 bilateral vasectomies for male sterilization performed over a period of 18 months was reviewed to assess the safety of the surgical procedure, the onset of sterility, and the acceptability of the procedure. Before the procedure a preoperative interview of the applicant and his wife was done. 315 of the patients were suitable for follow-up. One group of men produced negative semen samples within 180 days and the second delivered the sample only after 180 days. The operation proved to be very safe with minor complications in less than 1% and epididymitis in 1.5%., hematoma in 0.2%, and scrotal abscesses in 0.4%. Psychosexually, all patients were satisfied with the procedure and would recommend it to friends. 281 patients, or 89.2% became sterile within a reasonable period of about 82 days and most resumed sexual intercourse 2-14 days after the intervention with a frequency of 2-3 times per week. No patients presented any symptoms of spermatic granuloma.

Female incontinence: how much work-up is necessary?

Female incontinence at an age where it cannot be classified as a geriatric situation is a major problem for gynecologists and urologists. For several years both disciplines in Louvain have been working together in order to assess more precisely the indications for the different therapeutic possibilities and to evaluate results and failures of these therapies. This paper presents reflections on this experience together with comments on recent literature.

A computerized experimental set-up for in vitro evaluation of smooth muscle contractility.

A fully automated system is designed and developed for the investigation of in vitro contractility of muscle tissue in response to dose-dependent pharmacologic and/or electrical stimulation. The heart of the set-up is a personal technical computer. It drives the experiment by selecting and changing drug concentrations, by applying electrical stimulation, by sampling the tissue's contractile response and by real-time calculation of results. Parameters of interest are derived and updated for further selection and statistical manipulation. Alpha-numerical or graphical hardcopies may be drawn at any time. Investigator's intervention is limited to preparing perfusing solutions, mounting the muscle tissue strips, deciding test condition parameters, supervising the experimental progress and leading statistical calculations.

[Ileo-ureteral reflux after urinary diversion through an ileal conduit]. / Ileo-ureteraler Reflux nach Harnableitung durch ein Ileum-Conduit.

The authors made a comparative study (intravenous urography, loopography and loopomanometry) between patients with inverted antireflux anastomosis, as proposed by Melchior, and 12 patients with classical uretero-ileostomy (Bricker bladder). Inverting the anastomosis results in greater incidence of obstruction, while less complications were seen using the classical technique. The importance of reflux in ileal loops and the validity of the classical and manometry loopogram is discussed. Antireflux procedure is only indicated in cases with dilated ureters.

Cough-induced electrostimulation in incontinence.

A new method for treatment of urinary stress incontinence is described. Through a vaginal plug the pelvic floor muscles receive a series of electric stimulations which are triggered by an increase of abdominal pressure, detected by an inbuilt pressure sensor. In this study the best parameters for the stimuli are determined during three successive coughs, which are the most common course of urine loss.

The after-contraction: a true detrusor contraction or a late dyssynergic urethral sphincter contraction?

OBJECTIVE: To evaluate the mechanism and significance of the after-contraction, recorded in bladder pressure by urodynamics, at the end of micturition. PATIENTS AND METHODS: The urodynamic recordings showing an after-contraction of the detrusor in 65 patients of all ages and with a variety of pathologies were re-examined. Special attention was directed to the anal or urethral sphincter needle electromyographic activity and to the monitored urethral pressure, to determine any relationships with the patterns of detrusor pressure. RESULTS: An after-contraction was noted in 61 patients with detrusor instability and in 11 with urethral instability. In 59 patients it was evident that the after-contraction, i.e. a renewed increase in detrusor pressure during the declining contraction, correlated with a sphincter contraction preceding it by a fraction of a second. Similar increases in detrusor pressure were apparent in patients with detrusor-sphincter dyssynergia throughout voiding. In six patients the relationship was less clear mainly because there were artefacts in the curves. CONCLUSION: The after-contraction arises by a sudden stopping of the outflow of urine, provoked by a sphincter contraction. This may occur by involuntary dyssynergia or by an early voluntary interruption of the voiding stream. The 'milk back' of urine from the proximal urethra to the bladder and the inhibited detrusor contraction (if the perineal contraction is prolonged) may cause some postvoid residual urine. It occurs mainly in the presence of detrusor and/or urethral instability.

The physiology and pathophysiology of the ureter.

A review is given of the theories concerning the transport of urine from the calyces to the bladder. The application of hydrodynamic laws on the propulsion of urine, the visco-elastic characteristics of the ureter wall, the myogenic versus the neurogenic origin of spontaneous activity of the ureter and the presence of pacemaker areas, are discussed. The changes of peristaltic activity and intraluminal pressure during obstruction, infection and reflux are summarized.

Physiological and pathological urethral pressure variations.

From an analysis of 202 patients and a careful literature analysis we conclude that pathological urethral instability should be differentiated from physiological urethral pressure variations by the following criteria: a pronounced amplitude of at least one third of the maximum urethral pressure variations by the following criteria: a pronounced amplitude of at least one third of the maximum urethral closure pressure (usually > 25 cm H2O), a short duration (1-5 s), a simultaneous inhibition of the electromyographic activity in urethral and (or) anal sphincter, and the occurrence of the phenomena starting at the beginning of bladder filling (100 ml).

A critical view on the value of urodynamics in non-neurogenic incontinence in women.

The requirements for reliable urodynamics are standardized techniques, including uniform pressure sensors, filling rates, position and posture during the investigation, and uniform diuresis. Physiological variations in flow and urethral pressure profile (UPP) (menstrual cycle, intensity of coughing, circadian variations) must be considered. Parameters of the UPP (maximum (closure) urethral pressure, pressure-transmission ratio and leak-point pressure) are useful if interpreted with caution. Uninhibited detrusor contractions are more frequently recorded in ambulatory urodynamics, and range from 'subthreshold' to very strong. No quantification formulae correlate with subjective symptoms or degree of urge (incontinence). Mixed incontinence can make the results of surgery worse, but do not so necessarily. Postoperative dysuria cannot be predicted from urodynamics, as surgical factors are more important. Electromyography is not useful in non-neurogenic female incontinence. For routine nonneurogenic incontinence extensive urodynamic testing can be reduced to one pressure measurement; more complicated cases must be tested by a physician with large practical experience and a theoretical background.

Psychological and sexual aspects in different types of bladder dysfunction.

Different types of dysfunctional voiding are described and correlated with psychological characteristics and sexual dysfunctions. Motoric as well as sensoric urge incontinence seems to be more frequently associated with psychological problems than stress incontinence and a psychosomatic therapy often results in cure without any surgery. A multidisciplinary approach to the problem is stressed.

Our approach to primary enuresis in children.

In 150 children with enuresis following protocol was applied: a detailed questionnaire, a voiding chart, clinical examination, ultrasound of the kidneys, and uroflow. A tentative treatment based on the flowchart shown in the paper is installed. If after 4-5 weeks no amelioration is observed observation is completed by a urodynamical examination and a permictional urethocystography and the treatment adapted to the results. On this bases each enuresis case could be categorized in one of 4 groups with typical clinical and urodynamical characteristics requiring a specific treatment. The study shows that by an appropriate selective treatment including physical and psychological training and medication nearly all children can get dry.

Sexual activity of men presenting with prostatism: effect of prostatectomy.

The sexual activity of 153 patients was compared before and three years after transurethral or open prostatectomy. A significant decrease of sexual activity was noted. Multifactorial causes are responsible such as age, general physical and psychological conditions, partners attitudes.

Bladder pressure and kidney function in children with myelomeningocoele: review article.

Therapy of children with myelomeningocoele should achieve a double goal: on the one hand, obtain continence and, on the other hand, preserve kidney function without complications. The first goal is a social and psychological one, the latter is a vital one.

Extensive surgery on the trigone for complete ureteral duplication does not cause incontinence or voiding problems.

OBJECTIVES: To evaluate whether extensive trigonal surgery for duplicated kidneys is harmful for later bladder and urethral function. METHODS: Of 201 surgically treated children with kidney and ureteral duplication, 145 were followed up for at least 1 year. The mean follow-up was 5 years (range 1 to 15), and all patients were at least 7 years old at the date of their last follow-up visit. Trigone surgery was performed in 105 children; bilateral trigonal surgery in 26, unroofing in 25, and total excision in 5. On all later consultations, the presence of infection, voiding habits, continence pattern, and ultrasound findings for residual urine volume and kidney function were noted. Children with recurrent urinary tract infection or dysfunctional voiding for more than 2 years underwent a urodynamic examination. RESULTS: Nine children, of whom five were boys, had nocturnal enuresis only. Eight patients had day and nighttime wetting. Seven of the 8 patients had recurrent urinary infections; urodynamic evaluation revealed a high compliance (with residual urine) in three of these children and four had detrusor instability. One girl had an irregular bladder neck, with stress incontinence. All reflux, whether surgically or conservatively treated and also three of four occurring de novo, disappeared within 1 year after surgery. In the group without voiding dysfunctions, seven cystitis and five pyelonephritis attacks occurred. CONCLUSIONS: Neither extensive trigonal surgery nor pre-existing trigonal deformation by ureteroceles provokes later bladder dysfunction.