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Purpose: The objective of this retrospective study is to show the importance of sonography in andrological patients with testicular microlithiasis (TM)., Patients and Methods: 1314 male patients were seen to our andrological clinic in the course of one year. The age range of these patients was 25 to 39 years (mean age 32 years). All patients underwent testicular sonography as well as a sperm-analysis., Results: 284 patients showed normozoospermia without any evidence of TM. Of the remaining 1030 patients with a pathological spermiogram, 8 were shown to display more than 10 echogenic foci per transducer field in both tests. 1 patient suffering from an already palpable testicular tumor only showed, unilateral, unifocal calcification. Another patient who had suffered from a maldescensus testicle in his early childhood discharged only one unifocal calcification. Tumor markers including AFP and beta-HCG were normal in 9 patients, but elevated in 1 patient suffering from a testicular tumor (AFP: 73 kU/l; beta-HCG: 10.6 U/l). The hormonal status was normal in 6 patients and pathological 4 patients with the diagnosis of OAT-syndrome., Conclusion: TM is a rare condition even in andrological patients. Nevertheless, a thorough scrotal sonography is mandatory in order to rule out testicular malignancy.

To determine the morphologic impact and safety of high-intensity focused ultrasound (HIFU) administered transrectally for tissue ablation, a total of 22 prostates were treated in vivo with transrectal HIFU prior to surgical removal. Location and size of the tissue lesions correlated well with the predefined target area and revealed sharply delineated coagulative necrosis in all cases. In a subsequent phase II clinical trial the clinical effectiveness of transrectal HIFU as a minimally invasive treatment modality for patients with symptomatic benign prostatic hyperplasia (BPH; n = 50) was studied. The maximum urinary flow rate (Qmax, ml/s) increased from 8.9 +/- 0.6 (n = 50; mean +/- SEM) to 12.8 +/- 0.9 (3 months, n = 46), 11.9 +/- 0.9 (6 months, n = 44) and 12.2 +/- 1.0 (12 months, n = 32). Within the same time period, the post-voiding residual volume (ml) decreased from 113 +/- 17 (mean +/- SEM) to 47 +/- 6, 57 +/- 7, and 49 +/- 6. These data demonstrate that transrectal HIFU can induce intraprostatic coagulative necrosis. The phase-II clinical data presented in this paper reveal that transrectal HIFU is an effective and safe minimally invasive treatment option for BPH. Nevertheless, a randomised phase-III trial comparing HIFU and TURP is mandatory to define the definitive role of transrectal HIFU in BPH, and is presently planned.

Testicular cancer is the most common malignancy in men aged 15 to 30 years. In the 1990s testicular cancer has become one of the most curable solid neoplasms, and it can serve as a paradigm for the multimodal treatment of solid malignancies, making even a metastasized cancer a curable disease. The dramatic improvements in survival have occurred as a result of the combination of effective diagnostic techniques, improvement in serum tumour markers, modification of surgical technique and, above all, the development of highly effective multidrug chemotherapeutic regimens based on cisplatin. In the 1990s overall survival for all stages of testicular cancer should be well above 80% and should approach 100% for patients with low stage disease. Important studies forming the basis for the most up to date multimodality treatment are reviewed in this article. Alternative strategies for salvage therapy in poor risk patients and those who failed to respond to treatment are discussed, as well as minimization of toxicity in low risk patients.

Symptomatic benign renal cysts in 23 patients were obliterated by ultrasound-guided puncture and instillation of sterile 95% ethanol. In no case did complications occur. In 5 cases the cysts recurred after an average of 3 months; the primary size (diameter) was more than 10 cm in all of these. This simple technique seems to be a suitable treatment option for smaller cysts up to 10 cm because of its low complication rate and because no hospital admission is required.

As a non-invasive, easily repeatable examination ultrasound can supplement or even replace angiography in cases of renal trauma. Since it is moreover cheap and quickly performable, an ultrasound examination should never be omitted when renal trauma is suspected. It does not matter whether it is performed before or after infusion urography; this will mainly depend on the facilities available. It must be stressed that ultrasound is diagnostic tool and that its full potential is only realized in combination with other diagnostic methods, e.g. urography, angiography, computerized tomography.

The most important aspects of the clinical findings, endocrinology and course of the disease in 14 patients with the histological diagnosis of pure seminoma of the testis and positive serum beta-HCG levels are presented. In addition to routine investigations, immunohistochemical examination of the formalin-fixed specimen by the immunoperoxidase technique was also carried out. Serum alpha-feto-protein levels remained normal in all 14 patients. There was no correlation between serum beta-HCG level and tumour stage. The longest period of observation was 76 months and the shortest 8 months. Patients with no evidence of metastatic disease (5 patients, N0M0) or patients with low-stage disease (5 patients, N1 or N2M0) respond very well to radiotherapy. 4 patients (N3-N4M0) with large retroperitoneal metastases or distant lymph node metastases underwent different combinations of treatment.

Between 1975 and 1980 35 patients with incurable carcinomas and bilateral ureteral obstruction who had been fitted with pull-through pyelonephrostomies were retrospectively studied with particular reference to the post-operative quality of their lives. 30 patients who died of the primary diseased had survived for periods of between 14 days and 30 months; the average was 7.5 months. There was no significant correlation between pre-operative kidney function and survival time. The post-operative quality of the lives of the patients who had shown good kidney function before the nephrostomy was fitted was significantly better than that of the patients with bad kidney function.

Out of 82 patients with acute swelling of the scrotum, 25 (30.5%) had hydatid torsion. Hydatid torsion was the second most common cause of acute scrotal swelling in the entire patient group. In the group of patients up to 14 years of age (n = 36), hydatid torsion was found in 47.2% and was the most common cause of acute scrotal swelling, followed by torsion of the spermatic cord. Only 3 patients had torsion of an appendage of the epididymis. All other patients (n = 22) had torsion of the hydatid of Morgagni (appendage of the testicle). A difference in anatomical structure and vascularization during childhood seems to be the most important aspect regarding hydatid torsion and hemorrhagic infarction. Ultrasonographic examination of the scrotum and checking to see if the typical physical signs are present can help in making the exact diagnosis. In 13 patients with hydatid torsion, the scrotum was examined with ultrasound high-frequency transducers (7.5, 10 and 12 MHz). In 4 patients, the diagnosis was hydatid torsion, as determined by ultrasonography. Two patients were treated conservatively with a daily follow-up including a clinical examination and investigation of the scrotum with ultrasound. The patients recovered very quickly and the acute symptoms resolved within a few days in virtually all instances. Thus, in cases where the diagnosis is proven and the course of the disease is reasonably mild and painless, conservative management of intrascrotal hydatid torsion is possible and can be an effective means of treatment in lien of surgical intervention.

Repeated blood sampling at 10-minute intervals over a 4-hour period (15.00 until 19.00) for simultaneous determination of FSH, LH and testosterone was carried out in 7 normospermic men and 8 patients presenting with idiopathic oligozoospermia. Fluctuations of LH and testosterone were observed within the 4-hour sampling period. Only minor alterations of FSH were found. Planimetric assessment of the areas under the curves of FSH, LH and testosterone did not show any significant difference in FSH. Testosterone was found to be significantly decreased in the oligospermic group (p less than 0.025), while LH showed a tendency to be increased (p less than 0.1). These results point out that single determinations of LH and testosterone do not provide exact information, due to the wide range of hormone fluctuation. Serial sampling of the hormones demonstrates Leydig cell dysfunction in patients with moderate idiopathic oligozoospermia.

30 patients with testicular cancer (20 seminoma, 10 non-seminomatous tumours) were investigated with respect to the determination of alpha-fetoprotein and beta-human chorionic gonadotropin in formalin-fixed slices by means of the indirect immunoperoxidase technique. The immunohistochemical method detected HCG-producing cells in 8 seminoma, whereas routine histology revealed syncytiotrophoblastic giant cells in 4 cases only. The immunohistochemical results and the serum AFT, and/or HCG values obtained by radioimmunoassay corresponded well in all patients with non-seminomatous tumours. Direct evidence of HCG production in the primary tumour can be important in therapeutic decisions, especially in patients with seminoma. The direct proof of AFP in the primary tumour might answer in the future the question of the incidence and the prognostic impact of yolk sac tumour parts in malignant teratomas.

An approach to differentiating tissues by means of local texture analysis is described and its diagnostic power is evaluated using various diseases of the liver, kidney and the prostate.

Studies on the absorption of Ethoglucid from human urinary bladder, utilizing a photometric method to determine Ethoglucid in biological fluids, gave the following results: The intact uroepithelium prevents absorption of interluminal Ethoglucid as well as no significant increase of absorption was seen in the presence of superficial, highly differentiated cancers or inflammatory alterations of the bladder. Urothelial lesions after transurethral resection or infiltrating cancers permit an intercellular diffusion of Ethoglucid from the bladder cavity into the systemic circulation, due to a loss of intercellular gaps between the urothelial elements.

In 66 patients with renal tumours on 30 patients a preoperative transfemoral embolisation of the renal artery of the tumour-bearing kidney was performed. The complications were established and compared with the 36 patients without occlusion. On account of the considerable side effects a preoperative occlusion seems to be reasonable only in selected cases.