Search

Background: Prostatitis is the most common urological disease in males under [corrected] the age of 50 years old. As bacteria are detected in only <5% of cases the disease can mostly be classified as chronic nonbacterial prostatitis. The symptoms of this problem complex, often described as chronic prostatitis and chronic pelvic pain syndrome (CP-CPPS), seem to be multifactorial so that an improvement can only rarely be achieved with conventional forms of therapy., Materials and Methods: The aim of this study was to investigate whether osteopathic treatment can influence the symptoms of CP-CPPS (randomized controlled study, 5 sessions, follow-up after 6 weeks and 1.5 years without treatment). The study was carried out in a practice for osteopathy. Patients were recruited by referral from urologists, newspaper articles and lectures on the topic. A total of 35 males with medically diagnosed CP-CPPS aged 29-70 years old took part in the study. Of the patients 20 were allocated to the treatment group and 15 to the placebo group whereby 2 patients had to retire from the study prematurely. Patients in the treatment group received 5 osteopathic treatment sessions separated by 1 week at the beginning and by up to 3 weeks at the end (total period 8 weeks). The osteopathic dysfunctions of the patients were treated according to the principles of osteopathy. The placebo treatment in the control group consisted of a training program with simple gymnastic and physiotherapeutic exercises. Improvements of the complaints by urination (LUTS), chronic pelvic pain (CPPS) and quality of life (QOL) were measured using the questionnaires for international prostate symptom score (IPSS), the National Institutes of Health chronic prostatitis symptom index (NIH-CPSI) and the quality of life index (QOL)., Results: Comparison of the results from the osteopathy and placebo groups revealed statistically significant differences in favor of the osteopathy group (p<0.0005). During the study period the average IPSS in the osteopathy group improved from 19.7 to 10.3 points (48%, p<0.0005), the NIH from 26.0 to 12.0 (54%; p<0.0005) and the QOL from 4.4 to 1.9 points (58%, p<0.0005). In contrast the corresponding values in the placebo group remained relatively constant. At the follow-up 6 weeks after the last session the improvements in the osteopathy group were found to be stabile and remained so at least up to the second follow-up after 1.5 years., Conclusions: The positive results of this study indicate that osteopathic treatment can be considered a genuine alternative to the conventional treatment of CP-CPPS and a closer cooperation between urologists/internists and osteopaths would be desirable. Further studies with larger numbers of patients should be carried out to substantiate these results.

The repair of an inguinal hernia is the surgical procedure most often performed. Complication rates after laparoscopic hernioplasty amount up to 19%, with hematoma/seroma, neuralgia, urinary retention, and chronic pain most frequently reported. Significant complications such as trocar site bleeding or bowel injury occur in 0.4-5.6%, and sporadic intraoperative lesions of the bladder have been mentioned. We present a 48-year-old patient with recurrent dysuria 3 years after transabdominal preperitoneal hernioplasty (TAPP). The preoperative diagnostic evaluation led to the assumption of an intravesical mesh dislocation. In spite of extensive adhesions between the mesh and the bladder wall, the mesh including five fixation coils could be removed via a suprapubic access. The postoperative period was without complications, and the patient has no complaints. The incidence of complications after laparoscopic hernioplasty is low. Still, severe problems such as mesh rejection, spermatic granuloma, or mesh migration into the small and large intestine do occur. Migration of a mesh into the urinary bladder has only been described twice.

In 60 patients with non-seminomatous testicular germ cell tumours in clinical stages I, IIa and IIb inguinal orchiectomy was performed as primary treatment, followed by modified retroperitoneal lymphadenectomy (RLA). In stage II disease chemotherapy was given in addition. After a follow-up period of at least 24 months only 5% of the patients showed progression of disease. Normal ejaculatory function was preserved in 88% of our patients. Modified RLA seems to be a safe procedure with an acceptably low rate of complications not only in stage I disease, but also in metastatic stages IIa and IIb.

In addition to neuropediatrical, neurosurgical and orthopedical care a continuous urological surveillance is indicated in children with myelodysplasia. Urodynamic assessment, voiding cystourethrography, kidney- and residual urine, ultrasound, excretory urography and radioisotope studies at birth and periodically until puberty are performed to evaluate the urinary tract. Early and specific treatment of bladder dysfunction is necessary to prevent urinary infection and preserve renal parenchyma. Urodynamic testing showed evidence of neurogenic bladder dysfunction in 13 of 14 evaluated children (including 8 newborns): detrusor-sphinkter-dyssynergia in 57 percent, detrusor hyperreflexia in 21 percent and detrusor areflexia in 14 percent. 4 of 5 children with detrusor-sphkincter-dyssynergia were treated effectively with anticholinergic agents and clean intermittend catheterization.

The results of clinical evaluation of 71 patients with primary or secondary enuresis are presented. In 66 patients a complete urodynamic assessment was possible. 35 percent of these patients showed a normal urodynamic pattern, in 45 percent detrusor hyperreflexia and in 18 percent a combination of detrusor hyperreflexia and a functional infravesical obstruction was demonstrated.

A new sensitive method for the determination of oxalate is presented. By using the chemiluminescence decay of monoperoxyoxalic acid very low concentrations of oxalate can be determined (up to 100 nmol/l). Oxalate determinations in urine require the precipitation of calcium oxalate, in order to avoid oxalate-unspecific side emissions. This could be avoided by combination with a specific enzymatic partial reaction, which would also permit the determination of low concentrations of other organic species (e.g. citrate, pyruvate, malate).

Between 1977 and 1979 a total of 79 patients with osteomyelitis were seen at the Surgical Dept. of the Greifswald-University. 144 operations were performed, 93 to cure infections, 17 for stabilisation of bones (preferably by "Fixateur externe", 34 for closure of bone and soft tissue defects. Special attention is devoted to transplantation of autologous cancellous bone chips, crossleg-flaps and splitskin grafts for secondary wound cover.

Isologous isolated islets of LANGERHANS were transplanted in the peritoneum and through the portal vein in the liver of diabetic rats. With the help of histological and immunohistochemical investigations, estimation of blood sugar and glucose tolerance tests was tested over a period of 12 month, whether the peritoneum or the liver is more suited as transplantation site for isolated islets of LANGERHANS. After transplantation of islets of LANGERHANS in the peritoneum of diabetic rats the blood glucose decreased and this effect could be maintained over a period of three months. The histological investigations showed strong periinsulinar reactions and the immunohistochemical insulin and glucagon proofs prospered over a period of three months. After transplantation of isolated islets in the liver it resulted in a normalization of blood glucose levels up to 12 months after transplantation and in this time prospered the immunohistochemical insulin and glucagon proof. These results have suggested, that the liver is more suited as transplantation site for isolated islets of LANGERHANS than the peritoneum.

Due to relative shortness of his penis a 67-year-old patient suffering from erectile dysfunction could not perform sexual intercourse, despite the implantation of a penile prosthesis. After intraspongious injection of 3 ml of a vasoactive substance mixture (papaverine 15 mg/ml and phentolamine 0,5 mg/ml) an increase in glandular circumference of 1.5 cm and in penile length of 1.8 cm took place, lasting for 1 1/2 h. By this means the patient regained the ability of a normal sexual life.

Isologe isolated islets of Langerhans were transplanted to diabetic rats in a peritoneal pouch and in liver tissue. By the immunhistochemical evidence of insulin and glucagon was examined the intangibility of the transplanted islets. It is profitable to transplant the isolated islets of Langerhans in the liver tissue than in the peritoneum.

Well defined results can be obtained quickly by in vitro test concerning the preservation effect of the preserved dog's pancreas. Clinical and chemical parameters were received during the hypothermic perfusion respectively during the refrigerant storage. The in vitro function tests were carried out after the preservation by insulin and glucagon stimulation. The results showed that the A and B cells of the dog's pancreas are completely able to function after a preservation of 24 hours. Thereby a strong formation of edemas by releasing high enzyme activities is caused during the mechanical perfusion of the organs. The simple refrigerant storage of the pancreata therefore, is the more suitable preservation form for organ transplantations.

Isolated islets of Langerhans were transplanted through the portal vein in the liver of 8 diabetic dogs; In 4 dogs a homologous transplantation was performed and another group of four dogs received isolated islets from their sisters or brothers. In both groups, there was an immediate effect on the blood glucose level. After pancreatectomy and injection of Alloxan the blood glucose rose to between 350 and 420 mg per 100 ml and after islet implantation the blood glucose decreased between 80 to 160 mg per 100 ml. The iv GTT'S were after islet implantation clear better than in the diabetic control animals. These results could maintained in the recipients with homologues islets over a period of 6 to 8 weeks and in the other group of dogs over a period of 6 to 12 months. We were able to show, that the islet implantation in the liver of diabetic dogs did not disturb the microscopic architecture of the liver. No signs of portal hypertension, hepatic congestion and embolism were found.

In 12 domestic pigs, body weight ranging between 30 and 40 kg at operation, under general anesthesia the continence organ was paracoccygeally dissected on one side, and in 6 other animals bilaterally, and immediately thereafter reconstructed. The reconstruction was done paying regard to the fascial skeleton. In all cases the wounds healed primarily. The functional results were good, incontinence was not observed.