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Anastomoses between the dorsal artery of penis and the deep penile artery are necessary for revascularization of penile arteries. Radiologic and anatomic proof is provided. Arterio-arterial anastomosis represents a risk factor for thrombosis. For its exclusion the necessary operative course of action is showed. By building an additional arteriovenous shunt close to the arterio-arterial anastomosis the risk of thrombosis is markedly decreased. Our technique produces good results in patients with diagnosed erectile dysfunction of vascular origin with a spontaneous erection when the occasion arises.

Zusammenfassung Bei einem 51jahrigen chronisch uramischen Patienten wurde wenige Tage nach der Nierenallotransplantation eine asymptomatische Candidurie festgestellt. Wahrend der ersten postoperativen Woche trat eine akute Abstosungskrise auf, die mit hochdosierter Prednisontherapie und lokaler Rontgenbestrahlung des Transplantates beherrschbar war. 2 Monate nach der Transplantation muste der Patient wegen einer akuten Anurie bei verschlechterter Nierenfunktion erneut hospitalisiert werden. Als Ursache fand sich eine den ganzen Ureter obstruierende Candidose mit Bezoarbildung. Andere Organmani-festationen fehlten. Unter Spuldrainage der ableitenden Harnwege mit Amphotericin B sowie peroraler Behandlung mit 5-Fluorocytosin (Ancotil) normalisierte sich die Nierenfunktion; die Candidurie verschwand innerhalb 12 Tagen und der Patient ist nun seit 1½ Jahren rezidivfrei. Es wird auf die Haufigkeit der Candidurie bei Nierentransplantierten eingegangen. Aufgrund dieser unserer Erfahrungen behandeln wir jede asymptomatische Candidurie bei Transplantationskandidaten und Nierentransplantierten auch bei quantitativ geringem Befund. In der Regel wenden wir eine Monotherapie mit 5-Fluorocytosin an. Summary A 51-year-old man with chronic glomerulonephritis was found to have candiduria a few days after bilateral nephrectomy and cadaver kidney transplantation. At the same time, an acute rejection crisis made high doses of prednisone and irradiation of the transplant necessary. Two months after transplantation, the patient was admitted again with acute anuria and impaired renal function. At operation, a complete obstruction of the transplant ureter by multiple fungus balls of Candida albicans was found. The renal function improved with drainage of the transplanted urinary tract, local rinsing with amphotericin B and oral treatment with 5-fluorocytosine (Ancotil). The candiduria disappeard within 12 days and the patient has been well for the last 1½ years. The occurrence of candiduria in patients with kidney transplants is discussed. Based on our experiences, we treat candiduria in transplant candidates and transplant recipients even if there are only a few fungi in the urine sediments. Usually, we prefere a mono-therapy with 5-fluorocytosine. Unter den Komplikationen nach Nierentransplantationen sind solche, die mit einer Anurie einhergehen, besonders dramatisch und in bezug auf das uberleben des Transplantates von groster Bedeutung. Der sehr seltene Fall einer Obstruktion des Ureters durch Pilzmassen soll deshalb beschrieben werden.

Results of the ANOVAs and Studentâ s t-tests reporting p-values for comparisons of left ventricular (LV) echocardiographic dimensions between age groups, genders and breeds groups. (DOCX 21 kb)

Results of the multivariate regression analyses, showing the influence of external factors considered as independent variables on left atrial (LA) and great vessel echocardiographic dimensions. (DOCX 29 kb)

Results of the ANOVAs and Studentâ s t-tests reporting p-values for comparisons of morphometric measurements between age groups, genders and breeds groups. (DOCX 17 kb)

Results of the ANOVAs and Studentâ s t-tests reporting p-values for comparisons of left atrial (LA) and great vessels dimensions between age groups, genders and breeds groups. (DOCX 18 kb)

Results of the multivariate regression analyses, showing the influence of external factors considered as independent variables on left ventricular (LV) echocardiographic dimensions. (DOCX 37 kb)

Results of the univariate linear regression analyses, showing the weak influence (expressed as R2) of the chosen explanatory parameters on left atrial (LA) and great vessel echocardiographic dimensions. (DOCX 16 kb)

Zusammenfassung: Der Blick ins Innere des Menschen ist ein alter Wunsch in der Medizin. Die Entwicklung der Zystoskopie ist den dafür Interessierten bekannt. Nachfolgend steht diese Untersuchung nicht im Zentrum des Blickpunktes, sondern die Menschen, die dahinter stehen, die ihre Energien und ihre Phantasie einsetzen, um das einmal Erreichte zu verbessern. Dabei kommt man nicht darum herum, über Menschliches—Allzumenschliches—zu berichten

Die Gedanken und Hypothesen des pathophysiologischen Geschehens bei erektiler Dysfunktion—ihre Irrungen und Wirrungen—werden wiedergegeben, beginnend bei Aristoteles und weitergefuhrt uber die Renaissance und Aufklarung. Erst Mitte des 19. Jahrhunderts wird das zentrale Geschehen der Relaxation der Trabekelmuskulatur erkannt. Es dauerte noch uber weitere 100 Jahre bis zur sinnvollen medikamentosen Therapieoption.

Introduction: As even experienced urologists have a high percentage of persisting carcinoma after transurethral bladder tumour resection (TUR-B) the importance of a routine second resection in the management of transitional cell carcinoma (TCC) of the bladder is defined. Patients and Methods: The medical records of all patients treated with TUR-B at our institution between January 1989 and September 2000 were reviewed. 214 patients with pTa and pT1 carcinoma undergoing a second resection 4–6 weeks later were included in the analysis. The rate of persisting carcinoma in the second resection was compared to the actual tumour stage and grade, the patient’s age, sex and the experience of the urologist performing the resection. Results: Of the 214 patients 99 had pTa and 115 pT1 carcinoma. The rate of persisting tumour in the second resection was 27% in pTa and 37% in pT1 carcinoma. This rate was independent of the patient’s age and sex. Urologists in training had an equally low rate of persisting carcinoma in the second resection compared to senior urologists (p = 0.08). Conclusions: Routine second resection of superficial transitional cell carcinoma of the bladder should be part of the treatment even in larger operative experience.

This article provides an overview on pharmacological and clinical trials with trospium chloride (TC1) in the treatment of urinary incontinence. A total of 19 clinical trials and post-marketing surveillance studies including more than 10,000 patients is reported. Selected pharmacological and clinical pharmacokinetic data are discussed as a basis for a better interpretation and understanding of the clinical trial results. The efficacy and safety of trospium chloride in the treatment of detrusor overactivity is well proven. Given a favorable risk/benefit ratio trospium chloride qualifies as a first choice drug for the treatment of urge incontinence and reflex incontinence.

Extracorporeal shock-wave lithotripsy (ESWL) has rapidly become established worldwide as a routine method for treatment of nephro- and ureterolithiasis. Although initial studies showed no tissue-damaging effect by the shock waves, we found, in an animal experiment using canine kidneys, that the ESWL-induced damage to the renal parenchyma is more marked than originally assumed. The damage is limited to the area that was focused on, and heals relatively rapidly by connective tissue encapsulation with final cicatrisation without any further residual effects being observed up to the present. This parenchymal damage is probably also the cause of the macrohematuria that is always observed during therapy. The resulting tissue damage is not extensive enough to cause a demonstrable reduction of function as measured by the usual methods (serum creatinine, creatinine clearance, isotopy renography, i.v. urography). In serum we observed a transient decrease of calcium, an immediate increase of lactate-dehydrogenase, transaminases (SGOT and SGPT) and a delayed increase of alkaline phosphates. Creatinine, blood urea nitrogen, sodium, potassium and amylase remained within normal limits. In urine, a decrease of creatinine and an increase of glucose excretion were noted. We believe that these changes represent a relatively mild and transient damage of renal cells and do not reflect the occasionally heavy morphological changes observed after shock-wave exposure. The main clinical complication is the large subcapsular hematoma which, according to the present knowledge, could well result from a lesion of the larger peripheral vessels. Damage to other organs such as subserous colonic and small bowel hematomata are to be expected although they do not lead to clinical symptoms.

Introduction: The aim of this study is to determine the relationship of hydrochloric acid secretion in gastric pouch (GP), an orthotopic neobladder using a stomach segment, to gastrin. Material and Method: Pentagastrin (PG) stimulation test (PGST) was applied in 10 patients who had had GP surgery 5–70 months ago, and their urinary pH changes in the next 2 h were observed. Results: Significant pH decreases (from 6.6 ± 0.6 to 2.9 ± 1.0 in the mean) 30–75 min after injection of PG, demonstrating gastrin-triggered acid secretion in GP were observed in all patients. The pH values were normalized in 2 h (6.6 ± 1.0 in the mean). Conclusion: In PGST, urinary pH decreases, demonstrating the close relationship between gastrin release and acid secretion in the GP. Inhibition of gastrin by any means may be useful in keeping the urinary pH on physiological levels.

Twenty-two patients with locally advanced prostatic carcinoma stage T3, N₀, M₀ have been treated with LH-RH agonists during a mean time of 5 months prior to radical retropubic p

The computed tomographic (CT) and magnetic resonance (MR) appearance of a retrovesical leiomyoma in a male patient is presented. Although leiomyomas are common lesions, the location within the retrovesical pouch is very unusual.

Within an overland transport agreement between Switzerland and the European Union, this paper describes how Switzerland has accepted the gradual increase in heavy goods vehicle (HGV) axle weight limits from 28 to 40 tons. Thus, people’s quality of life is influenced in the affected regions, as they are exposed to the pollution with noise and harmful substances. Hence, it is assumed that people move to less affected areas and accept longer journeys to their workplaces; on the other hand, the transalpine freight traffic might create new jobs in the affected municipalities. Thus, research on the transalpine freight traffic’s impact on people and environment is carried out at the Swiss Federal Institute for Forest, Snow and Landscape Research. The objective is to verify the previously formulated hypotheses. However, the analysis of demographic data showed for one municipality that people moved away from there because of lack of building land and because of the municipality’s location in a narrow shadowy valley. These persons accepted longer journeys to their workplaces, profiting from an improved supply of public transportation and increased mobility. Nonetheless, although the transalpine freight traffic created workplaces for this municipality, it can only partially explain why people commuted there. For another municipality, in spite of transalpine freight traffic increase, people moved there as they profited from the good attainability of larger cities, low taxes, the availability of building land and because the transalpine freight traffic’s noise was responsible for lower land prices. Analyses of socioeconomic data for further municipalities will be necessary and quantitative interviews will complete and thus confirm or modify the present results. The interviews shall be repeated regularly in order to evaluate the changes in quality of life in the affected municipalities.

■ Die PNL ist eine sichere und meistens wening invasive Methode zur Therapie einer Nephrolithiasis mit groser Steinmasse. ■ Auftretende Komplikationen konnen meistens konservativ beherrscht werden und zwingen nur selten zu einer offenen Revision. ■ Trotz groster Sorgfalt konnen selten auch vitale Komplikationen auftreten. ■ Die interdisziplinare Besprechung und Behandlung dient der Losung komplexer Probleme.

The development of HIV protease inhibitors has dramatically improved the treatment prognosis of HIV-infected patients. The treatment, however, is associated with the potential for adverse events that are unique to protease inhibitors. One of them, Indinavir, can lead to the development of urinary stones. Three weeks after starting treatment with Indinavir, Zidovudine and Lamivudine, a 66-year-old patient developed symptomatic hydronephrosis on the right side due to multiple Indinavir stones blocking the ureter. Microhematuria and characteristic crystals were found in the urine. After interruption of treatment and increased fluid intake, the crystallurea was not longer detectable and the patient became asymptomatic within 3 days. Nephrostomy and ureteral stent placement were not necessary. Patients on treatment with Indinavir are required to maintain a fluid intake of at least 1.5-2 l/day to reduce the risk of crystallization and urinary stones. Pharmacologic metaphylaxis to prevent crystallization is not recommended.

The aim of this prospective study was to observe immunophenotypic patterns in patients with noninflammatory chronic pelvic pain syndrome (Cat IIIB CPPS) for further description and as possible surrogate markers for diagnosis and treatment.Eighty-eight patients with a referral diagnosis of chronic prostatitis underwent fractionated urinary cultures including expressed prostate secretion (EPS) and ejaculate analysis twice on two occasions. Monthly serum analyses included C3c, C4, IL-1alpha, sIL-2R, and IL-6. One hundred samples from healthy individuals were used as the control group for serum analysis. Monthly ejaculate testing was done for IgG, IgA, IgM, IL-1alpha, sIL-2R, and IL-6. The control group for ejaculate analysis was composed of 96 normal ejaculates (according to the WHO criteria). Immunohistochemical detection of CD3 cells (T lymphocytes) and CD20 cells (B lymphocytes) was performed in 71 biopsy cylinders of Cat IIIB CPPS patients and in 25 prostate biopsy cylinders of men without symptoms or obstruction.Complete sampling of urinary, serum and ejaculate specimens was achieved in 50/88 (57%) patients. Cat IIIB CPPS was observed in 44/50 (88%) patients. Intra-acinar T-lymphocytic infiltrates were dominated by T cytotoxic cells (p = 0.05). Immunohistochemical studies showed inflammatory expression in serum complement, serum interleukin, and ejaculate interleukin concentrations in relation to the presence of large numbers of T cells (all p valuesor =0.01). No difference was found in the proportion of B lymphocytes in patients with Cat IIIB CPPS compared to the control group. Serum and ejaculate IL-6 and ejaculate IgA increased significantly and dropped again, correlating with a release of clinical symptoms.Interleukin, complement and immunoglobulin determinations in serum and ejaculate reveal an inflammatory process even in Cat IIIB CPPS. The findings of intra-acinar T-cell-rich infiltrates and the associated inflammatory reaction may be a significant advance in defining Cat IIIB CPPS caused by a possible autoimmune component. Serum and ejaculate IL-6 and ejaculate IgA are possible surrogate markers for the diagnosis and treatment of Cat IIIB CPPS.

We present 2 cases of malignant fibrous histiocytoma (MFH) of the retroperitoneum. Only 12-14% of all MFH occur in the retroperitoneum. Both patients were operated with the diagnosis of a kidney tumor. The surgical exposure showed a tumor arising from the retroperitoneum, infiltrating or surrounding the kidney. We would like to emphasize that large tumors of the retroperitoneum which resemble kidney tumors can also arise from mesen-chymal tissue.

We report a case of massive perirenal hemorrhage owing to an inferior segmental arterial rupture of an aneurysm, alongside a primarily inapparent polyarteritis nodosa associated with hepatitis B and C. We come to speak of the diagnostic procedure such as angiography, computerized tomography and MRI as well as the intervening measures like catheter embolization and surgical revision.

Controversy regarding the relative efficacy of treatments for the relief of the symptoms of benign prostatic hyperplasia (BPH).This was a 6-month double-blind randomized equivalence study that compared the effects of a plant extract (320 mg Permixon) with those of a 5 alpha-reductase inhibitor (5 mg finasteride) in 1,098 men with moderate BPH using the International Prostate Symptom Score (IPSS) as the primary end-point.Both Permixon and finasteride decreased the IPSS (-37% and -39%, respectively), improved quality of life (by 38 and 41%), and increased peak urinary flow rate (+25% and +30%, P = 0.035), with no statistical difference in the percent of responders with a 3 ml/sec improvement. Finasteride markedly decreased prostate volume (-18%) and serum PSA levels (-41%); Permixon improved symptoms with little effect on volume (-6%) and no change in PSA levels. Permixon fared better than finasteride in a sexual function questionnaire and gave rise to less complaints of decreased libido and impotence.Both treatments relieve the symptoms of BPH in about two-thirds of patients but, unlike finasteride, Permixon has little effect on so-called androgen-dependent parameters. This suggests that other pathways might also be involved in the symptomatology of BPH.

The aim of this study was to investigate whether intraurethral prostaglandin E1 (PGE1) improves vacuum-induced penile rigidity.Nineteen patients with a mean age of 55 years (range 30-66 years) complaining of erectile dysfunction for 24 months (range 3-156 months) were investigated. The penile diameter was measured and a mark was made 50 mm proximal of the coronary sulcus on the flaccid penis. Twenty micrograms of liquid PGE1 (pH 4.5; 308 mosm/l) were instilled intraurethrally; thereafter the meatus was occluded for 10 min. Penile diameter and increase in length of the initially 50-mm line were measured with both pure vacuum-induced erection as well as combined with PGE1.The vacuum erection device alone lengthened the distance by 26 mm (range 18-64 mm) and the diameter by 4 mm (range 2-10 mm). Combined with PGE1, 36 mm (range 27-70 mm; p = 0.016) and 7 mm (range 2-11 mm; p = 0.04) were found, respectively.We conclude that PGE1 significantly increases vacuum-induced tumescence. Optimized pharmacological preparations for intraurethral application are a new way to further improve vacuum-assisted erection.

We present 2 cases of malignant fibrous histiocytoma (MFH) of the retroperitoneum. Only 12-14% of all MFH occur in the retroperitoneum. Both patients were operated with the diagnosis of a kidney tumor. The surgical exposure showed a tumor arising from the retroperitoneum, infiltrating or surrounding the kidney. We would like to emphasize that large tumors of the retroperitoneum which resemble kidney tumors can also arise from mesenchymal tissue.

A case of postoperative hyperemia of the glans penis following revascularization surgery for erectile impotence is described. This new surgical concept (Hauri) combines arterial revascularization with an arteriovenous shunt. The so-called 'postoperative hyperemia of the glans penis' is observed in 10-20% of the cases after arterialization of the dorsal penile vein, i.e. a pure arteriovenous shunt, and in 2-3% of the cases in arterioarterial anastomoses. The ulcers of the glans penis, which occurred 1 year after the operation, healed under careful local anti-inflammatory and antibiotic therapy.

Twenty-two patients with locally advanced prostatic carcinoma stage T3, N0, M0 have been treated with LH-RH agonists during a mean time of 5 months prior to radical retropubic prostatectomy. Although tumors appeared to be confined to the organ in 68% of the patients after endocrine treatment, pathological examination of the surgical specimens showed in 89% evidence of extraprostatic disease, which questions the clinical impression of 'downstaging'. A disparity between the tumor grade of the biopsy and that of the operative specimen as well as an increased size of tumor-involved lymph nodes despite endocrine treatment led us to speculate that a certain proportion of patients will bear the risk of disease progression during preoperative androgen deprivation. Furthermore, there was local recurrence early in the postoperative course and at the high rate of 39%.

Basierend auf den von Dykstra et al. 1988 [1] beschriebenen Erfahrungen berichten wir uber unsere Resultate nach mehr als 2 Jahren Behandlung der Detrusor-Sphinkter-Dyssynergie mit Clostridium Botulinum-A-Toxin. 13 mannliche Querschnittgelahmte, 5 Paraplegiker und 8 Tetraplegiker mit einer neurogenen Blasendysfunktion vom Typ der Lasion des oberen motorischen Neurons, welche an einer Detrusor-Sphinkter-Dyssynergie litten, wurden mit transurethralen oder transperinealen Injektionen von Botulinum-A-Toxin (BAT) behandelt. Das erste Protokoll 1988–1989 [2] bestand in einer Injektion von 100 E BAT eventuell wiederholt nach 1–3 Monaten, je nach klinischem oder urodynamischem Verlaufsbild. Nach diesem ersten Schema wurden 10 Patienten mit 19 Injektionen behandelt. Aufgrund der Ergebnisse wurde ein zweites Protokoll aufgestellt mit Injektionen von BAT je einmal pro Monat wahrend 3 Monaten. In diesem zweiten Protokoll befanden sich 3 Patienten mit insgesamt 12 Injektionen. Alle Patienten wurden neuro-urologisch-klinisch und urodynamisch (Video-Zysto-Urethrometrographie) vor und nach der Behandlung mit BAT untersucht.

Es ist zur Zeit unbestritten, das bei lokalisiertem und nicht metastasiertem Prostatakarzinom die radikale Prostatovesikulektomie bezuglich definitiver Heilung die beste Prognose aufweist. Nur bedeuten die mogliche Urininkontinenz und die in hohem Mase zu erwartende postoperative erektile Impotenz seit jeher zwei Hindernisse, die diese Operation nie sehr popular gemacht haben. Allerdings kann dem Patienten bei entsprechender Operationstechnik schon praoperativ eine Kontinenz in hohem Prozentsatz garantiert werden, und zudem sind die postoperativen Erektionen sehr oft zu erhalten oder zumindest wiederherzustellen. Dies zu erklaren braucht einen Umweg uber die Anatomie und Embryologie.

After overcoming the Freudian quagmire and applying advanced techniques to the evaluation of erectile dysfunction, we have come to the realization that the vast majority of erectile impotence cases (80%–90%) have a morphologic cause. Up to 80% of these cases, in turn, can be linked to vascular disease, with arterial lesions playing a predominant role. The poor long-term results of venous surgery for impotence suggest that “venous leakage” is not strictly a venous disease; our experience indicates that arterial pathology also has causal significance in these cases.